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Biomedical subjects

M J Kelleher

Publications and source records attributed to M J Kelleher.

At least 19 recordsLinked to original sources
PubMed1999

The cost of hospital care in the year before and after parasuicide.

This study, based in Ireland in the Limerick centre of the WHO/EURO Multicentre Study of Parasuicide, tests the hypothesis that the uptake of hospital services increases significantly following an act of parasuicide. To investigate this, the costs of hospital attendance in the year before and in the year after an act of parasuicide are measured and compared. The sample is comprised of the first 100 individuals who attended an acute general hospital following an act of parasuicide after July 1, 1995. Using a computerized patient record system, every hospital attendance is identified, for each individual, in the 12 months before and after the parasuicide act. This includes every visit to the Emergency Room as well as both general and psychiatric inpatient admissions and outpatient attendances. There was a 50% increase in the uptake of hospital services--32% of the sample attended hospital in the year before compared with 48% in the year after. The total yearly costs for the 100 patients almost doubled from IR 53,652 Pounds (Euro 68,138) to IR 104,454 Pounds (Euro 132,657). Generalizing to the 539 individuals who engaged in parasuicide in the Limerick catchment area, total costs increased from IR 289,184 Pounds (Euro 367,264) to IR 563,007 Pounds (Euro 715,019). This study is an initial step toward the more complex task of estimating to what extent the increased uptake of hospital services is due to the consequences of parasuicide and how much is due to other aspects of the patient's health.

Adolescent↗
PubMed1998

A study of suicide and attempted suicide by self-immolation in an Irish psychiatric population: an increasing problem.

In the Western World self-immolation is an uncommon but dramatic method of attempting suicide. In-patients who attempt suicide by fire-setting tend to be female with severe psychopathology. In a previous study from the South of Ireland, seven cases from a psychiatric and prison population were identified in a five year period from 1984 to 1989. This would represent an annual rate of 1.07 per cent of burns treated in the burns unit at Cork University Hospital. In this study 12 cases were identified for the years 1994 and 1995. This represents an increase of 3.5 per cent from 1.07 to 4.6 per cent of all burns treated at the same institution. Ten of these patients had a previous psychiatric history and eight of them were resident on a psychiatric ward when they committed the act. Seven of the patients were found to have a high degree of suicide intent of whom four died of their injuries, which gives a mortality rate for this group of 33 per cent. Effective prevention policies are necessary if this increasing problem is to be curtailed.

Adult↗
PubMed1998

Religious sanctions and rates of suicide worldwide.

In order to understand differences in suicide rates between the countries affiliated to the International Association for Suicide Prevention (IASP), the present paper investigates whether there is a relationship between the existence of religious sanctions and aggregate national suicide rates as reported to the World Health Organization. Through their participation in this study, 49 IASP national representatives reported on the existence of religious sanctions against suicide. It was discovered that countries with religious sanctions were less likely to return rates of suicide to the WHO. Comparative analysis revealed that the average reported rates for countries with sanctions are lower than those for countries without religious sanctions. The difference is particularly significant for females. Overall, then, at an aggregate level, it would appear that an inverse relationship does exist; however, while countries with religious sanctions against suicide return lower rates of suicide, as recorded by the WHO, recording and reporting procedures may be affected by the existence of sanctions, thus diminishing the reliability of reported rates. Furthermore, distinctions between rates among the different denominations seem to have been somewhat blurred, in particular between Catholics and Protestants, to the extent that in certain societies Catholics have a higher reported rate of suicide--despite the fact that, doctrinally, Catholicism is more severe in the condemnation of suicide than the majority of Protestant churches (with a few notable exceptions, such as the Orthodox Calvinists).

Attitude to Health↗
PubMed1998

Euthanasia and related practices worldwide.

The present paper examines the occurrence of matters relating to the ending of life, including active euthanasia, which is, technically speaking, illegal worldwide. Interest in this most controversial area is drawn from many varied sources, from legal and medical practitioners to religious and moral ethicists. In some countries, public interest has been mobilized into organizations that attempt to influence legislation relating to euthanasia. Despite the obvious international importance of euthanasia, very little is known about the extent of its practice, whether passive or active, voluntary or involuntary. This examination is based on questionnaires completed by 49 national representatives of the International Association for Suicide Prevention (IASP), dealing with legal and religious aspects of euthanasia and physician-assisted suicide, as well as suicide. A dichotomy between the law and medical practices relating to the end of life was uncovered by the results of the survey. In 12 of the 49 countries active euthanasia is said to occur while a general acceptance of passive euthanasia was reported to be widespread. Clearly, definition is crucial in making the distinction between active and passive euthanasia; otherwise, the entire concept may become distorted, and legal acceptance may become more widespread with the effect of broadening the category of individuals to whom euthanasia becomes an available option. The "slippery slope" argument is briefly considered.

Ethics, Medical↗
PubMed1998

Euthanasia and the terminally ill: can the civil killing of others be eroded?

The present paper assesses attitudes towards the ending of life among a sample of 100 terminally ill hospice patients. Such a sample best provides an insight into the demand for euthanasia in this most extreme of circumstances. Of the completed interviews (64), 43 patients were fully aware of the implications of their condition; 35 expressed a definite opinion regarding euthanasia, 22 of whom favored the individual's right to choose the timing of death. Only 6 of these 22 were fully competent at the time of the interview and were not suffering from any depressive disorder. The implications of these results point to the need to consider the prevalence of depression, anxiety, and related disorders among those who seek an end to life. A failure to do so is likely to affect legislation worldwide, and, in turn, civilization itself.

Attitude to Death↗
PubMed1997

The service implications of regional differences in suicide rates in the Republic of Ireland.

This paper examines variations in suicide within the Republic of Ireland in order to determine if the services, as currently available, require redistribution. The rates of suicide and undetermined death in the four provinces, 26 counties and five cities of Ireland are examined for the years 1976 to 1994, with the age and gender distributions of local populations taken into consideration. Marked variations between areas are noted with a threefold difference between the counties with the highest and lowest rates. Counties tend to be similarly ranked for men and women but the male suicide rate, overall, was almost three times that for women. The male:female ratio was 2.3:1 for the first half of the study, but this increased to 3.4:1 for the second half; a reflection of increasing numbers of male suicides. Surprisingly, the male suicide rate in Dublin city has stayed steady at 12 per 100,000 over the entire study period, while the national male rate has more than doubled reaching approximately 18 per 100,000 in recent years. There is a need for improved services in rural Ireland. If the various available services are to help reduce the suicide rate, then a mechanism must be found to deliver these in areas of low population density where the need could well be greatest.

Female↗
PubMed1997

Elderly suicides in Ireland.

A comparison is made between the male and female Irish suicide rates for the young (15-24 year-olds) and the old (over 65 years). The incidence of suicide among the elderly has traditionally been higher than among the young. While this continues to be the case for females the rates for young and old have recently converged. Within the over 65 year-old age group itself, a further comparison was made between the suicide rates of the 'young' old and 'old' old. In general, suicide is significantly more common in the 'young' old age group. The method of suicide employed by the elderly was then analysed. As expected hanging, drowning and poisoning were most common although the extent to which they were used differed for males and females. Twelve elderly suicides were examined as part of an on-going psychological autopsy study of Cork suicides. Information relating to their domestic, marital and psychological situation is discussed. Given these findings and those relating to method of suicide, the subject of suicide prevention in the elderly is discussed.

Adolescent↗
PubMed1996

Deliberate self-poisoning, unemployment and public health.

The purpose of the present investigation was to explore further the known relationship between deliberate self-poisoning and social deprivation. Each individual who attended one of Cork city's three casualty departments following an act of deliberate self-poisoning in 1988 was examined. The place of residence (ward) of each city resident patient was established. The social status of the city's 34 wards was estimated using a number of indices obtained from the 1981 and 1986 census reports and social service records. A comparison was made between the 1988 self-poisoning rate for each ward and the rate found in a 1982 study of the city. Correlations between self-poisoning rate and seven social deprivation indices were found to be significant. Multiple regression, factor, and partial correlation analyses were carried out to examine more closely the interrelationships between the social deprivation indices. With respect to explaining the variation in the self-poisoning rate, unemployment alone performed almost as well as all of the indices together and as well as the factors derived using factor analysis. The correlation between unemployment and self-poisoning rate remained highly significant when the other related variables were controlled for. However, at fixed levels of unemployment, these variables were found to be independent of the self-poisoning rate. It is suggested that whereas clinical intervention may benefit the individual, deliberate self-poisoning as an issue requires a public health approach for its resolution.

Adolescent↗
PubMed1992

The influence of antidepressants in overdose on the increased suicide rate in Ireland between 1971 and 1988.

There has been almost a threefold increase in the incidence of suicide in Ireland during the past 20 years. When each case occurring between 1971 and 1988 was reviewed, the major causes of death were found to be drowning and hanging. Deliberate overdoses with tricyclic antidepressants accounted for less than 4% of all suicides, over the 17 years studied, and during this time, overdose with tricyclics has made a proportionately smaller contribution to the total number of suicides. Greater attention should be paid to identifying and treating the majority of suicidal patients who are at risk by other methods.

Adolescent↗
PubMed1990

A model of waveform reliability in facial nerve electroneurography.

This study identifies four factors that should be considered when evaluating the reliability of new testing methods in facial nerve electroneurography (ENOG): (1) waveform peak-to-peak amplitude; (2) response variability; (3) statistical significance of day-to-day test/retest differences; and (4) waveform morphology. These factors were applied to data gathered on seven normal subjects who had three trials of facial-nerve ENOG on three separate test days in order to determine an optimal recording electrode montage. Both bipolar and monopolar recording-electrode montages were used on the nasal alae and on the nasolabial crease. Resultant peak-to-peak amplitudes of combined motor action potentials were recorded and measured using a clinical evoked-potential instrument. A biphasic waveform shape with optimal peak-to-peak point rather than the nasolabial crease. The contribution to the assessment of response reliability of each of the four factors is discussed.

Action Potentials↗