scholarly journals A review of patients presenting to accident and emergency department with deliberate self-harm, KwaZulu-Natal, South Africa

Author(s):  
Josephat O. Ani ◽  
Andrew J. Ross ◽  
Laura M. Campbell

Background: The World Health Organization has described deliberate self-harm (DSH) as a major global health challenge. Little is known about the profile of patients admitted following DSH at district and regional combo hospitals in KwaZulu-Natal, South Africa.Aim: The aim of this study was to assess the profiles of patients and reasons for admission following DSH.Setting: The study was conducted on data from a busy Accident and Emergency (A&E) department in a combination district and regional hospital situated in Empangeni in northern KwaZulu-Natal.Method: This was a retrospective descriptive study. Data were collected from charts of all patients admitted to the A&E department from April 2012 to March 2013 following DSH. Variables assessed included age, gender, race, occupation, religion, education level, coexisting medical and mental health conditions, and reasons for DSH. Data were entered into SPSS and analysed descriptively.Results: A total of 262 charts were identified and 215 (82%) were selected for inclusion. Most patients admitted following DSH were young, single African women with at least secondary-level education. Most (169/215;78%) admissions were for parasuicide, with relational issues contributing in more than 50% of cases and circumstance challenges contributing in just under 30%.Conclusion: Although an underestimation, DSH is not an uncommon reason for patients to present in the A&E at this district and regional combo hospital. Findings from this study are consistent with those of other studies on DSH and highlight the need for a validated screening tool for the identification of patients at risk of DSH. There is a need to explore community-based intervention, which could address reasons for DSH and prevent future admissions.

Author(s):  
Nader Henry ◽  
Sunil Parthiban ◽  
Azzam Farroha

Objective The World Health Organization declared COVID-19 a pandemic on 11th March 2020. The UK government introduced strict social distancing measures on 23rd March 2020, with the country put into a full lockdown to further halt the spread of the virus. The aims of this article are to ascertain whether there was a rise in the incidence of deliberate self-harm (DSH) presentations to the emergency department at a level one trauma center associated with the introduction of lockdown measures. Method An observational study from a level one trauma center was carried out. Retrospective data from 23rd March 2020 to 1st May 2020 was collected and compared to the same time period in 2019. Data was collected from coded electronic patient records. Results Total attendances to the Emergency Department (ED) reduced from 2019 to 2020 (5198 and 3059 respectively). There was a significant increase in the total number of self-harm presentations between 2019 and 2020 (103 vs 113, p-value <0.001) as well as paracetamol, NSAID and opiate overdoses, with more cases requiring hospital admission in 2020 vs 2019. Conclusions Societal lockdown measures secondary to the COVID-19 pandemic have had a significant effect on the mental health of patients. One way this can be detected is through an increased incidence and severity of deliberate self-harm injuries presenting to the ED. These findings, in conjunction with the available, literature provide valuable implications for community and emergency physicians and psychiatrists for any future wave of disease or pandemic.


Author(s):  
Grigoris Gerotziafas ◽  
Mariella Catalano ◽  
Ioannis Theodorou ◽  
Patrick van Dreden ◽  
Vincent Marechal ◽  
...  

One year after the declaration of the COVID-19 pandemic by the World Health Organization (WHO) and despite the implementation of mandatory physical barriers and social distancing, humanity remains challenged by a long-lasting and devastating public health crisis. Non-pharmacological interventions (NPI) are efficient mitigation strategies. The success of these intense NPI is dependent on the approval and commitment of the population. The launch of a mass vaccination program in many countries in late December 2020 with mRNA vaccines, adenovirus-based vaccines, and inactivated virus vaccines has generated hope for the end of the pandemic. Current issues: The continuous appearance of new pathogenic viral strains and the ability of vaccines to prevent infection and transmission raise important concerns as we try to achieve community immunity against SARS-CoV-2 and its variants. The need of a second and even third generation of vaccines and the possibility of potentially harmful side-effects of the vaccines (i.e. venous thromboembolism ) have already been acknowledged. Perspectives: There is a critical and urgent need for a balanced and integrated strategy for the management of the COVID-19 outbreaks organized on three axes: (1) Prevention of the SARS-CoV-2 infection, (2) Detection and early diagnosis of patients at risk of disease worsening, and (3) Anticipation of medical care (PDA). Conclusion: The “PDA strategy” integrated into state policy for the support and expansion of health systems and introduction of digital organization (i.e. telemedicine, artificial intelligence and machine learning technology) is of major importance for the preservation of citizens’ health and life world-wide.


2021 ◽  
pp. 8-10
Author(s):  
Niraj Kumar Singh ◽  
Ayan Ghosh ◽  
Debrashi Jana

INTRODUCTION: India is the second largest contributor to Rabies mortality in the world. According to a recent report of World Health Organization (WHO), approximately 55,000 human deaths are reported every year worldwide due to rabies, with an overwhelming majority of 32,000 cases reported in Asia of which 20,000 occur in India. AIMS: The general awareness about the rabies in general population, awareness of people about anti rabies vaccines and health services utilization. MATERIAL AND METHOD: The study was an observational, questionnaire-based study. For the purpose of this thesis, a descriptive co relational analytical survey was used, in which a qualitative approach was undertaken to determine the answers of mentioned research questions. st st The study was slum to the general people. The expected duration of the study was approximately six months between 1 January 2019 to 30 Dec 2019. RESULTAND DISCUSSION:We found that 77(51.3%) patients answered that on being bitten from an infected animal, both people and animals can get rabies, 46(30.7%) patients answered that on several sorts of contact with an infected animal (e.g. bite, lick, scratch) people and animals can get rabies and 27(18.0%) patients don't know how can people and animals get rabies. It was found that 113(75.3%) patients had answered that the person who is infected with rabies gets crazy/mad/dangerous, 10(6.7%) patients had answered that the person who is infected with rabies of some can get better/get treatment/do not die and 27(18.0%) patients had answered they don't know about the outcome of the treatment. It was found that 60(40.0%) patients had answered rabies treatable, 63(42.0%) patients had answered no and 27(18.0%) patients had answered do not know. We found that 145(96.7%) patients preferred to take Anti-rabies vaccine. 75(50.0%) patients answered yes, these vaccines available free of cost in govt. hospitals, 82.0% of the study populations were found to have heard about rabies; Most of them had good knowledge regarding rst-aid measures. Our ndings indicate that the urban community has good knowledge about rabies but unfortunately, they are unaware about rabies fatality. Hence, there is need to create awareness regarding wound management and post-exposure immunization. CONCLUSION:The knowledge, attitude and practices with respect to prevention and treatment of rabies were found adequate amongst the urban population. Thus, community based health education may be increased in these areas to create awareness regarding rabies.


2006 ◽  
Vol 3 (1) ◽  
pp. 5-7
Author(s):  
Carolina de Mello-Santos ◽  
José Manoel Bertolote ◽  
Yuan-Pang Wang

Brazil is the largest and most populous country in South America (in 2002 the population was approximately 175 million). Although life expectancy in Brazil has increased, suicide and other forms of injury-related mortality, such as homicide and accident, have increased as a proportion of overall mortality (Oswaldo Cruz Foundation, 1984; Brazil Ministry of Health, 2001). The suicide rate in Brazil (3.0–4.0 per 100 000 inhabitants) is not considered high in global terms (World Health Organization, 1999). Nevertheless, it has followed the world tendency towards growth: during 1980–2000, the suicide rate in Brazil increased by 21%. Elderly people present the highest suicide rates in absolute numbers, but the alarming finding in the Brazilian data is that the youth population is increasingly dying by suicide (Mello-Santos et al, 2005). This statistic partially confirms a forecast by Diekstra & Guilbinat (1993) that the number of deaths by suicide would dramatically increase over the next decades, mainly in developing countries, including Latin America. In these regions, socio-economic factors (such as an increase in divorce and unemployment and a decrease in religiosity) increase the risk of self-harm. We discuss the reasons for the low suicide rate in Brazil and highlight the socio-economic factors affecting its increase among the youth population in particular.


2019 ◽  
Vol 7 (1) ◽  
pp. 51
Author(s):  
Vika Gress Vio Dilita ◽  
Lucia Yovita Hendrati

Background: According to the World Health Organization (WHO), Indonesia is one of the ten countries with the most significant number of measles cases in the world. Immunization coverage in Trenggalek Regency has reached the target of prevention of measles in the elimination stage, namely measles immunization coverage> 95%, the incidence of measles persists and increases in the last three years, from 2013 to 2015. Purpose: This study aimed to evaluate the trends between measles immunization status and the provision of vitamin A with the incidence of measles in Trenggalek Regency. Methods: This type of research is an observational study with a cross-sectional study design. The sample population is consist of 14 sub-districts in Trenggalek Regency. Data was taken from the health profile of Trenggalek Regency in 2013, 2014, and 2015. In this study, data processing were analysed by Health Mapper application version 4.3.0.0 with product version 4.03 to determine data descriptively. Results: Distribution of measles incidence with immunization coverage in Trenggalek Regency in 2013, 2014, and 2015 showed that measles incidence tended to increase followed with the decreasing number of measles immunization coverage each year. Ironically, the distribution of measles incidence with vitamin A administration in 2013, 2014, and 2015 showed the incidence of measles had increased because of the inconsistent amount of vitamin A administration. Conclusion: Measles incidence tends to occur in low immunization coverage areas and has decreased from the previous year. Giving vitamin A does not prevent the occurrence of measles, but serves to reduce compilation.


2021 ◽  
pp. bmjsrh-2021-201242
Author(s):  
Rebecca Blaylock ◽  
Shelly Makleff ◽  
Katherine C Whitehouse ◽  
Patricia A Lohr

IntroductionThe National Institute for Health and Care Excellence, the Royal College of Obstetricians and Gynaecologists and the World Health Organization recommend that services provide a choice between medical and surgical methods of abortion. We analysed qualitative study data to examine patient perspectives on abortion method choice and barriers to meeting them.MethodsIn-depth interviews with 24 clients who had an abortion at British Pregnancy Advisory Service clinics were carried out between December 2018 and July 2019 to examine perspectives of quality of abortion care. In this article we focus on client perspectives on choice of abortion method. We performed thematic analysis of data relating to choice of abortion method, refined the analysis, interpreted the findings, and organised the data into themes.ResultsParticipants’ preferences for abortion method were shaped by prior experience of abortion, accessibility and privacy, perceptions of risk and experiences of abortion method, and information gathering and counselling. Participants’ ability to obtain their preferred method was impacted by intersecting constraints such as appointment availability, service location and gestational age.ConclusionsOur findings show that many factors shape participants’ preferences for abortion method. In response to the COVID-19 pandemic, some abortion services have constrained abortion method choices, with an emphasis on medical abortion and ‘no-touch’ care. Providers in the UK and beyond should aim to restore and expand more treatment options when the situation allows.


2002 ◽  
Vol 19 (3) ◽  
pp. 84-85 ◽  
Author(s):  
Helen S Keeley ◽  
Carmel McAuliffe ◽  
Paul Corcoran ◽  
Ivan J Perry

AbstractObjective: The aim of this paper is to assess the level of agreement between clinical estimates of suicidal intent based entirely on information recorded in the Accident and Emergency acute assessment and Beck's Suicide Intent Scale (SIS) scores.Method: As part of the WHO/EURO Multicentre Study of Parasuicide, cases of deliberate self-harm (DSH) in Cork city hospitals were monitored. Over the period 1995-1997, the information recorded in the Accident and Emergency acute assessment was examined by a psychiatrist and, if possible on the available evidence, clinical estimates were made at three levels of suicidal intent: minimal, moderate and definite. Seventy-nine of these cases had fully completed Beck's SIS. Statistical comparison was made between the results of the SIS and the clinical estimate of suicide intent.Results: The agreement (Kappa = 0.146, p = 0.046) and concordance (Lin's concordance coefficient = 0.330, p = 0.001) between the two ratings are statistically significant but both are low. The overlap between those identified as high or low intent is low.Conclusions: These findings indicate low agreement between a clinician's rating of suicide intent based on clinical records and Beck's SIS. This is especially relevant given the increasing reliance on psychometric instruments in assessment in psychiatry. However, further investigation is necessary to clarify which is the more valid method.


2000 ◽  
Vol 176 (2) ◽  
pp. 126-131 ◽  
Author(s):  
Jane Hurry ◽  
Pamela Storey

BackgroundMany young people who harm themselves have chronic mental health or social problems or are at risk of future self-harm or even suicide. The accident and emergency (A&E) clinic is an important gateway to treatment.AimsTo describe the psychosocial assessment of 12- to 24-year-old patients attending A&E clinics following deliberate self-harm (DSH) and to identify features of service management and provision which maximise specialist assessment.MethodA postal questionnaire was sent to a sample of one in three A&E departments in England. In a representative sample of 18 of these hospitals, staff were interviewed and 50 case notes per hospital were examined.ResultsPsychosocial assessment by non-specialist doctors in A&E departments tended to be of variable quality, focused on short-term risk. Around 43% of patients aged 12–24 were assessed by a specialist; specialist assessment was associated with high admission rates and the presence of on-site psychiatric departments and DSH teams.ConclusionsYoung DSH patients at risk often go unidentified; as a result their psychological problems may not be treated. Hospitals are frequently unaware of the proportion of patients discharged without adequate assessment.


1997 ◽  
Vol 21 (6) ◽  
pp. 334-335 ◽  
Author(s):  
Gill Turnbull ◽  
Trudie Chalder

Accident and emergency (A&E) staff completed a general knowledge and attitude questionnaire related to suicide and deliberate self-harm (DSH) before and after a teaching package. The results showed an increase in general knowledge while attitudes remained the same. Following the teaching package there was an increase in the number of patients who contacted the Specialist Service for DSH.


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