Crucial elements in suicide prevention strategies

Ways of conceptualizing suicide prevention are reviewed briefly, and the preventive model: Universal, Selected, and Indicated prevention (USI) is chosen as the structure for the literature review, and the discussion. Universal preventive interventions are directed toward entire population; selective interventions are directed toward individuals who are at greater risk for suicidal behaviour; and indicated preventions are targeted at individuals who have already begun self-destructive behaviour.On the universal prevention level, an overview of the literature is presented with focus on restrictions in firearms and carbon monoxide gas. At the selective prevention level, a review of risk of suicide in homelessness and schizophrenia and risk factors for suicide in schizophrenia is conducted and possible interventions are mentioned together with the evidence for their effect. Suicide rate and preventive measures in affective disorder are also touched upon. At the indicated prevention level, studies of fatal and non-fatal suicide acts after suicide attempt are mentioned. The evidence of preventive measures to reduce repetition rates is presented.Finally, the state of the art is discussed with regard to prevention at the universal, the selected and the indicated level and clinical and research implications are outlined.     

Liposomal formulation of α-tocopheryl maleamide: In vitro and in vivo toxicological profile and anticancer effect against spontaneous breast carcinomas in mice

The vitamin E analogue α-tocopheryl succinate (α-TOS) is an efficient anti-cancer drug. Improved efficacy was achieved through the synthesis of α-tocopheryl maleamide (α-TAM), an esterase-resistant analogue of α-tocopheryl maleate. In vitro tests demonstrated significantly higher cytotoxicity of α-TAM towards cancer cells (MCF-7, B16F10) compared to α-TOS and other analogues prone to esterase-catalyzed hydrolysis. However, in vitro models demonstrated that α-TAM was cytotoxic to non-malignant cells (e.g. lymphocytes and bone marrow progenitors). Thus we developed lyophilized liposomal formulations of both α-TOS and α-TAM to solve the problem with cytotoxicity of free α-TAM (neurotoxicity and anaphylaxis), as well as the low solubility of both drugs. Remarkably, neither acute toxicity nor immunotoxicity implicated by in vitro tests was detected in vivo after application of liposomal α-TAM, which significantly reduced the growth of cancer cells in hollow fiber implants. Moreover, liposomal formulation of α-TAM and α-TOS each prevented the growth of tumours in transgenic FVB/N c-neu mice bearing spontaneous breast carcinomas. Liposomal formulation of α-TAM demonstrated anti-cancer activity at levels 10-fold lower than those of α-TOS. Thus, the liposomal formulation of α-TAM preserved its strong anti-cancer efficacy while eliminating the in vivo toxicity found of the free drug applied in DMSO. Liposome-based targeted delivery systems for analogues of vitamin E are of interest for further development of efficient and safe drug formulations for clinical trials.     

食盐加碘对轻度碘缺乏地区住院甲状腺疾病谱的影响

目的　研究全民食盐加碘 (USI)对住院甲状腺疾病谱的影响。方法　采用回顾性调查方法查阅甲状腺疾病住院病史。结果　USI实施 1～ 4年甲状腺疾病占总住院比例呈逐渐升高趋势 ,由 7.6‰升高到 11.0‰ ;男 /女比例由 1:3 .6升到 1:4.1;<2 0岁组比例由 2 .5 %上升到 3 .4% ;甲状腺良性肿瘤由 48.5 %下降到 3 8.5 % ,甲状腺功能亢进症由 2 7.1%上升到 3 7.2 %。实施USI后居民食盐碘含量和尿碘中位数分别由 <5mg/kg和 72 μg/L上升到 48mg/kg和 3 75 μg/L。 结论　住院甲状腺疾病的增加可能与USI的实施使碘营养状态急速改善有关。可适当降低食盐加碘量 ,使之达到推荐碘摄入水平。     

加碘食盐对儿童智力和精神运动功能发育影响

目的了解全民食盐加碘对碘缺乏病区出生儿童智力发育的影响。方法使用中国联合型瑞文测验津医精神运动功能成套测验分别测定儿童智商和精神运动功能,测定尿碘、盐碘含量并检查甲状腺肿大情况分析社会、经济、文化因素对智力影响。结果实施全民食盐加碘后儿童甲状腺肿大率明显下降,儿童尿碘水平由58.7μg/gcr上升至250.1μg/L。食盐加碘前出生儿童的智商均值为92.4±14.1,加碘后出生的儿童智商均值为100.8±13.9,并且全民食盐加碘后出生儿童的低智商比例明显降低,智商等级向高智商转移;加碘后出生儿童的智商、精神运动功能和低智商的比例与补碘前出生儿童比较差异有统计学意义(P<0.05)。将儿童的智商与其生活的社会、经济、文化因素进行多元逐步回归分析,R2=0.22。结论实施全民食盐加碘后,缺碘性智力损伤已得到有效控制,儿童脑发育已得到充分的保护。碘缺乏地区儿童在胎儿期的碘营养是决定智力发育的主要因素。而后天环境因素对儿童智力发育的影响有限。     

不同加碘时间及碘盐浓度变化人群甲状腺功能亢进流行病学研究

目的 研究不同加碘时间，不同碘盐浓度变化人群甲状腺功能亢进（简称甲亢）流行病学状况及普遍食盐加碘（USI）对甲亢发病率的影响。方法 四井子乡为碘营养正常地区，加碘时间早，USI前后补碘速度增加迅速；北台子乡为严重缺碘地区，USI前后补碘剂量变化不大；龙城乡为缺碘地区，加碘时间接近USI。针对3个地区调查37619人。同时检测患甲状腺功能，甲状腺自身抗体、甲状腺B超和尿碘含量。结果 3个地区甲亢总发病率由USI前4．53／10万人年（95％Cl:1.6-11.7)增加到USI后的24.53/10万人年（95％Cl:6.2-36.8)。加碘后人群甲亢发病率的相对危险度（RR）亦增加。结论 补碘时间早，甲亢病例出现早；补碘速度提高快，补碘剂量增加大，甲亢发病率亦随之增高。     

Transobturator vaginal tape for the treatment of stress urinary incontinence in elderly women without concomitant pelvic organ prolapse: is it effective and safe?

Objective

To evaluate the efficacy and safety of the transobturator approach (TVT-O) for the surgical management of stress urinary incontinence (SUI) in older women.

Study design

Between 2007 and 2010, all consecutive women with SUI undergoing an isolated TVT-O procedure were prospectively enrolled in this study. Patients were divided into two groups by age: older women (≥70 years old) were included in group 1, while younger women (<70 years old) in group 2. Intra- and post-operative outcomes were compared between the groups.

Results

During the study period 181 women met the inclusion criteria and were included for final analysis. Among these women, 60 (33.1%) and 121 (66.9%) were included in groups 1 and 2 respectively. After a median follow-up of 26 (IQR 15–41) months for the younger and 25 (IQR 18–40) months for older patients (p > 0.99), no differences were observed between the two groups in terms of cure rate (92.5% vs. 88.3%; p = 0.40). No differences were observed in terms of voiding dysfunction, vaginal erosion and persistent groin pain, or in terms of onset of de novo overactive bladder (9.0% vs. 13.3%; p = 0.44).

Conclusions

TVT-O appears to be a safe and effective procedure for the management of stress urinary incontinence also in elderly population.     

常州市区全民食盐加碘对甲状腺炎住院率的影响

[目的] 研究全民食盐加碘(USI)后甲状腺炎住院率动态变化,为策略调整提供依据。 [方法] 对甲状腺炎住院病例采用回顾性调查。 [结果] USI后甲状腺炎住院率增加到原来的2.1倍,AR百分比为52.0％,女性住院率高于男性的关联进一步加强,40岁住院率有所上升,急性炎症住院率增加2.8倍。 [结论] 甲状腺炎住院率上升五成以上原因归因于USI,建议碘来源不同的社区实行不同加碘剂量标准。     

Tension-free vaginal tape for the treatment of urodynamic stress incontinence: efficacy and adverse effects at 10-year follow-up

Background

One of the most effective and popular current procedures for the surgical treatment of stress urinary incontinence (SUI) is tension-free midurethral slings.

Objective

To evaluate the outcomes of women with retropubic tension-free vaginal tape (TVT) for urodynamic stress incontinence (USI) after 10-yr follow-up.

Design, setting, and participants

This was a prospective observational study. Consecutive women with proven USI were treated with TVT. Patients with mixed incontinence and/or anatomic evidence of pelvic organ prolapse were excluded.

Intervention

Standard retropubic TVT.

Measurements

Patients underwent preoperative clinical and urodynamic evaluations. During follow-up examinations, women were assessed for subjective satisfaction and objective cure rates. Multivariable analyses were performed to investigate outcomes.

Results and limitations

A total of 63 women were included. After 10 yr, 5 patients (8%) were lost or no longer evaluable. The 10-yr subjective, objective, and urodynamic cure rates were 89.7%, 93.1%, and 91.4%, respectively. These rates were stable across the whole study period (p > 0.99). De novo overactive bladder was reported by 30.1% and 18.9% of patients at 3-mo and 10-yr follow-up, respectively (p for trend = 0.19). A total of 84.2% of women with detrusor overactivity received antimuscarinic drugs, but 43.8% were nonresponders 12 wk later. At multivariable analysis, maximum detrusor pressure during the filling phase >9 cm H₂O (hazard ratio [HR]: 16.2; p = 0.01) and maximum detrusor pressure during the voiding phase ≤29 cm H₂O (HR: 8.0; p = 0.01) were independent predictors for the recurrence of SUI, as well as obesity was for the recurrence of objective SUI (HR: 17.1; p = 0.01) and of USI (HR: 8.9; p = 0.02), respectively. Intraoperatively, bladder perforation occurred in two cases; no severe bleeding or other complications occurred.

Conclusions

The 10-yr results of this study seem to demonstrate that TVT is a highly effective option for the treatment of female SUI, recording a very high cure rate with low complications after a 10-yr follow-up.     

轻病区全民食盐加碘后5～15年住院甲状腺疾病

目的 研究全民食盐加碘(USI)对住院甲状腺疾病影响。方法 住院甲状腺疾病采用回顾性调查方法。结果 实施USI后5～15年住院甲状腺疾病占总住院比例下降到1.9‰～2.8‰,平均2.2‰,女/男比率为4.2,<20岁组和≥60岁组比例分别为3.2％和12.2％。甲状腺良性肿瘤下降到37.9％,甲亢仍保持32.3％,甲状腺炎降到4.9％。居民食盐碘含量和目标人群尿碘分别增加到52.5ppm和572.0μg/L。结论 甲状腺毒症和甲状腺功能减退症的增加与盐中的碘过多有关。食盐加碘量应当调整使之达到推荐摄入量,调整依据是其它来源的碘量、每天食盐食用量和碘在盐中的丢失。