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Biomedical subjects

S Simkin

Publications and source records attributed to S Simkin.

At least 37 records · Page 2Linked to original sources
PubMed1998

Methods used for suicide by farmers in England and Wales. The contribution of availability and its relevance to prevention.

BACKGROUND: Farmers in the UK have an elevated risk of suicide. It has been suggested that this may be related to their ease of access to dangerous means for suicidal behaviour. The extent to which farmers use these means and changes in their use may be relevant to suicide prevention. METHOD: Data on 719 deaths in farmers of both genders in England and Wales between 1981 and 1993 in which a verdict of suicide or undetermined cause (open verdict) was recorded were analysed. RESULTS: Of 702 deaths in male farmers, firearms were involved in 40.0%, hanging in 29.6%, carbon monoxide in 16.4%, poisoning in 8.0% (over half of which involved agricultural or horticultural poisons) and other methods in 6.1%. There was a considerable excess of deaths due to firearms compared with the distribution of methods of suicide and open verdict deaths in males in the general population. Hanging was also somewhat more frequent. During the study period there was a reduction in firearm death rates, particularly after 1989 when there was national legislation on firearm ownership, registration and storage. There were also fewer farming suicides after this date. By the end of the study period hanging was more frequent than deaths involving firearms. CONCLUSIONS: Farmers who commit suicide tend to use methods to which they have easy access. Restriction of the ready availability of such methods, particularly in farmers known to be depressed or otherwise at risk, might prevent some suicides.

Adolescent↗
PubMed1997

Chronic fatigue syndrome: a qualitative investigation of patients' beliefs about the illness.

The chronic fatigue syndrome is a disabling chronic condition of uncertain cause. Previous studies have found that patients seen in hospital clinics with the syndrome often strongly believe that their illness is physical in nature and minimize the role of psychological and social factors. There is also evidence that patients cope by avoiding activity. However, almost all of these studies have assessed illness beliefs only by questionnaire. The aim of this study was to explore the nature and origin of illness beliefs in more detail using in-depth interviews and a qualitative analysis of patient responses. Sixty-six consecutive referrals meeting Oxford criteria for chronic fatigue syndrome were recruited. Analysis of responses indicated that, whereas the most commonly described explanation for the illness was a physical one, more than half the patients also believed "stress" had played a role. Patients believed that they could partially control the symptoms by reducing activity but felt helpless to influence the physical disease process and hence the course of the illness. Patients reported that they had arrived at these beliefs about the illness after prolonged reflection on their own experience combined with the reading of media reports, self help books, and patient group literature. The views of health professionals played a relatively small role. There is potentially a considerable opportunity to help patients arrive at a wider and more enabling explanation of their illness when they first present to primary care.

Adaptation, Psychological↗
PubMed1997

A study of suicide in farmers in England and Wales.

The proportional mortality ratio for suicide is higher in farmers than in the general population. The reasons for this are likely to be complex, but may include easy availability of firearms, stress related to work, financial difficulties, and family problems. A psychological autopsy study of suicide in 84 farmers who died between 1991-1994 is presented and some preliminary findings are discussed.

Adolescent↗
PubMed1997

Deliberate self-harm in alcohol and drug misusers: patient characteristics and patterns of clinical care.

The aims of this study were to describe the characteristics of alcohol and drug misusers presenting to a general hospital following suicide attempts and to investigate the patterns of clinical care they received before and after the attempts. The Oxford Monitoring System for Attempted Suicide and patient case-notes were used to obtain information on alcohol and drug misusers assessed by the general hospital psychiatric services after deliberate self-harm in 1992. Of 724 patients, 200 (28%) were substance misusers (36% of males, 23% of females). Both alcoholics and drug misusers were more likely than other attempters to be male, have histories of personality disorder and criminal offences and to make repeat attempts, and the drug misusers were more likely to be living alone and unemployed. These are characteristics associated with particularly high risk of suicide. A large proportion of the substance misusers had received specific treatment for their misuse before their attempts and the majority were offered this afterwards. Over a quarter did not accept the care they were offered. The general hospital management of attempted suicide patients must include systematic assessment for evidence of alcohol and drug misuse and maintain close links with substance misuse services. Patients identified as having problems in the use of alcohol without having developed dependence and/or physical symptoms are a group that warrants specific attention. Audits should be conducted in general hospitals to ensure that sufficient attention is being paid to the detection and management of suicide attempters with substance misuse.

Journal Article↗
PubMed1997

Use of paracetamol for suicide and non-fatal poisoning in the UK and France: are restrictions on availability justified?

OBJECTIVE: To investigate the relationship between the availability of paracetamol and its use for overdose and suicide. DESIGN: Analysis of routinely collected information on time trends for paracetamol suicides, non-fatal overdoses, and sales. SETTING: England and Wales and France. RESULTS: There were strong correlations between trends in paracetamol sales in the UK and trends in non-fatal paracetamol overdose in Oxford between 1976 and 1993 (Spearman's r = 0.86; 95% confidence interval (CI) 0.54, 0.96) and between paracetamol sales and non-fatal overdoses in France between 1974 and 1990 (r = 0.99; 95% CI 0.97, 1.00). Sales figures were also correlated with paracetamol related suicides in both England and Wales, 1983-91 (r = 0.72; 95% CI 0.11, 0.94) and France, 1974-90 (r = 0.79; 95% CI 0.50, 0.92). Similarly strong relationships were observed between trends in non-fatal overdoses and suicide by paracetamol poisoning in England and Wales (r = 0.85; 95% CI 0.61, 0.95) and France (r = 0.79; 95% CI 0.50, 0.92). It is estimated that approximately 32,000 overdoses involving paracetamol occur annually in England and Wales. Fatality rates from paracetamol overdose were four times as high in England and Wales (0.4%, 95% CI 0.38, 0.46) as in France (0.1%, 95% CI 0.06, 0.17). CONCLUSION: Trends towards greater availability of paracetamol are paralleled by increases in its use for both non-fatal overdose and suicide. Paracetamol related morbidity and mortality seem to be less frequent in France where the quantity of paracetamol in a single purchase is limited. Although not conclusive, these data add to a body of evidence which suggests that restrictions in the quantity of paracetamol available as a single purchase in the UK may reduce suicide and liver failure related to paracetamol.

Acetaminophen↗
PubMed1997

Trends in deliberate self-harm in Oxford, 1985-1995. Implications for clinical services and the prevention of suicide.

BACKGROUND: Deliberate self-harm (DSH) has been a major health problem in the UK for nearly three decades. Any changes in rates of DSH or the demographic characteristics of the patient population are likely to have important implications for clinical services and suicide prevention. METHOD: Data collected by the Oxford Monitoring System for Attempted Suicide were used to review trends in DSH between 1985-1995. RESULTS: There was a substantial increase in DSH rates during the 11-year study period, with a 62.1% increase in males and a 42.2% increase in females. The largest rise was in 15-24-year-old males (+ 194.1%). Changes in DSH rates correlated with changes in national suicide rates in both males and females in this age group. Rates of repetition of DSH increase in both genders during the study period. Paracetamol self-poisoning has continued to increase, half of all overdoses in 1995 involving paracetamol, and antidepressant overdoses have become more common. CONCLUSIONS: The increase in DSH, especially in young males, has important implications for general hospital DSH and medical services. It may herald a reversal of recent progress towards achievement of national suicide targets.

Adolescent↗
PubMed1996

Cognitive behaviour therapy for the chronic fatigue syndrome: a randomized controlled trial.

OBJECTIVE: To evaluate the acceptability and efficacy of adding cognitive behaviour therapy to the medical care of patients presenting with the chronic fatigue syndrome. DESIGN: Randomised controlled trial with final assessment at 12 months. SETTING: An infectious diseases outpatient clinic. SUBJECTS: 60 consecutively referred patients meeting consensus criteria for the chronic fatigue syndrome. INTERVENTIONS: Medical care comprised assessment, advice, and follow up in general practice. Patients who received cognitive behaviour therapy were offered 16 individual weekly sessions in addition to their medical care. MAIN OUTCOME MEASURES: The proportions of patients (a) who achieved normal daily functioning (Karnofsky score 80 or more) and (b) who achieved a clinically significant improvement in functioning (change in Karnofsky score 10 points or more) by 12 months after randomisation. RESULTS: Only two eligible patients refused to participate. All randomised patients completed treatment. An intention to treat analysis showed that 73% (22/30) of recipients of cognitive behaviour therapy achieved a satisfactory outcome as compared with 27% (8/30) of patients who were given only medical care (difference 47 percentage points; 95% confidence interval 24 to 69). Similar differences were observed in subsidiary outcome measures. The improvement in disability among patients given cognitive behaviour therapy continued after completion of therapy. Illness beliefs and coping behaviour previously associated with a poor outcome changed more with cognitive behaviour therapy than with medical care alone. CONCLUSION: Adding cognitive behaviour therapy to the medical care of patients with the chronic fatigue syndrome is acceptable to patients and leads to a sustained reduction in functional impairment.

Adaptation, Psychological↗
PubMed1996

Deliberate self-poisoning and self-injury in children and adolescents under 16 years of age in Oxford, 1976-1993.

BACKGROUND: Deliberate self-harm (DSH) is common in adolescents in the United Kingdom and suicide has greatly increased in frequency in older male adolescents. There is, however, very little information about DSH in older children and young adolescents. METHOD: Analysis of data collected by the Oxford Monitoring System for Attempted Suicide between 1976 and 1993 for all cases of DSH in under 16-year-olds referred to the general hospital in Oxford. RESULTS: Seven hundred and fifty-five individuals were involved in 854 episodes of DSH. There were very few cases under 12 years of age but after that the behaviour increased greatly in frequency with each year of age, especially in girls. Eighty-five per cent were girls, the sex ratio being 5.7 girls to each boy. Most cases involved self-poisoning. During the final six years of the study period paracetamol was involved in 54.7% of overdoses, compared with 19.5% in 1976-1981. A minority of individuals had had previous psychiatric treatment. The most frequent problems were relationship difficulties with parents, followed by difficulties with friends, school and social isolation. Among those who reported previous episodes of DSH, in the majority of cases these had not come to medical attention. Repetition of self-harm occurred in 9.4% of cases within a year of an episode and 19.3% during the overall study period. There was some indication that repetition was most common in youngsters discharged from the Accident and Emergency Department without a psychiatric assessment. CONCLUSIONS: DSH in under 16-year-olds is not uncommon and there is evidence that it occurs far more frequently in the community than is reflected in general hospital figures. The problem of paracetamol self-poisoning in this age group needs to be addressed. A psychiatric assessment should be performed in all cases coming to the general hospital.

Adolescent↗
PubMed1995

Attempted suicide in Oxford University students, 1976-1990.

During the 14 years between the beginning of academic year 1976-7 and the end of academic year 1989-90, 216 Oxford University students (119 females and 97 males) were referred to the general hospital in Oxford because of suicide attempts (254 in all). The rate of attempted suicide during university term-time (106/100,000) was lower than in other young people of similar age in Oxford City (164/100,000). The difference was particularly marked in females (178/100,000 v. 269/100,000). The lower rate in the students may in part reflect their generally higher socio-economic status. Very few of the attempts by the students appeared to be failed suicides. The most frequent problems faced by the students at the time of their attempts were interpersonal, especially difficulties regarding partners, followed by academic problems. The latter were usually problems with ongoing course work rather than with the Finals examinations. Approximately a quarter of the students had psychiatric problems, with personality disorders and depression being most common. At least 30% had a history of previous attempts. Suggestions are made concerning measures for improving the management and prevention of attempted suicide by students.

Adolescent↗
PubMed1995

Suicide in Oxford University students, 1976-1990.

BACKGROUND: The aim was to determine the extent, characteristics and timing of suicide in Oxford University students. METHOD: Students who died from suicide or undetermined cause between October 1976 and September 1990 were identified through University records and individual colleges. Information about each student was sought from coroners, college staff, general practitioners and hospital case notes. RESULTS: There were 21 suicides (16 men and 5 women) and one open verdict (female). The observed number of suicides (O) was greater than the number expected (E = 11.09) on the basis of mortality statistics for England and Wales (O/E = 1.89; 95% CI 1.17 to 2.90). When deaths due to undetermined cause were included, however, the difference between O and E (17.03) was much reduced (O/E = 1.29; 95% CI 0.81 to 1.95). There was no evidence of an association with the Finals examination but two-thirds of the students had been worried about academic achievement or their courses. Nearly half appeared to have had a psychiatric disorder (mostly depression). CONCLUSIONS: The much publicised apparent excess of Oxford University student suicides may be partly artefactual. Measures for preventing student suicides include careful induction upon arrival at university, means of alleviating academic stress and worries, and readily available and closely associated student counselling and psychiatric services.

Cause of Death↗
PubMed1995

Media influence on parasuicide. A study of the effects of a television drama portrayal of paracetamol self-poisoning.

BACKGROUND: Paracetamol self-poisoning, which carries a significant risk of fatal liver damage, is increasing in the UK, especially among adolescents. There is concern that media portrayal of suicidal behaviour may influence its occurrence. We have investigated the effects of two broadcasts of a television drama showing a teenage girl's overdose of paracetamol. METHOD: Data from the Oxford Monitoring System for Attempted Suicide were used to examine changes in the number of overdoses and the use of paracetamol in the three week period before and after both broadcasts. An analysis of log-linear models was carried out, using additional data from two previous years, in order to control for the effects of gender, age group, time period, season, year and drug. A questionnaire was used to ascertain whether the programme had influenced patients' decisions to take an overdose or their choice of drug. RESULTS: An increase in paracetamol overdoses occurred following the first broadcast, but when data from the two previous years were examined and the log-linear analysis was used there was no evidence of significant effects attributable to the broadcasts. The questionnaire study revealed that very few people had seen either episode, and only two claimed that it had influenced them (one in terms of getting help). CONCLUSIONS: It is important to use sound methodology to avoid interpreting chance fluctuations as a media effect. The potential positive benefits of such programmes should also be investigated.

Acetaminophen↗
PubMed1994

Use of psychiatric services by patients referred to a consultation unit.

The psychiatric case registers for the hospital catchment area were examined to determine the use of psychiatric services over a 14-year period by a 4-year cohort of consecutive inpatient referrals to the consultation-liaison service of a British general hospital. Two-thirds of the subjects had no other psychiatric care during the survey period, but a third made considerable use of a wide range of specialist psychiatric services. Alcohol problems and dementia were notably associated with complex history of psychiatric management. Management of patients with repeated episodes of psychiatric care requires close collaboration with other services.

Adolescent↗
PubMed1994

The epidemiology of attempted suicide in the Oxford area, England (1989-1992).

The epidemiological and clinical characteristics of attempted suicide in Oxford, United Kingdom, between 1989 and 1992 are reported on the basis of data collected as part of the WHO/EURO Multicentre Study of Parasuicide in Europe. Some further findings for the period 1976-1992 are also described. Rates of attempted suicide were particularly high among females aged 15-19 years. There was a very marked association in males and females between attempted suicide and both lower socioeconomic status and unemployment. The percentage of first-time attempters entering the attempted suicide population remained steady between 1976 and 1992, with approximately two-thirds of attempters each year making their first attempts. There was a great increase in the use of paracetamol (acetominophen) for self-poisoning between 1976 and 1992, this being involved in 14.3% of overdoses in 1976 and 43.2% in 1992. On the basis of the Oxford rates, there are approximately 100,000 general hospital admissions for attempted suicide each year in England and Wales, approximately 19,000 involving teenagers (mostly girls). Oxford has a similar pattern of attempted suicide to that in the rest of the UK. The findings indicate that the UK has one of the highest rates of attempted suicide in Europe.

Adolescent↗
PubMed1991

The effects of road traffic accidents on driving behaviour.

Questionnaires about the effects of accidents on subsequent driving behaviour were sent to 869 people admitted consecutively to a general hospital as a result of involvement in road traffic accidents 4-6 years previously. There were 418 (48 per cent) replies, 67 per cent of delivered questionnaires. One-fifth of the motorcyclists had stopped using a motorcycle. Nearly one-half the motorcyclists and vehicle drivers reported that they now drove more slowly and that they were more cautious. A considerable proportion of replies described emotional distress, avoidance and limitation of activities. Lack of confidence in driving was common immediately after the accident. After 4-6 years, one-third of respondents reported that they still suffered specific anxiety about the place of the accident and about situations similar to the accident. Many people were anxious about being passengers. The findings have implications for road safety, for the recognition and management of a common, and often disabling, clinical problem, and for the assessment of disabilities in medical reports for compensation proceedings.

Accidents, Traffic↗
PubMed1988

Female unemployment and attempted suicide.

Unemployment became more common among females attempting suicide in Oxford between 1976 and 1985, although the rise was less than expected from the increased general-population female unemployment rate. Rates of attempted suicide among unemployed women between 1979 and 1982 were 7.5-10.9 times higher than those of employed women, and were particularly high in women unemployed for more than a year. Many more unemployed than employed women attempting suicide had a history of psychiatric difficulties, were suffering from alcoholism, and made repeat attempts. Two possible explanations are: firstly, the secondary consequences of unemployment increase the risk of suicidal behaviour; and, secondly, women already predisposed to psychiatric difficulties and hence attempted suicide are more likely to become unemployed.

Adolescent↗
PubMed1981

Intraepithelial carcinoma of the vulva with extension to the anal canal.

Ten patients with intraepithelial carcinoma of the vulva that extended to the anus were studied. The patients were seen and treated over a 3-year period, from January 1976 through December 1978. During the 10-year period before 1976 the authors had encountered no patients with this problem. Treatment consisted predominantly of a skinning vulvectomy with split-thickness skin graft and excision of the anal disease. Failure to recognize the extension to the anus will result in persistent disease following surgical therapy.

Adult↗
PubMed1979

The reasons people give for taking overdoses: a further inquiry.

A representative sample of 41 cases of self-poisoning was studied in depth. In each case 'reasons' for taking the overdose, both stated spontaneously and chosen from a presented list, were recorded. The commonest spontaneous reason was the 'wish to die'. Nearly one-third indicated some non-suicidal purpose early in the interview and consistently denied suicidal intent subsequently. Apart from suicidal intent, reasons chosen from the list bore little resemblance to reasons that had been offered earlier in the interview and are therefore of uncertain relevance. Three psychiatric judges attributed reasons for each case based on common-sense criteria. Several reasons were seldom or never chosen by them; four were chosen frequently with good agreement, i.e. communicating hostility, influencing others, relieving a state of mind and suicidal intent. The first two were the most frequently chosen, attributed to 71 per cent and 54 per cent of cases respectively. They were the reasons chosen least frequently by the self-poisoners themselves. Of 23 (56 per cent) subjects indicating suicidal intent, 12 (29 per cent) were judged to be suicidal by psychiatrists. These were not clearly distinguishable on the basis of their original interviews, except that those judged suicidal tended to indicate suicidal intent early in the interviews. The clinical and research implications of these findings are discussed.

Adolescent↗