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Objectives. Acts of suicide are heterogeneous with respect to level of intent. Data on correlates of intent are overwhelmingly from Western samples. We sought to identify correlates of low-intent and high-intent suicide attempts in China. Methods. We compared 277 adult case patients who presented to the emergency department in a rural hospital because of attempted suicide to 277 community control individuals, pair-matched for age, gender, and location of residence. Attempted suicides were stratified into 3 levels of suicide intent: low, intermediate, and high. Paired logistic regression analyses were used to analyze the data. Results. High-intent acts of suicide were associated with major depression, chronic stress, and a relative or associate who had a history of suicidal behavior. These correlates were not associated with low intent acts of suicide. Conclusions. High-intent acts of suicide in China are the culmination of long standing difficulties or symptoms including depression, chronic stress, and previous exposure to suicidal behavior. Prevention of high-intent acts of suicide should include a focus on these domains. (Am J Public Health. 2007;97: 1842-1846. doi:10.2105/AJPH.2005.077420)

ALCOHOL DEPENDENCE IS A POTENT risk factor for suicidal ideation and behavior. A meta-analysis of international studies estimated that individuals with alcohol dependence are at 9.8 (95% confidence interval [CI]: [...], Objective: Using a heuristic model of suicidal ideation and behavior, the two objectives were to identify correlates of(l) unique suicide-related outcomes (ideation, planning, planned attempt, unplanned attempt) and (2) specific transitions from one suicide-related category to the next. Method: Analyses were conducted with data from the Collaborative Study on the Genetics of Alcoholism (COGA), a six-site family pedigree study of individuals in treatment for alcoholism, their relatives, and control families. There were 3,729 subjects in the analysis; all were age 18 years or older with a diagnosis of current alcohol dependence according to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised. Lifetime suicidal ideation, planning, and attempts were analyzed retrospectively. Correlates of each lifetime transition were analyzed using a series of multivariate logistic regressions. Multivariate multinomial regression analysis was used to examine correlates of each lifetime outcome. Results: Female gender is uniquely associated with transitions to unplanned and planned attempts. Independent depression and substance-induced depression are associated with transitions to ideation and planning, whereas alcohol-related aggression is correlated with transitions to unplanned attempts. Analyses of suicide-related outcomes show that women are at higher risk for unplanned and planned attempts. Substance use and impairment are related to suicidal plans and attempts but not ideation. Independent and substance-induced depressions are associated with each suicide-related outcome, whereas alcohol-related aggression is uniquely related to unplanned attempts. Conclusions: Data underscore the heterogeneity of suicidal ideation and behavior among alcoholics and indicate the need to make clear distinctions between types of suicidal ideation and behavior in research and prevention efforts.

The goal of patient-centered communication (PCC) is to help practitioners provide care that is concordant with the patient's values, needs and preferences, and that allows patients to provide input and participate actively in decisions regarding their health and health care. PCC is widely endorsed as a central component of high-quality health care, but it is unclear what it is and how to measure it. PCC includes four communication domains: the patient's perspective, the psychosocial context, shared understanding, and sharing power and responsibility. Problems in measuring PCC include lack of theoretical and conceptual clarity, unexamined assumptions, lack of adequate control for patient characteristics and social contexts, modest correlations between survey and observational measures, and overlap of PCC with other constructs. We outline problems in operationalizing PCC, choosing tools for assessing PCC, choosing data sources, identifying mediators of PCC, and clarifying outcomes of PCC. We propose nine areas for improvement: (1) developing theory-based operational definitions of PCC; (2) clarifying what is being measured; (3) accounting for the communication behaviors of each individual in the encounter as well as interactions among them; (4) accounting for context; (5) validating of instruments; (6) interpreting patient ratings of their physicians; (7) doing longitudinal studies; (8) examining pathways and mediators of links between PCC and outcomes; and (9) dealing with the complexity of the construct of PCC. We discuss the use of observational and survey measures, multi-method and mixed-method research, and standardized patients. The increasing influence of the PCC literature to guide medical education, licensure of clinicians, and assessments of quality provides a strong rationale for further clarification of these measurement issues. Keywords: Patient-centered: Communication: Measurement: Doctor patient communication

Lyme disease is caused by the spirochete Borrelia burgdorferi, and is passed from one person or animal to another by the bite of the pinhead-sized tick Ixodes dammini. Although it was first described in 1977 in Lyme, Connecticut, the disease is not new nor is it limited to Lyme: New York State accounted for over half the reported cases in 1988. This article describes the spread of Lyme disease in New York State from 1977 to 1989. Between 1977 and 1981, 150 cases were reported; between 1986 and 1989, the number grew to 8,357 (of which 4,174 met the case definition, presented in a table). The number of confirmed cases of Lyme disease reported in 1989 was 1,942. As these figures increased, so, too, did the number of hospital discharges related to Lyme disease. The range of Ixodes dammini during the years studied is plotted. Before 1986, Lyme disease transmission in New York State took place in only four counties (Suffolk, Nassau, Westchester, Putnam): later, four adjacent counties were known sites of transmission (Rockland, Orange, Dutchess, Ulster). The considerable increase in the incidence of Lyme disease results in part from increased awareness, better diagnostic techniques, overdiagnosis and better reporting, as well as a true increase in the number of cases. As the range of infected and uninfected Ixodes dammini has expanded beyond its original range in Connecticut and Long Island, the Lyme disease rate has climbed. It is likely that reported rates underestimate the incidence of the disease. Physicians and patients alike should be aware of the symptoms, diagnosis and treatment of Lyme disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Epidemiological data on 136 cases of human babesiosis reported from laboratories and clinicians in the state of New York from 1982 to 1991 were reviewed. All but two patients, who had traveled to Nantucket Island in Massachusetts, acquired disease in Suffolk County, Long Island. The highest average age-group-specific annual incidence rates occurred among men ⩾80 years of age (7.72 per 100,000) and among women 70–79 years of age (3.61 per 100,000). Seven patients (5%) had previously undergone splenectomy, and 31 (23%) had evidence of concurrent Lyme disease. One hundred three patients (76%) were hospitalized, and seven (5%) died. Although the geographic distribution of this disease has remained constant, the recent introduction of babesiosis in mainland Connecticut and the spread of Lyme disease in New York suggest that the geographic distribution of babesiosis could also spread in New York. [ABSTRACT FROM PUBLISHER]