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Suicide is the leading cause of death for Australians aged 15 to 44, with fifty to sixty per cent of individuals who die by suicide ‘flying under the radar’, dying in this way without receiving formal mental health care or treatment. This paper explores how people bereaved by suicide interpret and narrate the lead-up to, act and aftermath of a male family member who died by suicide. We used qualitative semi-structured interviews to explore how narratives of suicide were articulated by loved ones bereaved by suicide. Analytic findings were conceptualised through Bamberg’s four layers of cognitive narrative structure–setting, complication, resolution, coda. We derived three complications conveyed by the group as a whole: that the men felt sentenced by fate, charged with fury and were fueled by alcohol. These narratives by individuals bereaved by suicide draw us into the larger picture of meaning-making, the loss of life and finding closure. They also speak to the need for early interventions, as most of these stories are rooted in childhood tragedy that was not sufficiently addressed or supported.

For Australians experiencing a suicide crisis, the emergency department (ED) is the recommended point of contact for intervention and to ensure personal safety. However, negative ED experiences can deter individuals from returning, thus impacting future suicide risk. In order to improve the ED environment for individuals in suicidal crisis, an in-depth understanding of this experience is needed. In-depth semi-structured interviews with 17 help seekers and 16 support persons were conducted. A grounded theory approach uncovered a core organising concept—all participants wanted a “a sustained, productive, constructive relationship with someone who can help” during the ED visit—which guided analysis. Thematic analysis resulted in two themes and four subthemes exploring the systemic and interpersonal aspects of the ED visit and the roadblocks and pathways to development of the relationship. Interpersonal factors included aspects of staff interaction and presence of a support person. Systemic factors related to aspects controlled by the physical space and internal policies and procedures and included aspects such as the chaotic environment, long waiting times, and access to staff. Overwhelmingly, there were more roadblocks than pathways reported by participants. Improving the ED environment, increasing staff training and encouraging the presence of support persons may help mitigate some of these roadblocks.

A multi-province outbreak of listeriosis occurred in Canada from June to November 2008. Fifty-seven persons were infected with 1 of 3 similar outbreak strains defined by pulsed-field gel electrophoresis, and 24 (42%) individuals died. Forty-one (72%) of 57 individuals were residents of long-term care facilities or hospital inpatients during their exposure period. Descriptive epidemiology, product traceback, and detection of the outbreak strains of Listeria monocytogenes in food samples and the plant environment confirmed delicatessen meat manufactured by one establishment and purchased primarily by institutions was the source of the outbreak. The food safety investigation identified a plant environment conducive to the introduction and proliferation of L. monocytogenes and persistently contaminated with Listeria spp. This outbreak demonstrated the need for improved listeriosis surveillance, strict control of L. monocytogenes in establishments producing ready-to-eat foods, and advice to vulnerable populations and institutions serving these populations regarding which high-risk foods to avoid.

A syndrome of red eyes and respiratory symptoms was noted following receipt of influenza vaccine in Canada during the 2000-2001 influenza season. We conducted intra-dermal skin testing to determine if oculo-respiratory syndrome (ORS) was related to failure of the splitting process during vaccine manufacturing, if it was associated with a particular viral strain and to identify individuals at risk for subsequent ORS reaction. Skin testing with minute quantities of vaccine antigen induced ORS symptoms at a higher rate amongst persons previously affected by this syndrome compared to previously unaffected persons. Skin test reaction size or quality could not identify persons at risk of ORS. Skin testing could not identify a specific strain or the stage in the manufacturing process during which the trigger may have been introduced.

In 2012, Lancashire County Council launched a programme to improve public health, by reducing hospital admissions, and to decrease excess winter illness/ deaths among vulnerable households at risk of severe cold in Lancaster, Wyre and Fylde. Interventions included providing practical help and information together with preventative and remedial support services.Local needs assessments identified vulnerable groups, and services were commissioned to build their resilience to cold weather. Public health messages were communicated and immediate advice and practical support services were provided to the isolated and vulnerable throughout the winter. The project ensured that more long term sustainable measures are in place to protect those most vulnerable to the cold. As a result strong partnerships have been created for the future with several agencies. These include: District and City Councils; Care and Repair Wyre and Fylde; Home Improvement Agency Lancaster; Citizens Advice Bureaux; Age UK Lancashire; LESS Community Interest Company; North West Ambulance Service; Groundworks and New Progress Housing; Lancashire Fire and Rescue Service; Energy Inform; Food Banks; Help Direct; and Lifeline Pendant Alarms.INTERVENTIONThe programme initially used funds made available for local authorities to bid for through the Department of Health's 2011/12 Warm Homes Healthy People (WHHP) initiative. As funding was announced in December when winter was already upon us, there was little time for planning. There was also no requirement to monitor or evaluate the intervention.Despite this, North Lancashire monitored the interventions provided to support some of the vulnerable members of the community and found evidence of partnership working and benefits to the local population from the interventions delivered with WHHP money. This evidence prompted NHS North Lancashire to further invest approximately £150,000 in projects across the Primary Care Trust (PCT) footprint by securing significant funding for Affordable Warmth. Therefore, for the first time it was possible to plan ahead in 2012/13 prior to the winter months and offer preventative up-stream measures, rather than taking the usual reactive approach. A referral criterion was set identifying Care and Repair and the Home Improvement Agency as the single points of access for front line agencies. Historically, referrals from health staffwere few in number during previous initiatives. On investigation, it was found that front line staffhad limited time to explore what measures were available or where to refer to, so they rarely did so. Providing one contact number for each locality would ensure access to support and give staffconfidence that an assessment would be carried out to determine the level of support needed. For the purpose of the project, the definition of 'vulnerable' used to ensure funding reached those whose health and wellbeing would be most affected by cold, damp living conditions is identified below as:* A person who is receiving services such as:* personal care or nursing or support to live independently in his/her own home; or* social care services;* A person who is affected by the following conditions:* learning or physical disability;* physical or mental illness, chronic or otherwise, including those receiving treatment for cancer and palliative care; or* reduction in physical or mental capacity.* A person with a disability of the type listed below:* dependency upon others in the performance of, or a requirement for assistance in the performance of, basic physical functions; or* severe impairment in the ability to communicate with others; or* A person with an impaired ability to protect him/herself from assault, abuse or neglect.When planning the second phase of the intervention funded by NHS North Lancashire, the Affordable Warmth team was able to build on lessons learnt in the first interventions of 2011/12. …

During the 2000-2001 influenza immunization campaign in Canada, a new adverse event, oculo-respiratory syndrome (ORS), was noted in association with administration of vaccine supplied by one manufacturer. The original case definition for ORS specified bilateral conjunctivitis, facial edema, or respiratory symptoms beginning 2-24 h after influenza vaccination and resolving within 48 h after onset. To characterize the spectrum, severity, and impact of ORS, we contacted persons who had reported any influenza vaccine-associated adverse event in British Columbia, Canada, during the 2000-2001 vaccination campaign. With use of a standardized telephone interview, we collected information from 609 (79%) of 769 eligible persons. Thirteen percent of ORS-affected persons reported onsetor=2 h after vaccination, 27% experienced symptoms for48 h, and 42% considered the symptoms to be severe. The surveillance case definition for ORS for 2001-2002 was revised to include onsetor=24 h after vaccination, with no restriction on duration. ORS should be incorporated into annual influenza vaccine safety monitoring.

During the postvaccine era in Canada, most cases of pertussis have been reported in children

Verapamil is generally a safe and effective drug in the treatment of many vascular disorders. During the past 10 years, a number of serious poisonings have been attributed to verapamil overdose. A relatively new problem is toxicity with the sustained-release form of verapamil. Complications of verapamil overdose can be understood as simply an extension of its pharmacologic activity. Consistently effective therapy remains elusive. Specific calcium channel blocker antidotes are under investigation, but supportive therapy remains the mainstay for serious verapamil overdose.

Epilepsy is almost as common as diabetes and some 750 people with epilepsy die suddenly and prematurely each year. Unfortunately, the management of epilepsy has been much neglected and services often remain fragmented and difficult for patients to understand. We employed a nurse specialist in epilepsy to work with practice nurses in a group of general practices to promote better care, to make patients aware of sources of help and support, and to provide information about issues such as driving, employment and pregnancy. Over 70% of patients with epilepsy attended ‘clinics' run by the specialist nurse and many previously unidentified problems were successfully resolved—including misdiagnosis, over-medication and lack of awareness of the side-effects of antiepileptic drugs. Nurse specialists in epilepsy, working with groups of general practices but in collaboration with hospital specialists and voluntary organizations, can take a lead role in facilitating joint working between all those involved in service provision, in training practice nurses and others in the special needs of people with epilepsy and in providing support in hospital clinics.

A 23-year-old healthy woman in her third trimester of pregnancy developed adult respiratory distress syndrome secondary to Blastomyces dermatitides. Pregnancy-related immunosuppression was believed to be responsible for the fungal infection. Following emergency delivery of the infant and a full course of amphotericin B therapy, the patient made an uneventful recovery. Although the fetal and maternal sides of the placenta demonstrated fungal spores, the child remained healthy. To our knowledge, this is the first report of blastomycosis-associated adult respiratory distress syndrome occurring during pregnancy.