Overview evidence on interventions for population suicide with an eye to identifying best-supported strategies for LMICs.

Globally, over 800 000 people died by suicide in 2012 and there are indications that for each adult who died of suicide there were likely to be many more attempting suicide. There are many millions of people every year who are affected by suicide and suicide attempts, taking into consideration the family members, friends, work colleagues and communities, who are bereaved by suicide. In the WHO Mental Health Action Plan 2013-2020, Member States committed themselves to work towards the global target of reducing the suicide rate in countries by 10% by 2020. Hence, the first-ever WHO report on suicide prevention, Preventing suicide: a global imperative, published in September 2014, is a timely call to take action using effective evidence-based interventions. Their relevance for low- and middle-income countries is discussed in this paper, highlighting restricting access to means, responsible media reporting, introducing mental health and alcohol policies, early identification and treatment, training of health workers, and follow-up care and community support following a suicide attempt.

Comparative evaluation of fracture resistance of root obturated with resilon and gutta-percha using two different techniques: an in vitro study.

INTRODUCTION: Present study evaluated the fracture resistance of endodontically treated teeth filled with Gutta percha and a new resin based obturating material (Resilon). MATERIALS AND METHODS: A total of 150 freshly extracted Mandibular premolar with fully formed apices were selected and decoronated at cemento-enamel junction (CEJ). Teeth were divided into Group A and Group B of 75 teeth each. In Group A canals were prepared up to # no 40 K file and Group B up to #no 80 K file. Both the groups were sub divided into five group of 15 teeth each as control group (unfilled canals), lateral condensation with Gutta-percha using AH 26 sealer, vertical condensation with Gutta-percha using AH 26 sealer, lateral condensation with Resilon using resilon sealer, vertical condensation with Resilon using resilon sealer. Each specimen was subjected to compressive load using Universal testing machine. The force required to fracture was recorded and data were analysed by ANOVA, Duncan's test and student T test. RESULT: The result showed that there is statistically significant difference among experimental groups (p < 0.05). The groups with the Resilon material displayed higher mean fracture loads than the Gutta percha groups. No statistically significant differences were observed between different preparation techniques. CONCLUSION: Obturating the canals with the new resin-based obturation material increases the in vitro fracture resistance of endodontically treated teeth when compared with standard Gutta percha techniques.

Scanning Electron Microscopic Evaluation of Root Canal Surfaces Prepared with LightSpeed & Endowave Rotary System.

BACKGROUND AND OBJECTIVES: The purpose of this in vitro study was to evaluate and compare the cleaning efficiency on root canal surfaces prepared with LightSpeed and Endowave rotary instruments. MATERIALS AND METHODS: A total of 30 freshly extracted human mandibular premolars were subjected for the study. They were divided into two groups, each group consisting of 15 teeth. Group 1: The canals were prepared with LightSpeed system. Group 2: Endowave rotary system. All the groups were prepared according to manufacturer's recommendation, using 5.25% sodium hypochlorite and 17% EDTA (dent wash, prime dent) alternately as an irrigants. Crowns of each tooth were removed with diamond disks at the level of cement enamel junction. Canal length was determined by placing a size 10 K-file. The working length was 0.5 mm short of canal length. Two longitudinal grooves were prepared on the lingual and buccal surfaces of each root to facilitate vertical splitting with a chisel after canal instrumentation. The sections were then observed under SEM for presence or absence of debris and smear layer and the photographs were taken at coronal, middle and apical 1/3 with a magnification of 200 X and 1000X respectively. The scores recorded were statistically analysed using one-way-ANOVA and Mann- Whitney test. RESULTS: There was statistically significant difference between two groups. All groups resulted in significantly more debris and smear layer in the apical 1/3 of the canal, compared to coronal and middle 1/3 (p, <0.01). INTERPRETATION AND CONCLUSION: The study demonstrated that, LightSpeed instrumentation removed debris and smear layer more effectively on root canal surface than compared to Endowave instrument.

Trained volunteer-delivered mental health support to those bereaved by Asian tsunami--an evaluation.

INTRODUCTION: While mental health consequences following the Asian December 2004 tsunami have been studied, its impact on the survivors who lost close family members deserves attention. We investigated the usefulness of trained volunteer-delivered mental health support for the bereaved persons. METHOD: Non-randomized control design involving all adults aged 18 years or above who lost at least one close family member during tsunami from two geographically different coastal areas in Chennai, India. From the intervention and control sites, 45 and 57 participants were recruited respectively for the study. One year after baseline assessment, all 102 participants in intervention and control sites were interviewed. RESULTS: Participants receiving interventions on a consistent basis from trained volunteers were less likely to report depressive symptoms and general psychological distress compared with participants who did not receive the above intervention. Regression analysis for predicting the effect of intervention on the difference between the baseline and follow-up in BDI as well as GHQ scores, found a significant association between intervention and the improvement in BDI (adjusted beta (SE): -0.53 (2.44); p = 0.000) and GHQ (adjusted beta (SE): -0.52 (1.81); p = 0.001) scores. Suicidal attempts were also significantly less in the intervention group (FET p = 0.02). CONCLUSION: In settings where mental health professionals are limited in number, trained lay volunteers can offer empathetic listening, support and referrals that can be potentially beneficial.

Mental health status in children exposed to tsunami.

As a vulnerable group, children are more prone to experiencing trauma and its sequelae. After the Asian tsunami we set out to evaluate the effect of exposure to the tsunami nearly one year after the event and to explore the family history of psychopathology on the mental health of children. This community-based study of 230 children was conducted in Srinivasapuram, a coastal village in Tamil Nadu. A youth self-report form (YSR) of the Child Behaviour Checklist (CBCL), exposure to the tsunami, post-traumatic stress disorder (PTSD) and family history of psychopathology were assessed. The severity of exposure to the tsunami correlated with anxiety and somatic domains of the DSM IV and PTSD symptoms. Family history of psychopathology correlated with affective and somatic symptoms. Multiple regression analysis revealed that family psychopathology influenced affective problems (R2 = 0.071 (n = 199), F = 15.13, p = 0.00) while exposure to the tsunami influenced anxiety problems (R2 = 0.046 (n = 208), F = 9.91, p = 0.002). The findings from this study reveal that targeted specialized mental health services are needed for children with severe exposure to the tsunami and positive family history of psychopathology.

Controlling the environment to prevent suicide: international perspectives.

BACKGROUND: Suicide and suicidal behaviour are multifaceted events requiring complex solutions. Controlling the environment is a neglected solution, despite strong support for this approach from the World Health Organization (WHO). METHOD: To discuss this approach from a global view, this review is written by authors from various cultures: American, Australian, Canadian, Chinese, Cuban, Dutch, Indian, Irish, Japanese, Lithuanian, Native North American, Russian, and South African. RESULTS: We examine gun control to illustrate the environmental control approach; however, the worldwide diversity of suicide methods calls for diverse responses. Further, controlling the environment encompasses more than restricting the means of suicide, which we illustrate with examples of toned-down media reports and restricted medicine availability. CONCLUSIONS: Controlling the environment may be a viable strategy for preventing suicide, although research shows that few clinicians implement such approaches.

Are risk factors for suicide universal? A case-control study in India.

OBJECTIVE: The majority of suicides in India occur in the young. Indian society, religion and culture are very different to those in the West. The aim of the present study was to identify the risk factors for completed suicide. METHOD: A population-based case-control study employing the 'psychological autopsy' technique was conducted. In total, 100 completed suicides and 100 neighbourhood controls were studied. RESULTS: The odds ratios for the risk factors were 19.5 (CI, 7.32-73.35) for presence of an Axis I disorder, 12.75 (CI, 4.69-48.59) for family history of psychopathology and 15.1 (CI, 2.4-93.9) for life events in the previous month. CONCLUSION: The presence of an Axis I disorder, family history of psychopathology and recent life events were all found to be significant risk factors. These findings suggest that risk factors for completed suicide are universal across countries and cultures.

Attitudes towards suicide among medical students: comparison between Madras (India) and Vienna (Austria).

Attitudes towards suicide among medical students in Madras (India) and Vienna (Austria) were compared using the SUIATT questionnaire by Diekstra and Kerkhof (1989). Results show a very restrictive attitude in Madras, rejecting the right to commit suicide, nearly always judging suicide as a cowardly act, and rejecting the idea of assisted suicide. On the other hand, in Vienna a more permissive attitude was found. It is interpreted that the Indian pattern comes close to a "medical" or "disease model", with stronger emphasis on mental illness, impulsiveness and emotional aspects, whereas the Viennese pattern reflects a "theoretical", "rational model", concentrating on cognitive factors and minimizing the influence of mental illness, emotional difficulties and restrictions related to suicidal behaviour. This pattern may be influenced by the public discussion on assisted suicide and the right to die in Europe in the last decade. Possible relations to the risk for actual suicidal behaviour are discussed using respective answers concerning previous suicidal ideation and suicide attempts. The answers concerning suicidal ideation seem to be strongly influenced by the different attitude patterns: only 16.8% reported previous suicidal ideation in Madras, compared to 51.5% in Vienna, whereas the percentage of reported suicide attempts is equal in both centres (5.9%:4.9%).

Suicide pacts.

Suicide pacts in an Indian population were studied through police records of the state of Tamul Nadu. A total of 148 suicide pacts, involving 324 persons, were identified. More women died in them than might be expected from general population figures. Social stressors like financial problems and marriage-related issues were the principal causes. The results and their implications are discussed and compared with those obtained in Western and other Eastern countries.