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Background: The incidence of self-harm in young people in primary care is increasing dramatically and many young people who self-harm visit their GP surgery as a first point of contact for help. Aim: To explore with young people, GPs and Practice Nurses; 1) why young people present with self-harm to primary care and 2) whether young people, GPs and Practice Nurses can take steps to have more helpful consultations about self-harm in GP surgeries that include self-help materials developed by young people being used to support such consultations to take place. Design and setting: Participatory action research with GPs, Practice Nurses and young people employed mixed methods to collect statistical and narrative data.Methods: Statistics from 285 young people’s medical records were captured including more detailed analyses of a random sample of 75 of these records. A series of 24 focus groups with a total of 45 GPs, Practice Nurses and Young People, with an average number of 8 participants in each group were conducted. Statistical data was subject to descriptive and inferential analyses and thematic analysis was applied to the transcripts from the focus groups. Results and conclusion: The type of self-harm young people presented with influenced whether they would see a GP or Practice Nurse. While self-help materials were welcomed and deemed helpful, young people, GPs and Practice Nurses were ambivalent about using these in short consultations where time was an overriding constraint. More research is needed on the feasibility of adopting self-help assisted interventions in GP surgeries.

This guide is designed to support care home organisations who wish to implement Namaste Care. It should be read together with its partner guide: ‘Guidance for Namaste Workers: Delivering Namaste Care’. This guide focuses on supporting care home organisations to plan, deliver and evaluate Namaste Care for their residents. The Namaste Workers’ guide addresses the details of running Namaste Care sessions. These guidance documents have been developed following a 3-year research project and as such are based in the experience of care home organisations and practitioners. Selected quotes or examples from their practice are used throughout. To read the full research project report go to: www.worc.ac.uk/dementia This guidance is not intended to replace the original book: Simard, J (2013) “The end of life Namaste Care program for people with dementia.” In addition, St Christopher’s Hospice have developed a toolkit for Namaste Care which is also a valuable resource.It is available at: www.stchristophers.org.uk

Additional file 2. Search terms.

Background: Suicide is a global public health concern, but it is preventable. Increased contact with primary care before the suicide or attempted suicide raises opportunities for intervention and prevention. However, suicide assessment and management is an area that many General Practitioners (GPs) find particularly challenging. Previous research has indicated significant variability in how GPs understand, operationalise and assess suicide risk which subsequently has an impact on clinical decision making. Clinical Decision Support systems (CDSS) have been widely implemented across different healthcare settings, including primary care to support practitioners in clinical decision making. CDSS may reduce inconsistencies in the identification, assessment and management of suicide risk by GPs by guiding them through the consultation and generating a risk assessment plan that can be shared with a service user or with specialised mental health services.Objective: To co-develop and test with end users (e.g. GPs, primary care attendees, mental health professionals) an e-CDSS to support GPs in the identification, assessment and management of suicidality in primary care. Methods: An ongoing embedded mixed methods study with four phases: 1) Qualitative interviews with GPs to explore their views on the content, format and use of the e-CDSS; consultation with two service user advisory groups (people aged ? 25 and people aged ?25) to inform the content of the e-CDSS including phrasing of items and clarity; 2) Participatory co-production workshops with GPs, service users and clinical experts in suicidality to determine the content and format of the e-CDDS; gain consensus of the relevance of items; establish content validity (CVI) and identify pathways to implementation, using the Consolidated Framework for Implementation Research; 3) Building the e-CDSS so that it guides the GP through a consultation and 4) Usability testing of the e-CDSS with GPs and service users in one primary care practice involving a non-live and a live stage. Conclusions: This study will be the first to explore the feasibility, acceptability and usability of electronic guided decision support system for use in primary care consultations for the improved assessment and management of suicidality.

Objective: Chronic blood transfusion remains the most feasible therapeutic option for lifelong transfusion-dependent β-thalassemia (lifelong TDβT). However, it is associated with serious risks and complications. Hydroxyurea (HU), an oral chemotherapeutic drug, is expected to increase hemoglobin levels, thereby minimizing the burden of blood transfusion and its complications. Growing literature over the last twenty years suggests promising results of the use HU in lifelong TDβT; however, its role and safety remain unanswered questions. The objective of this study was to evaluate the clinical efficacy and safety of HU in patients with lifelong TDβT. Methods: MEDLINE, EMBASE, Cochrane databases, and major preceding conferences for studies that assessed HU in lifelong TDβT patients were searched. The effect size was estimated as a proportion (responder/sample size). Results: Eleven observational studies, collectively involving 859 patients, fulfilled eligibility criteria. HU was associated with a significant decrease in transfusion need with complete and overall (≥50%) response rates of 26% [95% confidence interval (CI), 13–41%] and 60% (95% CI, 41–78%), respectively. No serious adverse effects were reported. All of the studies had several limitations, such as lack of a comparison group. Conclusion: HU appears to be effective, well tolerated; however, large randomized clinical trials should be done to confirm such findings

BackgroundIt is not known whether associations between child problem behaviours and maternal depression can be accounted for by comorbid borderline personality disorder (BPD) dysfunction.AimTo examine the contributions of maternal depression and BPD symptoms to child problem behaviours.MethodDepression trajectories over the fist-year postpartum were generated using repeated measurement from a general population sample of 997 mothers recruited in pregnancy. In a stratified subsample of 251, maternal depression and BPD symptoms were examined as predictors of child problem behaviours at 2.5 years.ResultsChild problem behaviours were predicted by a high maternal depression trajectory prior to the inclusion of BPD symptoms. This association was no longer significant after the introduction of BPD symptoms.ConclusionsRisks for child problem behaviours currently attributed to maternal depression may arise from more persistent and pervasive difficulties found in borderline personality dysfunction.

BackgroundAccording to fetal origins hypotheses, mismatched prenatal-postnatal conditions will be associated with poor health outcomes. Based on previous findings from the Wirral Child Health and Development Study (WCHADS) that associations between prenatal anxiety and child anxious- depressed symptoms were modified by mothers’ reports of infant stroking, we predicted similar effects following mismatched prenatal-postnatal maternal anxiety. Low stroking would be associated with poorer outcome. In view of associations between oppositional defiant disorder (ODD) irritability and adolescent depression, our models predicted irritability, controlling for general psychopathology ‘p’, and contrasted with headstrong, to test for specificity. Based on animal and human evidence we predicted that the effect would be seen only in girls.MethodsMothers in the WCHADS, a general population cohort recruited at 20 weeks pregnancy, provided self- reported anxiety during pregnancy, and at 9 weeks, 14 months and 3.5 years postpartum, frequency of infant stroking at 9 weeks. Mothers and teachers reported child symptoms at age 7 years. Irritability scores were available from 668 children, and SEM models with maximum-likelihood estimates made use of data from 887 participants. ResultsThere was a three way interaction between prenatal and postnatal anxiety and maternal stroking. This arose because lower stroking at 9 weeks was associated with higher irritability at 7 years, only in the mismatched, low-high and high-low maternal anxiety groups. The effect was unchanged after accounting for associations with general psychopathology, ‘p’. There was no effect on headstrong symptoms. Despite an overall effect on irritability in separate analyses this was confined to girls. ConclusionsPostnatal modifications of prenatal effects of maternal anxiety were specific to child irritability, and seen only in girls. Given associations between child irritability and adolescent depression, the findings provide further indications of mechanisms for fetal and postnatal origins of affective disorders in adolescence and beyond.

Background\ud \ud The precipitating role of life events in the onset of depression is well-established. The present study sought to examine whether life events hypothesised to be personally salient would be more strongly associated with depression than other life events. In a sample of women making the first transition to parenthood, we hypothesised that negative events related to the partner relationship would be particularly salient and thus more strongly predictive of depression than other events.\ud \ud Methods\ud \ud A community-based sample of 316 first-time mothers stratified by psychosocial risk completed interviews at 32 weeks gestation and 29 weeks postpartum to assess dated occurrence of life events and depression onsets from conception to 29 weeks postpartum. Complete data was available from 273 (86.4%). Cox proportional hazards regression was used to examine risk for onset of depression in the 6 months following a relationship event versus other events, after accounting for past history of depression and other potential confounders.\ud \ud Results\ud \ud 52 women (19.0%) experienced an onset of depression between conception and 6 months postpartum. Both relationship events (Hazard Ratio = 2.1, p = .001) and other life events (Hazard Ratio = 1.3, p = .020) were associated with increased risk for depression onset; however, relationship events showed a significantly greater risk for depression than did other life events (p = .044).\ud \ud Conclusions\ud \ud The results are consistent with the hypothesis that personally salient events are more predictive of depression onset than other events. Further, they indicate the clinical significance of events related to the partner relationship during pregnancy and the postpartum.