The impact of the COVID-19 pandemic on presentations of self-harm over an 18-month period to a tertiary hospital

OBJECTIVES

To examine and compare rates and methods of self-harm presenting to a tertiary referral hospital during an 18-month period since the onset of the COVID-19 pandemic with a similar period immediately prior to the pandemic onset.

METHODS

Data from an anonymized database compared rates of self-harm presentations and methods employed between 1st March 2020 and 31st August 2021 to a similar time-frame prior to the onset of the COVID-19 pandemic.

RESULTS

A 9.1% increase in presentations with self-harm was noted since the onset of the COVID-19 pandemic. Periods of more stringent restrictions were associated with higher levels of self-harm (daily rate of 2.10 v 0.77). A higher lethality of attempt was demonstrated post-COVID-19 onset (χ2 = 15.38, p < 0.001). Fewer individuals presenting with self-harm were diagnosed with an adjustment disorder since the onset of the COVID-19 pandemic (n = 84, 11.1%, v. n = 112, 16.2%, χ2 = 7.898, p = 0.005), with no other differences pertaining to psychiatric diagnosis noted. More patients actively engaged with mental health services (MHS) presented with self-harm (n = 239 (31.7%) v. n = 137, (19.8%), χ2 = 40.798, p ≤ 0.001) since the onset of the COVID-19 pandemic.

CONCLUSIONS

Despite an initial reduction, an increase in rates of self-harm has occurred since the onset of the COVID-19 pandemic with higher rates evident during periods of higher government mandated restrictions. An increase in active patients of MHS presenting with self-harm potentially relates to reduced availability of supports and particularly group activities. The recommencement of group therapeutic interventions for individuals attending MHS in particular is warranted.

Local and Nanoscale Methanol Mobility in Different H-FER Catalysts

The dynamical behaviour of methanol confined in zeolite H-FER has been studied using quasielastic neutron scattering (QENS) and classical molecular dynamics (MD) simulations to investigate the effects of the Si/Al...

Molecular behaviour of phenol in zeolite Beta catalysts as a function of acid site presence: a quasielastic neutron scattering and molecular dynamics simulation study

The dynamic behaviour of phenol in zeolite Beta is strongly influenced by the presence of Brønsted acid sites.

Effectiveness of 2010/2011 seasonal influenza vaccine in Ireland

We conducted a case-control study to estimate the 2010/2011 trivalent influenza vaccine effectiveness (TIVE) using the Irish general practitioners' influenza sentinel surveillance scheme. Cases were influenza-like illness (ILI) patients with laboratory-confirmed influenza. Controls were ILI patients who tested negative for influenza. Participating sentinel general practitioners (GP) collected swabs from patients presenting with ILI along with their vaccination history and other individual characteristics. The TIVE was computed as (1 - odds ratiofor vaccination) x100%. Of 60 sentinel GP practices, 22 expressed interest in participating in the study and 17 (28%) recruited at least one ILI patient. In the analysis, we included 106 cases and 85 controls. Seven controls (8.2%) and one influenza case (0.9%) had been vaccinated in 2010/2011. The estimated TIVE against any influenza subtype was 89.4% [95% CI: 13.8; 99.8%], suggesting a protective effect against GP-attended laboratory confirmed influenza. This study design could be used to monitor influenza vaccine effectiveness annually but sample size and vaccination coverage should be increased to obtain precise and adjusted estimates.

Abstract S2-6: Aromatase Inhibitors and Risk of Myocardial Infarction, Stroke and Fracture

Randomized trials have demonstrated that aromatase inhibitors (AI's) are more effective than tamoxifen in preventing breast cancer recurrence. Since many women with early stage disease have a modest risk of recurrence, it is important to consider carefully the potential side effects of treatments in this setting. Trials have suggested increased risk of fracture is the only serious side effect of AI's, but study participants are often healthier than the general population, and little is known about toxicities of AI's in nontrial populations. We sought to evaluate the association between use of AI's and the incidence of myocardial infarction (MI), stroke, and fracture in community-based populations.

Methods: Using encounter and pharmacy data from WellPoint plans in the HealthCore Integrated Research Database, 44,463 women aged ≥50 years with at least 2 diagnosis codes for breast cancer between 2001 and 2007 were identified and followed through the end of 2008. We used propensity score methods to identify matched controls from a cohort of 88,101 women aged ≥50 years enrolled in WellPoint plans who had no diagnosis codes for breast cancer. We identified receipt of aromatase inhibitors and tamoxifen and used Cox proportional hazards models with time-varying treatment variables to assess whether treatment with aromatase inhibitors or tamoxifen was associated with MI, stroke, and fracture among women with breast cancer and to assess the association of breast cancer with the outcomes of interest.

Results: Among 44,049 breast cancer patients and 44,049 matched controls, the average age was 67 and 87% of cases and controls had no baseline comorbidities. After a median follow-up of 899 days for cases and 1004 for controls, 1.3% of women had an MI, 2.9% an ischemic stroke, 1.5% a hip fracture and 9.5% any fracture. Breast cancer patients treated with AI's had a significantly lower adjusted hazard of ischemic stroke and a significantly higher adjusted hazard of fracture compared with breast cancer patients not receiving an AI or tamoxifen.

Table. Adjusted hazard ratio (95% CI) associated with breast cancer and hormonal therapy

Treatment with AI or tamoxifen was not associated with MI or any fracture. Patients treated with tamoxifen had a significantly lower adjusted hazard of stroke and hip fracture compared with breast cancer patients not receiving hormonal therapy.

Conclusion: The side effect profile of AI's in this community-based population was similar to that seen in clinical trials and suggests that these drugs are associated with few serious side effects.

Inreach and outreach interventions to improve mammography use

OBJECTIVE

to assess the effectiveness of patient-targeted interventions in increasing mammography use when performed outside (outreach) or inside the primary care medical setting (inreach).

METHODS

We performed a meta-analysis of controlled interventions to increase mammography use in patients in the United States published between 1980 and February 2001. Interventions were classified by setting (inreach or outreach), mechanism of action (behavioral, cognitive, sociologic, or a combination), type of control group (active or usual care), number of strategies, and mode of delivery (static or interactive). Summary estimates were calculated with DerSimonian and Laird random effects models for each group of interventions.

RESULTS

We included 66 studies with 98 separate interventions. Inreach and outreach interventions were equally effective in increasing mammography use. Compared to active controls, behavioral interventions with multiple strategies increased mammography use by 14.0% (95% CI, 8.7-19.2) in inreach and 18.7% (95% CI, 4.9-32.4) in outreach settings. Theory-based educational strategies delivered interactively increased mammography use by 10.7% (95% CI, 6.8-14.7) and 19.9% (95% CI, 10.6-29.1) in inreach and outreach settings, respectively. Interventions that combined behavioral and theory-based educational strategies with usual care controls increased mammography use by 14.0% (95% CI, 7.9-20.2) in inreach and 27.3% (95% CI, 14.7-40.0) in outreach settings. Finally, sociologic interventions increased mammography use by 10.7% (95% CI, 3.4-18.0) and 9.1% (95% CI, 1.7-13.3) in inreach and outreach settings, respectively.

CONCLUSIONS

Inreach and outreach interventions to increase mammography use were similarly effective within intervention categories based on mechanism of action, mode of delivery, and type of control group. Ultimate decisions about intervention strategies will depend on the characteristics of the target population, practical considerations, and relative cost-effectiveness.

Transient spine density increases in the mid-molecular layer of hippocampal dentate gyrus accompany consolidation of a spatial learning task in the rodent

In previous studies, we observed a transient increase in dendritic spine frequency in the molecular layer of the dentate gyrus at 6h following passive avoidance training [O'Malley A., O'Connell C. and Regan C. M. (1998) Neuroscience 87, 607-613]. To determine if a similar change is associated with spatial forms of learning, we have estimated time-dependent modulations of spine number in the dentate gyrus of the adult rat following water maze training. All animals exhibited significant reductions in the latency to locate the platform over the five training sessions of the single trial (median and interquartile ranges of 60, 8 versus 8, 3 s for trials 1 and 5, respectively) and this improved performance was retained just prior to killing at the 6h post-training time. The unbiased dissector stereological procedure was used to estimate spine number in serial pairs of ultrathin coronal sections obtained at a point 3.3 mm caudal of Bregma. This analysis revealed a significant learning-associated increase in spine number at the 6h post-training time (1.32+/-0.18 spines/microm(3)) as it was not observed in paired controls exposed to the water maze for a similar swim-time (0.66+/-0.11 spines/microm(3)). The increase was transient as spine number returned to control levels at the 72 h post-training time. These spine frequency changes are proposed to reflect increased synapse turnover rate and concomitant change in connectivity pattern in the processing of information for long-term storage.

Ultrastructural analysis reveals avoidance conditioning to induce a transient increase in hippocampal dentate spine density in the 6 hour post-training period of consolidation

Concepts underlying memory consolidation invoke change in synapse structure and function. Such concepts relate to change in connectivity pattern enabled by increased synapse number, change in synaptic configuration resulting from overproduction and selective pruning, or structural change in synapse transmission zones. This study undertook the unbiased estimation of learning associated change in dendritic spine number on granule cells in the hippocampal dentate gyrus. Rats were trained to acquire a passive avoidance response after which spine number in the mid-molecular layer of the dorsal dentate gyrus were estimated at increasing post-training times. This showed there to be an increase in spine density with time after training which was initiated at 3 h, and maximal at 6 h. The increase at this latter time was not detected in passive control animals. At 72 h post-training spine density was seen to return to basal levels. These results are consistent with the various models for synapse connectivity change in memory formation whether they relate to altered number or connectivity pattern.

Transient, learning-induced ultrastructural change in spatially-clustered dentate granule cells of the adult rat hippocampus

In semithin, Toluidine Blue-stained plastic coronal sections, we have observed hyperchromatic granule cells in the dorsal crest of the adult rat dentate gyrus following passive avoidance learning. These exhibited a time-dependent, twenty- to thirty-fold increase in their frequency at the 5-7 h post-training time. The hyperchromatic cells formed a rostral-caudal ribbon, 250 microns in diameter and 60 microns in depth, in sections obtained from -2.6 to -4.5 mm with respect to bregma. This was not observed in passive animals or yoked controls. Ultrastructural analysis revealed their cytoplasm and dendrites to be enriched in ribosomes and microtubules, respectively. Dendrites associated with the hyperchromatic cells exhibited a two-fold increase in spine number as compared to those of normochromatic cells in the same region of the dorsal mid-molecular layer. These changes are suggested to be associated with modulation of L1 and neural cell adhesion molecule-mediated neuroplastic change within this discrete post-training period of memory consolidation.

Human emotion communication by touch: a modified replication of an experiment by Manfred Clynes

In 1973 Manfred Clynes wrote a paper about the biocybernetics of emotion communication in which he described an experiment which seemed to point to a universal metalanguage with which human beings communicate specific emotions by touch. In an attempt to confirm Clyne's findings by replicating his experiment, a flaw was discovered in the design of his apparatus for detecting tactile patterns, and the replication study was undertaken using an improved pressure-detection instrument. Data from the replication study were analysed using various techniques but no correlations were found to confirm Clyne's original work.

Altered sensitivity of Rous sarcoma virus transformed cells to inhibition of RNA synthesis by alpha-amanitin

Chick embryo cells transformed by Rous sarcoma virus (RSV) continue to synthesize 40--50 percent of control amounts of RNA following 12--24 hour exposure to 2 microng/ml of the toxin whereas normal chick embryo cells similarly treated synthesize less than 5 percent of control amounts of RNA. Analysis of cells treated with alpha-amanitin, or the resistant forms I and III polymerase, do not increase in infected cells over the levels found in uninfected control cells during the first 24 hours following infection indicating that increase in polymerase levels in infected cells does not account for the observed resistance. No significant difference was detected in the sensitivity to alpha-amanitin in the form II polymerase isolated from normal and transformed cells; The greater sensitivity of normal cells to alpha-amanitin can be reduced by growing the cells at low cell density but the resistance of RSV transformed cells is not significantly altered by changes in cell density. The results suggest that the resistance of RSV transformed cells may be related to altered control of density dependent contact-inhibition of the transformed cells.