Changes in elderly suicides in the USA and the developed world 1974–87: Comparison with current homicide

Between 1974 and 1987 there were increases overall in male suicide rates in the USA, with the greatest increases among elderly men. While female suicide levels overall fell in the USA, elderly female suicide rates failed to show the same improvement. Compared with the rest of the western world, suicide rates for elderly people in the USA were among the worst. Suicide was far more prevalent than homicide, but this is not reflected in the media, where homicide is given a high profile but where there is relative silence surrounding suicide among elderly people.     

Le suicide par saut et les stratégies de prévention

The topic of this article is to probe into the specificities of suicide by jumping. This means of suicide hasn't been studied much and isn't well known yet.We reviewed the international scientific literature so as to take an in-depth look at this type of auto-aggressive action and highlight the characteristics of the subjects likely to commit suicide by jumping. We thus focus on the available epidemiological data and risk factors associated to suicide jumping. We also describe the prevention strategies most often evoked to deal with this public health issue, which are respectively about improving safety on the identified suicide sites and providing medical and psychological care to individuals likely to commit suicide by jumping.This meta-analysis presents our critical analysis of the methodological limits in the studies exposed. We provide further hints for researching this field of study; they're based on both the taking into account of variables that could be risk factors for this particular means of suicide and the evaluation of the efficiency for the preventive measures used.     

自杀患者的原因及心理状况分析

目的探讨自杀患者的自杀原因及其心理状况。方法采用症状自评量表调查102例自杀患者的心理状况,并与常模进行比较。并分析其自杀原因。结果自杀患者心理状况差,处于忧郁、焦虑、偏执状态,人际关系较差。心理特点为自卑绝望、情绪低落及意志悲观消沉。结论对于各种因素所致的自杀患者,除了进行精心的治疗和护理外,更应重视患者的心理护理,以提高自杀患者的疗效,防止再自杀。     

Development of a Checklist for Predicting Suicidality Based on Risk and Protective Factors: The Gwangju Checklist for Evaluation of Suicidality

Objective The aim of the study was to develop a checklist for mental health clinicians to predict and manage suicidality. Methods A literature review of the risk and protective factors for suicide was conducted to develop a checklist for evaluating suicidality. Results The fixed risk factors included sex (male), age (older individuals), history of childhood adversity, and a family history of suicide. Changeable risk factors included marital status (single), economic status (poverty), physical illness, history of psychiatric hospitalization, and history of suicide attempts. Recent discharge from a mental hospital and a recent history of suicide attempts were also included. Manageable risk factors included depression (history and current), alcohol problems (frequent drinking and alcohol abuse), hopelessness, agitation, impulsivity, impaired reality testing, and command hallucinations. Protective factors included responsibility to family, social support, moral objections to suicide, religiosity, motivation to get treatment, ability to cope with stress, and a healthy lifestyle. A final score was assigned based on the sum of the risk and protective factor scores. Conclusion We believe that the development of this checklist will help mental health clinicians to better assess those at risk for suicidal behavior. Further studies are necessary to validate the checklist.     

有无自杀意念大学生的人格特征比较

目的探讨有无自杀意念大学生的人格特征,为大学生心理危机干预提供理论依据。方法采用卡特尔16种个性特征量表(16PF)对江西省1 010名在校大学生人格特征进行问卷调查。结果在16PF量表中的稳定性、兴奋性、敢为性、自律性、X2、X5、X6等因子上,有自杀意念组的得分要低于无自杀意念组(p<0.05或p<0.01);在怀疑性、忧虑性、独立性、紧张性、X1等因子上,有自杀意念组的得分要高于无自杀意念组(p<0.05或p<0.01)。结论大学生不良的人格特征与自杀意念的产生有重要关系。     

The effect of war on personal aggression

The effect of war on the suicide rate and on the relative likelihood of suicide as a proportion of total personal aggression was examined in the United States for the time period from 1933 to 1986. Once unemployment was controlled for, no effect of war was detected.     

Suicidal poisonings with methadone in France: Results of a two year national survey by the Toxicovigilance Network

Context. Methadone is used in France since March 1995, only for opioid maintenance treatment, in a syrup form. For the launching of a capsule form in April 2008, French health authorities requested a prospective survey of all cases involving exposure to methadone in either of the two available pharmaceutical forms. Objective. The aim was to document, in different circumstances and compare the safety of the new capsule form to the syrup. This report presents the findings of one arm of the study, devoted to methadone-related suicide attempts. Materials and method. From April 15, 2008 to April 15, 2010, all self-injurious methadone poisonings notified to or managed by the French Toxicovigilance Centers network were included. Analysis mainly focused on patients’ age and gender, estimated quantity ingested, eventual concomitantly taken substances, distribution of symptoms, and site of treatment. Results. 135 methadone-related suicide attempts were recorded. Analysis showed identical epidemiologic and clinical patient characteristics for the two pharmaceutical forms. Ten deaths occurred. The only discrepancy was a higher incidence of suicide attempts in the capsule group. However, as the number of capsule-treated patients increased during the second year, this difference remained significant but tended to decrease. Discussion. Combining these results with Pharmacovigilance and Addictovigilance arms, health authorities estimated that the benefit/risk balance of this new pharmaceutical form remains positive. They revised their position on requirements for prescribing and dispensing of the capsule form, and made them slightly easier. Following this, this “suicide” arm of Toxicovigilance survey was suspended, whereas the second one, concerning accidental pediatric methadone-related poisonings, has been extended until April 2014. Conclusion. In France, suicide attempts were more likely to occur with the capsule formulation. The clinical severity of intoxication was similar between the capsule and liquid forms.     

pcDNA3/AFP/TK/Angio融合基因靶向性治疗人原发性肝癌的实验研究

目的研究pcDNA3/AFP/TK/Angio融合基因对人肝癌细胞系SMMC-7721裸鼠移植瘤模型的靶向性治疗作用。方法建立人原发性肝癌裸鼠皮下移植瘤模型,将荷瘤裸鼠随机分成肿瘤对照组、空质粒组、丙氧鸟苷（GCV）组、pcDNA3/TK/Angio组及pcDNA3/AFP/TK/Angio组5组。于瘤体内分别直接注射不同的质粒,同时于裸鼠腹腔内注射GCV,观察不同时段皮下肿瘤的生长情况并做病理学检查,免疫组化法检测肿瘤微血管密度（MVD）以及血管内皮细胞生长因子（VEGF）的表达量,原位末端标记（TUNEL）法检测细胞原位凋亡。放免法检测裸鼠血清甲胎蛋白（AFP）的变化,透射电镜观察肿瘤细胞超微结构的变化。结果裸鼠皮下成瘤率100%;pcDNA3/TK/Angio组及pcDNA3/AFP/TK/Angio组的肿瘤体积、血清AFP含量、肿瘤MVD和VEGF表达强度均明显低于对照组、空质粒组和GCV组（P〈0.05）,细胞凋亡指数都明显高于后3组（P〈0.05）,可见较多的凋亡细胞。而pcDNA3/AFP/TK/Angio组的肿瘤体积、AFP、MVD及VEGF表达强度又明显低于pcDNA3/TK/An-gio组（P〈0.05）,凋亡指数高于后者（P〈0.05）。结论pcDNA3/AFP/TK/Angio融合基因系统可显著抑制肿瘤的生长,有望成为治疗原发性肝癌的新型生物制剂之一。     

Defining the need for blood and blood products transfusion following suicide bombing attacks on a civilian population: A level I single-centre experience

Introduction

Knowledge of patterns of blood use in the care of mass casualty settings is important for preparedness of medical centre resources and for maximising survival when blood supplies are limited. Our objectives were to review of our experience with the use of blood products and define the utilisation of blood transfusion following suicide bombing attacks.

Patients and methods

We conducted a retrospective analysis of blood and blood product transfusion following civilian bombing attacks at a level I trauma centre in Jerusalem, Israel from 2000 to 2005. The study group consisted of 137 patients who were admitted following 17 suicide bombing attacks which were carried out in Jerusalem during the 5-year period. Demographic data, number of units of blood and blood products transfused and the need for massive transfusions were recorded and analyzed.

Results

Fifty-three patients received blood transfusions (38.7%). There were 33 males (62.2%) with a median ISS of 13 (range 4–25). These 53 patients received 524 PRBC, 42 WB, and 449 FFP. The mean number of PRBC transfused/admitted patient was 3.82 units (range 0–59). Thirty patients (21.9%) received 236 PRBC (45% of total PRBC) at the first 2 h. The ratio of ordered to transfused blood was 946:524. The FFP:PRBC ratio for all transfused patients was 1:1.17. The number of PRBC transfused per attack correlated with the number of patients admitted per attack. The most commonly transfused blood type was A (52.3%). Only 18 units of uncrossed-matched blood were transfused (3.3% of total). 14 patients (10.2%) received massive transfusions. These patients received 399 PRBC (76.1% of total units transfused) and the average number of PRBC transfused was 28.5/patient (10–59).

Conclusions

More than 1/3 of casualties admitted following civilian bombing attacks received transfusions, most in the first 2 h. Large-scale attacks will require more blood and blood products than small-scale attacks. Twice the number of PRBC ordered than transfused reflects a known trend for over-triage during the initial assessment following bombing attacks. One tenth of patients received massive transfusion.     

芦山地震中胫腓骨远端开放性骨折的治疗

目的 总结地震灾害所致胫腓骨远端开放性骨折的特点,并探讨其治疗. 方法 2013年4月21日至27日共收治12例地震伤所致胫腓骨远端开放性骨折伤员,男5例,女7例;年龄33～85岁(平均54.8岁).开放性骨折按Gustilo分型:Ⅱ型5例,ⅢA型4例,ⅢB型3例.2例患者合并同侧膝关节闭合性骨折,3例患者合并内、外踝骨折.1 1例患者在急诊行清创、HoffmannⅡ型组合式单边外固定支架固定,l例患者伤后5d行外固定支架固定.对于一期手术后下肢力线偏离、关节对应关系不佳及伴有踝关节脱位的患者,进行二期外固定支架调整. 结果 11例行急诊清创外固定支架固定术的患者中,4例下肢力线恢复满意,7例下肢力线恢复不满意.4例患者因软组织损伤较轻,拟近期更换内固定时直接调整下肢力线;另3例患者软组织损伤严重,且伴有内外踝骨折、踝关节脱位,行二期外固定支架调整术.此3例患者术后骨折均获得良好复位,下肢力线恢复满意,关节对应关系良好. 结论 组合式外固定支架可以快速、有效处理地震灾害中的胫腓骨远端开放性骨折.对于地震伤员,应尽可能一次将骨折复位及下肢力线固定好.对于复位不良者,应及时进行调整,以免因转运而影响治疗和最终功能.