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OBJECTIVE Despite their widespread use, there is limited evidence on whether crisis lines are effective, how to identify callers at risk or the best ways of supporting callers to prevent suicide. This study compared the features of callers and call patterns in service users who had died by suicide with those who were currently alive from 2008 to 2011. METHODS Using information contained on Contact's (Northern Ireland's "Lifeline" service) Client Information Management System (CIMS), 118 deaths by suicide from 2008 to 2011 were compared with a matched control group (matched on age, gender, and main presenting issue on first contact) who had not died by suicide. RESULTS Clients who had "check-in" calls were significantly less likely to die by suicide. Those with a substance dependency or those who had made a prior suicide attempt were significantly more likely to die by suicide. Duration of service access had a negative association with suicide risk. CONCLUSIONS "Check-in" calls are an important part of the service. Information on previous suicide attempts and substance dependency may be useful in identifying callers who may benefit from proactive support and outreach. Wider interventions are needed to promote service user follow-up and to encourage longer term engagement with the service.

Background Child health research in clinical practice is increasing throughout the UK. Nurses and midwives facilitate access to patients, enact research study protocols and have a critical role in parental decisions to enrol children into research studies. Little is known about their perception of this process. Aims & Objectives To explore the views of nurses towards child health research and to identify factors influencing their willingness to facilitate it in practice. Design This study was a descriptive study design. Methods A newly designed questionnaire was completed in 2013 by 105 nurses in 3 neonatal and 2 children's units in 2 discrete acute hospital sites. Results Overwhelming support for clinical research was reported. Participants were motivated to facilitate research in order to improve patient care and contribute to the evidence base; but discouraged by external organisational factors and ethical concerns. Training, education and a dedicated team to support research were considered important. Misconceptions regarding consent and the allocation of treatment were reported. Participants raised particular concerns about trials of Investigational Medicinal Product (IMP). Conclusion Negative views of nurses towards research, combined with a lack of knowledge of research processes, governance and ethics have the potential to threaten the success of clinical research studies. Recommendations for clinical practice Focus on three main areas; staff education, improved communication and the demonstration of managerial commitment to clinical research. This article is protected by copyright. All rights reserved.

Northern Ireland is an appropriate region to examine the impact of traumatic experiences, owing to the many years of civil violence that have characterized its recent history, known colloquially as the "Troubles." Given the prominence of traumatic experiences among the aging population of Northern Ireland (NI), an evidence base is required to inform the planning and provision of effective mental health and other services. We analyzed the follow-up interviews (n = 225) of individuals from the Northern Ireland Study of Health and Stress (NISHS), aged 45 years and older, who experienced one or more conflict-related traumatic events. This study demonstrated that in NI traumatic events, such as being involved in an explosion, seeing someone killed or seriously injured, and living in a region of terror were most likely to be related to the Troubles. However, event types that we had not previously known to be related to conflict (such as the sudden death of a loved one), were also often related to the Troubles. Two-thirds of participants (67.1%) reported exposure to a Troubles-related event, and 57.8% reported being a civilian in a region of terror. The vast majority (85.9%) of participants who experienced a Troubles-related trauma never sought help, despite 59.1% meeting the criteria for a lifetime mental disorder. The reasons for not seeking help and sources of help are outlined. Policy makers must address Troubles-related mental health effects, in terms of how they carry forward into aging, and consider ways of improving engagement with services and treatments.

Introduction We assess the ability of low-dose hybrid iterative reconstruction (IR) and ‘pure’ model-based IR (MBIR) images to maintain accurate Hounsfield unit (HU)-determined tissue characterization. Methods Standard-protocol (SP) and low-dose modified-protocol (MP) CTs were contemporaneously acquired in 34 Crohn's disease patients referred for CT. SP image reconstruction was via the manufacturer's recommendations (60% FBP, filtered back projection; 40% ASiR, Adaptive Statistical iterative Reconstruction; SP-ASiR40). MP data sets underwent four reconstructions (100% FBP; 40% ASiR; 70% ASiR; MBIR). Three observers measured tissue volumes using HU thresholds for fat, soft tissue and bone/contrast on each data set. Analysis was via SPSS. Results Inter-observer agreement was strong for 1530 datapoints (rs > 0.9). MP-MBIR tissue volume measurement was superior to other MP reconstructions and closely correlated with the reference SP-ASiR40 images for all tissue types. MP-MBIR superiority was most marked for fat volume calculation – close SP-ASiR40 and MP-MBIR Bland–Altman plot correlation was seen with the lowest average difference (336 cm3) when compared with other MP reconstructions. Conclusions Hounsfield unit-determined tissue volume calculations from MP-MBIR images resulted in values comparable to SP-ASiR40 calculations and values that are superior to MP-ASiR images. Accuracy of estimation of volume of tissues (e.g. fat) using segmentation software on low-dose CT images appears optimal when reconstructed with pure IR.

The objective of this study was to estimate the economic costs of posttraumatic stress disorder (PTSD) among the Northern Ireland (NI) adult population. The authors present a prevalence-based, bottom-up study based primarily on data from 1,986 participants in the Northern Ireland Study of Health and Stress (NISHS). Both direct costs of treatment and indirect costs of productivity losses were included. Units of service and medication resource use were obtained from the NISHS and combined with their relevant unit costs from the Personal Social Services Research Unit and Prescription Costs Analysis data for NI. Indirect costs included the costs of incapacity days due to PTSD and presenteeism costs, with gender-specific wage rates used as the relevant unit costs. The total direct and indirect cost of PTSD in NI (2008) was £172,756,062. This figure is likely to be conservative due to the exclusion of a number of cost categories. Nevertheless, comparison of estimates of the burden of PTSD with the estimated cost of treating all adults with PTSD with the recommended treatments shows the potential for substantial economic gains to be made through extension and investment in effective evidence-based treatments.

The authors provide epidemiological estimates of trauma, posttraumatic stress disorder (PTSD), and associated mental disorders in Northern Ireland (NI) with a focus on the impact of civil conflict using data from the NI Study of Health and Stress (NISHS), a representative epidemiological survey of adults in NI. Overall 60.6% had a lifetime traumatic event, and 39.0% experienced a presumed conflict-related event. Men were significantly more likely to experience any traumatic event and most conflict-related event types (p < .05). The lifetime and 12-month prevalence of PTSD were 8.8% and 5.1%, respectively. Furthermore, the lifetime prevalence of any mental disorder among men and women who experienced a conflict-related trauma (46.0% and 55.9%, respectively) was significantly higher than the prevalence among men and women who did not experience this type of traumatic event (27.2% and 31.1%, respectively). Given the public health burden posed by PTSD and additional impact of conflict, specific attention must be paid to the policy, service, and clinical challenge of delivering evidence-based treatments in the wake of a tumultuous period of conflict.

Introduction: This study investigated the optimal Hounsfield unit (HU) threshold range when using threshold-based segmentation to estimate volumes of contained gas (i.e. intestinal gas) on CT. Methods: A water-filled cylindrical acrylic imaging phantom containing two saline bags modified to allow injection of known volumes of gas (room air) was constructed. The phantom was imaged with CT following injection of known gas volumes. Images were analysed using standard threshold-based 3D region growing with human-entered seed points. The lower threshold was −1024 HU, and upper thresholds between −700 HU and −200 HU were tested for each volume. Appropriate statistical analysis was performed. Results: Measurements were normally distributed. There was excellent correlation between measured and injected volumes for all thresholds (Pearson's r > 0.99). The optimal upper threshold for small gas volumes (1–6 mL) was −550 HU with 0.1% ± 3.9% (mean ± standard deviation) error. The optimal upper threshold for large gas volumes (10–50 mL) was −350 HU with 0.7 ± 3.6% (mean ± standard deviation) error with Pearson correlations of r > 0.99 for both. Conclusion: Accurate estimation of gas volumes on CT is possible using threshold-based segmentation software with a wide range of upper thresholds. The optimal upper threshold for estimation of small volumes (1–6 mL) was −550 HU and −350 HU for volumes of 10–50 mL.

Objectives. The aim of this study was to address the gap in our understanding of the experiences of people with diabetic retinopathy (DR) and how they manage their daily lives. Methods. Individual, semi-structured interviews were held with 10 individuals residing in Co. Donegal, Ireland who were diagnosed with diabetes and had visual loss as a result of retinopathy. Verbatim transcripts of these interviews were analysed using interpretative phenomenological analysis. Results. The main themes identified in the qualitative analysis were losses resulting from DR; coping with the emotional impact of loss; and self-management and lifestyle. DR was associated with a number of losses. The visual loss was accompanied by a sense of dependence, social isolation, and the loss of important social and occupational roles. The perceived loss of independence and mobility resulted in a need for support in managing the lifestyle changes necessary for good blood sugar control particularly with regard to exercise. A variety of coping strategies were employed and social and family support was perceived to be important to maintain psychological well-being. Conclusions. The findings highlight the importance of providing these individuals with appropriate professional support to facilitate the management of both conditions.

BACKGROUND: Unexpected death of a loved one (UD) is the most commonly reported traumatic experience in cross-national surveys. However, much remains to be learned about posttraumatic stress disorder (PTSD) after this experience. The WHO World Mental Health (WMH) survey initiative provides a unique opportunity to address these issues. METHODS: Data from 19 WMH surveys (n = 78,023; 70.1% weighted response rate) were collated. Potential predictors of PTSD (respondent sociodemographics, characteristics of the death, history of prior trauma exposure, history of prior mental disorders) after a representative sample of UDs were examined using logistic regression. Simulation was used to estimate overall model strength in targeting individuals at highest PTSD risk. RESULTS: PTSD prevalence after UD averaged 5.2% across surveys and did not differ significantly between high-income and low-middle income countries. Significant multivariate predictors included the deceased being a spouse or child, the respondent being female and believing they could have done something to prevent the death, prior trauma exposure, and history of prior mental disorders. The final model was strongly predictive of PTSD, with the 5% of respondents having highest estimated risk including 30.6% of all cases of PTSD. Positive predictive value (i.e., the proportion of high-risk individuals who actually developed PTSD) among the 5% of respondents with highest predicted risk was 25.3%. CONCLUSIONS: The high prevalence and meaningful risk of PTSD make UD a major public health issue. This study provides novel insights into predictors of PTSD after this experience and suggests that screening assessments might be useful in identifying high-risk individuals for preventive interventions. The World Health Organization World Mental Health (WMH) Survey Initiative is supported by the National Institute of Mental Health (NIMH; R01 MH070884 and R01 MH093612-01), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558) and the Fogarty International Center (FIRCA R03- TW006481). The São Paulo Megacity Mental Health Survey is supported by the State of São Paulo Research Foundation (FAPESP) Thematic Project grant 03/00204-3. The ESEMeD project is funded by the European Commission (contracts QLG5-1999-01042; SANCO 2004123, and EAHC 20081308; the Piedmont Region [Italy]), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spain and Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP) . The World Mental Health Japan (WMHJ) survey is supported by the Grant for Research on Psychiatric and Neurological Diseases and Mental Health (H13-SHOGAI-023, H14-TOKUBETSU026, H16-KOKORO-013) from the Japan Ministry of Health, Labour and Welfare. The Lebanese Evaluation of the Burden of Ailments and Needs of the Nation (L.E.B.A.N.O.N.) is supported by the Lebanese Ministry of Public Health and the WHO (Lebanon), National Institute of Health/Fogarty International Center (R03 TW006481-01). The South Africa Stress and Health Study (SASH) is supported by the US National Institute of Mental Health (R01-MH059575). The Ukraine Comorbid Mental Disorders during Periods of Social Disruption (CMDPSD) study is funded by the US National Institute of Mental Health (RO1-MH61905). The US National Comorbidity Survey Replication (NCS-R) is supported by the National Institute of Mental Health (NIMH; U01-MH60220) with supplemental support from the National Institute of Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Robert Wood Johnson Foundation (RWJF; grant 044708), and the John W. Alden Trust