scholarly journals Suicide and Self-inflicted Injury in Diabetes: A Balancing Act

2019 ◽  
Vol 14 (6) ◽  
pp. 1010-1016 ◽  
Author(s):  
Katharine D. Barnard-Kelly ◽  
Diana Naranjo ◽  
Shideh Majidi ◽  
Halis K. Akturk ◽  
Marc Breton ◽  
...  
Keyword(s):  
Glycemic Control ◽  
General Population ◽  
Complication Rates ◽  
Psychological Burden ◽  
The United Kingdom ◽  
Use Of Technology ◽  
Diabetes Technology ◽  
Increased Risk ◽  
Control And Prevention ◽  
Self Harm

Glycemic control in type 1 diabetes mellitus (T1DM) remains a challenge for many, despite the availability of modern diabetes technology. While technologies have proven glycemic benefits and may reduce excess mortality in some populations, both mortality and complication rates remain significantly higher in T1DM than the general population. Diabetes technology can reduce some burdens of diabetes self-management, however, it may also increase anxiety, stress, and diabetes-related distress. Additional workload associated with diabetes technologies and the dominant focus on metabolic control may be at the expense of quality-of-life. Diabetes is associated with significantly increased risk of suicidal ideation, self-harm, and suicide. The risk increases for those with diabetes and comorbid mood disorder. For example, the prevalence of depression is significantly higher in people with diabetes than the general population, and thus, people with diabetes are at even higher risk of suicide. The Center for Disease Control and Prevention reported a 24% rise in US national suicide rates between 1999 and 2014, the highest in 30 years. In the United Kingdom, 6000 suicides occur annually. Rates of preventable self-injury mortality stand at 29.1 per 100 000 population. Individuals with diabetes have an increased risk of suicide, being three to four times more likely to attempt suicide than the general population. Furthermore, adolescents aged 15 to 19 are most likely to present at emergency departments for self-inflicted injuries (9.6 per 1000 visits), with accidents, alcohol-related injuries, and self-harm being the strongest risk factors for suicide, the second leading cause of death among 10 to 24 year olds. While we have developed tools to improve glycemic control, we must be cognizant that the psychological burden of chronic disease is a significant problem for this vulnerable population. It is crucial to determine the psychosocial and behavioral predictors to uptake and continued use of technology in order to aid the identification of those individuals most likely to realize benefits of any intervention as well as those individuals who may require more support to succeed with technology.

Psychotic experiences and risk of self-injurious behaviour in the general population: a systematic review and meta-analysis

2015 ◽  
Vol 46 (2) ◽  
pp. 237-251 ◽  
Author(s):  
S. Honings ◽  
M. Drukker ◽  
R. Groen ◽  
J. van Os
Keyword(s):  
Systematic Review ◽  
General Population ◽  
Meta Analysis ◽  
Full Range ◽  
Effect Sizes ◽  
Psychotic Experiences ◽  
Increased Risk ◽  
Self Harm ◽  
Specific Association ◽  
Residual Confounding

BackgroundRecent studies suggest that psychotic experiences (PE) in the general population are associated with an increased risk of self-injurious behaviour. Both the magnitude of this association and the level of adjustment for confounders vary among studies. A meta-analysis was performed to integrate the available evidence. The influence of possible confounders, including variably defined depression, was assessed.MethodA systematic review and meta-analysis was conducted including general population studies reporting on the risk of self-injurious behaviour in individuals with PE. Studies were identified by a systematic search strategy in Pubmed, PsycINFO and Embase. Reported effect sizes were extracted and meta-analytically pooled.ResultsThe risk of self-injurious behaviour was 3.20 times higher in individuals with PE compared with those without. Subanalyses showed that PE were associated with self-harm, suicidal ideation as well as suicidal attempts. All studies had scope for considerable residual confounding; effect sizes adjusted for depression were significantly smaller than effect sizes unadjusted for depression. In the longitudinal studies, adjustment for psychopathology resulted in a 74% reduction in excess risk.ConclusionsPE are associated with self-injurious behaviour, suggesting they have potential as passive markers of suicidality. However, the association is confounded and several methodological issues remain, particularly how to separate PE from the full range of connected psychopathology in determining any specific association with self-injurious behaviour. Given evidence that PE represent an indicator of severity of non-psychotic psychopathology, the association between PE and self-injurious behaviour probably reflects a greater likelihood of self-injurious behaviour in more severe states of mental distress.

scholarly journals Mental health in the general population over 1 year of the Covid-19 pandemic: findings from Ireland

2021 ◽  
Vol 31 (Supplement_3) ◽  
Author(s):  
MI Troya
Keyword(s):  
Public Health ◽  
Mental Health ◽  
General Population ◽  
Heavy Drinking ◽  
Depression And Anxiety ◽  
Suicidal Thoughts ◽  
Health Measures ◽  
Increased Risk ◽  
Self Harm ◽  
Nationally Representative

Abstract Background The effects of the Covid-19 pandemic and associated public health measures on mental health is a cause of increasing concern. We have measured indices of mental health among adults in the general population in the Republic of Ireland (ROI) during the period of May 2020-April 2021. Methods Nationally representative cross-sectional telephone survey with data collected in ROI during four study waves involving 3,920 participants: Wave 1: May 26-June 17, 2020 (N = 969), Wave 2: July 1-23, 2020 (N = 1014), Wave 3: September 5-28, 2020 (N = 1008), Wave 4: April 16-28, 2021 (N = 929). Participants were recruited from adults resident in RoI, aged 18 years+ using random-digit-dialling of land lines and mobile phones and interviewed by a professional market research organisation (Ipsos MRBI). Data from Waves 1-4 will be presented including trends over the 12-month period. Finding from Waves 1 and 2 are presented here. Mental health was assessed using the Patient Health Questionnaire Anxiety Depression Scale (PHQ-ADS), including standard questions on self-harm and/or suicidal thoughts. Results Of the 1,983 participants from Waves 1-2, 27.7% (n = 549; 95%CI:0.26%-30%) reported symptoms of depression and anxiety, 74 (3.8%;95%CI:3%-5%) disclosed self-harm and/or suicidal thoughts. Female participants (RR:1.60, 95%CI:1.37-1.87), employed individuals experiencing work change (RR:1.50,95%CI:1.24-1.82), participants cocooning due to a health condition (RR:1.34,95%CI:1.08-1.66), those self-isolating (RR:1.25,95%CI:1.03-1.51) and those reporting moderate-heavy drinking (RR:1.27,95%CI:1.09-1.47) were at increased risk of depression and anxiety symptoms. Participants aged 18-29 and those in the two lowest income categories were most likely to report self-harm and/or suicidal thoughts. Conclusions The prevalence of țanxiety and depression in the general population has increased relative to pre-pandemic estimates in response to the Covid-19 pandemic and associated public health measures. Key messages In nationally representative telephone surveys of Irish adults conducted following the onset of the Covid-19 pandemic, the prevalence of anxiety and depression is estimated at approximately 30%. Higher than average levels of anxiety or depression were reported in females, those who had experienced a change in their work, individuals cocooning and those with moderate to heavy drinking.

scholarly journals Excess risk of lower extremity amputations in people with type 1 diabetes compared with the general population: amputations and type 1 diabetes

2019 ◽  
Vol 7 (1) ◽  
pp. e000602 ◽  
Author(s):  
Arndís Finna Ólafsdóttir ◽  
Ann-Marie Svensson ◽  
Aldina Pivodic ◽  
Soffia Gudbjörnsdottir ◽  
Thomas Nyström ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
General Population ◽  
Lower Extremity ◽  
Excess Risk ◽  
Diabetes Duration ◽  
Renal Complications ◽  
Increased Risk ◽  
Type 1 Dm

ObjectiveThis study investigates how the excess risk of lower extremity amputations (amputations) in people with type 1 diabetes mellitus (DM) differs from the general population by diabetes duration, glycemic control, and renal complications.Research design and methodsWe analyzed data from people with type 1 DM from the Swedish National Diabetes Register without prior amputation from January 1998 to December 2013. Each person (n=36 872) was randomly matched with five controls by sex, age, and county (n=184 360) from the population without diabetes. All were followed until first amputation, death or end of follow-up.ResultsThe overall adjusted HR for all amputation was 40.1 (95% CI 32.8 to 49.1) for type 1 DM versus controls. HR increased with longer diabetes duration. The incidence of amputation/1000 patient-years was 3.18 (95% CI 2.99 to 3.38) for type 1 DM and 0.07 (95% CI 0.05 to 0.08) for controls. The incidence decreased from 1998–2001 (3.09, 95% CI 2.56 to 3.62) to 2011–2013 (2.64, 95% CI 2.31 to 2.98). The HR for major amputations was lower than for minor amputations and decreased over the time period (p=0.0045). Worsening in glycemic control among patients with diabetes led to increased risk for amputation with an HR of 1.80 (95% CI 1.72 to 1.88) per 10 mmol/mol (1%) increase in hemoglobin A1c.ConclusionsAlthough the absolute risk of amputation is relatively low, the overall excess risk was 40 times that of controls. Excess risk was substantially lower for those with good glycemic control and without renal complications, but excess risk still existed and is greatest for minor amputations.

scholarly journals Prevalence and correlates of domestic violence among people seeking treatment for self-harm: data from a regional self-harm register

2019 ◽  
pp. emermed-2018-207561
Author(s):  
Tom Rollo Dalton ◽  
Duleeka Knipe ◽  
Gene Feder ◽  
Salena Williams ◽  
David Gunnell ◽  
...  
Keyword(s):  
Emergency Department ◽  
Domestic Violence ◽  
General Population ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Increased Risk ◽  
Self Harm ◽  
The Uk ◽  
Previous Occurrence

BackgroundPrevious research suggests that there is an association between domestic violence (DV) and self-harm (SH). Yet, the prevalence and clinical significance of DV among individuals presenting acutely to hospital with SH in the UK is unknown.ObjectiveTo measure the prevalence and correlates of DV among patients presenting to hospital with SH.MethodsWe conducted a cross-sectional study using registry data in order to describe the prevalence of DV within a UK population of people presenting to the emergency department (ED) with SH (n=1142).Results11.1% (95% CI 9.4% to 13.1%) of the sample reported DV. Those reporting DV were more likely to be female and separated from a partner. DV was associated with self-poisoning and with previous occurrence of SH.ConclusionOur findings suggest that DV victimisation is more prevalent among those presenting to ED with self-harm than among the general population of ED attenders, and that the presence of DV may signify increased risk among those presenting to ED with SH.

scholarly journals Impact of Month of Birth on the Risk of Development of Autoimmune Addison’s Disease

2016 ◽  
Vol 101 (11) ◽  
pp. 4214-4218 ◽  
Author(s):  
Agnieszka Pazderska ◽  
Marta Fichna ◽  
Anna L. Mitchell ◽  
Catherine M. Napier ◽  
Earn Gan ◽  
...  
Keyword(s):  
United Kingdom ◽  
General Population ◽  
Addison’S Disease ◽  
Addison's Disease ◽  
Distribution Analysis ◽  
Month Of Birth ◽  
Ratio Distribution ◽  
Autoimmune Thyroid ◽  
The United Kingdom ◽  
Increased Risk

Context: The pathogenesis of autoimmune Addison’s disease (AAD) is thought to be due to interplay of genetic, immune, and environmental factors. A month-of-birth effect, with increased risk for those born in autumn/winter months, has been described in autoimmune conditions such as type 1 diabetes and autoimmune thyroid disease. Objective: Month-of-birth effect was investigated in 2 independent cohorts of AAD subjects. Design, Setting, and Patients: The monthly distribution of birth in AAD patients was compared with that of the general population using the cosinor test. A total of 415 AAD subjects from the United Kingdom cohort were compared with 8 180 180 United Kingdom births, and 231 AAD subjects from the Polish cohort were compared with 2 421 384 Polish births. Main Outcome Measures: Association between month of birth and the susceptibility to AAD. Results: In the entire cohort of AAD subjects, month-of-birth distribution analysis showed significant periodicity with peak of births in December and trough in May (P = .028). Analysis of the odds ratio distribution based on month of birth in 2 cohorts of patients with AAD versus the general population revealed a December peak and May trough, and January peak and July trough, in the United Kingdom and Polish cohorts, respectively. Conclusion: For the first time, we demonstrate that month of birth exerts an effect on the risk of developing AAD, with excess risk in individuals born in winter months and a protective effect when born in the summer. Exposure to seasonal viral infections in the perinatal period, coupled with vitamin D deficiency, could lead to dysregulation of innate immunity affecting the risk of developing AAD.

836-P: Cannabis Use in Adults with Type 1 Diabetes (T1D) Is Associated with Poor Glycemic Control and Increased Risk for Diabetic Ketoacidosis (DKA)

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 836-P ◽  
Author(s):  
VIRAL N. SHAH ◽  
DANIEL D. TAYLOR ◽  
NICOLE C. FOSTER ◽  
ROY BECK ◽  
HALIS K. AKTURK ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Diabetic Ketoacidosis ◽  
Cannabis Use ◽  
Poor Glycemic Control ◽  
Increased Risk

CLINICAL CHALLENGES FOR ANESTHESIOLOGIST FACING PATIENT WITH ACROMEGALY. CASE REPORT

2020 ◽  
Vol 30 (3) ◽  
pp. 56-59
Author(s):  
Jūratė Gudaitytė ◽  
Justina Jermolajevaitė ◽  
Martynas Judickas
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
General Population ◽  
Metabolic Disorders ◽  
Upper Airway ◽  
Cardiovascular Complications ◽  
Case Presentation ◽  
Increased Risk ◽  
Fluid Regulation ◽  
Class Iv

Background and objectives: Acromegaly is endocri­nal disorder which results in changes involving ge­neral appearance as well as upper airway abnorma­lities, cardiovascular and metabolic disorders which can aggravate the anesthesia and can lead to compli­cations. We aim to discuss the challenges for anesthe­siologist that occurs facing patient with acromegaly and are necessary to investigate before performing any kind of intervention. Case Presentation: 79 years old male patient presen­ted the hospital with recently diagnosed acromegaly for rectal prolapse surgery. From anamnesis he had NYHAIII with cardiomyopathy, atrial fibrillation and arterial hypertension, also multiple old compressive fractures Th10 – L5. He was graded with Mallam­pati score IV and ASA class IV. The complemen­tary examinations were made to assess the possible complications. In induction of general anesthesia the intubation was performed using fibro- bronchoscope and anesthesia went without complications except hypotension which was managed. After surgery the patient was leaded to the postoperative room for furt­her monitoring. Discussion and Conclusion: Acromegalic patients have an increased risk of difficulty during anesthe­sia compared to general population due to difficult intubation, cardiovascular complications , OSA , alte­ration in intraoperative glucose intolerance and fluid regulation. Therefore profound investigation and as­sessment are necessary to predict and prepare for possible difficulties in the surgery room.

scholarly journals Cardiovascular disease risk factors of ultra-Orthodox Jewish women in Israel: a comparison study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Leiter ◽  
K L Greenberg ◽  
M Donchin ◽  
O Keidar ◽  
S Siemiatycki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
General Population ◽  
Secondhand Smoke ◽  
Smoke Exposure ◽  
Orthodox Jewish ◽  
Minority Population ◽  
Secondhand Smoke Exposure ◽  
Community Based ◽  
Increased Risk

Abstract Background Women from low socio-economic, culturally insular populations are at increased risk for cardiovascular disease (CVD). The ultra-Orthodox Jewish (UOJ) community in Israel is a difficult to access, rapidly growing low socio-economic, insular minority with numerous obstacles to health. The current study investigates CVD-related risk factors (RF) in a sample of OUJ women, comparing sample characteristics with the general population. Addressing the questions, 'Are UOJ women at increased risk for CVD?', 'Which RFs should be addressed beyond the general population's?', this study can inform public health initiatives (PHI) for this and similar populations. Methods Self-administered questionnaires completed by a cluster randomized sample of 239 women from a UOJ community included demographics, fruit, vegetables, and sweetened drink consumption, secondhand smoke exposure, physical activity (PA) engagement, and BMI. Population statistics utilized for comparison of demographic and cardiovascular risk factors were obtained from government-sponsored national surveys. Results Compared with the general population, UOJ women were less likely to consume 5 fruits and vegetables a day (12.7% vs. 24.3%, p<.001) and more likely to consume > 5 cups of sweetened beverages a day (18.6% vs. 12.6%, p=.019). UOJ women also reported less secondhand smoke exposure (7.2% vs. 51.4%, p<.001) and higher rates of PA recommendation adherence (60.1% vs. 25.6%, p<.0001) than the general population. Obesity was higher in UOJ women (24.3% vs. 16.1%, p<.0001). Conclusions This study suggests that PHIs in this population target healthy weight maintenance, nutrition, and PA. As a consequence of this study, the first CVD prevention intervention has been implemented in this population, targeting the identified RFs. Utilizing a mixed methods and community-based participatory approach, this innovative 3-year intervention reached over 2,000 individuals. Key messages This study identified nutrition risk behaviors and high levels of obesity in a difficult to access, minority population. This study informed the planning and implementation of a community-based PHI.

Improving Safety of Bilateral Knee Arthroplasty: Impact of Selection Criteria on Perioperative Outcome

2021 ◽  
pp. 155633162110148
Author(s):  
Philipp Gerner ◽  
Stavros G. Memtsoudis ◽  
Crispiana Cozowicz ◽  
Ottokar Stundner ◽  
Mark Figgie ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Selection Criteria ◽  
Perioperative Complications ◽  
Perioperative Outcomes ◽  
Cardiac Complications ◽  
Complication Rates ◽  
Major Complications ◽  
Increased Risk ◽  
Comorbidity Burden ◽  
Rate Ratios

Background: Bilateral total knee arthroplasty (BTKA) procedures are associated with an increased risk of complications when compared with unilateral approaches. In 2006, in an attempt to reduce this risk, our institution implemented selection criteria that specified younger and healthier patients as candidates for BTKA. Questions/Purpose: We sought to investigate the effect of these selection criteria on perioperative outcomes. Methods: In a retrospective cohort study, we used institutional data to identify patients who underwent BTKA between 1998 and 2014. Patients were divided into 2 groups: those who underwent surgery before the 2006 introduction of our selection criteria (1998–2006) and those who underwent surgery after (2007–2014). Groups were compared in terms of demographics, comorbidity burden, and incidence of perioperative complications. Regression analysis was performed, calculating incidence rate ratios to evaluate changes in complication rates. Results: Before the selection criteria were implemented in 2006, patients who underwent BTKA were older and had a higher comorbidity burden. The rate of major complications per 1000 hospital days decreased from 31.5 in 1998 to 7.9 in 2014. A reduction in cardiac complications was the most significant contributor to this decrease in major complications. Conclusion: After stringent criteria for BTKA candidates were implemented at our institution, selection of younger patients with lower comorbidity burden was accompanied by a reduction in the incidence of operative complications. This suggests that introducing such criteria can be associated with a reduction in adverse perioperative outcomes.

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