Self-harm in adults: a comparison between the middle-aged and the elderly.

AIM: In New Zealand, men aged 45-49 years and 85 years and above have one of the highest suicide rates. As the population in New Zealand ages, it is anticipated that the absolute number of late-life suicides will rise. Self-harm is one of the better predictors of future suicide. The aims of this study are to: (i) characterise middle-aged (45-64 years) and older-aged people (65+ years) who have self-harmed; and (ii) determine whether there are differences between the two age groups. METHOD: Clinical data were retrospectively collected on people aged 45+ years who presented with a self-harm attempt to a large emergency department in New Zealand from 2010 to 2013. Further clinical information for the 12-month period following their presentation was also collected. RESULTS: Three hundred and seventy-one middle-aged (56.6% female) and 49 older-aged (38.8% female) people presented with a total of 513 and 56 self-harm attempts respectively during the study period. The older-aged group was more likely to report physical illness as a stressor (p=0.001), have a history of depression (p<0.0001) and be diagnosed with depression at the time of their attempt (p<0.0001). Suicidal intent was more common among the older-aged people who have self-harmed (p=0.004), and they had lower survival rates in the 12 months after their self-harm attempt (risk ratio=7.5; 95% CI=3.1 to 18.1). CONCLUSION: The significant differences between older-aged and middle-aged people who have self-harmed highlights the need for age-specific suicide interventions, with particular focus on addressing physical illness and depression in older-aged people.

Predictors for repeat self-harm and suicide among older people within 12 months of a self-harm presentation.

BACKGROUND: A past history of self-harm is a significant risk factor for suicide in older people. The aims of this study are to (i) characterize older people who present with self-harm to emergency departments (EDs); and (ii) determine the predictors for repeat self-harm and suicide. METHODS: Demographic and clinical data were retrospectively collected on older people (age 65+ years), who presented to seven EDs in New Zealand following an episode of self-harm between 1st July 2010 and 30th June 2013. In addition, 12-month follow-up information on repeat self-harm and suicide was collected. RESULTS: The sample included 339 older people (55.2% female) with an age range of 65-96 years (mean age = 75.0; SD = 7.6). Overdose (68.7%) was the most common method of self-harm. 76.4% of the self-harm cases were classified as suicide attempts. Perceived physical illness (47.8%) and family discord (34.5%) were the most common stressors. 12.7% of older people repeated self-harm and 2.1% died by suicide within 12 months. Older people who had a positive blood alcohol reading (OR = 3.87, 95% Cl = 1.35-11.12, p = 0.012) and were already with mental health services at the index self-harm (OR = 2.73, 95% Cl = 1.20-6.25, p = 0.047) were more likely to repeat self-harm/suicide within 12 months. CONCLUSION: Older people who self-harm are at very high risk of repeat self-harm and suicide. Screening and assessment for alcohol use disorders should be routinely performed following a self-harm presentation, along with providing structured psychological treatment as an adjunct to pharmacological treatment for depression and interventions to improve the person's resilience resources.

Increasing primary antibiotic resistance and ethnic differences in eradication rates of Helicobacter pylori infection in New Zealand--a new look at an old enemy.

AIMS: To determine the current prevalence, primary antibiotic resistance and eradication rate with standard triple therapy of Helicobacter pylori (H. pylori) infection in South Auckland, New Zealand (NZ). METHODS: Consecutive patients undergoing gastroscopy in 2012 were prospectively enrolled. The prevalence of primary H. pylori infection was determined from all Campylobacter-like organism (CLO) tests performed. Antibiotic susceptibility testing was performed for a range of relevant antibiotics and the success of eradication therapy was determined by stool antigen clearance. RESULTS: The prevalence of H. pylori infection by ethnic group; European (7.7%), Maori (34.8%), Pacific People (31.3%) and Orientals (23.8%). Metronidazole resistance was found in 49.3% of isolates, clarithromycin resistance in 16.4%, and moxifloxacin resistance in 9.5%. No isolates were resistant to tetracycline. Clarithromycin resistance (greater than and equal to 15%) was prevalent among Maori, Pacific People and Orientals. Metronidazole resistance has increased significantly from 32.7% in 1999 to 49.3% in 2012 (p=0.011), and clarithromycin resistance from 7% in 1999 to 16.4% in 2012 (p=0.021). The eradication rate (intention to treat) with standard omeprazole, amoxicillin and clarithromycin (OAC) therapy in ethnic groups where clarithromycin resistance was <15% was 85.7% versus 64.9% in groups where clarithromycin resistance was greater than and equal to 15% (p=0.024). CONCLUSION: H. pylori infection is very common among certain ethnic groups living in South Auckland. Resistance to clarithromycin and metronidazole have increased significantly among treatment naive patients compared to historical NZ data. Ethnic groups with clarithromycin resistance of greater than and equal to 15% were associated with lower eradication rates with OAC therapy. This suggests a need to review the current NZ H. pylori eradication guidelines to accommodate ethnic differences in the response to first-line regimens.

Quantifying synovitis in rheumatoid arthritis using computer-assisted manual segmentation with 3 Tesla MRI scanning.

PURPOSE: To investigate the reliability, validity and feasibility of a computer-assisted manual segmentation method for determining the synovial membrane volume as a surrogate measure for synovitis in patients with rheumatoid arthritis (RA). MATERIALS AND METHODS: The 3 Tesla (T) MRI scans were acquired in 22 early RA and 16 established RA patients. Synovial membrane volumes in postcontrast T1w axial images at three wrist joint regions were determined by two nonradiologist observers using a computer-assisted manual segmentation method. RESULTS: Intraobserver reliability, measured by intraclass correlation coefficients (ICCs), was excellent in the early (ICC = 0.99) and established (ICC = 0.99) RA cohorts. Interobserver reliability (mean ICC [95% Confidence Interval]) was moderate to excellent in the early and established RA groups (ICCs = 0.87 [0.68,0.94] and 0.88 [0.66, 0.96], respectively). There was a strong correlation between the synovial membrane volumes derived by segmentation and the RA MRI scoring system (RAMRIS) scores for synovitis at all joints in the early (Spearman rho = 0.86-0.96) and established (Spearman rho = 0.85-0.93) RA cohorts. The entire segmentation technique took 19 to 21 min per patient. CONCLUSION: Measurement of MRI synovitis using a computer-assisted manual segmentation method demonstrated excellent intraobserver and very good interobserver reliability, content validity (represented by its strong correlation with RAMRIS synovitis), and moderate feasibility.