The impact of assessment on repeat deliberate self-harm

Deliberate self-harm is a pervasive issue that is the topic of worldwide clinical and research focus. Among the extensive research findings two salient issues emerge that provide the foundation for this study. The first is that a deliberate self-harm attempt is a significant risk factor for future attempts. The second is that a comprehensive assessment of a person presenting with an incident of deliberate self-harm can reduce further deliberate self-harming behaviour. A limitation of existing research is that no study has clearly identified the nature of assessments that impact on the likelihood of future self-harm attempts. The initial aim of this study was to replicate studies that explored the impact of an assessment after a deliberate self-harm episode, using Western Australian data. It was anticipated that the risk of a re-presentation will be reduced by increasing the likelihood that representation would take longer if an assessment was undertaken. It was also anticipated that some types of assessment would be more beneficial than others. A further aim of this study was to determine what the relevant health professionals believed led to this outcome, in particular, if one type of assessment was more beneficial than the others. In order to achieve these aims the research team examined data of patients who presented to the emergency departments of three teaching hospitals in Perth, Western Australia between 1995 and 2004 and had reported a deliberate self-harm attempt. A total of 8656 files were examined, from a total of 13,500 presentations during this period. Cox proportional hazards regression showed that compared to patients who had no assessment, the time between initial presentation and any further presentation for a self harm episode at one of the participating hospitals was significantly longer for those who received an assessment. Those who received either a social work assessment, or both a social work and mental health assessment, were significantly more likely to take longer to re-present. In an attempt to identify the content of the social work assessment that may have impacted on these findings the researcher interviewed six practitioners who undertook these assessments. These interviewees reported the relationship they established with patients; their exploration of the psychosocial context of the patient; and their conviction that the assessment is in itself an intervention, as the distinguishing factors of these assessments. Based on these findings, it is hypothesized that a psychosocial approach may be influential when conducting assessments of deliberate self harm. These assessments may benefit from a focus on developing a relationship with the client, combined with an attempt to resolve identified needs and should this occur during the assessment it may impact on future self harming behaviours

Does an Intervention Need to be Personalised to be More Effective in Changing Intentions, Motivations, Attitudes and Fear Arousal Towards Sun Protection?

Previous health campaigns promoting sun-safe practices have not been as successful as would have been hoped in reducing the incidences of skin cancer in Australia. In the past, health-based and education-based messages have been used in these interventions to try to reduce the rate of intentional sun exposure. The present literature review concludes that health-based and education-based campaigns have been successful in increasing knowledge regarding the negative consequences of excessive sun exposure, however, what all these campaigns fail to take into consideration is the primary reason behind intentional tanning, which is the fact that people tan because they think it makes them look more attractive and healthy. Recently, interventions using appearance-based messages that counter this view have been examined. Results from an appearance-based approach focusing on attractiveness of tans have been more successful, although are still limited regarding their effect on intentions, motivations, attitudes and fear arousal towards sun protection. The most recent direction research has taken is to show participants what the sun has actually done to their appearance through the use of ultraviolet photographs. The few studies undertaken using this strategy have shown promising results by allowing participants to see the damage, not normally visible to the naked eye, that the sun has already caused. The present literature review concludes that personalising an intervention through the use of ultraviolet photographs in addition to an appearance-based message may be more effective in changing intentions, motivations, attitudes and fear arousal towards sun protection than an appearance-based message that was not personalised

The Effects of Intracerebral Injections of Substance P, and a Substance P Fragment (5-11) into the Medial Preoptic Nucleus on Lordosis Behavior in the Female Rat

In this study either substance P (SP), SP 5-11, an analogue resistant to enzymatic degradation, or acidified saline was injected bilaterally into the medial preoptic nucleus (MPN) of the medial preoptic area (MPOA) in ovariectomized (ovx) estrogen-primed female rats. The lordosis quotient (LQ) and the lordosis intensity scale (LIS) were recorded using a steroid regime that produced a slow increase of sexual receptivity. In experiment 1, when receptivity was low, bilateral injections of 2 different doses of SP (100 ng,1000 ng/ cannula), had no effect on lordosis behavior when compared to those injected with acidified saline. In experiment , however, when receptivity was maximal, SP 5-11 (1000 ng/cannula) produced a marked decrease in lordosis responding. The results indicate t.hat the effects of bilateral injections of SP on lordosis behavior is dependent on the level of sexual receptivity, and therefore, estrogen levels

ESTIMATING IMPORT DEMAND IN THE MEXICAN CHEESE MARKET

Mexico is the fastest growing market for US dairy exports and it is the largest market for U.S. cheese. The U.S. has always enjoyed a large share of the Mexican cheese market. However, its share growth has been less dynamic than the share of Europe, Oceania and other countries, despite advantages in proximity, shipping costs, and delivery times. We use an Almost Ideal Demand System to estimate own and cross-price elasticities in the Mexican cheese import market to assess the comparative position of the U.S. relative to other cheese market participants.Demand and Price Analysis, International Relations/Trade,

Evaluating Food Commodity Procurement Strategies

We use a case study approach to determine the primary factors affecting food manufacturers' commodity procurement decisions, as well as to examine the strategic nature of commodity procurement departments. The research fills a gap in both the commodity and procurement literature. A large literature exists on commodity marketing; however, very little exists on the topic of commodity procurement. Existing procurement literature tends to focus on non-commodity products rather than commodity products. The results suggest a model for the strategic role of commodity procurement departments within food manufacturers. The initial procurement strategy must be supply maintenance, which once accomplished, allows the commodity procurement department to progress to a profit-focused strategy, which is generally cost-based. Finally, the role of the commodity procurement department can expand by offering additional services to customers, such as designing promotional programs.Marketing,

A randomised controlled comparison of early post-pyloric versus early gastric feeding to meet nutritional targets in ventilated intensive care patients

To compare outcomes from early post-pyloric to gastric feeding in ventilated, critically ill patients in a medical intensive care unit (ICU).Prospective randomized study. Ventilated patients were randomly assigned to receive enteral feed via a nasogastric or a post-pyloric tube. Post-pyloric tubes were inserted by the bedside nurse and placement was confirmed radiographically.A total of 104 patients were enrolled, 54 in the gastric group and 50 in the post-pyloric group. Bedside post-pyloric tube insertion was successful in 80% of patients. Patients who failed post-pyloric insertion were fed via the nasogastric route, but were analysed on an intent-to treat basis. A per protocol analysis was also performed. Baseline characteristics were similar for all except Acute Physiology and Chronic Health Evaluation II (APACHE II) score, which was higher in the post-pyloric group. There was no difference in length of stay or ventilator days. The gastric group was quicker to initiate feed 4.3 hours (2.9 - 6.5 hours) as compared to post-pyloric group 6.6 hours (4.5 - 13.0 hours) (P = 0.0002). The time to reach target feeds from admission was also faster in gastric group: 8.7 hours (7.6 - 13.0 hours) compared to 12.3 hours (8.9 - 17.5 hours). The average daily energy and protein deficit were lower in gastric group 73 Kcal (2 - 288 Kcal) and 3.5 g (0 - 15 g) compared to 167 Kcal (70 - 411 Kcal) and 6.5 g (2.8 - 17.3 g) respectively but was only statistically significant for the average energy deficit (P = 0.035). This difference disappeared in the per protocol analysis. Complication rates were similar.Early post-pyloric feeding offers no advantage over early gastric feeding in terms of overall nutrition received and complicationsanzctr.org.au:ACTRN12606000367549

A Tri-state Investigation of Firearms Confiscation on Three Regional University Campuses

While the use of firearms is pronounced throughout the US, there are few studies that address the availability of firearms on university campuses in states that are adjacent to each other. This study uses a five-year longitudinal design to investigate three universities that were randomly selected in the neighboring states of North Carolina, Virginia, and South Carolina to examine the extent of firearm confiscation by public safety officers. In the final analysis, we conclude that unless viable strategies that target preventing firearms used in domestic violence, alleviating access to guns, and addressing mental health illnesses among college students are created to effectively confiscate firearms on university campuses, deadly violence could become an inevitable occurrence

Meat goat marketing and price seasonality

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