Understanding suicide among indigenous adolescents: a review using the PRECEDE model

The Nursing Effect of PRECEDE Management on Occupational Exposure to Surgical Smoke: Based on a Randomized Controlled Study

Background

Occupational exposure seriously threatens the physical and mental health of professionals and has become an important public health problem. In clinical medical and nursing work, medical staff, especially nursing staff, are faced with the status quo of occupational exposure with high risk, serious harm, and severe situation. Therefore, a sound management system must be established to control the occupational exposure of nurses.

Aims

According to the PRECEDE management model, evaluate the operating room nurses' knowledge, belief, and behavior scores on the protection of surgical smoke, understand their awareness of surgical smoke and the current status of protection, improve the mastery rate and protection compliance of surgical smoke-related knowledge in the operating room, reduce the harm of surgical smoke to the human body, and provide a basis for smoke protection.Materials and methods. 125 doctors working in the operating room of our hospital were selected as the control group of this study, and 112 nonsmoke-exposed nurses working in the operating room of our hospital were selected as the observation group. The nurses' knowledge-belief behavior scores and self-evaluation scores of smoke influence were counted before and after the intervention in the operating room. SPSS25.0 was used to process the data. Tests and repeated measures analysis of variance were used to compare the effects before and after intervention.

Results

After one month of intervention, the knowledge scores of nurses in the operating room on the protection of surgical smoke increased significantly, and the difference was significant (P < 0.05); the scores of related concepts, physical properties, chemical properties, and authoritative protection standards increased significantly (P < 0.05). There was no significant increase in the scores of smoke hazards (P > 0.05); the attitude of smoke protection increased significantly, which was statistically significant (P < 0.05); and the behavior compliance of smoke protection was significantly increased, which was statistically significant (P < 0.05). After one month of intervention, the self-evaluation score of smoke effect of operating room nurses decreased significantly, and the difference was statistically significant (P < 0.05). The data was analyzed by repeated measure analysis of variance. The knowledge of surgical smoke (F = 65.570, P < 0.001), attitude (F = 78.307, P < 0.001), and behavior (F = 403.015, P < 0.001) scores gradually increased. The observation group's total cholesterol, low-density lipoprotein cholesterol, and the proportion of low-density lipoprotein cholesterol were higher than that of the control group, and the proportion of high-density lipoprotein cholesterol was lower than that of the control group. The difference was statistically significant P < 0.05.

Conclusion

After the intervention of operating room nurses under the guidance of PRECEDE management mode, the theoretical knowledge of operating room nurses is effectively improved, the operations are standardized, the self-evaluation scores of smoke influence are reduced, and the safety level of operating room is improved. More importantly, the health of nursing staff is fully guaranteed.

Socio-demographic, psychosocial and environmental factors associated with suicidal behaviour in Indigenous Sami and Greenlandic Inuit adolescents; the WBYG and NAAHS studies

Background. For young Indigenous people, suicide is one of the leading causes of death, and high rates in Arctic areas indicate serious health- and societal concerns. More knowledge is needed, as suicidal behaviour predictslater death by suicide.Objectives. The objective was to study associations between suicidal thoughts and suicide attempts and socio-demographic, psychosocial, and environmental factors in Sami and Greenlandic adolescents, within and between groups and gender.Methods. Working samples included 442 Sami and 399 Greenlandic Inuit (15-16-year-olds), in "The Norwegian Arctic Adolescent Health Study" (NAAHS) and "Well-being among Youth in Greenland" (WBYG). Multivariable logistic regression explored associations between suicidal behaviour and family , ethnic language , school, friendship, and suicide in close relations.Results. Across Indigenous groups, suicidal behaviour was associated with the female gender, relationships with parents, suicide of friends, and rural living. Sami adolescents in stepparent families reported more suicidal behaviour. Inuit adolescents living outside the family and with poor school performance reported more suicidal thoughts. Inuit adolescents spending less time with friends reported more attempts. Gender differences occurred in both groups.Conclusion. To Sami and Greenlandic Inuit, family and peer relations are important factors of suicidal behaviour. Prevention programmes should be sensitive to gender and bereavement.

Suicide in children: Concept analysis using Rodgers's evolutionary approach

TOPIC

Although the concept of suicide in children and adolescents is widely present in the literature, its conceptual definition varies according to context, discipline, and time. How this concept is defined impacts the delivery of care to children and adolescents regarding suicide prevention in mental health settings and in the community.

PURPOSE

Using Rodgers's evolutionary method, we examined the antecedents, attributes, and consequences of "suicide in children" through temporal trends, and geographic locations.

SOURCES

In total, 106 articles were included. Searches were performed using CINAHL, PsycINFO, and Medline, as well as Google Scholar as a complementary tool.

CONCLUSIONS

Through a thematic analysis, we identified three themes: (1) developmental perspectives, (2) factors predicting suicide in children, and (3) the emancipation of children as active agents in society. Recent literature shows a movement toward acknowledging the voice of children and adolescents regarding suicide. We address clinical and future implications for the development of this concept.

Social Integration and Indigenous Suicidality

Aspects of social integration including religion and residential stability have often been found to serve as protective factors against suicide in sociological analyses. However, empirical research on Canadian indigenous suicidality has neglected these dimensions of integration. The present study fills this gap, while controlling for other major predictors of suicide ideation (SI). Methods: Data are from a national representative sample (N = 15,294) from the 2012 Aboriginal Peoples Survey. The dependent variable is a dichotomy: lifetime prevalence of SI. Measures of social integration include religious affiliation, marital status, family ties, and residential stability. Controls are incorporated for alternative predictors of SI including psychiatric symptoms (e.g., mood disorder), economic strain, ethnicity, and demographics. Results: Findings from a multivariate logistic regression analysis confirmed an association between SI and most measures of social integration (e.g., married persons were 14% less apt to report SI than non married persons), but not with religious affiliation. Further, each unit increase in income reduced the risk of SI by 3.8%. Psychiatric symptoms increased risk of SI (e.g., mood disorder, OR = 3.16, substance abuse, OR = 2.38), and Inuit ethnicity increased SI risk by 57% (OR = 1.57). The model explained 26.1% of the variance in SI. Conclusions: Generally, measures of social integration, psychiatric symptoms, and economic strain predicted SI. However, there was no evidence that religion acted as a protective factor against SI. Future research is needed on other dimensions of religion such as self-reported religiousness, which may protect against suicidality.

An analysis of child deaths by suicide in Queensland Australia, 2004-2012. What are we missing from a preventative health services perspective?

BACKGROUND

This article analyzes case descriptions of child suicides from 2004 to 2012 to inform future policy and practice.

METHODS

Quantitative data and case descriptions for 159 child suicides (less than 18 years) in Queensland, Australia, were analyzed quantitatively using SPSS and qualitatively using automated content analysis (Leximancer).

RESULTS

More than three quarters of child suicides involved hanging and 81% of suicides occurred in the family home. Less than 20% of the deceased left a note, however there was evidence of planning in 54% of cases. Most common triggering events were family conflicts.

CONCLUSIONS

Effective suicide prevention interventions require a comprehensive understanding of risk factors. Quality of case descriptions varied widely, which can hamper injury prevention efforts through an incomplete understanding of characteristics of and important factors in child suicide. Additional attention and resources dedicated to this public health issue could enhance the development and implementation of effective intervention strategies targeting child and adolescent suicide.

A systematic review of suicide prevention interventions targeting indigenous peoples in Australia, United States, Canada and New Zealand

BACKGROUND

Indigenous peoples of Australia, Canada, United States and New Zealand experience disproportionately high rates of suicide. As such, the methodological quality of evaluations of suicide prevention interventions targeting these Indigenous populations should be rigorously examined, in order to determine the extent to which they are effective for reducing rates of Indigenous suicide and suicidal behaviours. This systematic review aims to: 1) identify published evaluations of suicide prevention interventions targeting Indigenous peoples in Australia, Canada, United States and New Zealand; 2) critique their methodological quality; and 3) describe their main characteristics.

METHODS

A systematic search of 17 electronic databases and 13 websites for the period 1981-2012 (inclusive) was undertaken. The reference lists of reviews of suicide prevention interventions were hand-searched for additional relevant studies not identified by the electronic and web search. The methodological quality of evaluations of suicide prevention interventions was assessed using a standardised assessment tool.

RESULTS

Nine evaluations of suicide prevention interventions were identified: five targeting Native Americans; three targeting Aboriginal Australians; and one First Nation Canadians. The main intervention strategies employed included: Community Prevention, Gatekeeper Training, and Education. Only three of the nine evaluations measured changes in rates of suicide or suicidal behaviour, all of which reported significant improvements. The methodological quality of evaluations was variable. Particular problems included weak study designs, reliance on self-report measures, highly variable consent and follow-up rates, and the absence of economic or cost analyses.

CONCLUSIONS

There is an urgent need for an increase in the number of evaluations of preventive interventions targeting reductions in Indigenous suicide using methodologically rigorous study designs across geographically and culturally diverse Indigenous populations. Combining and tailoring best evidence and culturally-specific individual strategies into one coherent suicide prevention program for delivery to whole Indigenous communities and/or population groups at high risk of suicide offers considerable promise.

Risk indicators of suicide ideation among on-reserve First Nations youth

BACKGROUND

Despite the known disparity in suicide rates in Canada, there is limited information on the independent risk indicators of suicide ideation among First Nations youth living on reserve.

OBJECTIVE

To determine the prevalence and adjusted risk indicators for suicide ideation among on-reserve First Nations youth.

METHODS

Saskatoon Tribal Council (Saskatchewan) First Nations students enrolled in grades 5 through 8 who were living on reserve were asked to complete a health survey using validated questionnaires. In total, 75.3% of the students completed the survey. The study was led by the Saskatoon Tribal Council with assistance from three departments at the University of Saskatchewan (Saskatoon, Saskatchewan).

RESULTS

Among on-reserve First Nations youth, 23% experienced suicide ideation within the past 12 months. In comparison, 8.5% of Saskatoon urban youth and 19% of Saskatoon urban Aboriginal youth within the same grades experienced suicide ideation. Wanting to leave home (OR 13.91 [95% CI 3.05 to 63.42]), having depressed mood (OR 2.98 [95% CI 1.16 to 7.67]) and not feeling loved (OR 3.85 [95% CI 1.49 to 9.93]) were independently associated with suicide ideation among on-reserve youth. None of the children with a father who was professionally employed reported suicide ideation.

CONCLUSIONS

Understanding the independent risk indicators associated with suicide ideation among First Nations youth living on reserve will hopefully aid in appropriate interventions.

Physician champions are key to improving antibiotic prescribing quality

BACKGROUND

The previously reported IMPAACT study was a cluster randomized controlled trial of a patient and physician educational intervention designed to reduce antibiotic prescribing for acute respiratory tract infections (ARIs) in emergency departments (EDs) in the United States. On average, the intervention resulted in a modest improvement in antibiotic prescribing behavior at the end of Year 1 and further improvement after Year 2. Yet the intervention's impact was large at some sites but minimal or even negative at others. A study was undertaken to identify organizational factors that influenced the effectiveness (Organizational Effect Modifiers [OEMs]) of the intervention.

METHODS

Focus groups of nurses and ED staff and semistructured interviews of local project leaders, nurse managers, and quality improvement (QI) officers were performed at seven EDs across the United States. Effectiveness of the local project leader, institutional emphasis on patient satisfaction ratings, and institutional history with and approach to QI were initially identified as key potential OEMs. Two investigators independently read the transcripts for each site and, using prespecified rating scales, rated the presence of each OEM.

FINDINGS

The perceived effectiveness of the local project leader was most strongly linked to the effectiveness of the intervention. Perceived institutional emphasis on patient satisfaction and institutional history of and approach to QI (top down or bottom up) did not appear to be closely linked with intervention effectiveness.

DISCUSSION

An effective local leader to serve as a physician champion was key to the success of this project. Organizational factors modify the effectiveness of QI interventions targeting individual physician performance and should be addressed during program implementation.

Suicide in Newfoundland and Labrador: a linkage study using medical examiner and vital statistics data

OBJECTIVE

To examine suicide epidemiology in Newfoundland and Labrador from 1997 to 2001.

METHOD

Data from the Office of the Chief Medical Examiner (CME) were linked with data derived from the Canadian Vital Statistics Death Database. Ninety-five percent confidence intervals (CI) were calculated to assess variation of rates. We used the chi-square test to compare categorical data.

RESULTS

The CME recorded 225 suicide deaths, compared with 187 in the Canadian Vital Statistics Death Database. Most deaths not coded as suicide in the national database were coded as accidental. Using the CME data, the overall suicide rate was 9.5/100000, aged 10 years and older. The rate among males (15.8/100 000, 95% CI, 10.7 to 20.8) was almost 5 times that of females (3.3/100000; 95% CI, 1.0 to 5.5). Age-standardized rates decreased over the study period, from 10.9 to 8.0/100000; however, the difference was not significant. The proportionate mortality ratio for suicide deaths was highest among those aged 10 to 19 years (20.0%) and decreased with age. The suicide rate was highest among those aged 50 to 59 years. The rate for unpartnered individuals (17.0/100000, 95% CI, 10.7 to 23.0) was significantly higher, compared with partnered individuals (5.1/100000; 95%CI, 2.5 to 7.8). Males used more violent methods than females. Suicide was significantly higher in Labrador (27.7/100000, 95% CI, 18.4 to 37.0), an area with a higher Aboriginal population, compared with the island of Newfoundland (8.5/100000, 95% CI, 7.3 to 9.7). Psychiatric illness was the most common predisposing factor.

CONCLUSIONS

Suicide deaths are highest among males, unpartnered individuals, and individuals with psychiatric disorders.

Suicide among Guaraní Kaiowá and Nandeva youth in Mato Grosso do Sul, Brazil

Information on morbidity and mortality are critical for developing appropriate prevention and health promotion programs. This study summarizes data on the Guaraní (Kaiowá and Nandeva) communities in Mato Grosso do Sul, Brazil, about which little addressing suicide has been documented. Epidemiologic and anthropological data were used to examine suicidal behavior in these indigenous communities. Several findings in this report about the Guaraní Kaiowá and Nandeva communities were remarkable: the rates of suicide among these communities appear higher than the national average; suicide deaths disproportionately affect adolescents and young adults; and suicide rates among young males appear to be increasing. Data in this report highlight the need for health information data specific to a community in order to identify emerging health problems.

Indigenous suicide in New Zealand

This article describes patterns of suicide and attempted suicide among the indigenous (Măori) population of New Zealand using official data from the New Zealand Health Information Service (NZHIS). The majority of Măori suicides (75%) occurr in young people aged <35 years. Rates of suicide are higher among Măori males and females aged <25 than in their non-Măori peers. Rates of hospitalization for attempted suicides are higher amongst Măori males aged 15-24, compared to non-Măori. In contrast, suicide is virtually unknown amongst older Măori (60 years). This article reviews explanations for the observed rates of suicide in Măori, and examines approaches to effective intervention to reduce rates of suicide in young Măori.

Indigenous suicide in Australia, New Zealand, Canada, and the United States

This paper reviews literature on self-harm and suicide among Indigenous populations in four nations with histories of British colonization, with a more detailed exploration of patterns and primary care considerations in Australian Aboriginal and Torres Strait Islander populations. Issues of definition, under-reporting, lack of reporting, varying coronial practices and the influence of race on investigative procedures make comparisons of suicide rates among indigenous populations problematic. However, international interpretations highlight the impact of the breakdown of cultural structures and historical processes associated with colonization. Recent studies suggest that the predisposition to suicide by vulnerable young people is influenced not only by absolute living standards but also how they view their circumstances relative to those around them. The complexity of associations with mental disorder, alcohol use and 'meaning' in an indigenous context are considered. Responses in terms of prevention and treatment are presented, highlighting the importance of hospital-based practitioners as the likely first point of contact. The article concludes by outlining considerations in the primary care management of indigenous self-harm.