Real-Time Suicide Surveillance: Comparison of International Surveillance Systems and Recommended Best Practice

OBJECTIVE

Some countries have implemented systems to monitor suicides in real-time. These systems differ because of the various ways in which suicides are identified and recorded. The main objective of this study was to conduct an international comparison of major real-time suicide mortality surveillance systems to identify joint strengths, challenges, and differences, and thereby inform best-practice criteria at local, national, and international levels.

METHODS

Five major real-time suicide mortality surveillance systems of various coverage levels were identified and selected for review via an internet-based scoping exercise and prior knowledge of existing systems. Key information including the system components and practices was collated from those organizations that developed and operate each system using a structured template. The information was narratively and critically synthesized to determine similarities and differences between the systems.

RESULTS

The comparative review of the five established real-time suicide surveillance systems revealed more commonalities than differences overall. Commonalities included rapid, routine surveillance based on minimal, provisional data to facilitate timely intervention and postvention efforts. Identified differences include the timeliness of case submission and system infrastructure.

CONCLUSION

The recommended criteria could promote replicable components and practices in real-time suicide surveillance while offering flexibility in adapting to regional/local circumstances and resource availability.HIGHLIGHTSEvidence-informed recommendations for current best practice in real-time suicide surveillance.Proposed comprehensive framework can be adapted based on available resources and capacity.Real-time suicide mortality data facilitates rapid data-driven decision-making in suicide prevention.

The development and validation of a dashboard prototype for real-time suicide mortality data

Introduction/Aim

Data visualisation is key to informing data-driven decision-making, yet this is an underexplored area of suicide surveillance. By way of enhancing a real-time suicide surveillance system model, an interactive dashboard prototype has been developed to facilitate emerging cluster detection, risk profiling and trend observation, as well as to establish a formal data sharing connection with key stakeholders via an intuitive interface.

Materials and Methods

Individual-level demographic and circumstantial data on cases of confirmed suicide and open verdicts meeting the criteria for suicide in County Cork 2008–2017 were analysed to validate the model. The retrospective and prospective space-time scan statistics based on a discrete Poisson model were employed via the R software environment using the “rsatscan” and “shiny” packages to conduct the space-time cluster analysis and deliver the mapping and graphic components encompassing the dashboard interface.

Results

Using the best-fit parameters, the retrospective scan statistic returned several emerging non-significant clusters detected during the 10-year period, while the prospective approach demonstrated the predictive ability of the model. The outputs of the investigations are visually displayed using a geographical map of the identified clusters and a timeline of cluster occurrence.

Discussion

The challenges of designing and implementing visualizations for suspected suicide data are presented through a discussion of the development of the dashboard prototype and the potential it holds for supporting real-time decision-making.

Conclusions

The results demonstrate that integration of a cluster detection approach involving geo-visualisation techniques, space-time scan statistics and predictive modelling would facilitate prospective early detection of emerging clusters, at-risk populations, and locations of concern. The prototype demonstrates real-world applicability as a proactive monitoring tool for timely action in suicide prevention by facilitating informed planning and preparedness to respond to emerging suicide clusters and other concerning trends.

Workforce Planning Models for Oral Health Care: A Scoping Review

BACKGROUND

For health care services to address the health care needs of populations and respond to changes in needs over time, workforces must be planned. This requires quantitative models to estimate future workforce requirements that take account of population size, oral health needs, evidence-based approaches to addressing needs, and methods of service provision that maximize productivity. The aim of this scoping review was to assess whether and how these 4 elements contribute to existing models of oral health workforce planning.

METHODS

A scoping review was conducted. MEDLINE, Embase, HMIC, and EconLit were searched, all via OVID. Additionally, gray literature databases were searched and key bodies and policy makers contacted. Workforce planning models were included if they projected workforce numbers and were specific to oral health. No limits were placed on country. A single reviewer completed initial screening of abstracts; 2 independent reviewers completed secondary screening and data extraction. A narrative synthesis was conducted.

RESULTS

A total of 4,009 records were screened, resulting in 42 included articles detailing 47 models. The workforce planning models varied significantly in their use of data on oral health needs, evidence-based services, and provider productivity, with most models relying on observed levels of service utilization and demand.

CONCLUSIONS

This review has identified quantitative workforce planning models that aim to estimate future workforce requirements. Approaches to planning the oral health workforce are not always based on deriving workforce requirements from population oral health needs. In many cases, requirements are not linked to population needs, while in models where needs are included, they are constrained by the existence and availability of the required data. It is critical that information systems be developed to effectively capture data necessary to plan future oral health care workforces in ways that relate directly to the needs of the populations being served.

KNOWLEDGE TRANSFER STATEMENT

Policy makers can use the results of this study when making decisions about the planning of oral health care workforces and about the data to routinely collect within health services. Collection of suitable data will allow for the continual improvement of workforce planning, leading to a responsive health service and likely future cost savings.

Histologically confirmed tuberculosis-associated obstructive pulmonary disease

Although chronic airflow limitation (CAL) is an important long-term consequence of tuberculosis (TB), little is known about the disease process. We present what we believe to be the first case of histologically confirmed residual TB-associated obstructive pulmonary disease (TOPD) in a 23-year-old non-smoking man who developed severe CAL after one episode of TB, with no other plausible risk factors. Lung biopsies identified residual post-TB pathology affecting the small airways and vessels throughout his lung; this has not been reported previously. These findings strengthen the argument that TOPD may be a phenotype of CAL distinct from both smoking-related chronic obstructive pulmonary disease and bronchiectasis.

Journal peer review: a bar or bridge? An analysis of a paper's revision history and turnaround time, and the effect on citation

Journal peer review lies at the heart of academic quality control. This article explores the journal peer review process and seeks to examine how the reviewing process might itself contribute to papers, leading them to be more highly cited and to achieve greater recognition. Our work builds on previous observations and views expressed in the literature about (a) the role of actors involved in the research and publication process that suggest that peer review is inherent in the research process and (b) on the contribution reviewers themselves might make to the content and increased citation of papers. Using data from the journal peer review process of a single journal in the Social Sciences field (Business, Management and Accounting), we examine the effects of peer review on papers submitted to that journal including the effect upon citation, a novel step in the study of the outcome of peer review. Our detailed analysis suggests, contrary to initial assumptions, that it is not the time taken to revise papers but the actual number of revisions that leads to greater recognition for papers in terms of citation impact. Our study provides evidence, albeit limited to the case of a single journal, that the peer review process may constitute a form of knowledge production and is not the simple correction of errors contained in submitted papers.

Theory of mind as a predictor of maternal sensitivity in women with severe mental illness

BACKGROUND

Research has shown that maternal mental illness can affect mother-infant interactions with implications for infant outcomes. Severe and chronic mental illness (SMI), particularly schizophrenia, is associated with the greatest risk. Schizophrenia is also associated with impairments in attribution of mental states, 'theory of mind' (ToM). Recent attachment research has suggested that maternal mentalizing skills are strongly associated with attachment outcome in infants. To date, no research has explored the relationship between ToM and maternal sensitivity in mothers with SMI using standard tests of ToM. The present study was designed as an exploratory study in order to investigate this.

METHOD

A total of 40 women with SMI in the postpartum period were administered a battery of ToM tasks and general neuropsychological tasks. The women were also filmed in an unstructured play session with their infants, which was coded for maternal sensitivity using the Crittenden CARE-Index.

RESULTS

One ToM task, the Frith-Happé Animations, predicted maternal sensitivity across all diagnoses. There was also an effect of diagnosis, with lower sensitivity observed in women with schizophrenia. ToM impairments did not fully explain the effect of diagnosis on sensitivity. Mothers of girls were rated as being more sensitive than mothers of boys.

CONCLUSIONS

The results suggest that ToM is a significant predictor of maternal sensitivity across all mental health diagnoses, extending the results of studies focusing on healthy populations. Clinical interventions emphasizing the importance of understanding the perspective of the infant may enhance maternal sensitivity.

Spatial analysis of tuberculosis in an urban west African setting: is there evidence of clustering?

OBJECTIVES

To describe the pattern of tuberculosis (TB) occurrence in Greater Banjul, The Gambia with Geographical Information Systems (GIS) and Spatial Scan Statistics (SaTScan) and to determine whether there is significant TB case clustering.

METHODS

In Greater Banjul, where 80% of all Gambian TB cases arise, all patients with TB registered at chest clinics between March 2007 and February 2008 were asked to participate. Demographic, clinical characteristics and GPS co-ordinates for the residence of each consenting TB case were recorded. A spatial scan statistic was used to identify purely spatial and space-time clusters of tuberculosis among permanent residents.

RESULTS

Of 1145 recruited patients with TB, 84% were permanent residents with 88% living in 37 settlements that had complete maps available down to settlement level. Significant high- and low-rate spatial and space-time clusters were identified in two districts. The most likely cluster of high rate from both the purely spatial analysis and the retrospective space-time analysis were from the same geographical area. A significant secondary cluster was also identified in one of the densely populated areas of the study region.

CONCLUSIONS

There is evidence of significant clustering of TB cases in Greater Banjul, The Gambia. Systematic use of cluster detection techniques for regular TB surveillance in The Gambia may aid effective deployment of resources. However, passive case detection dictates that community-based active case detection and risk factor surveys would help confirm the presence of true clusters and their causes.

Review: what evidence is there about the specific environmental needs of older people who are near the end of life and are cared for in hospices or similar institutions? A literature review

Relatively little is known about the type of physical environment which is needed and preferred by patients aged 65 and over, with a prognosis of 1 year or less, who are receiving care in hospitals, care homes and hospices, and their families and staff. A narrative literature review was conducted to identify and analyse evidence on this issue, with twenty-nine papers meeting the inclusion criteria. The patients were found to have a wide range of views on their environment, but there was some variation between the views of patients and those of their families and staff. Four main themes emerged: the physical environment should be 'homely'; it should support patients' need for social interaction and privacy; it should support the caring activities of staff, family members and patients; and it should allow opportunities for spiritual expression. It is evident that the physical environment contributes significantly to the quality of life of older people with a life-limiting illness, and there is a need for more research in this area. Regular assessment of patients' environmental needs should form part of care planning.

Comparison of linear accelerations from three measurement systems during "reach & grasp"

Given the increased use of accelerometers in movement analysis, validation of such inertial sensors against conventional 3D camera systems and performance comparisons of different sensors have become important topics in biomechanics. This paper evaluates and compares linear acceleration trajectories obtained from two different 3D accelerometers and derived from Vicon position data for an upper limb "reach & grasp" task. Overall, good correspondence between the three measurement systems was obtained. Sources of error are discussed.

Cognitive behaviour therapy: its evolution and basic principles

The historical and theoretical background to Cognitive Behaviour Therapy (CBT) is outlined. The main therapeutic approaches of Behaviour Therapy (BT) and Cognitive Therapy (CT) are described--and an overview is provided of the applications of these approaches to clinical problems. The relationships between BT, CT and CBT are clarified.

Chernobyl post-accident management: the ETHOS project

ETHOS is a pilot research project supported by the radiation protection research program of the European Commission (DG XII). The project provides an alternative approach to the rehabilitation of living conditions in the contaminated territories of the CIS in the post-accident context of Chernobyl. Initiated at the beginning of 1996, this 3-y project is currently being implemented in the Republic of Belarus. The ETHOS project involves an interdisciplinary team of European researchers from the following institutions: the Centre d'etude sur l'Evaluation de la Protection dans le domaine Nucleaire CEPN (radiological protection, economics), the Institute National d'Agronomie de Paris-Grignon INAPG (agronomy, nature & life management), the Compiegne University of Technology (technological and industrial safety, social trust), and the Mutadis Research Group (sociology, social risk management), which is in charge of the scientific co-ordination of the project. The Belarussian partners in the ETHOS project include the Ministry of Emergencies of Belarus as well as the various local authorities involved with the implementation site. The ETHOS project relies on a strong involvement of the local population in the rehabilitation process. Its main goal is to create conditions for the inhabitants of the contaminated territories to reconstruct their overall quality of life. This reconstruction deals with all the day-to-day aspects that have been affected or threatened by the contamination. The project aims at creating a dynamic process whereby acceptable living conditions can be rebuilt. Radiological security is developed in the ETHOS project as part of a general improvement in the quality of life. The approach does not dissociate the social and the technical dimensions of post-accident management. This is so as to avoid radiological risk assessment and management being reduced purely to a problem for scientific experts, from which local people are excluded, and to take into consideration the problems of acceptability of decisions and the distrust of the population towards experts. These cannot be solved merely by a better communication strategy. This paper presents the main features of the methodological approach of the ETHOS project. It also explains how it is being implemented in the village of Olmany in the district of Stolyn (Brest region) in Belarus since March 1996, as well as its initial achievements.

Uptake of screening for breast cancer in south Lancashire

STUDY OBJECTIVE

To describe and explain variation among general practices in the uptake of screening for breast cancer.

DESIGN

Analysis of the variation in uptake of screening by general practice. Uptake rates are calculated and related to a social deprivation score created for each practice, and to the presence of at least one female general practitioner.

SETTING

South Lancashire Health Authority, England.

PATIENTS

All women aged 50-64 y registered with Lancashire Family Health Services Authority and resident in South Lancashire in 1988-1995.

MAIN RESULTS

Variation in the uptake of screening for breast cancer during Round 1 of the national programme is explained partly by a deprivation score for each practice and by the presence of at least one female general practitioner. In Round 2 the deprivation index continues to explain variation, but the effect of a female GP has diminished. The number of hours worked by practice nurses has no effect on uptake of breast screening.

CONCLUSIONS

Variation in the uptake of breast cancer screening is closely related to social deprivation. Results suggest that the presence of a female general practitioner has a beneficial effect on uptake.

Prevalence of human immunodeficiency virus and associated risk behaviour in injection drug users in Toronto

During 1989-90, interviews were conducted with 582 current injection drug users in the City of Toronto, 535 of whom also provided blood and/or saliva for anonymous unlinked HIV antibody testing. The rate of seropositivity identified was 4.3% (95% CI 3-6). The subjects were predominantly male, with a mean age of 28.3. The commonest drug of choice was cocaine (70%). Forty-six percent of the subjects reported using someone else's needle in the preceding six months, 60% of these indicating that they always cleaned it first. Eighty-one percent of those interviewed had been in jail at some time since they began injecting; 25% of these had injected while in custody, and of these 61% had shared injection equipment. Eighty-two percent of the men and 85.4% of the women reported opposite sex partners in the previous six months. Only about 20% of men reported consistent condom use, while 22% of females reported condom use at least 75% of the time.

A comparison of the determinants of safe injecting and condom use among injecting drug users

A sample of 582 injecting drug users were interviewed as part of an evaluation of an AIDS prevention programme for drug users. This paper examines the biographic and predispositional determinants of five HIV preventive behaviours--equipment sharing (not receiving and not giving) and and condom use (with regular partners, casual partners and sex clients). A two-stage sequential approach was adopted for a logistic regression analysis. Initially, to model each of the five preventive behaviours, biographical and drug use variables were entered. In a second set of models, behavioural predisposition factors were included. Age, drug use and prison experience correlate with variables in both models, although not consistently in the same direction. While a predisposition to reject sharing correlates with safer rejecting and condom use, the predisposition to safer sex only correlates with condom use. Needle exchange programmes that only target the individual would seem to be inadequate. To enhance targeted interventions changes in public and agency policy that create a social environment conductive to behaviour change are required.

Biographical characteristics of injection drug users and behavioural predispositions related to HIV prevention and drug use

OBJECTIVE

This paper presents a preliminary analysis of the determinants of selected behavioural predispositions toward HIV prevention among injection drug users.

METHOD

An exploratory factor analysis was used to group attitudinal, behavioural intention and change statements into five predisposing factors and the correlates with these were examined using general linear regression.

RESULTS

The analysis demonstrates that many IDUs have responded to AIDS and highlights the characteristics of those who are predisposed to unsafe practices. Predispositions toward safer sex appear to be contextually determined, and needle-sharing determined by socio-behavioural history.

CONCLUSIONS

The data emphasize the need for prevention programs in educational and correctional systems along with community-wide harm reduction and HIV prevention strategies, especially for younger persons. For older drug users, there may be a need for more intensive rehabilitation programs. Some evidence suggest that greater attention be given to the type of drug dependence when focusing programs.

Error types in ideomotor apraxia: a qualitative analysis

Seventeen brain-damaged subjects with dominant hemisphere pathology and 24 matched control subjects were asked to perform simple familiar gestures under four conditions: (1) verbal command (pantomime), (2) imitation, (3) with the actual object, and (4) verbal command a second time. The subjects subsequently watched a video of an actor performing simple movements and decided whether or not these were performed accurately. The gestural production task was videoed and analyzed for error type. Error type remained consistent over the four task conditions, although subgroups of patients made different types of errors. One group of patients with Ideomotor Apraxia (IMA) made more errors but of the same type as the controls, i.e., movement-related errors and the use of "body part as object" (BPO). The second group made mainly substituted (i.e. unrelated) movements and perseverative errors. The second group of subjects was also poorer at discriminating incorrectly performed movements in the recognition task. BPO errors were commonly made by the control group and they were also chosen as correct in the recognition task. This indicated that use of BPO may reflect a convention in symbolising gestures rather than pathology. The performance of the IMA subjects was discussed in relation to current theories of the mechanisms underlying apraxia.

The effect of advancing age on the sympathetic response to laryngoscopy and tracheal intubation

The effect of aging on the hemodynamic and sympathetic response to tracheal intubation was evaluated in 27 patients aged 18 to 80 years, ASA Class I and II, given atropine 0.4 mg and diazepam 10 mg as premedication and thiopental, 4.0 mg/kg, and succinylcholine 100 mg for anesthesia induction. Laryngoscopy and tracheal intubation was performed 60 seconds after induction. The elderly had significantly less chronotropic response to intubation 2, 3, 4, and 5 minutes after induction so that the maximum increase in heart rate above awake values was negatively correlated with age (R = -0.66, P less than 0.001). Baseline systolic blood pressure (SBP) and mean BP increased significantly with age (R = 0.81, P less than 0.001 and R = 0.76, P less than 0.001, respectively) but age was not significantly related to increases in SBP and mean BP following intubation. Baseline plasma norepinephrine (NE) levels increased with age ( R = 0.51, P less than 0.01). Following intubation, mean plasma NE concentrations were significantly higher in elderly patients than young patients, despite the diminished heart rate response. Heart rate (HR) per pg/ml of NE, a measure of cardiac sensitivity to beta stimulation, was therefore significantly less 2, 3, and 4 mins after induction in elderly patients than in younger patients. To determine if this alteration in cardiac sensitivity to endogenous catecholamines was reflected by changes in beta receptor function on lymphocytes, beta receptor density and the proportion of receptor binding agonist with high affinity (%RH) were measured. No significant correlation between beta-receptor affinity for agonist, %RH, or receptor density was found with age, HR, or HR per pg/ml NE.(ABSTRACT TRUNCATED AT 250 WORDS)

Mania precipitated by benzodiazepine withdrawal

A case of mania following abrupt benzodiazepine withdrawal in an 83-year-old woman is described. It is argued that the withdrawal state acted as a significant life event in precipitating the manic episode.

Altered beta-adrenoceptor internalization does not explain reduced beta-adrenergic responsiveness in the elderly

To determine whether altered beta-adrenoceptor internalization contributes to the reduced adrenergic responsiveness of the elderly, the ability to internalize beta-adrenoceptors in young and elderly men was studied by in vitro exposure of whole lymphocytes to a range of isoproterenol concentrations. The total numbers of receptors per cell were similar in the two groups [young, 1645 +/- 206 +/- SE); elderly, 1707 +/- 120], as were the basal levels of beta-adrenoceptor internalization (young, 8.85 +/- 1.09%; elderly, 8.73 +/- 1.35%). Incubation in the presence of isoproterenol resulted in dose-dependent internalization of receptors. The EC50 values for isoproterenol-induced internalization were similar in the young (20.7 +/- 3.5 nmol/L) and elderly groups (26.9 +/- 4.4 nmol/L). These results suggest that altered receptor internalization does not contribute to impaired beta-adrenoceptor function in the elderly.

Scintigraphy of gastrointestinal hemorrhage: superiority of 99mTc red blood cells over 99mTc sulfur colloid

The relative efficacy of 99mTc sulfur colloid and in vitro-labeled 99mTc red blood cells in detecting and localizing gastrointestinal hemorrhage was evaluated in a prospective tandem study of 100 patients referred for suspicion of gastrointestinal tract hemorrhage. Thirty-eight true-positive scintigrams were obtained with 99mTc red blood cells, whereas 99mTc sulfur colloid detected only five sites of hemorrhage. Scintigraphic findings were corroborated by clinical, endoscopic, arteriographic, and surgical findings. 99mTc red blood cells were clearly superior, with a sensitivity of 93%, specificity of 95%, and overall accuracy of 94% in detecting and localizing gastrointestinal hemorrhage.

Effect of various milk feeds on numbers of Escherichia coli and Bidifobacterium in the stools of new-born infants

Escherichia coli was found in a similar proportion of stool specimens from infants who were breast-fed and from others fed on three different artificial-milk preparations. When E. coli was present its mean colony count in the stools of breast-fed infants was within the range of the mean counts for infants receiving the artificial -milk feeds. There was no consistent relation between high counts of bifidobacteria (Lactobacillus bifidus) and low counts of E. coli. This suggests that measures aimed at implanting or stimulating the growth of bifidobacteria in the large intestine of artificially fed infants may not greatly influence the E. coli population therein. The results are discussed in relation to the protection of artifically fed infants from E. coli enteritis.

False Positive Reaction Due to Methocarbamol in the Screening Test for Vanilmandelic Acid (VMA)

Methocarbamol, a widely prescribed muscle relaxant, gives a positive result for increased vanilmandelic acid excretion with the useful screening test devised by Gitlow for evidence of pheochromocytoma. Evidence for the presence of this drug can be obtained from a positive color reaction with the 5-hydroxyindoleacetic acid test, used in the screening for carcinoid tumor.