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Search Results: 1 - 10 of 53031 matches for " David Gunnell "
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Does Restricting Pack Size of Paracetamol (Acetaminophen) Reduce Suicides?
Nicholas A Buckley ,David Gunnell
PLOS Medicine , 2007, DOI: 10.1371/journal.pmed.0040152
Hospital Presenting Self-Harm and Risk of Fatal and Non-Fatal Repetition: Systematic Review and Meta-Analysis
Robert Carroll, Chris Metcalfe, David Gunnell
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0089944
Abstract: Background Non-fatal self-harm is one of the most frequent reasons for emergency hospital admission and the strongest risk factor for subsequent suicide. Repeat self-harm and suicide are key clinical outcomes of the hospital management of self-harm. We have undertaken a comprehensive review of the international literature on the incidence of fatal and non-fatal repeat self-harm and investigated factors influencing variation in these estimates as well as changes in the incidence of repeat self-harm and suicide over the last 30 years. Methods and Findings Medline, EMBASE, PsycINFO, Google Scholar, article reference lists and personal paper collections of the authors were searched for studies describing rates of fatal and non-fatal self-harm amongst people who presented to health care services for deliberate self-harm. Heterogeneity in pooled estimates of repeat self-harm incidence was investigated using stratified meta-analysis and meta-regression. The search identified 177 relevant papers. The risk of suicide in the 12 months after an index attempt was 1.6% (CI 1.2–2.4) and 3.9% (CI 3.2–4.8) after 5 years. The estimated 1 year rate of non-fatal repeat self-harm was 16.3% (CI 15.1–17.7). This proportion was considerably lower in Asian countries (10.0%, CI 7.3–13.6%) and varies between studies identifying repeat episodes using hospital admission data (13.7%, CI 12.3–15.3) and studies using patient report (21.9%, CI 14.3–32.2). There was no evidence that the incidence of repeat self-harm was lower in more recent (post 2000) studies compared to those from the 1980s and 1990s. Conclusions One in 25 patients presenting to hospital for self-harm will kill themselves in the next 5 years. The incidence of repeat self-harm and suicide in this population has not changed in over 10 years. Different methods of identifying repeat episodes of self-harm produce varying estimates of incidence and this heterogeneity should be considered when evaluating interventions aimed at reducing non-fatal repeat self-harm.
The global distribution of fatal pesticide self-poisoning: Systematic review
David Gunnell, Michael Eddleston, Michael R Phillips, Flemming Konradsen
BMC Public Health , 2007, DOI: 10.1186/1471-2458-7-357
Abstract: We have systematically reviewed the worldwide literature to estimate the number of pesticide suicides in each of the World Health Organisation's six regions and the global burden of fatal self-poisoning with pesticides. We used the following data sources: Medline, EMBASE and psycINFO (1990–2007), papers cited in publications retrieved, the worldwide web (using Google) and our personal collections of papers and books. Our aim was to identify papers enabling us to estimate the proportion of a country's suicides due to pesticide self-poisoning.We conservatively estimate that there are 258,234 (plausible range 233,997 to 325,907) deaths from pesticide self-poisoning worldwide each year, accounting for 30% (range 27% to 37%) of suicides globally. Official data from India probably underestimate the incidence of suicides; applying evidence-based corrections to India's official data, our estimate for world suicides using pesticides increases to 371,594 (range 347,357 to 439,267). The proportion of all suicides using pesticides varies from 4% in the European Region to over 50% in the Western Pacific Region but this proportion is not concordant with the volume of pesticides sold in each region; it is the pattern of pesticide use and the toxicity of the products, not the quantity used, that influences the likelihood they will be used in acts of fatal self-harm.Pesticide self-poisoning accounts for about one-third of the world's suicides. Epidemiological and toxicological data suggest that many of these deaths might be prevented if (a) the use of pesticides most toxic to humans was restricted, (b) pesticides could be safely stored in rural communities, and (c) the accessibility and quality of care for poisoning could be improved.The World Health Organisation (WHO) estimated that there were 873,000 suicides worldwide in 2002[1] which makes suicide a major cause of premature mortality globally. A central component of suicide prevention strategies is restricting access to lethal m
Suicide epidemics: the impact of newly emerging methods on overall suicide rates - a time trends study
Kyla Thomas, Shu-Sen Chang, David Gunnell
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-314
Abstract: We studied the epidemic rises in domestic coal gas (1919-1935, England and Wales), motor vehicle exhaust gas (1975-1992, England and Wales) and barbecue charcoal gas (1999-2006, Taiwan) suicide using Poisson and joinpoint regression models. Joinpoint regression uses contiguous linear segments and join points (points at which trends change) to describe trends in incidence.Epidemic increases in the use of new methods of suicide were generally associated with rises in overall suicide rates of between 23% and 71%. The recent epidemic of barbecue charcoal suicides in Taiwan was associated with the largest rise in overall rates (40-50% annual rise), whereas the smallest rise was seen for car exhaust gassing in England and Wales (7% annual rise). Joinpoint analyses were only feasible for car exhaust and charcoal burning suicides; these suggested an impact of the emergence of car exhaust suicides on overall suicide rates in both sexes in England and Wales. However there was no statistical evidence of a change in the already increasing overall suicide trends when charcoal burning suicides emerged in Taiwan, possibly due to the concurrent economic recession.Rapid rises in the use of new sources of gas for suicide were generally associated with increases in overall suicide rates. Suicide prevention strategies should include strengthening local and national surveillance for early detection of novel suicide methods and implementation of effective media guidelines and other appropriate interventions to limit the spread of new methods.Suicide is among the leading causes of premature mortality in the world [1]. In 2004 suicide was the 8th leading cause of potential years of life lost among 15 to 44 year olds worldwide [1]. Whilst social, economic, cultural and psychological factors are significant contributors to suicide rates, there is good evidence that the changing availability and popularity of lethal methods are also important [2-4].To date, most studies investigating associat
Suicide in the Philippines: time trend analysis (1974-2005) and literature review
Maria Redaniel, May Lebanan-Dalida, David Gunnell
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-536
Abstract: Data for suicide deaths occurring between 1974 and 2005 were obtained from Philippine Health Statistics. Age- and sex-specific trends were examined graphically. Underreporting was investigated by comparing trends in suicides, accidents and deaths of undetermined intent. To provide a fuller picture of suicide in the Philippines, a comprehensive search for published papers, theses and reports on the epidemiology of suicide in the Philippines was undertaken.The incidence of suicide in males increased from 0.23 to 3.59 per 100,000 between 1984 and 2005. Similarly, rates rose from 0.12 to 1.09 per 100,000 in females. Amongst females, suicide rates were highest in 15-24 year olds, whilst in males rates were similar in all age groups throughout the study period. The most commonly used methods of suicide were hanging, shooting and organophosphate ingestion. In non-fatal attempts, the most common methods used were ingestion of drugs, specifically isoniazid and paracetamol, or organophosphate ingestion. Family and relationship problems were the most common precipitants. While rates were lower compared to other countries, there is suggestive evidence of underreporting and misclassification to undetermined injury. Recent increases may reflect either true increase or better reporting of suicides.While suicide rates are low in the Philippines, increases in incidence and relatively high rates in adolescents and young adults point to the importance of focused suicide prevention programs. Improving data quality and better reporting of suicide deaths is likewise imperative to inform and evaluate prevention strategies.Suicide is a major contributor to premature mortality worldwide and is among the leading causes of death in the Western Pacific Region [1]. Approximately 32% of the world's suicides occur in the region, and its annual incidence of 19.3 per 100,000 is 30% higher than the global average [2]. While acknowledged as an important and neglected health issue, it remains a low pr
Adolescent self-harm and suicidal thoughts in the ALSPAC cohort: a self-report survey in England
Judi Kidger, Jon Heron, Glyn Lewis, Jonathan Evans, David Gunnell
BMC Psychiatry , 2012, DOI: 10.1186/1471-244x-12-69
Abstract: Cross-sectional analysis of self-reported questionnaire data collected from members of the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort, England. Respondents (n?=?4810) were aged 16–17?years old and have been followed up since birth.Altogether 905 (18.8%) respondents had ever self-harmed. The prevalence of lifetime self-harm was higher in females (25.6%) than males (9.1%). The most commonly used method was self-cutting: this was used alone or in combination in 73.5% of episodes, compared to 10.0% who took overdoses alone or in combination with other methods. Of those who reported self-harm, 25.3% wanted to die during the most recent episode. Concurrent depression was associated with a greatly increased risk of self-harm (OR 5.43). Only 12.4% of participants sought medical help following their most recent episode of self-harm, although this figure was higher (30.1%) where self-harm was carried out with desire to die. Of the whole sample, 15.8% had ever thought of killing themselves, and 4.3% had ever made plans to kill themselves. Compared to those who had never self-harmed, those who had self-harmed but not wanted to die during the most recent episode were at increased risk of ever having had suicidal thoughts (37.6% compared to 7.8% χ2 =102.3, p?<?0.001) and ever making suicidal plans (8.7% compared to 0.7%, χ2 =166.9, p?<?0.001). As the frequency of self-harm increased, so did the risk of suicidal thoughts and plans.Self-harm and suicidal thoughts are common among 16/17?year olds. Although the majority of self-harm behaviour is not accompanied by a desire to die, all self-harm regardless of motivation is associated with increased risk of suicidal thoughts and plans, particularly when it is carried out repeatedly.Self-harm is of public health concern not only because of the immediate physical harm that it causes, but also due to its association with psychological distress, and elevated risk of suicide [1,2]. It is rare under the age of twel
Simpson's Paradox, Lord's Paradox, and Suppression Effects are the same phenomenon – the reversal paradox
Yu-Kang Tu, David Gunnell, Mark S Gilthorpe
Emerging Themes in Epidemiology , 2008, DOI: 10.1186/1742-7622-5-2
Abstract: This article discusses three statistical paradoxes that pervade epidemiological research: Simpson's paradox, Lord's paradox, and suppression. These paradoxes are not just tantalising puzzles of purely academic interest; potentially, they have serious implications for the interpretation of evidence from observational studies. Scenarios which are associated with and can be explained by these paradoxes are discussed. A concise explanation of these paradoxes and an historical overview is also provided. Simulated data based upon the foetal origins of adult diseases hypothesis [1,2] are used to illustrate how the three paradoxes are different manifestations of one phenomenon – the reversal paradox – depending on whether the outcome and explanatory variables are categorical, continuous or a combination of both; this renders the issues and remedies for any one to be similar for all three. All statistical analyses were performed within SPSS 15.0 (SPSS Inc, Chicago, USA).The 'foetal origins of adult disease' hypothesis (FOAD), which has evolved into the 'developmental origins of health and disease' (DOHaD) hypothesis [1,2], was proposed to explain the associations observed between low birth weight and a range of diseases in later life. These associations have been interpreted as evidence that growth retardation in utero has adverse long-term effects on the development of vital organ systems which predispose the individuals to a range of metabolic and related disorders in later life. Nevertheless, although an inverse association between birth weight and disease in later life was found in some studies, this relationship was only established in many studies after the current body size variables such as body mass index (BMI), body weight and/or body height were adjusted for in the regression analysis. As body sizes may be in the causal pathway from birth weight to health outcomes in later life, the justification of this adjustment of current body sizes has been questioned recentl
Narratives, Space and Drama: Essential Spatial Aspects Involved in the Performance and Reception of Oral Narrative
Terry Gunnell
Folklore : Electronic Journal of Folklore , 2006,
Abstract: In the past, oral narrative tended to be regarded as a two-dimensional phenomenon largely confined to the form of the spoken or (later) printed word. Over the last twenty years, however, oral narratives have gradually gained “thickness” in the eyes of folklore scholars who have increasingly demanded that more attention be paid to the social and personal contexts that gave rise to these narratives. This present article reviews the ways in which the understanding of oral narrative depends on its physical, mental and social surroundings, noting also how the process is actually reciprocal, since while taking much from their surroundings, narratives are also capable of subtly changing the contexts that gave birth to them. Working out from the three-dimensional nature of the oral narrative performance, it is argued that much could be gained from analysing oral narratives as pieces of theatre or dramatic performances rather than as pieces of text.
Sagnagrunnur: A New Database of Icelandic Folk Legends in Print
Terry Gunnell
Folklore : Electronic Journal of Folklore , 2010,
Abstract: One of the main problems with researching “traditional” Icelandiclegends (apart from the fact that only about 3 % of them are available to people who cannot read Icelandic) is that up until very recently there has been no archive of folk legend material in Iceland. This has meant that the only way to find material on legends of a particular type, gender and job-related distribution of storytellers, distribution of legends, local beliefs and so on has been to plough through all the various collections, and listen to all of the tapes in the Arnamagn an Institute in Reykjavík, a task daunting enough to put even the most dogged researcher off. Matters, however, are beginning to change in Iceland. Over the last five years, folklorists at the University of Iceland have been working on two large databases of printed and recorded legendary material,each containing over 10,000 entries. The plan is that these databases will eventually be linked, and connected to a mapping programme allowing immediate distribution analysis. In the following article, the situation in Iceland past and present will be analysed, and the draft form of the database of printed material (Sagnagrunnur) presented, along with a review of the possibilities that this willopen up for scholars both in Iceland and abroad. At the same time as outlining the advantages of such an approach, some discussion will be made of the difficulties regarding such a database, and the potential weaknesses that need to be considered.
Six-Year Follow-Up of Impact of Co-proxamol Withdrawal in England and Wales on Prescribing and Deaths: Time-Series Study
Keith Hawton ,Helen Bergen,Sue Simkin,Claudia Wells,Navneet Kapur,David Gunnell
PLOS Medicine , 2012, DOI: 10.1371/journal.pmed.1001213
Abstract: Background The analgesic co-proxamol (paracetamol/dextropropoxyphene combination) has been widely involved in fatal poisoning. Concerns about its safety/effectiveness profile and widespread use for suicidal poisoning prompted its withdrawal in the UK in 2005, with partial withdrawal between 2005 and 2007, and full withdrawal in 2008. Our objective in this study was to assess the association between co-proxamol withdrawal and prescribing and deaths in England and Wales in 2005–2010 compared with 1998–2004, including estimation of possible substitution effects by other analgesics. Methods and Findings We obtained prescribing data from the NHS Health and Social Care Information Centre (England) and Prescribing Services Partneriaeth Cydwasanaethau GIG Cymru (Wales), and mortality data from the Office for National Statistics. We carried out an interrupted time-series analysis of prescribing and deaths (suicide, open verdicts, accidental poisonings) involving single analgesics. The reduction in prescribing of co-proxamol following its withdrawal in 2005 was accompanied by increases in prescribing of several other analgesics (co-codamol, paracetamol, codeine, co-dydramol, tramadol, oxycodone, and morphine) during 2005–2010 compared with 1998–2004. These changes were associated with major reductions in deaths due to poisoning with co-proxamol receiving verdicts of suicide and undetermined cause of ?21 deaths (95% CI ?34 to ?8) per quarter, equating to approximately 500 fewer suicide deaths (?61%) over the 6 years 2005–2010, and ?25 deaths (95% CI ?38 to ?12) per quarter, equating to 600 fewer deaths (?62%) when accidental poisoning deaths were included. There was little observed change in deaths involving other analgesics, apart from an increase in oxycodone poisonings, but numbers were small. Limitations were that the study was based on deaths involving single drugs alone and changes in deaths involving prescribed morphine could not be assessed. Conclusions During the 6 years following the withdrawal of co-proxamol in the UK, there was a major reduction in poisoning deaths involving this drug, without apparent significant increase in deaths involving other analgesics. Please see later in the article for the Editors' Summary
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