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The association between motives for deliberate self-harm (DSH), level of suicide intent, and history of DSH is poorly understood. As part of the WHO/EURO Multicentre Study on Suicidal Behavior, the Suicide Intent Scale, and the Motives for Parasuicide Questionnaire were administered to 146 patients presenting with DSH in the Cork region in Ireland. DSH patients reporting high suicide intent were more motivated to escape from their problem (M = 3.15, p less than 0.001) compared to those with low suicide intent, who were more motivated to appeal to others (M = 1.61, p less than 0.001) and to get a temporary break from their problem (M = 2.47, p less than 0.001). Repeaters more often reported motives aimed at escape (M = 2.98, p less than 0.01), revenge (M = 0.60, p less than 0.005), and appeal (M = 1.43, p = less than 0.05). Self-harming patients are characterized by ambivalence and struggle with aversive thoughts and situations. Therapeutic approaches should include distress management and coping strategies.

Alterations in intestinal microbiota composition are associated with several chronic conditions, including obesity and inflammatory diseases. The microbiota of older people displays greater inter-individual variation than that of younger adults. Here we show that the faecal microbiota composition from 178 elderly subjects formed groups, correlating with residence location in the community, day-hospital, rehabilitation or in long-term residential care. However, clustering of subjects by diet separated them by the same residence location and microbiota groupings. The separation of microbiota composition significantly correlated with measures of frailty, co-morbidity, nutritional status, markers of inflammation and with metabolites in faecal water. The individual microbiota of people in long-stay care was significantly less diverse than that of community dwellers. Loss of community-associated microbiota correlated with increased frailty. Collectively, the data support a relationship between diet, microbiota and health status, and indicate a role for diet-driven microbiota alterations in varying rates of health decline upon ageing., The gut microbiota is required for development and for homeostasis in adult life. Compositional changes have been linked with inflammatory and metabolic disorders (1), including inflammatory bowel disease (2,3), irritable [...]

The association between motives for deliberate self-harm (DSH), level of suicide intent, and history of DSH is poorly understood. As part of the WHO/ EURO Multicentre Study on Suicidal Behavior, the Suicide Intent Scale, and the Motives for Parasuicide Questionnaire were administered to 146 patients presenting with DSH in the Cork region in Ireland. DSH patients reporting high suicide intent were more motivated to escape from their problem (M = 3.15, p < .001) compared to those with low suicide intent, who were more motivated to appeal to others (M = 1.61, p < .001) and to get a temporary break from their problem (M = 2.47, p < .001). Repeaters more often reported motives aimed at escape (M = 2.98, p < .01), revenge (M = .60, p < .005), and appeal (M = 1.43, p =

BACKGROUND. After perinatal asphyxia, predicting which infants will develop significant hypoxic-ischemic encephalopathy and neonatal seizures remains a difficult task. High-risk markers (Apgar score, acidosis, nucleated red blood cells, and resuscitation) have been used to predict neonatal seizures with varying success. The "3 strikes" of Apgar score of METHOD. We recruited term infants with perinatal asphyxia. Continuous video electroencephalography was commenced soon after birth and continued for 24 to 72 hours. The abilities of high-risk markers to predict electroencephalographic seizurs, background electroencephalographic activity, and Sarnat grade were examined. RESULTS. Forty-nine infants were suitable for analysis. Electrographic seizures occurred in 11 of the 49 infants. Encephalopathy was scored by using Sarnat grade (6, severe; 18, moderate; 25, mild) and electroencephalographic findings (4 inactive, 4 major abnormalities, 16 moderate abnormalities, and 25 normal/mildly abnormal). Apgar score of CONCLUSION. After perinatal asphyxia, neither the condition at birth nor the degree of metabolic acidosis reliably predict neonatal seizures. www.pediatrics.org/cgi/doi/10.1542/peds.2005-1524 doi:10.15421peds.2005-1524 Key Words hypoxic-ischemic encephalopathy, video electroencephalography, neonatal seizures, seizure prediction Abbreviations PPV--positive predictive value BD--base deficit NRBC--nucleated red blood cell EEG--electroencephalographic HIE--hypoxic-ischemic encephalopathy Cl--confidence interval, AFTER PERINATAL ASPHYXIA, the occurrence of seizures remains a significant neurologic event. The outlook for long-term neurologic development is changed dramatically by the occurrence of clinical seizures, which place the [...]

Purpose: Globally, public health policies are targeting modifiable lifestyle behaviors. We explore the independent association of moderate-to-vigorous physical activity (MVPA) and sedentary behavior on the risk of childhood overweight/obesity. Method: A cross-sectional survey of children aged 8--11 years (N = 826). Objective body mass index was used to classify children as normal weight or overweight/obese. Children wore wrist-worn Geneactiv accelerometers for 7-days and thresholds were applied to categorize MVPA and sedentary time. Screen time (ST) was parent reported. Poisson regression examined the independent association of (1) MVPA (2), objective sedentary time and (3) ST on the risk of overweight/obesity. Results: Overall, 23.7% (95% CI, 20.8-26.6%) of children were overweight/obese. On average, children spent 10.8% of waking time at MVPA and 61.3% sedentary. One-fifth (22.1%, 95% CI, 19.3-25.0%) of children achieved MVPA recommendations (≥ 60 min each day) and 17.5% (95% CI, 14.9-20.1%) met ST recommendations (<2 hr per day). Time spent at MVPA was inversely associated with the risk of overweight/obese independent of total sedentary time. Total time spent sedentary was not associated with overweight/obese independent of MVPA. ST was associated with an increased risk of overweight/obese independent of physical activity. Conclusion: Few schoolchildren met physical activity and screen time recommendations suggesting population based measures are needed. [ABSTRACT FROM AUTHOR]

Abstract Background The prevalence of chronic kidney disease (CKD) using available estimating equations with the Republic of Ireland is unknown. Methods A randomly selected population based cross-sectional study of 1,098 adults aged 45 years and older was conducted using data from the 2007 Survey of Lifestyle, Attitudes and Nutrition (SLÁN). Estimated Glomerular Filtration Rate (eGFR) was calculated from a single IDMS aligned serum creatinine using the CKD-EPI and the MDRD equations, and albumin to creatinine ratio was based on a single random urine sample. Results The sample clinical characteristics and demography was similar to middle and older age adults in the general Irish population, though with an underrepresentation of subjects >75 years and of males. All results are based on subjects with available blood and urine samples. Applying weighting to obtain survey based population estimates, using Irish population census data, the estimated weighted prevalence of CKD-EPI eGFR2 was 11.6%, (95% confidence interval; 9.0, 14.2%), 12.0% ( 9.0, 14.2%) of men and 11.2% (7.3, 15.2%) of women. Unweighted prevalence estimates were similar at 11.8% (9.9, 13.8%). Albuminuria increased with lower CKD-EPI eGFR category. 10.1% of all subjects had albuminuria and an eGFR≥60 mL/min/1.73 m2 giving an overall weighted estimated prevalence of National Kidney Foundation (NKF) defined CKD 21.3% (18.0, 24.6%), with the unadjusted estimate of 21.9% (19.5, 24.4%). MDRD related estimates for eGFR 2, and NFK defined CKD were higher than CKD-EPI and differences were greater in younger and female subjects. Conclusions CKD is highly prevalent in middle and older aged adults within the Republic of Ireland. In this population, there is poor agreement between CKD-EPI and MDRD equations especially at higher GFRs. CKD is associated with lower educational status and poor self rated health.

Abstract Background Elevated white blood cell counts (WBC) in acute coronary syndromes (ACS) increase the risk of recurrent events, but it is not known if this is exacerbated by pro-inflammatory factors. We sought to identify whether pro-inflammatory genetic variants contributed to alterations in WBC and C-reactive protein (CRP) in an ACS population. Methods WBC and genotype of interleukin 6 (IL-6 G-174C) and of interleukin-1 receptor antagonist (IL1RN intronic repeat polymorphism) were investigated in 732 Caucasian patients with ACS in the OPUS-TIMI-16 trial. Samples for measurement of WBC and inflammatory factors were taken at baseline, i.e. Within 72 hours of an acute myocardial infarction or an unstable angina event. Results An increased white blood cell count (WBC) was associated with an increased C-reactive protein (r = 0.23, p < 0.001) and there was also a positive correlation between levels of β-fibrinogen and C-reactive protein (r = 0.42, p < 0.0001). IL1RN and IL6 genotypes had no significant impact upon WBC. The difference in median WBC between the two homozygote IL6 genotypes was 0.21/mm3 (95% CI = -0.41, 0.77), and -0.03/mm3 (95% CI = -0.55, 0.86) for IL1RN. Moreover, the composite endpoint was not significantly affected by an interaction between WBC and the IL1 (p = 0.61) or IL6 (p = 0.48) genotype. Conclusions Cytokine pro-inflammatory genetic variants do not influence the increased inflammatory profile of ACS patients.

Background: Implementation science experts recommend that theory-based strategies, developed in collaboration with healthcare professionals, have greater chance of success.Aim: This study evaluated the impact of a theory-based strategy for optimising the use of serum immunoglobulin testing in primary care.Design and Setting: An interrupted time series with segmented regression analysis in the Cork-Kerry region, Ireland. An intervention was devised comprising a guideline and educational messages-based strategy targeting previously identified GP concerns relevant to testing for serum immunoglobulins.Method: Interrupted time series with segmented regression analysis was conducted to evaluate the intervention, using routine laboratory data from January 2012 to October 2016. Data were organised into fortnightly segments (96 time points pre-intervention and 26 post-intervention) and analysed using incidence rate ratios with their corresponding 95% confidence intervals.Results: In the most parsimonious model, the change in trend before and after the introduction of the intervention was statistically significant. In the 1-year period following the implementation of the strategy, test orders were falling at a rate of 0.42% per fortnight (P<0.001), with an absolute reduction of 0.59% per fortnight, corresponding to a reduction of 14.5% over the 12-month study period.Conclusion: The authors' tailored guideline combined with educational messages reduced serum immunoglobulin test ordering in primary care over a 1-year period. Given the rarity of the conditions for which the test is utilised and the fact that the researchers had only population-level data, further investigation is required to examine the clinical implications of this change in test-ordering patterns. [ABSTRACT FROM AUTHOR]