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Item does not contain fulltext OBJECTIVE: Maternal smoking has been associated with increased risk of miscarriage. However little is known about the influence of paternal smoking. The study aimed to examine maternal and paternal smoking as risk factors for miscarriage. STUDY DESIGN: A cohort study was conducted in a large, tertiary hospital (8,500 deliveries per annum) in the Republic of Ireland in 2012. Women randomly selected at their first booking visit (10-14 wks) were asked to complete a detailed lifestyle questionnaire including maternal and paternal smoking and the mother's exposure to partner's smoke. All participants were followed up at 20 weeks gestation to determine pregnancy outcome. RESULTS: Of the 417 participants, the prevalence of maternal and paternal smoking was 26.3% and 30.7%, respectively, and 13.4% of mothers were exposed to their partner's smoke. One in three (n = 134, 32.1%) had a confirmed miscarriage at follow-up. Miscarriage was not associated with maternal smoking (30.6% for non-smokers versus 32.4% for smokers; P = 0.737) or paternal smoking (31.2% for non-smokers versus 32.8% for smokers; P = 0.763). A higher proportion of women exposed to their partner's smoke experienced miscarriage (44.2% vs. 29.9%; Odds ratio = 1.86, 95% CI = 1.03-3.38; P = 0.038). The association remained even after adjustment for the mother's own smoking (Adjusted odds ratio = 2.22, 95% CI = 1.12-4.40; P = 0.022). CONCLUSION: Our findings suggest an association between mother's exposure to partner's smoke and miscarriage. That risk of miscarriage could be influenced by passive smoking but not active smoking is biologically implausible. However, a mother's exposure to her partner's smoke may be a proxy for other risk factors that warrant further investigation.

Anxiety and concerns in daily life may result in sleep problems and consistent evidence suggests that inadequate sleep has several negative consequences on cognitive performance, physical activity, and health. The aim of our study was to evaluate the association between mean hours of sleep per night, psychologic distress, and behavioral concerns.A cross-sectional analysis of the correlation between the number of hours of sleep per night and the Zung Self-rating Anxiety Scale (Z-SAS), the Paykel Suicidal Scale (PSS), and the Strengths and Difficulties Questionnaire (SDQ), was performed on 11,788 pupils (mean age±standard deviation [SD], 14.9±0.9; 55.8% girls) from 11 different European countries enrolled in the SEYLE (Saving and Empowering Young Lives in Europe) project.The mean number of reported hours of sleep per night during school days was 7.7 (SD, ±1.3), with moderate differences across countries (r=0.06; P.001). A reduced number of sleeping hours (less than the average) was more common in girls (β=0.10 controlling for age) and older pupils (β=0.10 controlling for sex). Reduced sleep was found to be associated with increased scores on SDQ subscales of emotional (β=-0.13) and peer-related problems (β=-0.06), conduct (β=-0.07), total SDQ score (β=-0.07), anxiety (Z-SAS scores, β=-10), and suicidal ideation (PSS, β=-0.16). In a multivariate model including all significant variables, older age, emotional and peer-related problems, and suicidal ideation were the variables most strongly associated with reduced sleep hours, though female gender, conduct problems measured by the SDQ, and anxiety only showed modest effects (β=0.03-0.04).Our study supports evidence that reduced hours of sleep are associated with potentially severe mental health problems in adolescents. Because sleep problems are common among adolescents partly due to maturational processes and changes in sleep patterns, parents, other adults, and adolescents should pay more attention to their sleep patterns and implement interventions, if needed.

Item does not contain fulltext OBJECTIVE: The Women's Health Study was designed to examine associations between maternal and paternal reproductive histories, behavioural and lifestyle risk factors and miscarriage. The objective of this study was to examine underlying differences in characteristics and pregnancy outcome between responders and non-responders. METHODS: A cohort study was conducted in a large, tertiary hospital (8,500 deliveries per annum) in the Republic of Ireland in 2012. Women were randomly selected at their first booking visit (10-14wks) and were asked to complete a detailed lifestyle postal questionnaire containing common risk factors for miscarriage. Basic demographic data and pregnancy status at 20 weeks gestation were collected for all recruited women. Chi-square tests were performed to assess differences in characteristics and pregnancy status. RESULTS: 715 women agreed to participate in the study of which 61.3% (n = 431) completed the detailed questionnaire. Responders and non-responders were similar in terms of the proportions who were primiparous (39.1% vs. 38.5%) and multiparous (25.0% vs. 21.1%). Average age was the same (32.8 (5.6) versus 32.1 (5.3) years; p = 0.441). Non-responders were slightly more likely to be nulliparous (40.5% vs. 35.9%; P = 0.256) and married (65.4% vs. 62.6%). In terms of the outcome, non-responders had a higher rate of miscarriage (40.4% vs. 32.1%; p = 0.025). CONCLUSIONS: While basic demographics were broadly similar between responders and non-responders, the discrepancy between miscarriage rates may be a result of unobserved factors. Participation bias towards healthier individuals is frequent in clinical and public health studies, and thus subsequent results should be interpreted with caution.

Item does not contain fulltext OBJECTIVE: Miscarriage is the most common adverse outcome in pregnancy. Investigations suggest numerous risk factors however the cause remains poorly understood. The study aimed to examine the contribution of an array of psychological factors to risk of miscarriage. STUDY DESIGN: A cohort study was conducted in a large, tertiary hospital (8,500 deliveries per annum) in the Republic of Ireland in 2012. Women randomly selected at their first booking visit (10-14wks) were asked to complete a detailed lifestyle questionnaire, which included common risk factors for miscarriage. Emotional wellbeing, social support, life orientation and perceived stress were assessed using the following validated psychometric tests; the RAND 36-Item Health Survey, the Maternity Social Support Scale, the Revised Life Orientation Test and the Perceived Stress Scale. All participants were followed up at 20 weeks gestation to determine pregnancy outcome. Logistic regression was conducted to assess associations with risk of miscarriage. RESULTS: Of the 417 participants, 32.1% (n = 134) had a confirmed miscarriage at follow-up. After adjustment, women with high levels of perceived stress had an increased odds of miscarriage (OR: 1.97; 95% CI: 1.14-3.44) relative to women with low perceived stress (44.1% vs. 26.0%). While high emotional wellbeing was somewhat protective (OR: 0.68; 95% CI: 0.38-1.11) relative to women with low emotional wellbeing (26.8% vs. 35.9%). Maternal social support and life orientation were not associated with miscarriage. CONCLUSION: Perceived stress and low emotional wellbeing may increase risk of miscarriage. Early assessment and greater support to vulnerable women may be important and warrants further investigation.

Objective: In support of a whole-school approach to mental health promotion, this study was conducted to find out whether and how significantly teachers’ satisfaction with school and their subjective psychological well-being are related to the belief that they can help pupils with mental health problems. Design: Cross-sectional data were collected as a part of the European Union’s, Seventh Framework Programme for Research (FP7) Saving and Empowering Young Lives in Europe (SEYLE) study. One of the elements of the SEYLE study was to evaluate teachers’ attitudes and knowledge related to pupils’ mental health issues and their own psychological well-being, as well as their satisfaction with the school environment. Setting: The sample of schools from the SEYLE study sites representing 11 European countries was randomly chosen according to prior defined inclusion and exclusion criteria. The final cross-sectional database used for analysis in the current study comprised 2485 teachers from 158 randomly selected schools. Method: Respondents’ belief that teachers can help pupils with mental health problems served as the outcome variable in our predictions with probability of the positive answer being modelled in the logistic regression analysis. Teachers’ subjective psychological well-being and school satisfaction were included as independent variables in the logistic regression model and several other relevant variables were added to statistically control for them. Multiple models were tested in order to obtain the final model. Results: Logistic regression models showed that better satisfaction with general school climate, higher psychological well-being, and the ability to understand pupils’ mental health problems increased the odds of teachers’ readiness to help pupils with mental health problems. Conclusion: By providing a good school environment, by valuing the subjective psychological well-being of the teachers, and by providing adequate training to fulfil their ‘gatekeeper’ role, the preconditions to improve the mental health of the pupils they teach will be achieved. These suggestions are in line with a whole-school approach to mental health promotion.

There is expedient evidence showing that differences in adolescent alcohol consumption and other risk-behaviour depend on both family structure and family member drunkenness exposure. Data were obtained among adolescents (N = 12,115, mean age 14.9 +/- 0.89) in Austria, Estonia, France, Germany, Hungary, Ireland, Israel, Italy, Romania, Slovenia and Spain within the European Union's 7th Framework Programme funded project, 'Saving and Empowering Young Lives in Europe (SEYLE)'. The current study reveals how adolescents' alcohol consumption patterns are related to their family structure and having seen their family member drunk. The results revealed statistically significant differences in adolescent alcohol consumption depending on whether the adolescent lives in a family with both birth parents, in a single-parent family or in a family with one birth parent and one step-parent. The study also revealed that the abstaining from alcohol percentage among adolescents was greater in families with both birth parents compared to other family types. The study also showed that the more often adolescents see their family member drunk the more they drink themselves. There is no difference in adolescent drinking patterns whether they see their family member drunk once a month or once a week. This study gives an insight on which subgroups of adolescents are at heightened risk of alcohol abuse and that decrease of family member drunkenness may have positive effects on the drinking habits of their children.

Item does not contain fulltext OBJECTIVE: To assess the incidence of severe maternal morbidity (SMM) and examine associated factors in Ireland. METHODS: In 2011, 67,806 maternities were reported from 19 maternity units, representing 93% of maternities in Ireland. SMM was classified as the presence of one or more of 15 categories of morbidity including: major obstetric haemorrhage (MOH), eclampsia, renal/liver dysfunction, cardiac arrest, pulmonary oedema, acute respiratory dysfunction, coma, cerebrovascular accident, status epilepticus, septicaemic shock, anaesthetic complications, pulmonary embolism, peripartum hysterectomy, ICU admission and interventional radiology. MOH criteria included an estimated blood loss of >/=2,500 ml, a transfusion of >/=5 units of blood or documented coagulopathy treatment. The methodology was based on the Scottish Confidential Audit of Severe Maternal Morbidity (SCASMM). RESULTS: Overall, 260 women experienced SMM, a national rate of 3.8 per 1,000 maternities. Almost half (42.3%) experienced two or more severe morbidities. The perinatal mortality rate for women experiencing SMM was five times the national rate (32.6 vs. 6.6 per 1,000 births). MOH was the most frequent SMM (61.2%, 2.3/1000maternities) followed by ICU admission (42.7%, 1.6/1000maternities), renal/liver dysfunction (10.0%, 0.4/1000 maternities) and peripartum hysterectomy (8.8%, 0.3/1000 maternities). MOH was associated with Caesarean section and peripartum hysterectomy was associated with a history of Caesarean section and a morbidly adherent placenta. CONCLUSION: The incidence of SMM in Ireland compares favourably to international Figures. 2-4 However, the current trend of increasing Caesarean section rates in Ireland may lead to an increase in SMM. Ongoing national audit of SMM is critical to assessing trends and informing clinical practice.

Risk assessment forms a key component in self-harm management. Among self-harm presentations generally, lethality of an index act is a poor predictor of future non-fatal repetition. However, no study has examined whether severity of an index self-cutting episode is associated with prospective repetition.To examine factors associated with severity of self-cutting and in particular the association between severity of self-cutting and prospective repetition of self-harm.All index self-cutting presentations to emergency departments in Ireland over 5 years were grouped by treatment received and compared on the basis of demographic and clinical characteristics.Receiving more extensive medical treatment was associated with male gender, being aged more than 15 years, and not combining self-harm methods. Receiving less extensive treatment conferred a higher risk of prospective 12-month repetition, even after controlling for demographic and clinical characteristics. Repeat self-harm presentations by those with more severe self-cutting in an index act were less prevalent but were more likely to involve high-lethality methods of self-harm.The results indicate that the already-elevated repetition risk among self-cutting patients is further increased for those receiving less extensive wound closure treatment. Severity of self-cutting might also affect suicide risk but such an association has yet to be examined.

Objectives: This study examines the backgrounds of 100 people who died by suicide and whose cases were adjudicated on consecutively over a five-year period, by the two Cork City coroners.Method: Five main sources of information were used; coroners, relatives, investigating police, general practitioners and hospital records. The cases were examined under the headings of age and gender differences; methods used; social circumstances; illness; treatment prior to death and previous attempts. Certain information may have been missed because peers were not interviewed. There were 72 males and 28 females.Results: In the 15-44 age group, the male female ratio was 4:1; in those over 45 the ratio was almost equal. Men were more likely to be unmarried even when age differences were taken into account. All the women and all but seven of the men had a psychiatric diagnosis, but women were more than more likely to have received medical treatment in the year before their suicide than men (OR = 6.6). Thirty-seven had made at least one previous suicide attempt.Conclusions: The study confirms that suicide, particularly for men is becoming more a young person's problem. Psychiatric illness is the single commonest association. Over a third of suicides had made a previous attempt. These findings point to the need to improve recognition of psychological distress and find effective methods to reduce parasuicide.

This study, based in Ireland in the Limerick centre of the WHO/EURO Multicentre Study of Parasuicide, tests the hypothesis that the uptake of hospital services increases significantly following an act of parasuicide. To investigate this, the costs of hospital attendance in the year before and in the year after an act of parasuicide are measured and compared. The sample is comprised of the first 100 individuals who attended an acute general hospital following an act of parasuicide after July 1, 1995. Using a computerized patient record system, every hospital attendance is identified, for each individual, in the 12 months before and after the parasuicide act. This includes every visit to the Emergency Room as well as both general and psychiatric inpatient admissions and outpatient attendances. There was a 50% increase in the uptake of hospital services--32% of the sample attended hospital in the year before compared with 48% in the year after. The total yearly costs for the 100 patients almost doubled from IR 53,652 Pounds (Euro 68,138) to IR 104,454 Pounds (Euro 132,657). Generalizing to the 539 individuals who engaged in parasuicide in the Limerick catchment area, total costs increased from IR 289,184 Pounds (Euro 367,264) to IR 563,007 Pounds (Euro 715,019). This study is an initial step toward the more complex task of estimating to what extent the increased uptake of hospital services is due to the consequences of parasuicide and how much is due to other aspects of the patient's health.

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 present paper examines the occurrence of matters relating to the ending of life, including active euthanasia, which is, technically speaking, illegal worldwide. Interest in this most controversial area is drawn from many varied sources, from legal and medical practitioners to religious and moral ethicists. In some countries, public interest has been mobilized into organizations that attempt to influence legislation relating to euthanasia. Despite the obvious international importance of euthanasia, very little is known about the extent of its practice, whether passive or active, voluntary or involuntary. This examination is based on questionnaires completed by 49 national representatives of the International Association for Suicide Prevention (IASP), dealing with legal and religious aspects of euthanasia and physician-assisted suicide, as well as suicide. A dichotomy between the law and medical practices relating to the end of life was uncovered by the results of the survey. In 12 of the 49 countries active euthanasia is said to occur while a general acceptance of passive euthanasia was reported to be widespread. Clearly, definition is crucial in making the distinction between active and passive euthanasia; otherwise, the entire concept may become distorted, and legal acceptance may become more widespread with the effect of broadening the category of individuals to whom euthanasia becomes an available option. The “slippery slope” argument is briefly considered.

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.

This paper presents a statistical model constructed using logistic regression to identify those at high-risk of repeating parasuicide. The subjects in the study are Cork city residents who exhibited parasuicidal behaviour between I January and 30 June 1995. Repetition of the behaviour within six months of the index episode distinguishes repeaters from non-repeaters. The model was designed so that it could be used by non-clinicians and hence does not require information relating to psychiatric diagnosis or use of psychiatric services. The proportion of subjects correctly classified remained stable across a range of cut-point probabilities (mean - 86%. range: 83.9-87.5%). Using a cut-point of 0.2. 96% of repeaters and 81% of non-repeaters were correctly classified. Using 0.45 led to the correct identification of 81% of repeaters and 90% of non-repeaters. If these high levels of sensitivity and specificity are maintained in validation tests on future cohorts in Cork city then the model could form th...

PURPOSE Suicide is a leading cause of death among adolescents. Self-harm is the most important risk factor for suicide, yet the majority of self-harm does not come to the attention of health services. The purpose of this study was to establish the relative incidence of adolescent suicide, hospital-treated self-harm and self-harm in the community. METHODS Annual suicide rates were calculated for 15-17 year-old in the Cork and Kerry region in Ireland based on data from the Central Statistics Office. Rates of hospital-treated self-harm were collected by the Irish National Registry of Deliberate Self-Harm. Rates of self-harm in the community were assessed using a survey of 3,881 adolescents, the Child and Adolescent Self-harm in Europe study. RESULTS The annual suicide rate was 10/100,000. Suicide was six times more common among boys than girls. The annual incidence rate of hospital-treated self-harm was approximately 344/100,000, with the female rate almost twice the male rate. The rate of self-harm in the community was 5,551/100,000, and girls were almost four times more likely to report self-harm. For every boy who died by suicide, 16 presented to hospital with self-harm and 146 reported self-harm in the community. For every female suicide, 162 girls presented to hospital with self-harm and 3,296 reported self-harm. CONCLUSIONS Gender differences in relative rates of self-harm and suicide are very large, with boys who have harmed themselves at particularly high risk of suicide. Knowledge of the relative incidence of self-harm and suicide in adolescents can inform prevention programmes and services.

Objectives: To investigate the prevalence and associated psychosocial factors of occasional and repetitive direct self-injurious behavior (D-SIB), such as self-cutting, -burning, -biting, -hitting, and skin damage by other methods, in representative adolescent samples from 11 European countries. Methods: Cross-sectional assessment of adolescents was performed within the European Union funded project, Saving and Empowering Young Lives in Europe (SEYLE), which was conducted in 11 European countries. The representative sample comprised 12,068 adolescents (F/M: 6,717/5,351; mean age: 14.9 0.89) recruited from randomly selected schools. Frequency of D-SIB was assessed by a modified 6-item questionnaire based on previously used versions of the Deliberate Self-Harm Inventory (DSHI). In addition, a broad range of demographic, social, and psychological factors was assessed. Results: Overall lifetime prevalence of D-SIB was 27.6%; 19.7% reported occasional D-SIB and 7.8% repetitive D-SIB. Lifetime prevalence ranged from 17.1% to 38.6% across countries. Estonia, France, Germany, and Israel had the highest lifetime rates of D-SIB, while students from Hungary, Ireland, and Italy reported low rates. Suicidality as well as anxiety and depressive symptoms had the highest odds ratios for both occasional and repetitive D-SIB. There was a strong association of D-SIB with both psychopathology and risk-behaviors, including family related neglect and peer-related rejection/victimization. Associations between psychosocial variables and D-SIB were strongly influenced by both gender and country. Only a minor proportion of the adolescents who reported D-SIB ever received medical treatment. Conclusion: These results suggest high lifetime prevalence of D-SIB in European adolescents. Prevalence as well as psychosocial correlates seems to be significantly influenced by both gender and country. These results support the need for a multidimensional approach to better understand the development of SIB and facilitate culturally adapted prevention/intervention. Keywords: Direct self-injurious behavior, self-harm, nonsuicidal self-injury, psychopathology, gender, adolescents, suicide.

While there are 35,000 diagnosed oral cancers per year and 7,500 deaths, there are 30 times this amount when it comes to cases of skin cancer, the majority of which are found on the head and neck. Because many patients see their dentist more frequently than their medical doctor, dentistry is in an advantageous position to reduce the mortality/morbidity of this most common malignancy. This article discusses various types of head and neck skin cancer and how dental practitioners can perform clinical examinations to provide early detection for patients.

Background: Research suggests that patients presenting to hospital with self-cutting differ from those with in- tentional overdose in demographic and clinical characteristics. However, large-scale national studies comparing self-cutting patients with those using other self-harm methods are lacking. We aimed to compare hospital-treated self-cutting and intentional overdose, to examine the role of gender in moderating these differences, and examine the characteristics and outcomes of those patients presenting with combined self-cutting and overdose. Methods: Between 2003 and 2010, the Irish National Registry of Deliberate Self-Harm recorded 42,585 self-harm presentations to Irish hospital emergency departments meeting the study inclusion criteria. Data were obtained on demographic and clinical characteristics by independent data registration officers. Results: Compared with overdose only, involvement of self-cutting (with or without overdose) was significantly more common in males than females, with an overrepresentation of males aged

Using longitudinal and prospective measures, the authors assessed the relationship between childhood trauma and psychotic experiences, addressing the following questions: 1) Does exposure to trauma predict incident psychotic experiences? 2) Does cessation of trauma predict cessation of psychotic experiences? 3) What is the direction of the relationship between childhood trauma and psychotic experiences?This was a nationally representative prospective cohort study of 1,112 school-based adolescents 13-16 years of age, assessed at baseline and at 3-month and 12-month follow-ups for childhood trauma (physical assault and bullying) and psychotic experiences.A bidirectional relationship was observed between childhood trauma and psychosis, with trauma predicting psychotic experiences over time and vice versa. However, even after accounting for this bidirectional relationship with a number of strict adjustments (only newly incident psychotic experiences occurring over the course of the study following exposure to traumatic experiences were examined), trauma was strongly predictive of psychotic experiences. A dose-response relationship was observed between severity of bullying and risk for psychotic experiences. Moreover, cessation of trauma predicted cessation of psychotic experiences, with the incidence of psychotic experiences decreasing significantly in individuals whose exposure to trauma ceased over the course of the study.After a series of conservative adjustments, the authors found that exposure to childhood trauma predicted newly incident psychotic experiences. The study also provides the first direct evidence that cessation of traumatic experiences leads to a reduced incidence of psychotic experiences.

Exposure to suicidal behavior of others was examined among 3,881 Irish adolescents in the Child and Adolescent Self-harm in Europe (CASE) study. One third of the sample had been exposed to suicidal behavior, and exposed adolescents were eight times more likely to also report own self-harm. Exposed adolescents shared many risk factors with those reporting own self-harm. Those reporting both exposure and own self-harm presented the most maladaptive profile on psychological, life event, and lifestyle domains, but neither anxiety nor depression distinguished this group. Exposed adolescents are burdened by a wide range of risk factors and in need of support.

Background: There is evidence for an association between suicidal behavior and coping style among adolescents. Aims: The aims of this study were to examine associations between coping style, mental health factors, and self-harm thoughts and acts among Irish adolescents, and to investigate whether coping style mediates associations between mental health factors (depression, anxiety, and self-esteem) and self-harm. Method: A cross-sectional school-based survey was carried out. Information was obtained on history of self-harm, life events, and demographic, psychological, and lifestyle factors. Results: Emotion-oriented coping was strongly associated with poorer mental health and self-harm thoughts and acts. Problem-Oriented Coping was associated with better mental health. Mediating effects of Emotion-Oriented Coping on associations between mental health factors and deliberate self-harm (DSH) was found for both genders and between Problem-Oriented Coping and mental health factors for girls. Similar mediating effects of coping style were found when risk of self-harm thoughts was examined. Limitations: Since the methodology used was cross-sectional, it is impossible to draw conclusions regarding causal relationships between coping style and associated factors. The coping measure used was brief. Conclusions: Promotion of positive coping skills and reduction of emotion-focused approaches may build resilience to self-harm thoughts and acts among adolescents experiencing mental health problems.

Background Under the Transformation Programme (2006) of the Health Service Executive (HSE), emergency and urgent care in Ireland is moving towards a ‘systems-based’ approach for discrete geographical regions. The SIREN (Study of the Impact of Reconfiguration on Emergency and Urgent Care Networks) project aims to describe and evaluate the performance of the different emergency and urgent care systems (EUCS) in Ireland. Methods Directly age and case mix -standardised case fatality ratios (CFRs) and directly age and gender standardised population mortality rates (PMRs) were constructed at a regional level for a series of emergency conditions. The regional rates were weighted by the 2012 national standard population to yield the adjusted rates. For the PMRs, the standard population was based on the national population by age group and gender. When constructing the CFRs, the standard population was based on the annual number of emergency condition events (deaths and admissions) seen nationally by age group and condition. Using a Poisson model, we predicted the change to CFRs associated with a 10% increase in boundary crossing i.e. the proportion of emergency patients travelling to another county to attend a hospital. Results PMRs for the selected emergency conditions fell over the period. The national PMR almost halved from the observed 2002 level of 22 per 10,000 to 12 per 10,000 by 2012. Admissions for total conditions fell by 17% nationally but to 1,596 per 10,000 between 2002 and 2012. Consistent regional variation, over time and condition, has been identified in both PMRs and CFRs. Many of the highest results were observed in the West and South-West of the country, areas with high levels of geographical remoteness. While all counties experienced significant decreases in PMRs, the rate of decline observed in CFRs varied, with some counties not registering significant changes over the 10 years. Four counties experienced an absolute change in boundary crossing of 10% or more in successive years. Initial analysis did not find evidence of an association between boundary crossing and changes in case fatality ratios. Conclusion Despite a fall in PMRs and CFRs, both nationally and across regions, a distinct pattern between the predominantly urban East and rural areas in the West and the South exist. Initial analysis suggests changes in the movement of patients between regions did not significantly change county CFRs. Further research will explore these findings.

BackgroundEpidemiological research has shown that hallucinations and delusions, the classic symptoms of psychosis, are far more prevalent in the population than actual psychotic disorder. These symptoms are especially prevalent in childhood and adolescence. Longitudinal research has demonstrated that psychotic symptoms in adolescence increase the risk of psychotic disorder in adulthood. There has been a lack of research, however, on the immediate clinicopathological significance of psychotic symptoms in adolescence.AimsTo investigate the relationship between psychotic symptoms and non-psychotic psychopathology in community samples of adolescents in terms of prevalence, co-occurring disorders, comorbid (multiple) psychopathology and variation across early v. middle adolescence.MethodData from four population studies were used: two early adolescence studies (ages 11–13 years) and two mid-adolescence studies (ages 13–16 years). Studies 1 and 2 involved school-based surveys of 2243 children aged 11–16 years for psychotic symptoms and for emotional and behavioural symptoms of psychopathology. Studies 3 and 4 involved in-depth diagnostic interview assessments of psychotic symptoms and lifetime psychiatric disorders in community samples of 423 children aged 11–15 years.ResultsYounger adolescents had a higher prevalence (21–23%) of psychotic symptoms than older adolescents (7%). In both age groups the majority of adolescents who reported psychotic symptoms had at least one diagnosable non-psychotic psychiatric disorder, although associations with psychopathology increased with age: nearly 80% of the mid-adolescence sample who reported psychotic symptoms had at least one diagnosis, compared with 57% of the early adolescence sample. Adolescents who reported psychotic symptoms were at particularly high risk of having multiple co-occurring diagnoses.ConclusionsPsychotic symptoms are important risk markers for a wide range of non-psychotic psychopathological disorders, in particular for severe psychopathology characterised by multiple co-occurring diagnoses. These symptoms should be carefully assessed in all patients.

AIMS: To investigate the prevalence of pathological internet use (PIU) and maladaptive internet use (MIU) among adolescents in 11 European countries in relation to demographic, social factors and internet accessibility. DESIGN: Cross-sectional survey. SETTING: The 7th Framework European Union (EU) funded project, Saving and Empowering Young Lives in Europe (SEYLE), is a randomized controlled trial (RCT) evaluating interventions for risk behaviours among adolescents in Austria, Estonia, France, Germany, Hungary, Ireland, Israel, Italy, Romania, Slovenia and Spain, with Sweden serving as the coordinating centre. PARTICIPANTS: A total of 11 956 adolescents (female/male: 6731/5225; mean age: 14.9 ± 0.89) recruited from randomly selected schools within the 11 study sites. MEASUREMENTS: Internet users were classified by gender into three categories: adaptive, maladaptive and pathological, based on their score in the Young Diagnostic Questionnaire for Internet Addiction (YDQ). FINDINGS: The overall prevalence of PIU was 4.4%; it was higher among males than females (5.2% versus 3.8%) and differed between countries (χ(2) = 309.98; d.f. = 20; P

Concession speeches by defeated American presidential candidates constitute a readily identifiable genre, but they have been largely ignored in the massive literature on campaign communications and presidential rhetoric. An analysis of concession speeches by defeated presidential candidates from 7952 to 1992 reveals consistent patterns of strategy, style, and content. The speeches are formulaic and performed as an awkward, perfunctory gesture at a time of devastating personal stress. They are concerned with failure. Yet conceding is a settled convention in the dramaturgy of victory and defeat in the contest for power. The concession is a customary framing device imposed by the media, despite the losing candidate's other intentions. The candidate's dilemma is resolved in the concession speech by an elaborate periphrasis that converts the combative imagery of defeat into metaphors of sport, chivalry, and epic quest.

The aim of the study was to review breastfeeding support provided by Public Health Nurses in Ireland. The objectives were to identify the availability of appropriate guiding policies, educational preparation, attitude of Public Health Nurses and the availability and use of other supportive services.Breastfeeding rates in Ireland are among the lowest in Europe. The main source of formal support for breastfeeding mothers in the community in Ireland is from Public Health Nurses who can make referral to other non-statutory resources. The nature of this support is determined by policies guiding clinical practice and education that increases breastfeeding confidence and competence of all personnel. Consequently, an assessment of breastfeeding resources requires an analysis of all these variables.A large quantitative, cross-sectional study was conducted, involving Public Health Nurses and mothers. This paper represents the results from the perspective of Public Health Nurses.Directors of Public Health Nursing (n = 24) and Public Health Nurses (n = 204) completed self-report questionnaires by mail and online. Data were analysed using the Statistical Package for Social Sciences and reported using descriptive and inferential statistics.Public Health Nurses are well educated to support breastfeeding and have a positive attitude and a high degree of self-assessed confidence and competence. A wide variety of non-statutory support exists for breastfeeding but is not always used to their full potential.Standardising educational requirements for Public Health Nurses in supporting breastfeeding is an area that requires attention. Ultimately, service delivery in relation to supporting breastfeeding mothers would benefit from being more timely and responsive.Awareness of support resources is necessary for Public Health Nurses to make appropriate referrals for breastfeeding mothers. Furthermore, Directors of Public Health Nursing need to encourage the breastfeeding supportive role of Public Health Nurses and facilitate continuing professional development.

Background: The incidence of hospital-treated attempted suicide has not been well established in Spain. Aims: To determine the incidence of suicide attempters presenting to a hospital in Oviedo, Spain, to describe the nature of the suicidal behavior, and to identify sociodemographic subgroups of the population with high rates. Methods: All admitted to the Hospital Universitario Central de Asturias, Oviedo, during the period 1 May 2008 to 30 April 2009 were examined and those meeting the internationally-recognized case definition were identified. Results: A total of 308 suicide attempt presentations (39% male, 61% female) were made by 279 individuals. Almost 90% of the suicide attempts involved a drug overdose. The age-adjusted total, male, and female attempted suicide rates were 83, 66, and 99 per 100,000, respectively. The highest rate was among 35–44-year-olds for men and women (141.1 and 191.8 per 100,000, respectively). Incidence rates varied widely by sociodemographic characteristics with especially high rates among separated/divorced men (2.4%) and women (1.1%). Conclusions: The reported incidence of hospital-treated attempted suicide is below average in the European context but higher than that reported by previous Spanish studies. Persons separated or divorced constitute a high-risk group.

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.

Objective To investigate whether functional polymorphisms directly (HTR2A and SLC6A4 genes) or indirectly (IL-1 gene complex, APOE and ACE genes) related with serotonergic neurotransmission were associated with suicidal behavior. Subjects and methods 227 suicide attempters, 686 non-suicidal psychiatric patients, and 420 healthy controls from a homogeneous Spanish Caucasian population were genotyped using standard methods. Results There were no differences in genotype frequencies between the three groups. The −1438A/G [χ 2 (df) = 9.80 (2), uncorrected p = 0.007] and IL-1α −889C/T [χ 2 (df) = 8.76 (2), uncorrected p = 0.013] genotype frequencies between impulsive and planned suicide attempts trended toward being different (not significant after Bonferroni correction). Suicide attempts were more often impulsive in the presence of −1438G/G or IL-1α −889C/T or C/C genotypes. There was interaction between the polymorphism 5-HTTLPR and age [LRT (df) = 6.84 (2), p = 0.033] and between the polymorphisms APOE and IL-1RA (86 bp) n [LRT (df) = 12.21 (4), p = 0.016] in relation to suicide attempt lethality. Conclusion These findings further evidence the complexity of the association between genetics and suicidal behavior, the need to study homogenous forms of the behavior and the relevance of impulsive and aggressive traits as endophenotypes for suicidal behavior.

Background: Many studies have examined the reliability of national suicide statistics. Aims: To examine the Irish system of certifying suicide deaths and data collected by it. Methods: Data were recorded from a police form (Form 104) completed and sent to the Irish Central Statistics Office (CSO) after all inquested deaths that occurred in Ireland in 2002. Results: Of the approximately 1,800 inquested deaths, 6% (and 4% of suicides) were not included in routine mortality statistics because of late registration. Of the 495 deaths thought by the police to be suicide, 485 (98%) were so recorded by the CSO. Information relating to medical history and contributory factors was provided in just 54% and 34% of suicides, respectively. Suicide deaths showed significant variation by weekday (excess on Mondays) and calendar month (summer peak). The peak suicide rate (35 per 100,000) was among men aged 25–34 years. Persons separated, living alone, and unemployed had significantly elevated suicide rates. Conclusions: There is a need for a better understanding of national suicide recording systems, as this study has provided for Ireland. Such systems may routinely provide data relating to sociodemographic factors but not relating to medical and psychosocial factors.

Durkheim's nineteenth-century analysis of national suicide rates dismissed prior concerns about mortality data fidelity. Over the intervening century, however, evidence documenting various types of error in suicide data has only mounted, and surprising levels of such error continue to be routinely uncovered. Yet the annual suicide rate remains the most widely used population-level suicide metric today. After reviewing the unique sources of bias incurred during stages of suicide data collection and concatenation, we propose a model designed to uniformly estimate error in future studies. A standardized method of error estimation uniformly applied to mortality data could produce data capable of promoting high quality analyses of cross-national research questions.

Background Data from epidemiological genetic studies suggest that variability in personality traits is explained, at least partly, by genetic factors. Recently, a growing number of molecular genetic studies have suggested the involvement of the serotonin system in specific traits. Objective To investigate the association between three serotonergic polymorphisms [A-1438G (rs6311) of the HTR2A gene, and STin2 VNTR and 5-HTTLPR of the SLC6A4 gene] and personality traits assessed with the Temperament and Character Inventory. Materials and methods Four hundred and four unrelated healthy volunteers [50% males, mean age (standard deviation)=40.5 (11.3)] from Asturias (northern Spain) were genotyped using standard methods. Cloninger's Temperament and Character Inventory was used for investigation of temperament and character traits. Results The genetic variants were in Hardy–Weinberg equilibrium and genotypic frequencies were similar in both the sexes. 5-HTTLPR was associated with a direct effect on self directedness (F=6.20, P=0.002), and interacting with educational level (F=3.10, P=0.016) and A-1438G (F=3.34, P=0.011) with respect to novelty seeking. STin2 VNTR interacted with age in relation to reward dependence (F=2.74, P=0.013) and with sex in relation to cooperation (F=5.10, P=0.007). In addition, SLC6A4 haplotypes had significant effects on harm avoidance (lower in volunteers with L12), self directedness (higher in volunteers with L12), and self transcendence (higher in volunteers with S10). Conclusion Our findings suggest a strong genetic component in personality traits manifested primarily through interaction effects that occur between genetic factors alone and between genetic and demographic factors.

Background: Studies have identified employment as a protective factor against suicide. We examined employment status and risk of suicide in Ireland during the 11-year period 1996–2006, a period of economic boom commonly known as the Celtic Tiger. Methods: Data relating to the 5270 suicides and 789 deaths of undetermined intent registered as occurring in Ireland in 1996–2006 and relevant population data were obtained from the Irish Central Statistics Office and analysed using Poisson regression. Results: Unemployment fell from 12% in 1996 to 4% in 2000, a level at which it remained until 2006. Male and female rates of suicide and undetermined death were stable during 1996–2006 though suicide among unemployed men increased. Relative to employment, unemployment was associated with a 2–3-fold increased risk of male suicide and undetermined death but generally a 4–6-fold increased risk in women. Unemployment was associated with greater increased risk of suicide and undetermined death when its level was low (2001–06) than in the period of decreasing unemployment (1996–2000). Unemployment was a stronger risk factor in men aged 35–54 years and with increasing age in women. Retired persons aged >55 years had a similar risk to their employed counterparts. Being a homemaker was associated with increased risk in women aged >35 years. Conclusion: The current Irish context of rapidly increasing unemployment suggests that rates may rise again as in previous recessions. Appropriate social policy responses are required to mitigate the potential impact of unemployment on suicides.

BackgroundDeliberate self-harm (DSH) is a major public health problem, with young people most at risk. Lifetime prevalence of DSH in Irish adolescents is between 8% and 12%, and it is three times more prevalent among girls than boys. The aim of the study was to identify the psychological, life-style and life event factors associated with self-harm in Irish adolescents.MethodA cross-sectional study was conducted, with 3881 adolescents in 39 schools completing an anonymous questionnaire as part of the Child and Adolescent Self-harm in Europe (CASE) study. There was an equal gender balance and 53.1% of students were 16 years old. Information was obtained on history of self-harm life events, and demographic, psychological and life-style factors.ResultsBased on multivariate analyses, important factors associated with DSH among both genders were drug use and knowing a friend who had engaged in self-harm. Among girls, poor self-esteem, forced sexual activity, self-harm of a family member, fights with parents and problems with friendships also remained in the final model. For boys, experiencing bullying, problems with schoolwork, impulsivity and anxiety remained.ConclusionsDistinct profiles of boys and girls who engage in self-harm were identified. Associations between DSH and some life-style and life event factors suggest that mental health factors are not the sole indicators of risk of self-harm. The importance of school-related risk factors underlines the need to develop gender-specific initiatives in schools to reduce the prevalence of self-harm.

BACKGROUND: Distalgesic, the prescription-only analgesic compound of paracetamol (325 mg) and dextropropoxyphene (32.5 mg) known as co-proxamol in the UK, was withdrawn from the Irish market as of January 2006. This study aimed to evaluate the impact of the withdrawal of distalgesic in terms of intentional drug overdose (IDO) presentations to hospital emergency departments (EDs) nationally. METHODS: A total of 42,849 IDO presentations to 37 of the 40 hospitals EDs operating in Ireland in 2003-2008 were recorded according to standardised procedures. Data on sales of paracetamol-containing drugs to retail pharmacies for the period 1998-2008 were obtained from IMS Health. RESULTS: The withdrawal of distalgesic from the Irish market resulted in an immediate reduction in sales to retail pharmacies from 40 million tablets in 2005 to 500,000 tablets in 2006 while there was a 48% increase in sales of other prescription compound analgesics. The rate of IDO presentations to hospital involving distalgesic in 2006- 2008 was 84% lower than in the three years before it was withdrawn (10.0 per 100,000). There was a 44% increase in the rate of IDO presentations involving other prescription compound analgesics but the magnitude of this rate increase was five times smaller than the magnitude of the decrease in distalgesic-related IDO presentations. There was a decreasing trend in the rate of presentations involving any paracetamol-containing drug that began in the years before the distalgesic withdrawal. CONCLUSIONS: The withdrawal of distalgesic has had positive benefits in terms of IDO presentations to hospital in Ireland and provides evidence supporting the restriction of availability of means as a prevention strategy for suicidal behaviour.

Background: There have been only a few reports illustrating the moderate effectiveness of suicide-preventive interventions in reducing suicidal behavior, and, in most of those studies, the target populations were primarily adults, whereas few focused on adolescents. Essentially, there have been no randomized controlled studies comparing the efficacy, cost-effectiveness and cultural adaptability of suicide-prevention strategies in schools. There is also a lack of information on whether suicide-preventive interventions can, in addition to preventing suicide, reduce risk behaviors and promote healthier ones as well as improve young people's mental health. The aim of the SEYLE project, which is funded by the European Union under the Seventh Framework Health Program, is to address these issues by collecting baseline and follow-up data on health and well-being among European adolescents and compiling an epidemiological database; testing, in a randomized controlled trial, three different suicide-preventive interventions; evaluating the outcome of each intervention in comparison with a control group from a multidisciplinary perspective; as well as recommending culturally adjusted models for promoting mental health and preventing suicidal behaviors. Methods and design: The study comprises 11,000 adolescents emitted from randomized schools in 11 European countries: Austria, Estonia, France, Germany, Hungary, Ireland, Israel, Italy, Romania, Slovenia and Spain, with Sweden serving as the scientific coordinating center. Each country performs three active interventions and one minimal intervention as a control group. The active interventions include gatekeeper training (QPR), awareness training on mental health promotion for adolescents, and screening for at-risk adolescents by health professionals. Structured questionnaires are utilized at baseline, 3- and 12-month follow-ups in order to assess changes. Discussion: Although it has been reported that suicide-preventive interventions can be effective in decreasing suicidal behavior, well-documented and randomized studies are lacking. The effects of such interventions in terms of combating unhealthy lifestyles in young people, which often characterize suicidal individuals, have never been reported. We know that unhealthy and risk-taking behaviors are detrimental to individuals' current and future health. It is, therefore, crucial to test well-designed, longitudinal mental health-promoting and suicide-preventive interventions by evaluating the implications of such activities for reducing unhealthy and risk behaviors while concurrently promoting healthy ones. Link to the SEYLE website: http://www.seyle.eu/ Link to the page on the website of the National Suicide Research Foundation (NSRF) where work on the SEYLE study was carried out in Ireland (http://nsrf.ie/projects/seyle/)

Over the past ten years there has been significant interest in the application of sensor arrays to discriminate between odorous mixtures. Such a system could have numerous uses in fields as diverse as agriculture, foodstuffs, brewing, perfumery and air quality measurement. At present, progress is limited by the sensor technology. To date, most of the research undertaken has been centred around the commercially available Taguchi Gas Sensor (TGS) range. These devices consist of a thick‐film tin oxide layer, the conductance of which is modulated upon exposure to a range of flammable materials. This can only occur when the sensor is operated at temperatures in the region 300–700°C. These devices are also bulky and have high power consumptions (0.9W at 300°C). This makes them unsuitable for remote field applications requiring battery supplies, particularly when there are a large number of sensors in the array.

The impact of widowhood on suicide and accident mortality in Ireland was investigated using Poisson regression analysis applied to routine data relating to all 10 561 suicidal and accidental deaths of married or widowed persons aged at least 35 years in Ireland during 1986-2005. Mortality rates were almost always higher among the widowed and often by a 2-fold, statistically significant difference. The excess mortality was equivalent to 2083 or 57.6% of all suicidal or accidental deaths of widowed persons in 1986-2005. Routine contact with recently widowed persons by public health professionals may be warranted with a view to reducing their excess mortality.

The Unified Biosocial Theory of Personality developed by Cloninger has been applied in different cultures. Distribution by age and sex of the Temperament and Character Inventory (TCI) dimensions were assessed cross-culturally for samples in Spain and the USA. Three non-clinical samples were included: i) 404 participants from Asturias (Spain); ii) 240 participants from Burgos (Spain); and iii) 300 adults from St. Louis (USA). Each participant was assessed by means of the TCI. A significant negative correlation between NS and both HA (r=-0.329; P

Postnatal depression (PND) is a significant public health issue, with variable prevalence and a dearth of research on risk and protective factors. This quantitative longitudinal study of 512 first-time mothers identified the prevalence of PND and examined the relationships between functional and structural social support at 6 and 12 weeks postpartum. The prevalence of PND was 13.2% at 6 weeks and 9.8% at 12 weeks. At 6 and 12 weeks, the only social support dimension independently associated with PND was total functional social support. At-birth formal structural support and emotional functional support were independently predictive of PND at 12 weeks.

This paper describes the design and fabrication of an integrated array of tin oxide odour sensors using planar micro-electronic silicon technology. Some fundamental properties of the device structure are discussed, including power consumption, along with its response to several odours. In addition, the sensing element is modelled as a pair of finite coplanar electrodes lying upon a thin oxide layer, and an analytical conductance equation obtained that relates its conductance to electrode geometry in a diffusion-limited model. The physical conditions that require the use of a diffusion or reaction model are discussed.

Background Cerebral palsy (CP) is the most common cause of physical disability in children but its impact on quality of life is not well understood. This study examined participation in everyday activities among children without CP and children with mild, moderate and severe impairment due to CP. We then examined ten domains of quality of life in children with CP and investigated whether participation in everyday activities was associated with improved quality of life independent of gender, age and level of impairment. Methods This was a cross-sectional study of children aged 8–12 years based on two questionnaires, frequency of participation (FPQ) and KIDSCREEN, completed by parents of 98 children on the South of Ireland Cerebral Palsy Register (response rate = 82%) and parents of 448 children attending two Cork city schools (response rate = 69%) who completed one questionnaire (FPQ). Multiple linear regression was used: firstly to estimate the effect of severity of CP on participation in everyday activities independent of age and gender and secondly we estimated the effect of participation on quality of life independent of age gender and level of impairment. Results Participation in 11 of the 14 everyday activities examined varied across the children without CP and the children with varying severity of CP. In general, increased impairment decreased participation. Independent of age and gender, there was a highly significant decrease in overall participation with a fall of -6.0 (95% CI = -6.9 to -5.2) with each increasing level of impairment. The children with CP generally had high quality of life. Increased impairment was associated with diminished quality of life in just two domains – Physical well-being and Social support and peers. Overall participation in everyday activities was significantly associated with quality of life in 3 of the 10 domains (Physical well-being, Social support and peers & Moods and emotions) in analysis adjusted for gender age and level of impairment. Conclusion While increased impairment due to CP restricts participation in the majority of everyday activities, the level of participation has a limited effect on the quality of life of the children with CP in age 8–12 years.

Background: Deliberate self-harm among young people is an important focus of policy and practice internationally. Nonetheless, there is little reliable comparative international information on its extent or characteristics. We have conducted a seven-country comparative community study of deliberate self-harm among young people. Method: Over 30,000 mainly 15- and 16-year-olds completed anonymous questionnaires at school in Australia, Belgium, England, Hungary, Ireland, the Netherlands and Norway. Study criteria were developed to identify episodes of self-harm; the prevalence of self-harm acts and thoughts, methods used, repetition, reasons given, premeditation, setting for the act, associations with alcohol and drugs, hospitalisation, and whether other people knew, were examined. Results: Self-harm was more than twice as common among females as males and, in four of the seven countries, at least one in ten females had harmed herself in the previous year. Additional young people had thought of harming themselves without doing so. More males and females in all countries except Hungary cut themselves than used any other method, most acts took place at home, and alcohol and illegal drugs were not usually involved. The most common reasons given were ‘to get relief from a terrible state of mind’ followed by ‘to die’, although there were differences between those cutting themselves and those taking overdoses. About half the young people decided to harm themselves in the hour before doing so, and many did not attend hospital or tell anyone else. Just over half those who had harmed themselves during the previous year reported more than one episode over their lifetime. Conclusions: Deliberate self-harm is a widespread yet often hidden problem in adolescents, especially females, which shows both similarities and differences internationally. Keywords: Adolescence, cross-cultural, self-harm, gender differences, motives.

(1990). Critical synthesis on the very idea of an opportunity. Social Epistemology: Vol. 4, No. 1, pp. 57-73.