Prevalence of suicide attempt and associations with deliberate self-harm, mental health problems, drug misuse and traumatic experiences - a cross sectional survey of the Norwegian population.

BACKGROUND: Monitoring self-reported suicide attempts (SA) with nationally representative surveys is important to initiate suicide prevention strategies. The aim of the study was to assess the prevalence of SA and compare deliberate self-harm, (DSH), mental health, drug misuse and traumas between SA and non-suicide attempters (NSA). METHODS: In this cross-sectional survey of a representative sample (N=1757) of the Norwegian population, we compared people with self-reported SA (n=54) to NSA (n=1703) regarding sociodemographic data, mental health problems, drug misuse and exposure to trauma. RESULTS: The prevalence of SA was 3.1 %. There was a higher proportion of welfare recipients and more deliberate self-harm, mental health problems, drug misuse and traumas in the SA group compared to NSA. CONCLUSION: This national study confirms the association between suicide attempt and deliberate self-harm, mental health problems, drug misuse and traumas.

Healthcare utilisation, induced labour and caesarean section in the pregnancy after stillbirth: a prospective study.

OBJECTIVE: To investigate healthcare utilisation, induced labour and caesarean section (CS) in the pregnancy after stillbirth and assess anxiety and dread of childbirth as mediators for these outcomes. DESIGN: Population-based pregnancy cohort study. SETTING: The Norwegian Mother and Child Cohort Study. SAMPLE: A total of 901 pregnant women; 174 pregnant after stillbirth, 362 pregnant after live birth and 365 previously nulliparous. METHODS: Data from questionnaires answered in the second and third trimesters of pregnancy and information from the Medical Birth Registry of Norway. MAIN OUTCOME MEASURES: Self-reported assessment of antenatal care, register-based assessment of onset and mode of delivery. RESULTS: Women with a previous stillbirth had more frequent antenatal visits (mean 10.0; 95% CI 9.4-10.7) compared with women with a previous live birth (mean 6.0; 95% CI 5.8-6.2) and previously nulliparous women (mean 6.3; 95% CI 6.1-6.6). Induced labour and CS, elective and emergency, were also more prevalent in the stillbirth group. The adjusted odds ratio for elective CS was 2.5 (95% CI 1.3-5.0) compared with women with previous live birth and 3.7 (1.8-7.6) compared with previously nulliparous women. Anxiety was a minor mediator for the association between stillbirth and frequency of antenatal visits, whereas dread of childbirth was not a significant mediator for elective CS. CONCLUSIONS: Women pregnant after stillbirth were more ample users of healthcare services and more often had induced labour and CS. The higher frequency of antenatal visits and elective CS could not be accounted for by anxiety or dread of childbirth. TWEETABLE ABSTRACT: Women pregnant after stillbirth are ample users of healthcare services and interventions during childbirth.

Neural and non-neural related properties in the spastic wrist flexors: An optimization study.

Quantifying neural and non-neural contributions to increased joint resistance in spasticity is essential for a better understanding of its pathophysiological mechanisms and evaluating different intervention strategies. However, direct measurement of spasticity-related manifestations, e.g., motoneuron and biophysical properties in humans, is extremely challenging. In this vein, we developed a forward neuromusculoskeletal model that accounts for dynamics of muscle spindles, motoneuron pools, muscle activation and musculotendon of wrist flexors and relies on the joint angle and resistant torque as the only input measurement variables. By modeling the stretch reflex pathway, neural and non-neural related properties of the spastic wrist flexors were estimated during the wrist extension test. Joint angle and resistant torque were collected from 17 persons with chronic stroke and healthy controls using NeuroFlexor, a motorized force measurement device during the passive wrist extension test. The model was optimized by tuning the passive and stretch reflex-related parameters to fit the measured torque in each participant. We found that persons with moderate and severe spasticity had significantly higher stiffness than controls. Among subgroups of stroke survivors, the increased neural component was mainly due to a lower muscle spindle rate at 50% of the motoneuron recruitment. The motoneuron pool threshold was highly correlated to the motoneuron pool gain in all subgroups. The model can describe the overall resistant behavior of the wrist joint during the test. Compared to controls, increased resistance was predominantly due to higher elasticity and neural components. We concluded that in combination with the NeuroFlexor measurement, the proposed neuromusculoskeletal model and optimization scheme served as suitable tools for investigating potential parameter changes along the stretch-reflex pathway in persons with spasticity.

Lower suicide intention in patients with personality disorders admitted for deliberate self-poisoning than in patients with other diagnoses.

BACKGROUND: People with deliberate self-poisoning and personality disorders are in increased risk for suicide. Intention and psychiatric features are important factors in a psychiatric evaluation and for planning aftercare. METHODS: Patients admitted to medical departments after deliberate self-poisoning were studied (n = 117). Patients with personality disorder according to (ICD-10, F.60-69) were compared to patients with affective disorders, substance use disorders, and unknown psychiatric diagnosis on Beck Suicide Intention Scale (SIS), Beck Suicide Ideation Scale (BSI), Beck Hopelessness Scale (BHS), and Beck Depression Inventory (BDI). RESULTS: The mean suicide intention score (SIS) was significantly lower among patients with personality disorders compared with patients with other psychiatric diagnoses 10.2 (95% CI 8.1-12.4) vs. 14.6 (95% CI 12.7-16.4) (p = 0.040). The hopelessness scores (BHS) were significantly higher among patients with personality disorders 13.0 (95% CI 10.9-15.2) compared with patients with affective disorders 8.2 (95% CI 6.1-10.3) and substance use disorders 9.9 (95% CI 5.2-14.6) (p = 0.0014) and unknown psychiatric diagnoses 10.6 (95% CI 9.1-12.2). There were no significant differences between the groups on suicide ideation (BSI) and depression (BDI). CONCLUSIONS: Although patients with personality disorders had lower suicide intention compared to patients with other psychiatric diagnoses, they reported significantly more hopelessness. This distinction is an important implication in the clinical assessment and planning of further treatment of DSP patients.

Post-traumatic stress among rescue workers after terror attacks in Norway.

BACKGROUND: On 22 July 2011, Norway was struck by two terror attacks. Seventy-seven people were killed, and many injured. Rescue workers from five occupational groups and unaffiliated volunteers faced death and despair to assist victims. AIMS: To investigate the level of, and associations between, demographic variables, exposure and work-related variables and post-traumatic stress symptoms (PTSS). METHODS: A cross-sectional study of general and psychosocial health care personnel, police officers, firefighters, affiliated and unaffiliated volunteers were conducted ~10 months after the terror attacks. The respondents answered a self-reported questionnaire. Post-traumatic stress disorder (PTSD) Checklist - specific (PCL-S) assessed PTSS. RESULTS: There were 1790 participants; response rate was 61%. About 70% of the professional rescue workers had previous work experience with similar tasks or had participated in training or disaster drills. They assessed the rescue work as a success. Firefighters and unaffiliated volunteers reported more perceived threat compared with the other groups. Among the professional personnel, the prevalence of sub-threshold PTSD (PCL 35-49) was 2% and possible PTSD (PCL ≥ 50) 0.3%. The corresponding figures among the unaffiliated volunteers were 24% and 15%, respectively. In the multivariate analysis, female gender (ß = 1.7), witnessing injured/dead (ß = 2.0), perceived threat (ß = 1.1), perceived obstruction in rescue work (ß = 1.6), lower degree of previous training (ß = -0. 9) and being unaffiliated volunteers (ß = 8.3) were significantly associated with PTSS. CONCLUSIONS: In the aftermath of a terror attack, professional rescue workers appear to be largely protected from post-traumatic stress reactions, while unaffiliated volunteers seem to be at higher risk.

Structured follow-up by general practitioners after deliberate self-poisoning: a randomised controlled trial.

BACKGROUND: General Practitioners (GPs) play an important role in the follow-up of patients after deliberate self-poisoning (DSP). The aim was to examine whether structured follow-up by GPs increased the content of, adherence to, and satisfaction with treatment after discharge from emergency departments. METHODS: This was a multicentre, randomised trial with blinded assignment. Five emergency departments and general practices in the catchment area participated. 202 patients discharged from emergency departments after DSP were assigned. The intervention was structured follow-up by the GP over a 6-month period with a minimum of five consultations, accompanied by written guidelines for the GPs with suggestions for motivating patients to follow treatment, assessing personal problems and suicidal ideation, and availability in the case of suicidal crisis. Outcome measures were data retrieved from the Register for the control and payment of reimbursements to health service providers (KUHR) and by questionnaires mailed to patients and GPs. After 3 and 6 months, the frequency and content of GP contact, and adherence to GP consultations and treatment in general were registered. Satisfaction with general treatment received and with the GP was measured by the EUROPEP scale. RESULTS: Patients in the intervention group received significantly more consultations than the control group (mean 6.7 vs. 4.5 (p = 0.004)). The intervention group was significantly more satisfied with the time their GP took to listen to their personal problems (93.1% vs. 59.4% (p = 0.002)) and with the fact that the GP included them in medical decisions (87.5% vs. 54. 8% (p = 0.009)). The intervention group was significantly more satisfied with the treatment in general than the control group (79% vs. 51% (p = 0.026)). CONCLUSIONS: Guidelines and structured, enhanced follow-up by the GP after the discharge of the DSP patient increased the number of consultations and satisfaction with aftercare in general practice. Consistently with previous research, there is still a need for interventional studies. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01342809. Registered 18 April 2011.

A bioinspired autonomous swimming robot as a tool for studying goal-directed locomotion.

The bioinspired approach has been key in combining the disciplines of robotics with neuroscience in an effective and promising fashion. Indeed, certain aspects in the field of neuroscience, such as goal-directed locomotion and behaviour selection, can be validated through robotic artefacts. In particular, swimming is a functionally important behaviour where neuromuscular structures, neural control architecture and operation can be replicated artificially following models from biology and neuroscience. In this article, we present a biomimetic system inspired by the lamprey, an early vertebrate that locomotes using anguilliform swimming. The artefact possesses extra- and proprioceptive sensory receptors, muscle-like actuation, distributed embedded control and a vision system. Experiments on optimised swimming and on goal-directed locomotion are reported, as well as the assessment of the performance of the system, which shows high energy efficiency and adaptive behaviour. While the focus is on providing a robotic platform for testing biological models, the reported system can also be of major relevance for the development of engineering system applications.

Cardiovascular pre-participation screening does not distress professional football players.

BACKGROUND: It has been debated whether cardiovascular screening of athletes creates negative psychological reactions in those being screened. Neither the athletes' level of distress towards, nor their opinion about screening has actually been examined. Therefore, the aim of this study was to assess the level of distress among Norwegian elite male football players and their experiences of screening. METHODS: After screening, players completed a 10-item scale assessing their experience on a Likert scale. Their level of distress was measured with the intrusion sub-scale of Impact of Event Scale (IES) (7 items) on a six-point scale (grade 0-5). A sum score of ≥19 indicates a clinical stress problem. Twenty-five out of 28 teams, 441 of 591 players (75%, mean age 26 [18-39] years) consented to participate. RESULTS: Sixty-four percent felt more confident when playing football and 88% were satisfied having completed the screening. The majority (77%) felt a need for the screening and 84% would strongly recommend it to others. Sixteen percent were afraid that the screening result might have consequences for their own health, and 13% were afraid of losing their license to play football. Less than 3% experienced distress (IES ≥ 19). CONCLUSIONS: The majority of the players were satisfied having completed the screening, felt more confident and would recommend it to other players. Only a marginal proportion of the players were distressed by the screening, but were at least as likely to recommend it.

Attitudes to animal-assisted therapy with farm animals among health staff and farmers.

Green care is a concept that involves the use of farm animals, plants, gardens or the landscape in cooperation with health institutions for different target groups of clients. The present study aimed at examining psychiatric therapists' (n = 60) and farmers' (n = 15) knowledge, experience and attitudes to Green care and animal-assisted therapy (AAT) with farm animals for people with psychiatric disorders. Most respondents had some or large knowledge about Green care, but experience with Green care was generally low in both groups. Both farmers and therapists believed that AAT with farm animals could contribute positively to therapy to a large or very large extent, with farmers being significantly more positive. Most of the therapists thought that AAT with farm animals contributes to increased skills in interactions with other humans, with female therapists being more positive than males. Two-thirds of the therapists believed that AAT with farm animals to a large extent could contribute better to mental health than other types of occupational therapy. There were no differences in attitudes to AAT between psychiatrists/psychologists and psychiatric nurses. This study confirms the marked potential of offering AAT services with farm animals for psychiatric patients by documenting positive attitudes to it among psychiatric therapists.

Clinical assessment compared to laboratory screening in acutely poisoned patients.

Acute poisonings may require identification of the toxic agents. It is impossible for routine laboratories to provide a full spectrum of toxicological analyses, and clinicians should know the reliability of the clinical diagnoses of toxic agents. We performed a 1-year study of hospitalized acute poisonings to determine the agreement between the clinical assessment on admission and serum laboratory tests for eight common toxic agents. Blood samples were drawn in 665 (70%) of the 947 admissions. The total number of laboratory found agents (967) exceeded the clinically suspected (871) by 11%. The agreement between the clinical assessment and laboratory analyses was good for ethanol and paracetamol (kappa = 0.70 for both), whereas only moderate or fair for other agents (kappa 0.22-0.51). Sensitivities of the clinical assessments compared to the laboratory results were better for common than rare agents, and better for higher than lower serum concentrations. The four most common agents (ethanol, benzodiazepines, paracetamol, and opiates) had overall sensitivity of 82% for higher-than-median serum concentrations, whereas the other agents had sensitivities ranging from 14% to 71% for higher-than-median concentrations. The reliability of the clinical diagnoses varied to such an extent that agents, which are important to recognize for specific treatment, should be tested for.

Acute poisonings treated in hospitals in Oslo: a one-year prospective study (I): pattern of poisoning.

OBJECTIVES: Prospective design is mandatory to study pattern of poisoning and suicidal intention of patients. MATERIAL AND METHODS: Prospective cross-sectional multi-center study of all patients contacting health care services because of acute poisoning during one year in Oslo, irrespective of intention. Data on the adult hospitalized patients (> or = 16 years) are presented here. RESULTS: Of a total of 3,775 such adult contacts (3,025 episodes), there were 947 (31 %) hospitalizations; annual incidence 1.9 (per 1,000) in males and 2.1 in females. Median age was 36 years (range 16-89); 54% females. Benzodiazepines (18%), ethanol (17%), paracetamol (12%), opioids (7%), and gamma hydroxybutyric acid (GHB) (7%) were most frequently taken. Patients stated suicidal intention in 29% of the admissions; physicians in 10%. CONCLUSION: Benzodiazepines and ethanol were the most common agents, but newer illicit drugs were frequent, especially GHB. Males often took ethanol and drugs of abuse; females often used prescription drugs with suicidal intention.

Clinical vs. laboratory identification of drugs of abuse in patients admitted for acute poisoning.

OBJECTIVE: The extent of drug abuse in patients admitted for self-poisonings is uncertain. The aim of this study was to assess the pattern of drugs of abuse among patients admitted for acute poisoning according to age and gender, and to study the concordance between the clinical assessments by the physicians on duty and the drug analyses. METHODS: Prospective cross sectional study of all patients (n = 405, 52% males, median age 31 years) treated for acute poisoning in our department during one year (2001). The physician on-call classified type of drug of abuse by history and clinical assessment. This was later compared to urine and blood samples analysed for ethanol, benzodiazepines, opiates, cocaine, ecstasy, GHB, amphetamine and cannabis. RESULTS: In 320 admissions (79%), the comparison between clinical diagnosis and laboratory analyses could be performed. A total of 478 drugs were suspected and 621 were found. The main toxic agents found were benzodiazepines (49.7%), ethanol (40.3%), opiates (35.3%), cannabis (23.8%) and amphetamine (21.3%). Ninety-two had used drugs of abuse. The agreement between clinical assessments and laboratory findings was best for GHB and ethanol (kappa = 0.43), and for opiates (k = 0.38). For benzodiazepines and cannabis, the concordance was poor (k = 0.18 and 0.10, respectively). However, the correct clinical evaluation for these substances was 59% and 77%, respectively. CONCLUSIONS: Drugs of abuse were more frequently found than suspected clinically. Benzodiazepines, ethanol and opiates were most common. The agreement between clinical assessment and drug analyses was moderate to low. Physicians seem to underestimate the use of these drugs.

The mediating role of appraisal and coping in the relationship between optimism-pessimism and quality of life.

Longitudinal data from 165 women diagnosed and treated for breast cancer were used to investigate if the relationship between optimism-pessimism and quality of life (QOL) is attributed to the appraisal and coping strategies. The women completed the Life Orientation Test-Revised (LOT-R), as a measurement of optimism-pessimism, the Mental Adjustment to Cancer (MAC) Scale, as a measure for coping, a VAS for appraisal and the EORTC QLQ-C30, as a measure for QOL at two time points: at diagnosis and 12-months after breast cancer surgery. Optimism-pessimism had both a direct and indirect influence on QOL. Two coping strategies were particularly strong mediators for the indirect influence: fighting spirit and hopeless/helpless. Optimists responded with fighting spirit, which had a positive effect on their QOL. On the other hand, pessimists responded with hopeless/helplessness, which had a negative effect on their QOL. The relationship between pessimism and QOL at time of diagnosis was also mediated by appraisal, such as threat. The two coping strategies remained fairly stable over the 12 months within the optimists and pessimists.The results suggest that the influence of optimism and pessimism on QOL appears to be mediated by coping both before and after treatment for breast cancer. Fighting spirit and hopeless/helplessness appear to reflect the characteristic coping strategies for optimists and pessimists.

Pessimism as a predictor of emotional morbidity one year following breast cancer surgery.

The prevalence of and predictive factors for emotional morbidity (measured by the Hospital Anxiety and Depression Scale (HAD)) one year following surgery, with special focus on dispositional optimism/pessimism (measured by the Life Orientation Test (LOT-R), was examined in 165 women, newly diagnosed with breast cancer. Patients characteristics, appraisal of cancer diagnosis, beliefs about treatment efficacy, treatment decision-making participation, coping and emotional morbidity was assessed by self-rating questionnaires. Prevalence of anxiety and depression cases at time of diagnosis was 34 and 12%, respectively, and 26 and 9% after one year. Prevalence of emotional morbidity was significantly enlarged among pessimists at all assessments. Pessimism was the strongest predictor for anxiety (OR: 0.86 C.I. 95% 0.77 - 0.95) and depression (OR: 0.83, C.I. 95% 0.73 - 0.95) one year following breast cancer surgery. Optimists and pessimists differed not only in regard to coping styles, but also in regards to predictors of emotional morbidity. Optimists experiencing anxiety at time of breast cancer diagnosis had about six times higher risk of experiencing anxiety after one year, compared to optimists without preoperative anxiety. For pessimists, the more pessimistic one was about one's overall future the higher risk for developing anxiety following one year of breast cancer surgery. Pessimists, who endorse helpless/hopeless coping style when receiving a diagnosis of breast cancer, had three times greater risk for experiencing depression one year after breast cancer surgery, than pessimists who did not. Health care professionals should therefore provide intervention for pessimists, as well as for patients with high anxiety scores at time of diagnosis.

A Bayesian attractor network with incremental learning.

A realtime online learning system with capacity limits needs to gradually forget old information in order to avoid catastrophic forgetting. This can be achieved by allowing new information to overwrite old, as in a so-called palimpsest memory. This paper describes an incremental learning rule based on the Bayesian confidence propagation neural network that has palimpsest properties when employed in an attractor neural network. The network does not suffer from catastrophic forgetting, has a capacity dependent on the learning time constant and exhibits faster convergence for newer patterns.

Do women newly diagnosed with breast cancer and consulting surgeon assess decision-making equally?

This study assesses the perception of the decision-making process of 25 surgeons and 194 patients (aged 21-81 years) who had newly diagnosed breast cancer and had to undergo mastectomy or breast-conserving surgery (BCS). The majority of women wanted to participate in decision-making. When it was medically possible to give a choice between BCS and mastectomy, only 59% of women received a choice. The main reason that 11% of the women went against surgeon's recommendations was fear of cancer recurrence. The most influential factors for women were the surgeon's recommendation, and fear of cancer recurrence. Medical assessment and the cosmetic result were the most influential factors for the surgeons. Female surgeons were more influenced by their assessment of the women's need for security, than male. In conclusion, not all women who are eligible for BCS receive an option. Women and surgeons emphasize influencing factors differently. The surgeon's gender was found to influence recommendation given.

[Placebo effect in research related to surgery and technical procedures]. / Placeboeffekt ved kirurgisk og prosedyrerelatert klinisk forskning.

BACKGROUND: Development of new technology has led to the introduction of many new high-tech surgical treatment modalities. It has been claimed that the use of high-tech medicine is a potent inductor of placebo effect; in fact, many new treatment modalities have been established before they have been evaluated in placebo-controlled trials. However, there are several ways to minimize the confounding effects of placebo in surgical trials. MATERIAL AND METHODS: This is a review based on a thoroughly performed search on Medline of Norwegian and English language publications published up until August 2000. RESULTS: Several studies have demonstrated that surgical treatment induces significant placebo effect. To minimize the confounding effects of placebo in trials evaluating new surgical modalities, it is important to use adequate blinding, neutral patient information, objective end-points, and correction for estimated placebo effects. The use of placebo surgery has been a source of lively controversy; many consider it ethically unacceptable.

Toward an integrative model of suicide attempt: a cognitive psychological approach.

Applying a cognitive approach, the purpose of the present study was to expand previous research on stress-vulnerability models of depression and problem-solving deficits, as it relates to suicide attempt. Structural equation modelling, involving latent variables, was used to evaluate (a) whether low self-esteem, a low sense of self-efficacy, loneliness, and divorce constituted vulnerability factors for the development of depression; (b) whether hopelessness and suicidal ideation mediated the relationship between depression and suicide attempt; and (c) whether problem-solving deficits mediated the relationship between the vulnerability factors and suicide attempt, separate from depression/hopelessness. A total of 123 individuals, aged 18-75 years, participated in the study (72 suicide attempters and 51 psychiatric outpatients with no history of suicidal behavior). The results indicated a two path model of suicide attempt. The first path began with low self-esteem, loneliness, and separation or divorce, which advanced to depression, and was further mediated by hopelessness and suicidal ideation which led to suicide attempt. The second path developed from low self-esteem and a low sense of self-efficacy and advanced to suicide attempt, mediated by a negative appraisal of one's own problem-solving capacity, and poor interpersonal problem-solving skills. The importance of addressing both depression/hopelessness, and problem-solving deficits when working with suicide attempters is noted.

[Suicide and suicide attempts in Baerum 1984-95]. / Selvmord og selvmordsforsøk i Baerum 1984-95.

BACKGROUND: Because of the lack of mandatory registration of deliberate self-inflicted injuries in most countries, few longitudinal epidemiological studies on suicide attempts have been published. This seriously impairs the possibilities for longitudinal analyses of suicide attempt rates within and between nations. MATERIAL AND METHODS: The present 12-year (1984-95) surveillance study includes all hospitalised suicide attempt patients (n = 1,031) and all suicides (n = 161) in Baerum, a suburban area outside Oslo, Norway. Statistical analyses were based on the index suicide attempt in the study period (person-based). RESULTS: The suicide attempt rate decreased by 53.5% during the study period, to a rate considerably lower (79/100,000/year in 1995) than in most other study centres in Northern Europe. However, the suicide rate in Baerum is somewhat higher than the Norwegian average, particularly among women. Among the suicide attempt patients, the suicide rate was 2.4% after an average of 6.5 years, which is rather moderate. INTERPRETATIONS: The study may indicate that the follow-up programme for suicide attempt patients in Baerum has contributed to a reduced suicide attempt rate in this community. The suicide figures are too small for any conclusions to be drawn.