Increasing incidence of admissions to a General Hospital for deliberate self-harm in trinidad / Aumento de la incidencia de ingresos al Hospital General por auto-daño deliberado en trinidad

BACKGROUND: Deliberate self-harm and suicidal behaviour have become an increasingly common form of morbidity in the developing world. Suicidal behaviour is a major public health problem in Trinidad as the country has the second highest completed suicide rate in the English-speaking Caribbean. The objectives of this study were to determine the epidemiology of attempted suicide and self-harm at a specified site (the Port-of-Spain General Hospital) and compare it to previous studies done at the same site. SUBJECTS AND METHODS: This was investigated through a review of one years' admissions to the Port-of-Spain General Hospital for suicidal behaviour. Incidence was compared with a previous study completed at this site and reported in 1974. Comparison of the demographic characteristics of the sample with that of the previous study was also undertaken using chi-square analysis and significance testing through the use of t tests. RESULTS: A total of 368 referrals were made for attempted suicide or deliberate self-harm over the period indicating a fourfold increase in the incidence of this behaviour with a greater increase among males where the female to male ratio has declined from 4 to 1 to 2 to 1, p < 0.001; the mean age of males was 34 years compared to females 22 (p < 0.0001). The males were more likely to use violent means compared to females who were more likely to ingest tablets or bleach. Relationship difficulties were most commonly cited by both males and females as the reason for their attempt. There was a trend to greater propensity for this behaviour among Indo-Trinidadians as compared to Afro-Trinidadians in both females and males. CONCLUSIONS: Increasing numbers of men are engaging in self-harm behaviour and are using more violent and physically harmful methods suggesting a greater degree of suicidal risk while women mainly engage in acts of ingestion with a much lower risk of death. The older mean age of these men suggests that their problems are presenting in middle adulthood while women are engaging in this behaviour in young adulthood. Suicidal behaviour or deliberate self-harm is a major public health problem in Trinidad.

ANTECEDENTES: El auto-daño deliberado y el comportamiento suicida se han convertido cada vez más en una forma común de morbosidad en el mundo en vías de desarrollo. El comportamiento suicida es un serio problema de salud pública en Trinidad, como país que tiene la tasa más alta de suicidios efectuados en el Caribe anglófono. Los objetivos de este estudio fueron determinar la epidemiología del suicidio efectuado y el auto-daño en un lugar específico (el Hospital General de Puerto España) y compararla con estudios previos realizados en el mismo lugar. SUJETOS Y MÉTODOS: Esto fue investigado mediante una revisión de los ingresados de un año al Hospital General de Puerto España por comportamiento suicida. La incidencia fue comparada con un estudio previo terminado en este sitio y reportado en 1974. La comparación de las características demográficas de la muestra con la del estudio previo se llevó a cabo usando un análisis de chi-cuadrado y pruebas de significatividad mediante el uso de tests t. RESULTADOS: Se produjeron un total de 368 casos referidos por intento de suicidio o auto-daño deliberado en el período en cuestión, lo cual indica que la incidencia de esta conducta aumentó en cuatro veces, con un mayor incremento entre los varones, y una disminución de la proporción hembras-varones de 4:1 a 2:1; p < 0.001); la edad promedio de los varones fue 34 años en comparación con la de las hembras, 22 (p < 0.0001). Los varones mostraron una tendencia mayor a usar medios violentos en comparación con las hembras, entre las que había una mayor probabilidad de ingerir tabletas o lejía. Las dificultades en las relaciones constituyeron la explicación más comúnmente dada como causa del intento, tanto por los varones como por las hembras. Hubo tendencia a una mayor propensión a este comportamiento entre los indo-trinitenses en comparación con los afro-trinitenses, tanto en hembras como varones. CONCLUSIONES: Un número cada vez mayor de hombres se involucran en conductas auto-agresivas y están usando métodos más violentos y físicamente dañinos, lo que sugiere un grado mayor de riesgo de suicidio, mientras que las mujeres se entregan principalmente a actos de ingestión con riesgo mucho menor de muerte. La edad promedio mayor de estos hombres sugiere que sus problemas se presentan en medio de su adultez, mientras que las mujeres se entregan a estas conductas como adultos jóvenes. La conducta suicida y el auto-daño deliberado constituyen un problema principal de salud pública en Trinidad.

Preliminary determination of median lethal dose of Azadirachta indica (A. ) Juss bark extract against Boophilus microplus

The study was carried out in order to determine the effective dose of Azadirachta indica as an acaride. From a range of effective doses, nine (9) test doses ranging from zero (0) parts per million to one hundred and fifty parts (150) per million were selected. The test species Boophilus microplus was subjected to a standard bioassay. A dose response curve was plotted of percentage mortality of B. microplus against logarithmic dosage of A indica. The lethal dose, LD50 and LD100 were also determined. The LD50 was 30.20 parts per million and LD100 was found to lie between 80 and 100 parts per million. Regression analysis was performed to verify correlation of data. The data proved to be linear with a correlation coefficient of 0.89. The results of this study indicate that when the dose required to achieve 50 percent mortality is compared to average yield of A. indica bark extract obtained in previous studies (Maharaj et al 2003), the extract appears to be feasible with respect to production for use as a prospective pesticide. This is an important point for consideration as the failure in the commercialization of many plant products is often due to the yields being too low. The bark extract of Azadirachta indica has thus far proven to be worthy of consideration for further development as a phytoacaricide

Suicide by poisoning

An epidemiological evaluation was conducted on 270 patients who died at the General Hospital, Port-of-Spain after presenting with deliberate self-poisoning between January, 1986 and June, 1990. The cause of death was confirmed by autopsy and toxicological analysis. Epidemiological variables of age, sex, race, precipitating factors and types of poison used were assessed. It was found that the male to female ratio was 2.7:1. East Indians accounted for 54.4%, Africans 42.0%, people of mixed ethnic origin 3% and Caucasians 0.6%. The majority of cases (52.6%) were seen in the age group 11-34 years. "Lovers' quarrels" (35.4% of cases), psychiatric illness (27.8% of cases) and family disputes (27% of cases) were reported as the most frequent precipitating events in suicide. East Indians predominated in those suicides precipitated by "lovers' quarrels" and family disputes, accounting for 63.2% and 58.9% of these cases, respectively; while for those suicides in which psychiatric illnesses were the main precipitating event, Africans were represented by 53.3% and East Indians 45.3%. Depression was the most common psychiatric illness diagnosed. Paraquat was the most popular poison used in 63.7% of the suicidal cases, and other agrochemicals were used in 20% of the cases.