Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence?

There is a commonly held perception in psychology that enquiring about suicidality, either in research or clinical settings, can increase suicidal tendencies. While the potential vulnerability of participants involved in psychological research must be addressed, apprehensions about conducting studies of suicidality create a Catch-22 situation for researchers. Ethics committees require evidence that proposed studies will not cause distress or suicidal ideation, yet a lack of published research can mean allaying these fears is difficult. Concerns also exist in psychiatric settings where risk assessments are important for ensuring patient safety. But are these concerns based on evidence? We conducted a review of the published literature examining whether enquiring about suicide induces suicidal ideation in adults and adolescents, and general and at-risk populations. None found a statistically significant increase in suicidal ideation among participants asked about suicidal thoughts. Our findings suggest acknowledging and talking about suicide may in fact reduce, rather than increase suicidal ideation, and may lead to improvements in mental health in treatment-seeking populations. Recurring ethical concerns about asking about suicidality could be relaxed to encourage and improve research into suicidal ideation and related behaviours without negatively affecting the well-being of participants.

Applied magnetic field design for the field reversed configuration compression heating experiment.

Detailed calculations of the formation, guide, and mirror applied magnetic fields in the FRC compression-heating experiment (FRCHX) were conducted using a commercially available generalized finite element solver, COMSOL Multiphysics(®). In FRCHX, an applied magnetic field forms, translates, and finally captures the FRC in the liner region sufficiently long to enable compression. Large single turn coils generate the fast magnetic fields necessary for FRC formation. Solenoidal coils produce the magnetic field for translation and capture of the FRC prior to liner implosion. Due to the limited FRC lifetime, liner implosion is initiated before the FRC is injected, and the magnetic flux that diffuses into the liner is compressed. Two-dimensional axisymmetric magnetohydrodynamic simulations using MACH2 were used to specify optimal magnetic field characteristics, and this paper describes the simulations conducted to design magnetic field coils and compression hardware for FRCHX. This paper presents the vacuum solution for the magnetic field.

Health professionals', expert patients' and dieters' beliefs and attitudes about obesity.

BACKGROUND: Research has suggested that patients and treatment providers hold different beliefs and models of obesity. This could impact upon the consistency and quality of interventions for weight management. The present study investigated the attitudes and beliefs of health professionals, commercial weight management advisors (expert patients) and overweight and obese dieters, towards obesity. METHODS: Data were collected using a self-administered questionnaire from 287 health professionals, 85 expert patients and 116 dieters. Respondents gave their views on obesity causation and consequences, and the most efficacious means to manage obesity. Demographic data and self-reported height and weight were also collected. Factor analysis, analysis of variance and t-tests were used to analyse the data. RESULTS: Health professionals, expert patients and dieters held similar models of obesity, identifying the same causes (lifestyle causes), consequences (medical consequences) and treatments (current recommended options) of obesity/overweight. CONCLUSIONS: The findings of the present study indicate a broader similarity between beliefs and attitudes of those involved in obesity treatment and those that they aim to treat than was previously assumed. The concordance of beliefs between patients and treatment providers is an encouraging finding and may have important implications for public health strategies in this area.

Idiopathic osteonecrosis of the hip during pregnancy: outcome in a subsequent gestation.

BACKGROUND: Idiopathic osteonecrosis of the hip is a serious complication of pregnancy, but there is little information available regarding its recurrence in a subsequent gestation. CASE: A woman with a history of pregnancy-related osteonecrosis, successfully treated with conservative therapy, presented for preconceptual counseling. Because a literature search uncovered only one applicable case, the patient was managed empirically. Her subsequent pregnancy was uneventful with no recurrence. CONCLUSION: Although idiopathic osteonecrosis of the hip during pregnancy is uncommon, it is important to establish the outcome in subsequent pregnancies. Avoidance of vigorous physical activity, measures to limit edema, and low-dose aspirin therapy were successful in this patient.

Wideband holographic three-dimensional ultrasonic imaging of breast and liver phantoms.

Wideband ultrasonic 3-D holography is a unique technique for volumetric imaging with extremely high lateral and depth resolution. The large frequency bandwidth, which is typically 25% to 100%, provides excellent depth resolution. The synthetic aperture provides optimum lateral resolution of one-half wavelength at the pulse center frequency. Wideband impulse holography is a multi-frequency detection and imaging technique where the reflected target's broadband time waveform signals are recorded over a defined aperture. The signals are then decomposed into their discrete frequency components as single frequency holograms, combined in the spatial frequency domain, and reconstructed into a 3-D composite image. The composite image may then be viewed with stereo glasses in 3-D. Recent 3-D holographic images of human female breast and liver phantoms with internal cysts (5 to 10 mm) at 5 MHz illustrate the efficacy of this technique for medical ultrasound 3-D volumetric imaging. A video of the breast and liver phantoms may be presented at the meeting.

The value of urine screening for glucose at each prenatal visit.

OBJECTIVE: To determine whether chemical (dipstick) urinalysis for glucose at each prenatal visit predicts gestational outcomes such as gestational diabetes, abruptio placentae, preterm delivery, fetal heart rate abnormality, cesarean delivery for dystocia, fetal macrosomia, and shoulder dystocia. METHODS: We retrospectively evaluated each of the 3217 women who were delivered at St. Joseph's Hospital between July 1, 1990, and September 1, 1993, and who had received all prenatal care at Marshfield Clinic. Study subjects had complete urinalyses at the first prenatal visit, blood glucose diabetes screening at 24-28 weeks, and dipstick urinalysis for glucose at each prenatal visit. Women were excluded because of preexisting diabetes, multiple gestation, glucosuria at the first prenatal visit, or failure to complete the recommended blood screening at 24-28 weeks. The remaining 2965 women were grouped according to whether their dipstick urine tests were positive for glucose. Then the two groups were compared with regard to relevant pregnancy outcomes. RESULTS: Women with glucosuria in the first two trimesters had a significantly higher incidence of gestational diabetes (12.8 versus 2.9%, P = .003). For women without evidence of gestational diabetes, there were no clinically important differences in the measured pregnancy outcomes between the two groups. CONCLUSION: Routine dipstick urinalysis for glucose can identify gravidas at increased risk for gestational diabetes, possibly allowing certain women with gestational diabetes to be diagnosed earlier than 24-28 weeks. However, most glucosuria testing is performed after a patient has completed routine blood screening for gestational diabetes. This third-trimester testing is not predictive of any clinically important pregnancy outcome.

The value of routine urine dipstick screening for protein at each prenatal visit.

OBJECTIVE: Our purpose was to determine whether dipstick urinalysis for protein, when performed as a routine screening test at each prenatal visit, predicts subsequent gestational outcome. STUDY DESIGN: All 3217 low-risk obstetric patients had dipstick urinalysis for protein at each prenatal visit. When there were any objective findings of a possible hypertensive disorder, the urine protein test for that visit was considered an indicated diagnostic test. Otherwise it was considered a routine screening test. Subjects were grouped according to whether those urine tests considered routine screening tests were positive for protein. The groups were then compared with regard to relevant pregnancy outcomes. RESULTS: There were no significant differences in the measured pregnancy outcomes between the groups. CONCLUSIONS: In low-risk women with no objective signs of a possible hypertensive disorder, routine dipstick proteinuria screening at each prenatal visit did not provide any clinically important information regarding pregnancy outcome.

Jumping from a general hospital.

Jumping is the most common reported means of suicide in general hospitals. There have been no published reviews of suicides of nonpsychiatric inpatients since 1980. We describe 12 subjects who, between January 1980 and January 1992, jumped from a large general teaching hospital. Eight of them succumbed, providing a rate of suicide of 1.7 per 100,000 admissions. There were three clinical subgroups: those admitted after suicide attempts, the acutely delirious, and the chronically medically ill. Factors appearing frequently in the third subgroup were pain, dyspnea, transient confusion, poor prognosis, and recent adverse news. When we compared the hospital jumpers with 30 nonfatal jumpers who attended our Emergency Department, the medical and psychiatric profiles differed in the frequency of medical illnesses, advancing age, male gender, and absence of preexisting psychiatric illness. Proximity and ease of access to balconies and windows appeared to be highly relevant to the prevention of hospital jumping.

Screening for Chlamydia trachomatis in low-risk obstetric patients.

OBJECTIVE: The purpose of this study was to evaluate the prevalence of Chlamydia trachomatis in our rural obstetric population and assess the appropriateness of selective vs. universal prenatal screening. METHODS: Between April 1, 1991 and May 1, 1993, 1,587 patients were screened at their first prenatal visit using a C. trachomatis antigen test. Patients who were unmarried, younger than 20 years of age, or had a history of a previous sexually transmitted disease (STD) were classified as being at high risk for C. trachomatis. All others were considered low risk for C. trachomatis. RESULTS: The overall prevalence of C. trachomatis was 2.0%. There was a significant difference (P < 0.001) in the 1,128 patients considered low risk [0.5%, 95% confidence interval (CI) 0.2-1.2] compared to the 459 patients with one or more identifiable risk factors (5.7%, 95% CI 3.7-8.2). CONCLUSIONS: Routine prenatal screening for C. trachomatis in our population is not appropriate for low-risk patients.

Effect of epidural analgesia on the primary cesarean rate.

There is some concern that providing parturients with epidural analgesia increases the likelihood of cesarean delivery. Because of the widespread interest in cesarean rates and the expanding use of epidural analgesia, we believed that this contention should be assessed. Hospital records were reviewed to determine the primary cesarean rate for 1084 parturients who delivered at our institution during 15 months in which there was a 24-hour "on demand" epidural service. This was compared with our primary cesarean rate during 15 months in which epidural analgesia was not available, even on physician request. Because of the characteristics of our institution, this control group consisted of patients from the same population base managed by the same eight obstetricians using the same management techniques. For patients in labor, the primary cesarean rate overall was 9.0% before and 8.2% after the epidural service began (P = .626). When subpopulations based on parity and indication for cesarean delivery were studied, there were no significant changes in the cesarean rate. These results demonstrate that the availability of on-demand epidural analgesia for patients in labor did not increase the primary cesarean rate, either in the aggregate or for any of the subpopulations studied.

Thyroid function and treatment in premenstrual syndrome.

In 1986 it was reported that a high percentage of women with premenstrual syndrome (PMS) were found to have thyroid hypofunction (TH), mostly subclinical hypothyroidism, as defined by an augmented response of TSH to TRH, and that all affected women had complete relief of PMS symptoms with L-T4 therapy. We studied baseline thyroid function (T4, T3 uptake, T3, TSH, and TSH response to TRH) in 15 normal women (group 1) and 44 women with PMS and treated 22 of the PMS women with L-T4 (group 2; 1.6 micrograms L-T4/kg dose) and the other half with placebo (group 3) for 2 months in a double blinded protocol. We found no evidence of thyroid dysfunction in group 2 or 3, except for 1 subject with slightly elevated TSH (6.2 microIU/mL) and moderate augmented response to TRH (change in TSH, 65 microIU/mL). During the treatment phase we found a complete relief of symptoms in 6 (27%), a partial relief of symptoms in 6 (27%), and some relief of symptoms in 12 (54%) in group 2. Whereas in group 3, 10 (45%) had complete relief, 5 (23%) had partial relief, and 15 (68%) had some relief of symptoms. These results show that 1) there is no significant thyroid disease in PMS; and 2) L-T4 is no better than placebo in treatment of PMS. We conclude that the high incidence of thyroid hypofunction previously reported in PMS is due to an unusually low TSH level for the limit of the normal range for the TRH stimulation test.

Basal, sham feed and pentagastrin stimulated gastric acid, pepsin and electrolytes after omeprazole 20 mg and 40 mg daily.

Gastric secretion was measured in nine patients with duodenal ulcer before, and after treatment for four weeks with omeprazole 20 mg or 40 mg daily. Basal acidity and acid output were affected variably by 20 mg, but inhibited totally by 40 mg daily. Sham feed stimulated acid output was reduced by 20 mg daily and completely inhibited by 40 mg daily. Maximal pentagastrin stimulated acid output was halved by 20 mg omeprazole daily and 84% inhibited by 40 mg daily. The reduction in acidity was always greater than the reduction of volume. Pepsin output after pentagastrin was little altered but with the reduced secretory volume pepsin concentrations were increased by both doses. The major cause of reduced aspirate acid output after omeprazole is decreased secretion of the primary acid component of the parietal cell by the proton pump H+K+ ATPase. Duodenogastric alkaline reflux is, however, markedly increased after omeprazole and is an additional factor in the resultant hypoacidity or even anacidity after this drug.