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Incidence rates of hospital-presenting self-harm are highest in people under 25 years and are reportedly increasing in some countries. Intentional drug overdose (IDO) is the most common self-harm method among young people, with paracetamol the drug most frequently used. This study aimed to describe the characteristics, incidence, and temporal trends in paracetamol-related IDO among young people. Data from the National Self-Harm Registry Ireland on hospital-presenting self-harm by individuals aged 1024 years during 2007–2018 were examined. Annual IDO rates per 100,000 were calculated by age and gender. Joinpoint regression analyses and incidence rate ratios were used to examine trends in the incidence of paracetamol-related IDO. During the study, 10,985 paracetamol-related IDOs were recorded. The incidence of paracetamol-related IDO among young people increased by 9% between 2007 and 2018 (IRR 1.09 95% CI 1.00–1.19), with the highest annual percentage change (APC) in females aged 18–24 years (APC 1.2%). Conversely, rates of paracetamol-related IDO among males aged 18–24 years decreased significantly (APC 1.6%). Between 2013 and 2018, excesses of 386 and 151 paracetamol-related IDOs were observed in females aged 10–17 and 18–24 years, respectively, and 42 excess presentations were observed for males aged 10–17 years. There were 107 fewer presentations than expected for males aged 18–24 years. The increase in paracetamol-related IDO among specific groups of young people, particularly young females is an issue of growing concern. Interventions targeting IDO among young people are needed, incorporating measures to address the availability of paracetamol and aftercare following IDO.

There is limited research on the associations between factors relating to mental and physical health in people who died by suicide. Consecutive suicide cases were included in a psychological autopsy study as part of the Suicide Support and Information System in southern Ireland. Chi-square tests and logistic regression analysis were used to examine factors associated with recorded presence or absence of mental and physical health problems. The total sample comprised 307 suicide cases, the majority being male (80.1%). Sixty-five percent had a history of self-harm and 34.6% of these cases had not been seen or treated following previous self-harm, although most (80.3%) had a history of recent GP attendance. Mental health diagnoses were present in 84.8% of cases where this variable was documented, and among these, 60.7% had a history of substance misuse and 30.6% had physical health problems. Variables associated with mental illness included gender, older age, previous self-harm episode(s), and presence of drugs in toxicology at time of death. Variables associated with physical illness included older age, death by means other than hanging, and previous self-harm episode(s). Different factors associated with suicide were identified among people with mental and physical illness and those with and without a diagnosis, and need to be taken into account in suicide prevention. The identified factors highlight the importance of integrated care for dual-diagnosis presentations, restricting access to means, and early recognition and intervention for people with high-risk self-harm.

Miscarriage is the most common adverse outcome in early pregnancy; however, high proportion of miscarriages are classified as unexplained. In addition, pregnant women attending early pregnancy assessment units might be more vulnerable. The purpose of this study was to explore the risk factors that might be associated with miscarriage among women attending an early pregnancy assessment unit (EPAU). A prospective cohort study was undertaken. The study was conducted on women attending an EPAU at a large, tertiary hospital. A detailed lifestyle questionnaire was completed. In addition, data from validated psychometric scales were collected. Participants were followed up to determine pregnancy outcome. The relative risk was calculated to estimate the probability of having a miscarriage for all independent variables. A total sample of 293 women were included in this study. Well-established risk factors for miscarriage were found in this group including advanced maternal age and high-risk pregnancy (i.e. threatened miscarriage and recurrent miscarriage). In addition, lack of emotional wellbeing did contribute to an increased risk of miscarriage. Conversely, presenting with nausea or low-medium energy levels early in pregnancy were associated with a decreased risk of miscarriage. Finally, our results did not find any association between stressful life events, general health and lifestyle factors in this group. Our findings indicated that maternal, psychological and obstetric factors may have an influence on miscarriage among women attending an EPAU. The insight of a relationship between emotional wellbeing and miscarriage opens a window for prevention in this area.

Background Early miscarriage is one of the most common obstetric causes of maternal morbidity early in pregnancy. However, data concerning non-fatal complications among hospitalisations for early miscarriage are lacking. The aim of this study was to determine whether there were changes in the incidence, management and outcomes of early miscarriage hospitalisations between 2005 and 2016. Methods This is a nationwide population-based study of 50,538 hospitalisations with a diagnosis of early miscarriage of all acute maternity hospitals in Ireland. Electronic health records were retrieved using the Hospital In-Patient Enquiry database. Main outcomes include the incidence rates of hospitalisations and management for early miscarriage, and rates of blood transfusion and length of stay over 2 days. Results Overall, 50,538 hospitalisations for early miscarriage were identified from 2005 to 2016. The risk of hospitalisation decreased from 70.6 per 1000 deliveries (95% CI 68.4 to 72.8) in 2005 to 49.7 per 1000 deliveries (95% CI 49.7 to 53.3) in 2016; however, the risk of blood transfusion increased over time (ratio: 2.0; 95% CI 1.6 to 2.4). Women of advanced maternal age had a higher risk of hospitalisations. There were less blood transfusions among women who undertook medical treatment (ratio: 0.3; 95% CI 0.1 to 0.5), but they had an increased risk of staying over 2 days at the hospital (ratio: 1.5; 95% CI 1.2 to 1.9) compared to evacuation of retained products of conception. Conclusions Hospitalisation rates for early miscarriage decreased over time with an increase in risk of blood transfusion and an extended length of stay at the hospital. Women who underwent medical management did not have as many blood transfusions as those undergoing surgical management. However, they had an increased risk of an extended stay. Research is needed to explore both outpatient and inpatient settings in order to improve the management and care provided. Electronic supplementary material The online version of this article (10.1186/s12978-019-0720-y) contains supplementary material, which is available to authorized users.

Background In the past decade, the Republic of Ireland has undertaken significant reconfiguration programmes to improve emergency services. During this time the public healthcare system experienced a large real decrease in resources. This study assesses national and regional population outcomes over the period 2002–2014, and whether changes coincide with system reconfiguration and the financial restrictions imposed by the 2008 recession. Methods Case fatality ratios (CFRs) were constructed for emergency conditions for 2002–2014. Total emergency conditions and individual condition trends were analysed nationally using joinpoint analysis. National results informed the investigation of trends at a regional and county level using an inverse standard error weighted generalised linear model with a log link to construct funnel plots. County-level CFRs were compared for the first and last 3 years of the period to further investigate the changes to county results over the 13 year period, specifically in comparison to the national-level CFR. Results Nationally, there was an annual fall in CFRs (2.1%). The decline was faster from 2002 to 2007 (annual percentage change = − 3.4; 95% CI-4.4, − 2.4), compared to 2007–2014 (annual percentage change = − 1.2; 95% CI -1.9, − 0.5). The South-East had a lower rate of decrease and the West had a higher rate. Cross sectional analysis of two periods (2002–2004 and 2012–2014) showed high consistency in the counties performance relative to the national CFR in both periods. Conclusion Change in the national trend coincided with the onset of economic stress on the public health system. Attributing the decline in CFR improvement to economic factors is weakened by the uneven nature of the trend change. No distinct pattern of change was identified among regions which underwent substantial reconfiguration of emergency services. Electronic supplementary material The online version of this article (10.1186/s12913-018-3260-1) contains supplementary material, which is available to authorized users.

There is evidence to suggest that both psychological characteristics and stressful life events are contributory factors in deliberate self-harm among young people. These links, and the possibility of a dose-response relationship between self-harm and both psychological health and life events, were investigated in the context of a seven-country school-based study. Over 30,000, mainly 15 and 16 year olds, completed anonymous questionnaires at secondary schools in Belgium, England, Hungary, Ireland, the Netherlands, Norway and Australia. Pupils were asked to report on thoughts and episodes of self-harm, complete scales on depression and anxiety symptoms, impulsivity and self-esteem and indicate stressful events in their lives. Level and frequency of self-harm was judged according to whether they had thought about harming themselves or reported single or multiple self-harm episodes. Multinomial logistic regression assessed the extent to which psychological characteristics and stressful life events distinguished between adolescents with different self-harm histories. Increased severity of self-harm history was associated with greater depression, anxiety and impulsivity and lower self-esteem and an increased prevalence of all ten life event categories. Female gender, higher impulsivity and experiencing the suicide or self-harm of others, physical or sexual abuse and worries about sexual orientation independently differentiated single-episode self-harmers from adolescents with self-harm thoughts only. Female gender, higher depression, lower self-esteem, experiencing the suicide or self-harm of others, and trouble with the police independently distinguished multiple- from single-episode self-harmers. The findings reinforce the importance of psychological characteristics and stressful life events in adolescent self-harm but nonetheless suggest that some factors are more likely than others to be implicated.

Coroners routinely enquire into suicide deaths and communicate with people bereaved by suicide. However, no research has been conducted into coroners' attitudes towards suicide and its prevention.We assessed attitudes towards suicide among Irish coroners in order to determine their understanding of suicide and its prevention.An internationally validated questionnaire assessing attitudes towards suicide was sent to all coroners in the Republic of Ireland and Northern Ireland.Sixty completed questionnaires (response 62%) were analysed. Overall, the coroners' responses reflected openness towards communication about suicide and suicide prevention initiatives. Approximately, one in five favoured the attitudes that suicide is a right or that it may be a justifiable resolution. Only 23% agreed that people who die by suicide are usually mentally ill.Irish coroners favour communication about suicide and have a positive attitude towards its prevention but they appear to underestimate the prevalence of mental illness.

Suicidal behaviour has become recognised as a major public health problem.To examine hospital-treated parasuicide and suicide in the Southern and Mid-Western Health Boards.Parasuicide data were derived from independent data collection in general and psychiatric hospitals and prisons between 1995 and 1997. The corresponding suicide data were obtained electronically from the Central Statistics Office.Respectively, the annual person-based male, female and total European age-standardised rates were 128.9, 154.3 and 141.3 per 100,000 for parasuicide compared to 22.7, 5.5 and 14.1 per 100,000 for suicide. The parasuicide/suicide ratio varied markedly by age, gender, area and marital status. The majority of suicides were by hanging or drowning whereas drug overdose made up the vast majority of parasuicide acts. Parasuicide was largely a city phenomenon confined to the young of both genders whereas suicide was a significant problem for city and county men, especially young adult men.There are striking differences between the patterns of fatal and non-fatal suicidal behaviour in Ireland, which should be considered in prevention initiatives.

The Republic of Ireland, a monotheistic society, has experienced a significant increase in suicide at a time when religious practice has declined. This paper investigates Thomas Masaryk's theory of an inverse relationship between these two phenomena. Age-standardised suicide rates were calculated by gender, province and for urban and rural areas, and compared with the results of four religious surveys. The increase in suicide is solely among males whereas both genders have shown a decline in religious practice. Furthermore, the areas that have experienced the least fall-off in religious practice have had the sharpest rise in suicide. These discrepancies suggest that the association between religious practice and suicide rates may not be as strong as Thomas Masaryk believed.

The relationship between suicide and homicide has long been ofinterest. It has often been written that the two are inversely relatedthough more recent reports, especially from North America, suggest thatthe two vary in parallel. In 1970, Kendell hypothesised that suicide andhomicide should be inversely related. This study tested this prediction inan Irish context by examining the suicide and homicide rates of theRepublic of Ireland and Northern Ireland for the years 1950–1990. The results suggest that, in general, suicide and homicide are positivelyrelated and that the inverse relationship hypothesis is limited to periodswhen a society is in a war-like situation. There is a positive relationshipbetween suicide and indictable crime in both countries, more so in the Republic of Ireland. In light of these findings a new hypothesis isproposed that, in general society, suicide, homicide and indictable crimeare positively related and reflect the level of disorder in society.

Under-reporting has been a frequent criticism of mortality statistics,especially in data from Ireland. Cantor et al. (1997) report a new study,claiming that the data in Ireland are unreliable, based on a sudden increasein suicide. However, this paper examined this belief further, showing thatthe data may well be reliable, and provides explanations for the regionalvariation in certification and the rise of suicide in Irish males. Becauseof the rise in suicide, an outline for reducing suicide in Ireland isreported, highlighting a national response, a National Task Force, and anindependent research foundation, Suicide Research Foundation.

Background In order to reduce fatal self-poisoning legislation was introduced in the UK in 1998 to restrict pack sizes of paracetamol sold in pharmacies (maximum 32 tablets) and non-pharmacy outlets (maximum 16 tablets), and in Ireland in 2001, but with smaller maximum pack sizes (24 and 12 tablets). Our aim was to determine whether this resulted in smaller overdoses of paracetamol in Ireland compared with the UK. Methods We used data on general hospital presentations for non-fatal self-harm for 2002 - 2007 from the Multicentre Study of Self-harm in England (six hospitals), and from the National Registry of Deliberate Self-harm in Ireland. We compared sizes of overdoses of paracetamol in the two settings. Results There were clear peaks in numbers of non-fatal overdoses, associated with maximum pack sizes of paracetamol in pharmacy and non-pharmacy outlets in both England and Ireland. Significantly more pack equivalents (based on maximum non-pharmacy pack sizes) were used in overdoses in Ireland (mean 2.63, 95% CI 2.57-2.69) compared with England (2.07, 95% CI 2.03-2.10). The overall size of overdoses did not differ significantly between England (median 22, interquartile range (IQR) 15-32) and Ireland (median 24, IQR 12-36). Conclusions The difference in paracetamol pack size legislation between England and Ireland does not appear to have resulted in a major difference in sizes of overdoses. This is because more pack equivalents are taken in overdoses in Ireland, possibly reflecting differing enforcement of sales advice. Differences in access to clinical services may also be relevant.

It has long been unfashionable to write about historical causes and effects. Historical ends fall under a similar stricture, whether intended in a teleological sense to signify a purposive telos, a higher reality, or simply a finis beyond decline and fall. For even longer it has been been out of fashion to use the old organic metaphors to depict the painful birth, promising youth, prolific maturity, faltering old age, and final demise of an epoch or civilization. An empiricist rectitude may save the rare historiographer from such claims, but many humanists feel, or at least write, as if history has its origins, aims, and ends. Our language cannot prevent an indulgence in the mythical conceit that history has shape and purpose, and is even somehow a reflection, however distorted, of the hopes and sorrows of human life. We are intelligent enough to know, of course, that this is not really true, or cannot be held to be true. Yet history, as the very word implies, is a story that cannot be deprived of its fictive elements.

Initial results of a small pilot project indicate thatCebus monkeys have the potential to serve as animal aides for quadriplegics. During the course of the pilot project the investigators developed a set of procedures for teaching aCebus monkey a variety of helping skills. Given a description of those procedures, a college student with no prior animal training experience was able to teach a naiveCebus apella nine different complex behaviors in 25.5 hr of training over a period of two months.