Psychosocial therapy and causes of death after deliberate self-harm: a register-based, nationwide multicentre study using propensity score matching

BACKGROUND

Psychosocial therapy after deliberate self-harm might be associated with reduced risk of specific causes of death.

METHOD

In this matched cohort study, we included patients, who after an episode of deliberate self-harm received psychosocial therapy at a Suicide Prevention Clinic in Denmark between 1992 and 2010. We used propensity score matching in a 1:3 ratio to select a comparison group from 59 046 individuals who received standard care. National Danish registers supplied data on specific causes of death over a 20-year follow-up period.

RESULTS

At the end of follow-up, 391 (6.9%) of 5678 patients in the psychosocial therapy group had died, compared with 1736 (10.2%) of 17 034 patients in the matched comparison group. Lower odds ratios of dying by mental or behavioural disorders [0.54, 95% confidence interval (CI) 0.37-0.79], alcohol-related causes (0.63, 95% CI 0.50-0.80) and other diseases and medical conditions (0.61, 95% CI 0.49-0.77) were noted in the psychosocial therapy group. Also, we found a reduced risk of dying by suicide as well as other external causes, however, not by neoplasms and circulatory system diseases. Numbers needed to treat were 212.9 (95% CI 139.5-448.4) for mental or behavioural disorders as a cause of death, 111.1 (95% CI 79.2-210.5) for alcohol-related causes and 96.8 (95% CI 69.1-161.8) for other diseases and medical conditions.

CONCLUSIONS

Our findings indicate that psychosocial therapy after deliberate self-harm might reduce long-term risk of death from select medical conditions and external causes. These promising results should be tested in a randomized design.

Forward error correction supported 150 Gbit/s error-free wavelength conversion based on cross phase modulation in silicon

We build a forward error correction (FEC) module and implement it in an optical signal processing experiment. The experiment consists of two cascaded nonlinear optical signal processes, 160 Gbit/s all optical wavelength conversion based on the cross phase modulation (XPM) in a silicon nanowire and subsequent 160 Gbit/s-to-10 Gbit/s demultiplexing in a highly nonlinear fiber (HNLF). The XPM based all optical wavelength conversion in silicon is achieved by off-center filtering the red shifted sideband on the CW probe. We thoroughly demonstrate and verify that the FEC code operates correctly after the optical signal processing, yielding truly error-free 150 Gbit/s (excl. overhead) optically signal processed data after the two cascaded nonlinear processes.

[Treatment and rehabilitation in an apoplexy unit increases the 5-year survival]

Treatment of stroke patients in specialised stroke units has become more frequent, but the longterm effect of this treatment has not been determined. In this prospective, community-based study of 1241 unselected acute stroke patients we compared outcome between patients geographically randomised to treatment in a stroke unit or in a general neurological/medical ward, from the time of acute admission to the end of rehabilitation. Baseline characteristics were comparable between the two treatment groups regarding age, sex, marital status, pre-stroke residence, and stroke severity. Patients treated in the stroke unit had higher comorbidity with regard to hypertension and diabetes. Multivariate linear and logistic regression analyses were applied to estimate the independent influence of stroke unit treatment on outcome. Stroke unit treatment significantly reduced not only initial mortality, but also mortality within five years from stroke onset. The relative risk of dying within the first five years from stroke was reduced by 40%, p < 0.01. Treatment and rehabilitation of unselected stroke patients in a stroke unit reduces initial mortality, discharge rate to nursing home, reduces cost of treatment, and improves longterm survival up to five years after stroke.

[Apoplexy units--reduced mortality, need for nursing homes, length of stay and cost savings]

Treatment of stroke patients on specialised stroke units has become more frequent, yet the effect of this treatment has not been determined. In this prospective, community-based study of 1241 unselected acute stroke patients we compared outcome between patients geographically randomised to treatment on a stroke unit or a general neurological/medical ward, from the time of acute admission to the end of rehabilitation. Baseline characteristics were comparable between the two treatment groups regarding age, sex, marital status, prestroke residence, and stroke severity. The patients treated on the stroke unit had higher comorbidity with regard to hypertension and diabetes. Multivariate linear and logistic regression analyses were applied to estimate the independent influence of stroke unit treatment on outcome. Stroke unit treatment significantly reduced in-hospital mortality (OR 0.50), case-fatality rate (OR 0.45), 6-month mortality (OR 0.57), 1-year mortality (0.59, and discharge rate to a nursing home (OR 0.61). The relative chance of being discharged to own home was almost doubled (OR 1.9), and the length of hospital stay reduced by 30% in patients treated on the stroke unit, P < 0.001. Treatment of unselected stroke patients on a stroke unit saves lives, nursing homes, and cost.

Contrasting effects of sewage sludge and commercial fertilizer on egg to adult development of two herbivorous insect species

Municipal sewage sludge containing heavy metals had a toxic effect on the development of the cabbage looper, Trichoplusia ni (Lepidoptera: Noctuidae), one of two herbivorous insects commonly found in an Ohio old-field which had been subjected to long-term sewage sludge application. Soils were removed in 1992 from an old-field following 11 years of heavy nutrient enrichment (1978 to 1988) with applications of either sewage sludge (Milorganite(®)) containing heavy metal contaminants or urea-phosphate fertilizer. Egg to adult development rate and survival of the blackfaced leafhopper, Graminella nigrifrons (Homoptera: Cicadellidae), and the cabbage looper was determined on maize (leafhopper) and broccoli (looper) seedlings grown in soils from sludge-treated, fertilizer-treated, or untreated control plots of the old-field. Fertilizer and sludgetreated soils had higher levels of N. P and organic matter, and a lower pH than the untreated control soils, while sludge-treated soils contained significantly higher concentrations of Cd, Cu, Pb, and Zn. Maize appeared to be unaffected by the three soil treatments, and survival and rate of egg to adult development of the leafhopper was not affected. Broccoli seedlings grown in both the high nutrient fertilizer and sludge soils were greener and larger than broccoli grown in control soils. However, the cabbage looper had significant larval and pupal mortality (25 to 40%) and prolonged egg to adult development on sludge-grown broccoli compared to control and fertilizer treatments. As assimilation into the food chain of heavy metals and other organic pollutants, such as PCBs, is in part a function of the interaction of soil chemistry and type of plant, the application of municipal sludges to old-fields needs to be carefully monitored, as contaminants may have significant developmental and behavioural effects on some secondary links in the old-field food chain.

[Markedly increasing incidence of apoplexy among men. A clinical, epidemiologic study of apoplexy incidence between 1972 and 1990 in the municipality of Frederiksberg]

The purpose of this study was to determine possible temporal changes of stroke incidence in a European community. All cases of first-ever stroke (n = 927) were prospectively recorded in the municipality of Frederiksberg, Denmark, in the two periods 1972-1974 and 1989-1990. Complete case ascertainment was ensured by registration of both hospitalized and nonhospitalized patients. Death certificates were also scrutinized. The annual stroke incidence rate per 1000 increased by 18% from 2.6 in 1972-1974, to 3.1 in 1989-1990 (p < 0.01). This increase was due solely to a 42% increase in men, for whom stroke incidence rose from 2.1 to 3.0 (p < 0.0005). Incidence was unchanged in women, 3.0 and 3.1 respectively. In the second study period 85% had CT or necropsy; 91% had cerebral infarction; 8% had intracerebral haemorrhage and 1% had subarachnoid haemorrhage. In a period when decline in stroke incidence has stopped in USA and has continued in Japan, a marked increase in stroke incidence in European men was observed.

Leadership, group activity and sociometric choice in service sororities and fraternities

Task and socio-emotional functions are specialized in many groups. The critical variable seems to be the extent to which the task goals are salient to all group members and consequently viewed as legitimate. The tasks in service fraternities and sororities are likely to be accepted by all members, since a condition for membership is a desire to serve. This study investigated the task and socio-emotional functions in eight such fraternities and sororities (N of 169). Significant correlations obtained between sociometric choice for real leader and actual leadership, between sociometric choice for real leader and best-liked person, and between best-liked person and assessment of task activity. Results suggest that role differentiation is a function of task legitimacy and consequently the legitimacy of leadership itself.