Psychiatric services utilization in completed suicides of a youth centres population

BACKGROUND: From a retrospective study of youth centres (YCs) and coroner's files, we investigated youths' history of medical service utilization who died by suicide. This is the second of two papers on YCs population, the first paper having shown that the rate of psychopathology was higher in the YCs population compared to the general adolescent population. METHODS: From 1995 to 2000, 422 youths, aged 18 years and younger, died as a result of suicide in Quebec. More than one-third received services from YCs at some point. Using the provincial physician payment and hospitalization database, we examined physical and psychiatric service utilization according to time intervals, as well as hospitalization for psychiatric reasons in the individuals' lifetime and in the year preceding suicide. Suicides were matched to living YCs youths for age, sex, and geographic area. YCs controls were then subdivided into two groups based on file information pertaining to the presence or absence of suicidal behavior or ideation. RESULTS: Compared to living YCs youths, suicides had a higher rate of psychiatric service utilization in the week, month, 90 days, and year preceding suicide, as well as higher levels of lifetime hospitalization for psychiatric reasons than controls with or without a history of suicidal behavior or ideation. We found that 28.3% YCs suicides made use of psychiatric services in the year preceding suicide. CONCLUSION: The rate of psychiatric service utilization by YCs youth suicides is substantially inferior to the needs of this population. Our study underscores the need for appropriate recognition of psychiatric and suicidal problems among YCs population by social and psycho-educational professionals. At the same time, it highlights the issues of general practitioners' risk identification, psychiatric referral and treatment. Our findings suggest the need for improved organization and coordination of psychiatric services to ameliorate treatment delivery

Evaluation of a community health center model for urban China

The Community health centre model intervention comprised four aspects: creating a new clinical model, improving coordination of care, restructuring financial management, and integrating clinical information systems. Financial management would involve prepaid fundholding arrangements with insurance institutions and government funds for the poor, and provider payment based on health outcomes and patient satisfaction. Clinical information systems would be implemented for quality assurance, evaluation, and strategic planning. The evaluation measures the level of implementation of the intervention and its effects, and evaluates the impact of contextual influences on the intervention

Extra-pair paternity in the monogamous Alpine marmot revealed by nuclear DNA microsatellite analysis

Times Cited: 58International audienceThe genetic parentage and pedigrees of 35 litters from 12 family groups of monogamous Alpine marmot (Marmota marmota) in the French Alps were analyzed using six hypervariable sequence repeat nuclear loci (microsatellites). All of the members of these family groups were sampled during a 5-year period. Hairs taken directly from animals served as a source of DNA for amplification of the loci. Our results indicate that the genetic mating system of the Alpine marmot is quite different from a strictly monogamous breeding system. Extra-pair paternity occurred in 11 of the 35 litters (31.4%). Of the 134 juveniles typed, 26 (19.4%) could be attributed to extra-pair copulation (EPC). We examine hypotheses which could explain the evolution of EPC and discuss the different patterns of extra-pair mating

Routine versus selective cardiac magnetic resonance in non-ischemic heart failure - OUTSMART-HF: Study protocol for a randomized controlled trial (IMAGE-HF (heart failure) project 1-B)

© 2013 Paterson et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Imaging has become a routine part of heart failure (HF) investigation. Echocardiography is a first-line test in HF given its availability and it provides valuable diagnostic and prognostic information. Cardiac magnetic resonance (CMR) is an emerging clinical tool in the management of patients with non-ischemic heart failure. Current ACC/AHA/CCS/ESC guidelines advocate its role in the detection of a variety of cardiomyopathies but there is a paucity of high quality evidence to support these recommendations. The primary objective of this study is to compare the diagnostic yield of routine cardiac magnetic resonance versus standard care (that is, echocardiography with only selective use of CMR) in patients with non-ischemic heart failure. The primary hypothesisis that the routine use of CMR will lead to a more specific diagnostic characterization of the underlying etiology of non-ischemic heart failure. This will lead to a reduction in the non-specific diagnoses of idiopathic dilated cardiomyopathy and HF with preserved ejection fraction.Design: Tertiary care sites in Canada and Finland, with dedicated HF and CMR programs, will randomize consecutive patients with new or deteriorating HF to routine CMR or selective CMR. All patients will undergo a standard clinical echocardiogram and the interpreter will assign the most likely HF etiology. Those undergoing CMR will also have a standard examination and will be assigned a HF etiology based upon the findings. The treating physician's impression about non-ischemic HF etiology will be collected following all baseline testing (including echo ± CMR). Patients will be followed annually for 4 years to ascertain clinical outcomes, quality of life and cost. The expected outcome is that the routine CMR arm will have a significantly higher rate of infiltrative, inflammatory, hypertrophic, ischemic and 'other' cardiomyopathy than the selective CMR group.Discussion: This study will be the first multicenter randomized, controlled trial evaluating the role of CMR in non-ischemic HF. Non-ischemic HF patients will be randomized to routine CMR in order to determine whether there are any gains over management strategies employing selective CMR utilization. The insight gained from this study should improve appropriate CMR use in HF. Trial registration: NCT01281384. © 2013 Paterson et al.; licensee BioMed Central Ltd