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Background: Term babies born smaller than expected for a given gestation are at greater risk of short- and long-term health conditions. Breastmilk is the optimum nutrition for all babies and offers specific protection from the risks that follow from being born small for gestational age. Aim: To explore breastfeeding outcomes for babies born with a birthweight below the 10th centile. Methods: Data were collected on all women giving birth in one maternity unit in the north of England over a year. Method of feeding at three time points was compared between small-for-gestational-age and appropriately grown babies. Findings: Small-for-gestational-age babies were significantly less likely to be breastfeeding at discharge from hospital and community services compared to larger babies. Conclusion: This study suggests that small-for-gestational-age babies are disadvantaged in establishing breastfeeding. [ABSTRACT FROM AUTHOR]

Rhinosinusitis is a common condition with adults experiencing 2-5 episodes per year. The European Positional Paper on Rhinosinusitis and Nasal Polyps (EP3OS) published in 2005 and updated in 2007 provided evidence-based guidelines on the management of sinus disease promoting a conservative approach to treatment. This study examines the effect of EP3OS on sinus surgery uptake and acute admissions for sinusitis in England and Wales. A retrospective study using the national electronic health databases of England (Hospital Episodes Statistics, HES online) and Wales (Patient Episodes Database of Wales, PEDW) was undertaken from 2000 to 2010 using the OPCS-4 codes E12-E17 (sinus surgery) and ICD10 code J01 (acute admission for sinusitis). Data were analysed for effect following the introduction of the EP3OS in 2005 using linear regression and Chi squared analysis. 116,370 sinus procedures and 10,916 acute admissions for sinusitis were made during the study period. No significant decrease in sinus surgery procedures occurred following the introduction of the EP3OS as may have been expected ( p > 0.05), although subgroup analysis suggested a significant increase in Wales ( p < 0.05). In addition, significant increases in acute admissions for sinusitis were observed following the introduction of EP3OS ( p < 0.05). However, subgroup analysis suggested this was not the case in Wales ( p > 0.05). The EP3OS appears to have had little impact on the rates of sinus surgery but more conservative approaches to managing of sinus disease may have led to an increase in acute admissions. Further research is required to investigate whether changes in practice were adopted. [ABSTRACT FROM AUTHOR]

Grommets insertion is a common otolaryngological procedure for the treatment of persistent otitis media with effusion. In 2002, the Department of Health (DoH) Day Surgery guidelines stipulated that at least 75% of grommets insertions should be undertaken as day-cases. In 2008, after governmental perception of a higher than necessary grommet insertion rate, the National Institute for Health and Clinical Excellence (NICE) guidelines aimed at reducing inappropriate grommet insertions. This study analyses the effect these national interventions have had on grommets insertion in England and Wales. A retrospective study was undertaken. Data were extracted from the patient episode databases of England (Health Episode Statistics) and Wales (Patient Episode Database of Wales) from 2000 until 2010 using OPCS-4 code D151. Statistical change in practice following the introduction of the interventions was assessed using linear regression. Results: 341,526 and 16,400 grommets insertions were performed in England and Wales, respectively. Linear regression analysis demonstrated that implementation of the Day Surgery guidelines significantly improved day-case rates in both national cohorts (England P < 0.0001, Wales P < 0.0001) and reduced mean waiting times for grommets insertion in both cohorts (England P < 0.05, Wales P < 0.01). Regression analysis also showed that implementation of the NICE guidelines had no effect on the number of grommet insertions in England ( P > 0.5) and Wales ( P > 0.5). In conclusion, the DoH guidelines have increased grommets day-case provision and reduced waiting times in both England and Wales, whereas the NICE guidelines have not affected overall levels of grommet insertion in either national cohort. [ABSTRACT FROM AUTHOR]

Background: Suicide has been repeatedly shown to have greatly increased incidence after non-fatal self-harm but far less is known about early death from other causes. The present study's aim was to describe mortality and risk factors concerning all causes of death after non-fatal self-poisoning. Methods: A prospective cohort study of 976 patients who attended the Emergency Department in Nottingham, UK during a 9-month period in 1985-1986. Information on deaths was obtained for 16 years following an episode of self-poisoning, from the records of the Office for National Statistics. Results: The observed:expected ratio for all-cause mortality was 2.2. Deaths due to diseases of the digestive and respiratory systems were, respectively, 4.4 and 2.9 times more frequent than expected. The risk for accidents was sixfold and for probable suicides 17-fold when compared with the risk in the general population. The main risk factor for subsequent deaths from natural causes was increasing age. Conclusions: The findings of this study suggest that patients who survive self-poisoning have an increased risk of death from natural and unnatural causes. The findings point towards the need for more effective clinical management and preventive initiatives. [ABSTRACT FROM AUTHOR]

Background: Quantitative research about self-harm largely deals with self-poisoning, despite the high incidence of self-injury.Aims: We compared patterns of hospital care and repetition associated with self-poisoning and self-injury.Method: Demographic and clinical data were collected in a multicentre, prospective cohort study, involving 10,498 consecutive episodes of self-harm at six English teaching hospitals.Results: Compared with those who self-poisoned, people who cut themselves were more likely to have self-harmed previously and to have received support from mental health services, but they were far less likely to be admitted to the general hospital or receive a psychosocial assessment. Although only 17% of people repeated self-harm during the 18 months of study, survival analysis that takes account of all episodes revealed a repetition rate of 33% in the year following an episode: 47% after episodes of self-cutting and 31% after self-poisoning (P<0.001). Of those who repeated, a third switched method of self-harm.Conclusions: Hospital services offer less to people who have cut themselves, although they are far more likely to repeat, than to those who have self-poisoned. Attendance at hospital should result in psychosocial assessment of needs regardless of method of self-harm. [ABSTRACT FROM AUTHOR]

Background: Self-harm is a major healthcare problem in the United Kingdom, but monitoring of hospital presentations has largely been done separately in single centres. Multicentre monitoring of self-harm has been established as a result of the National Suicide Prevention Strategy for England.Method: Data on self-harm presentations to general hospitals in Oxford (one hospital), Manchester (three hospitals) and Leeds (two hospitals), collected through monitoring systems in each centre, were analysed for the 18-month period March 2000 to August 2001.Results: The findings were based on 7344 persons who presented following 10,498 episodes of self-harm. Gender and age patterns were similar in the three centres, 57.0% of patients being female and two-thirds (62.9%) under 35 years of age. The largest numbers by age groups were 15-19 year-old females and 20-24 year-old males. The female to male ratio decreased with age. Rates of self-harm were higher in Manchester than Oxford or Leeds, in keeping with local suicide rates. The proportion of patients receiving a specialist psychosocial assessment varied between centres and was strongly associated with admission to the general hospital. Approximately 80% of self-harm involved self-poisoning. Overdoses of paracetamol, the most frequent method, were more common in younger age groups, antidepressants in middle age groups, and benzodiazepines and sedatives in older age groups. Alcohol was involved in more than half (54.9%) of assessed episodes. The most common time of presentation to hospital was between 10 pm and 2 am.Conclusions: Multicentre monitoring of self-harm in England has demonstrated similar overall patterns of self-harm in Oxford, Manchester and Leeds, with some differences reflecting local suicide rates. Diurnal variation in time of presentation to hospital and the need for assessment of non-admitted patients have implications for service provision. [ABSTRACT FROM AUTHOR]

Background: The National Confidential Inquiry into suicides in England and Wales found that a quarter of suicides are preceded by mental health service contact in the year before death. However, visits to accident and emergency departments due to self-harm may not lead to a record of mental health service contact. Aims To determine the proportion of suicides preceded by accident and emergency attendance in the previous year.Method: We obtained the list of probable suicides in Leeds for a 38-month period, and examined the records from the city's accident and emergency departments for a year before each death.Results: Eighty-five (39%) of the 219 people who later died by suicide had attended an accident and emergency department in the year before death, 15% because of non-fatal self-harm. Final visits due to self-harm were often shortly before suicide (median 38 days), but the National Confidential Inquiry recorded about a fifth of them as 'not in contact' with local mental health services.Conclusions: Although many suicides are preceded by recent attendance at accident and emergency departments due to non-fatal self-harm, local mental health service records may show no recent contact. Suicide prevention might be enhanced were accident and emergency departments and mental health services to work together more closely. [ABSTRACT FROM AUTHOR]

The article states that the computerization of membership lists offers considerable scope for postal surveys of trade unionists in England. Computerisation is now widespread and trade unions, like many modern organisations, have computerised their membership lists as an aid to administrative efficiency. Partly in response to the need to ensure comprehensive ballotting of members, partly because of the relative low cost of modern computer technology, and partly through a desire not to appear very old fashioned and unprofessional compared with employers, for example, trade unions have computerised much of their administration. The membership research departments of 16 trade unions were represented at a seminar held in Ruskin College, Oxford in July, 1983, and described the many difficulties inherent in computerisation and the dangers of assuming it necessarily results in greater accuracy. A qualitative in-depth study carried out for the union had identified major problems suffered by union members living on low pay. On investigation, it became clear that the lists were far from perfect and to treat them as such would be to misinterpret the response rate and overestimate the numbers of refusals.

Consecutive attenders (525) presenting at the Nottingham Accident and Emergency (A & E) department with deliberate self-poisoning were identified retrospectively. Their case-notes were examined for patient characteristics and clinical management. The Nottingham Psychiatric Case Register was examined for previous contact and use of psychiatric services over a 2-year follow-up period. Significant differences were found between those patients admitted to a ward and those who returned home from the A & E Department, in respect of likelihood of psychiatric morbidity and use of psychiatric services. One in three self-poisoning patients returns home directly from the accident department, and there seemed to be appropriate selection. [ABSTRACT FROM AUTHOR]

Background: Self-harm is common in the community with a lifetime prevalence of 13 %. It is associated with an elevated risk of overall mortality and suicide. People who harm themselves are high users of public services. Estimates of the 1-year risk of repetition vary between 5 and 15 % per year. Currently, limited evidence exists on the effectiveness of clinical interventions for young people who engage in self-harm. Recent reviews have failed to demonstrate any effect on reducing repetition of self-harm among adolescents receiving a range of treatment approaches. Family factors are particularly important risk factors associated with fatal and non-fatal self-harm among children and adolescents. Family therapy focuses on the relationships, roles and communication patterns between family members, but there have been relatively few studies of specifically family-focused interventions with this population. The Self-Harm Intervention: Family Therapy (SHIFT) Trial was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme (grant no. 07/33/01) following a commissioned call for this research.Methods/design: SHIFT is a pragmatic, phase III, multicentre, individually randomised, controlled trial comparing Family Therapy (FT) with treatment as usual (TAU) for adolescents aged 11 to 17 who have engaged in at least two episodes of self-harm. Both therapeutic interventions were delivered within the National Health Service (NHS) Child and Adolescent Mental Health Services (CAMHS) in England. Participants and therapists were, of necessity, aware of treatment allocation, but the researchers were blind to the allocations to allow unbiased collection of follow-up data. Primary outcome data (repetition of self-harm leading to hospital attendance 18 months post-randomisation) were collected from the Health and Social Care Information Centre (HSCIC), augmented by directed searches of medical records at Acute Trusts. Secondary outcome data (including suicidal intent, depression, hopelessness and health economics) were collected at 12 and 18 months post-randomisation via researcher-participant interviews and by post at 3 and 6 months.Discussion: SHIFT will provide a well-powered evaluation of the clinical and cost effectiveness of Family Therapy for young people who have self-harmed on more than one occasion. The study will be reported in 2016, and the results will inform clinical practice thereafter.Trial Registration: ISRCTN59793150 . 26 January 2009. [ABSTRACT FROM AUTHOR]

Background: Self-poisoning and self-injury have widely differing incidences in hospitals and in the community, which has led to confusion about the concept of self-harm. Categorising self-harm simply by a method may be clinically misleading because many hospital-attending patients switch from one method of harm to another on subsequent episodes. The study set out to determine the frequency, pattern, determinants and characteristics of method-switching in self-harm episodes presenting to the general hospital., Methods: The pattern of repeated self-harm was established from over 33,000 consecutive self-harm episodes in a multicentre English cohort, categorising self-harm methods as poisoning, cutting, other injury, and combined methods., Results: Over an average of 30 months of follow-up, 23% of people repeated self-harm and one-third of them switched method, often rapidly, and especially where the person was male, younger, or had self-harmed previously. Self-poisoning was far less likely than other methods to lead on to switching., Limitations: Self-harm episodes that do not lead to hospital attendance are not included in these findings but people who self-harmed and went to hospital but were not admitted from the emergency department to the general hospital, or did not receive designated psychosocial assessment are included. People in the study were a mix of prevalent as well as incident cases., Conclusions: Method of self-harm is fluctuating and unpredictable. Clinicians should avoid false assumptions about people׳s risks or needs based simply on the method of harm., (Crown Copyright © 2015. Published by Elsevier B.V. All rights reserved.)

Background: Around 150,000 people each year attend hospitals in England due to self-harm, many of them more than once. Over 5,000 people die by suicide each year in the UK, a quarter of them having attended hospital in the previous year because of self-harm. Self-harm is a major identifiable risk factor for suicide. People receive variable care at hospital; many are not assessed for their psychological needs and little psychological therapy is offered. Despite its frequent occurrence, we have no clear research evidence about how to reduce the repetition of self-harm. Some people who have self-harmed show less active ways of solving problems, and brief problem-solving therapies are considered the most promising psychological treatments., Methods/design: This is a pragmatic, individually randomised, controlled, feasibility study comparing interpersonal problem-solving therapy plus treatment-as-usual with treatment-as-usual alone, for adults attending a general hospital following self-harm. A total of 60 participants will be randomised equally between the treatment arms, which will be balanced with respect to the type of most recent self-harm event, number of previous self-harm events, gender and age. Feasibility objectives are as follows: a) To establish and field test procedures for implementing the problem-solving intervention; b) To determine the feasibility and best method of participant recruitment and follow up; c) To assess therapeutic delivery; d) To assess the feasibility of obtaining the definitive trial's primary and secondary outcomes; e) To assess the perceived burden and acceptability of obtaining the trial's self-reported outcome data; f) To inform the sample size calculation for the definitive trial., Discussion: The results of this feasibility study will be used to determine the appropriateness of proceeding to a definitive trial and will allow us to design an achievable trial of interpersonal problem-solving therapy for adults who self-harm., Trial Registration: Current Controlled Trials (ISRCTN54036115).

Background: Patients admitted to hospital because of self-harm should receive psychosocial assessment before discharge. In practice many of these assessments in the United Kingdom and elsewhere are undertaken by trainee rather than specialist psychiatrists., Aims: To compare psychosocial assessments, aftercare, and the pattern of non-fatal repetition for patients admitted to general hospital after self-harm: comparing assessments carried out by trainee psychiatrists, allocated to the task alongside other duties on a roster, or by mental health nurses with a designated role in self-harm services., Methods: Arrangements for aftercare and rates of non-fatal repetition of self-harm in 787 consecutive psychosocial assessments in a large UK city were compared, according to whether the assessments were carried out by trainee psychiatrists or mental health nurses., Results: Compared with nurses, psychiatrists were much more likely to arrange psychiatric admission or outpatient follow-up. Nurses more often pointed people towards voluntary sector help - such as drug, alcohol or relationship counselling. Repetition of self-harm was equally common among those assessed by nurses or psychiatrists (33%; hazard ratio 0.93, 95% confidence interval 0.71 to 1.2)., Conclusions: Despite making fewer aftercare arrangements that involved statutory mental health care services, psychosocial assessment by mental health nurses showed no sign of detrimental effects on repetition of self-harm.

Background: Suicide reduction is government strategy in many countries. We need to quantify the connection between non-fatal self-poisoning and eventual suicide., Aims: To determine mortality after an episode of self-poisoning and to identify predictors of death by any cause or by suicide., Method: A retrospective single-group cohort study was undertaken with 976 consecutive patients attending a large accident and emergency unit in 1985-1986 after non-fatal self-poisoning. Information about deaths was determined from the Office for National Statistics., Results: Of the original patients, 94% were traced 16 years later; 17% had died, 3.5% by probable suicide. Subsequent suicide was related to numerous factors evident at the time of the episode of self-poisoning but, when examined for their independent effects, only the severity of the self-poisoning episode and relevant previous history seemed important., Conclusions: Patients attending a general hospital after self-poisoning all require good basic assessment and care responsive to their needs. Attempts to reduce the huge excess of suicide subsequent to self-harm are not likely to achieve much if they are based on the identification of subgroups through'risk assessment'.

Objective: Older people who undertake self-harm are at higher suicide risk than are younger patients. This study examines whether this greater risk is reflected in the assessment and after-care that older patients receive when they attend accident and emergency., Method: This cross-sectional study, set in the two accident and emergency departments in a large industrial city in Northern England, compared 141 consecutive attendances due to self-harm among older patients (aged 55 years and over) with a random sample of 125 attendances of younger people (aged 15-54) attending because of self-harm. Data were drawn from accident and emergency records and from psychiatric and general hospital casenotes., Results: Compared with the younger group, older patients were significantly more likely to be admitted from accident and emergency to the general hospital, to receive a specialist assessment whilst at the hospital, and to be offered psychiatric after-care-either as a psychiatric in-patient or an out-patient., Conclusions: Fortunately, older people attending accident and emergency following self-harm seemed likely to receive psychosocial assessment from a mental health specialist, and they were much more likely than younger patients to be offered after-care. Hospitals will need to monitor accident and emergency and other records if they are to check that their services are responding to the high risks seen in older patients., (Copyright 2003 John Wiley & Sons, Ltd.)