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To make the treatment approach in patients suffering a European hornet sting allergy reaction more personalized, preparing them also for possible future risks.

The article discusses how firearms control reduced suicide rate in the Republic of Croatia. Topics discussed include Croatia's independence from the Socialist Federal Republic of Yugoslavia (SFRY) and fighters gaining access to weapons during war with SFRY; launch of voluntary weapons-collection programme (VWCP) that invited Croatian citizens to surrender their weapons or apply for legal ownership; and effects of campaigns on injuries and mortality with significant fall in suicides by firearms.

Background: Monitoring and measuring of the medicine utilisation enables to assess the quality of use of medicines, providing the evidence-based data for the improvement of the prescribing practice and a more rational use of medicines. The aim of this study was to analyse utilisation patterns of medicines and to compare the results with other countries. Methods: A retrospective, observational study to analyse outpatient medicines utilisation in the Republic of Srpska between 2009 and 2017. Data of medicines utilisation were retrieved from the national database in the Public Health Institute of the Republic of Srpska and calculated and analysed by using the Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) methodology. The results were expressed as Defined Daily Doses (DDDs) per 1,000 inhabitants per day. Results: Total medicines utilisation increased, from 448 DDDs in 2009 to 1,036 DDDs in 2017. Cardiovascular medicines (group C) were the most used medicines, and their share in the total utilisation increased from 36.6% in 2009 to 44.4% in 2017. Among them, the most frequently used were angiotensin-converting enzyme inhibitors, plain and in combinations with diuretics, namely enalapril. The share of medicines used in diabetes in the total utilisation increased from 3.9% in 2009 to 5.1% in 2017. Metformin and glimepiride accounted for about 83% of the blood glucose lowering medicines group (A10B). Among the antithrombotic medicines, the most frequently used were platelet aggregation inhibitors (B01AC), mainly acetylsalicylic acid whose use tripled since 2009. Diclofenac was the most frequently used non-steroidal anti-inflammatory and antirheumatic drug (M01). Conclusion: The trend of increased medicines utilisation was observed in this study. This finding is comparable with other countries. Variations between countries in the preferred medicines within a class as well as the extent of medicines use were observed. These differences were probably consistent, but not solely attributable, to differences in local guidelines and reimbursement policies.

Introduction. Healthcare-associated infections (HAI) are a global public health problem that exists in all health care systems and lead to very significant consequences. All health care systems are obliged to continuously improve preventive measures, which can reduce occurrence of HAI by 10 to 70 percent. First step in improving prevention is constitution of functional epidemiological surveillance over HAI. Aim of the study. The objective of this study was to show, through the point prevalence survey, the rates of HAI in surgical clinics of the University Clinical Centre of the Republic of Srpska (UCC RS), their most important epidemiological characteristics, the most frequently isolated microorganisms and their resistance to antibiotics. Material and methods. In this study, we used standardized methodology for the point prevalence survey of HAI and antimicrobial use, including case definitions established by the European Centre for Disease Control (ECDC). The study was conducted in October 2014 at the surgical clinics of the UCC RS, and it included a total of 196 patients. Results. The prevalence of HAI at the surgical clinics of the UCC RS was 11.7%. The most common localization of HAI were surgical site infections (60.8%). The most common isolated microorganisms were Acinetobacter spp., Enterococcus spp., Pseudomonas aeruginosa i Staphylococcus aureus. All isolated Acinetobacter and 50% ofisolated Pseudomonas were resistant to carbapenems, 50% of Staphylococcus aureus to methicillin, 50% Enterococcus spp. to vancomycin, and 40% Enterobacteriaceaeto cephalosporins, 3rd generation. Conclusion. The prevalence of HAI at the surgical clinics of the UCC RS is within the frame of the prevalence in developing countries. More attention must be given to this problem. The prevalence study may be the method of choice for HAI surveillanceat national level.

Introduction. Antimicrobial resistance is a very serious public health threat worldwide. The main cause of antimicrobial resistance is irrational use of antimicrobial drugs. The goal of the article is to analyze data on outpatient antibiotic consumption in the Republic of Srpska during the period from 2009 to 2014, to present outpatient consumption of the first six antibiotics (the fifth level of the ATC classification), and, finally, to compare the antibiotic use in Republic of Srpska in relation to the antibiotic use in European Union countries. Materials and Methods. Collection and analysis of data on drug consumption is done using ATC/DDD methodology, established by the WHO. Data are taken from the report on drug consumption and distribution in the Republic of Srpska during the period from 2009 to 2014, which are based on submitted data from pharmacies registered in the Republic of Srpska. Results. Results on outpatient antibiotic consumption in the Republic of Srpska, during the period from 2009 to 2014, indicate a total decrease by 3.41 DDDs/1000 inhabitants/day, with the exception of 2010 and 2013, when the antibiotic consumption was increased. In 2014, total outpatient antibiotic consumption in the Republic of Srpska was 31.2% lower than the average consumption in the European Union. During the period from 2010 to 2014, the European Union had a significant increase in antibiotic consumption, while antibiotic consumption in the Republic of Srpska had a tendency of falling. Conclusion. Presented results show a quantitative analysis of antibiotic consumption and provide insight into the outpatient use of antibiotics in the Republic of Srpska, and can be used for further pharmacoepidemiological analysis of antibiotic consumption, which would give a better insight into the therapeutic practice, with the aim of improving the rational pharmacotherapy in the Republic of Srpska.

Introduction: Controlling the presence of contaminants or harmful substances in milk and dairy products provides early detection of risks since their presence, even in legally permitted concentration, increases the risk of damaging human health, especially children's health, such as allergic manifestations, and they can have potentially toxic, carcinogenic and genotoxic effects. Aim of the Study: The aim is to determine the frequency of the presence of contaminants in samples of milk and dairy products in the Republic of Srpska from 2010 to 2012 (metals, radionuclides, aflatoxins and residues of antibiotics and pesticides), and especially to point out their public health significance because of possible health risks. The aim of the paper is to emphasize the need for monitoring all the other contaminants in milk and dairy products specified in regulations. Material and Methods: The frequency of the presence of contaminants in the samples of milk and dairy products (n= 407) was determined on the basis of legally prescribed methodology of sampling, chemical analyses and preparation of expert opinion on food safety in accordance with current food regulations. Descriptive statistical indicators were used (a number of the samples, minimum and maximum concentrations). Chi square test (χ2) of contingency was used for testing the significance of differences in presence of contaminants and residues analyzed and recommended by regulations in samples of milk and dairy products. Results: The results of public health research of contaminants in samples of milk and dairy products indicate that no health defective food samples were determined at tested parameters - metals, radionuclides, aflatoxins, and residues of antibiotics and pesticides. A statistically significant number of samples examined on heavy metal content (83.29% or 339 samples) was determined comparing to the number of samples examined on the other contaminants and residues recommended by regulations in milk and dairy products (χ2=1000.776, p

Introduction: Sex workers (SW) represent the population exposed to extremely high risk of HIV (HIV - Human Immunodeficiency Virus) and other sexually transmitted infections. Poor socioeconomic conditions in the country, insufficient education, high unemployment and other factors lead to an increase in prostitution, which represents a high risk for the spread of HIV and other sexually transmitted diseases. Aim of the study: The aim of this research was to evaluate the prevalence of HIV/ sexually transmitted infections among SW in Bosnia and Herzegovina as well as to examine knowledge, attitudes and behaviour relating to HIV/sexually transmitted infections. The results were compared with the results obtained in researches conducted in 2008 and 2010. Material and Methods: Research was performed in 2012 as a bio-behavioral study that covered 199 sex workers in five cities of Bosnia and Herzegovina. Interviewing was done voluntarily, anonymously and confidentially, and after informed consent and counselling, a biological material (blood) for laboratory testing on HIV, hepatitis b, hepatitis c and syphilis was taken. The research shows the presence of risk behaviour among SW, mostly related to frequent change of partners and frequent unprotected sexual intercourses. Results: Only one third of respondents (36,7%) use condom during every sexual intercourse with a client, and 13% use it with a steady partner. A sexual intercourse after effects of consumption of alcohol-87,9% of respondents and of drugs-36,7% of respondents. Although there is a risk behaviour, only 11,1% think that the risk of HIV/sexually transmitted infections is high, but 12,6% think that there is no risk. Sex workers are 13,5 times more exposed to HIV infection than all the other women aged 15- 49. Results of laboratory testing indicate a low level of HIV/sexually transmitted infections among sex workers in Bosnia and Herzegovina. Conclusion: Although there is a relative progress in prevention of HIV/sexually transmitted infections among sex workers and more frequent testing on HIV/sexually transmitted infections comparing to earlier periods, these things are insufficient for the maintenance of a low level of infection. Further research at certain time intervals among this population would enable monitoring time trends of HIV epidemic in Bosnia and Herzegovina and would become a basis for the development of preventable programmes.

Background: Suicide-related internet use (SRIU), defined as internet use related to one's own feelings of suicide, can be both a risk and protective factor, especially for isolated individuals. Despite its influence on suicidality, clinicians face challenges in assessing SRIU because of the private nature of internet usage. Current recommendations on enquiring about SRIU in a clinical setting concern mostly young people., Aims: To address the gap in understanding SRIU among patients of all ages, this study aims to explore mental health clinicians' experiences, attitudes and beliefs regarding enquiring about SRIU, as well as the risks and benefits it presents in the assessment and management of patients. Finally, the study aims to establish the role SRIU potentially plays in the assessment and management of patients., Method: Twelve clinicians practising at secondary mental health services in England participated in interviews. Thematic analyses were used for data interpretation., Results: Clinicians who participated in interviews rarely initiate discussions on SRIU with their patients despite considering this an important factor in suicidality. Age of both patients and clinicians has the potential to influence enquiry into SRIU. Clinicians recognise the potential benefits of patients finding supportive online communities but also express concerns about harmful and low-quality online content related to suicide., Conclusions: Integrating SRIU enquiry into standard clinical practice, regardless of the patient's age, is an important step towards comprehensive patient care. Broader training for clinicians on enquiring about online behaviours is essential to mitigate potential risks and harness the benefits of SRIU in mental health patients.

Background: Suicide-related internet use (SRIU) has been shown to be linked to suicide. However, there is limited research on SRIU among mental health patients, who are at 4 to 7 times increased risk of suicide compared to the general population. This study aims to address this gap by exploring the prevalence of SRIU among mental health patients who died by suicide in the UK and describing their characteristics., Methods: The study was carried out as part of the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH). Data were collected on sociodemographic, clinical, suicide characteristics and engagement in SRIU of patients who died by suicide between 2011 and 2021. The study utilised a case-control design to compare patients who engaged in suicide-related internet use with those who did not., Findings: The presence or absence of SRIU was known for 9875/17,347 (57%) patients; SRIU was known to be present in 759/9875 (8%) patients. The internet was most often used to obtain information on suicide methods (n = 523/759, 69%) and to visit pro-suicide websites (n = 250/759, 33%) with a significant overlap between the two (n = 152/759, 20%). Engaging in SRIU was present across all age groups. The case-control element of the study showed patients who were known to have engaged in SRIU were more likely to have been diagnosed with autism spectrum disorder (OR = 2.13, 95% CI: 1.43-3.18), have a history of childhood abuse (OR = 1.70, 95% CI: 1.36-2.13) and to have received psychological treatment (OR = 1.43, 95% CI: 1.18-1.74) than controls. Additionally, these patients were more likely to have died on or near a salient date (OR = 2.11, 95% CI: 1.61-2.76), such as a birthday or anniversary., Interpretation: The findings affirm SRIU as a feature of suicide among patients of all ages and highlight that clinicians should inquire about SRIU during assessments. Importantly, as the most common type of SRIU can expand knowledge on suicide means, clinicians need to be aware of the association between SRIU and choice of methods. This may be particularly relevant for patients approaching a significant calendar event., Funding: The Healthcare Quality Improvement Partnership., Competing Interests: N.K. is a member of the Department of Health and Social Care (England) National Suicide Prevention Advisory Group. He chaired the NICE Guideline Development Group for the Longer-Term Management of Self-Harm and the NICE Topic Expert Group (which developed the quality standards for self-harm services). N.K. is currently chair of the updated NICE Guideline for Depression and topic advisor for the current NICE Guideline Development Group for the Longer-term Management of Self-harm and is also supported by Mersey Care NHS Foundation Trust. L.A. is Chair of the National Suicide Prevention Strategy Advisory Group, DHSC. N.K., L.A. and P.T. report grants from the Healthcare Quality Improvement Partnership and NHS England. N.K., L.A. and P.T. report grants from the Department for Education and the Medical Research Council. P.T. reports a grant from the Gambling Research Exchange Ontario. I.H. reports grants from HQIP and from the Medical Protection Society Limited (MPS). All other authors declare no competing interests., (© 2024 The Author(s).)

Suicide is the leading cause of unnatural death among people with schizophrenia. Substance use is a highly prevalent comorbid feature of schizophrenia and a modifiable risk factor for suicide. However, no studies have examined changes in the frequency of substance use or self-poisoning in those who died by suicide over time. Knowing this could support more tailored approaches to reducing specific risk factors and access to means in those with schizophrenia who are at risk of suicide. We conducted an 11-year observational study on a clinical survey of people with schizophrenia in the UK who died by suicide within 12 months of contact with mental health services between 2010 and 2020 (n = 2718). Overall, alcohol, cannabis and stimulants were the most frequently reported substances. The odds of lifetime use significantly increased over time for cannabis, stimulants, heroin, and benzodiazepines. There were differences in socio-demographic, behavioural and clinical factors between those with recent and historical alcohol and drug use before death. Deaths by hanging, jumping and self-poisoning were the most common suicide methods. Though deaths by hanging significantly increased over time, deaths by self-poisoning significantly decreased, especially by means of psychotropic medication and opioids. To improve risk management, clinical efforts should focus on identifying and treating people with schizophrenia using specific substances. Nationwide initiatives for improving safety in prescribing could be contributing to reduced risks of suicide via self-poisoning in this group., Competing Interests: Declaration of competing interest LA chairs the National Suicide Prevention Strategy Advisory Group (NSPAG) at the Department of Health and Social Care in England; NK is a member of the Group and is supported by Greater Manchester Mental Health NHS Foundation Trust. NK chaired the 2022 NICE guideline development group for depression in adults and was a topic expert member for the NICE suicide prevention guideline. NK chaired the guideline development group for the NICE guidelines on the longer-term management of self-harm 2011 and was a topic advisor on the 2022 NICE guideline on self-harm. All other authors have no interests to declare., (Crown Copyright © 2024. Published by Elsevier B.V. All rights reserved.)

The association between previous convictions and perpetrating homicide has been previously described but little is known about the characteristics of homicide offenders without previous convictions. By utilizing the unique database on homicide offenders held by the National Confidential Inquiry into Suicide and Safety in Mental Health, this study aimed to describe the sample of homicide perpetrators in England and Wales who have committed homicide as their first offense based on their sociodemographic and clinical characteristics. Compared with those with previous convictions, homicide offenders without previous convictions were more likely to be female and a member of an ethnic minority group. More of those without previous convictions belonged to the youngest (<25) and oldest (>55) age groups and were more likely to kill somebody family member or a spouse. Schizophrenia and other delusional disorders as well as affective disorders were more prevalent in those without previous convictions as were mental illness/insanity as a circumstance in homicide, but those without previous convictions were less likely to have been in previous contact with mental health services. There are clear sociodemographic and clinical differences between homicide perpetrators with and without previous convictions. Implications of these findings are discussed., (© 2023 University of Manchester. Aggressive Behavior published by Wiley Periodicals LLC.)

Background: There are comparatively few international studies investigating suicide in military veterans and no recent UK-wide studies. This is important because the wider context of being a UK Armed Forces (UKAF) veteran has changed in recent years following a period of intensive operations. We aimed to investigate the rate, timing, and risk factors for suicide in personnel who left the UKAF over a 23-year period., Methods and Findings: We carried out a retrospective cohort study of suicide in personnel who left the regular UKAF between 1996 and 2018 linking national databases of discharged personnel and suicide deaths, using survival analysis to examine the risk of suicide in veterans compared to the general population and conditional logistic regression to investigate factors most strongly associated with suicide after discharge. The 458,058 individuals who left the UKAF accumulated over 5,852,100 person years at risk, with a median length of follow-up of 13 years, were mostly male (91%), and had a median age of 26 years at discharge. 1,086 (0.2%) died by suicide. The overall rate of suicide in veterans was slightly lower than the general population (standardised mortality ratio, SMR [95% confidence interval, CI] 94 [88 to 99]). However, suicide risk was 2 to 3 times higher in male and female veterans aged under 25 years than in the same age groups in the general population (age-specific mortality ratios ranging from 160 to 409). Male veterans aged 35 years and older were at reduced risk of suicide (age-specific mortality ratios 47 to 80). Male sex, Army service, discharge between the ages of 16 and 34 years, being untrained on discharge, and length of service under 10 years were associated with higher suicide risk. Factors associated with reduced risk included being married, a higher rank, and deployment on combat operations. The rate of contact with specialist NHS mental health services (273/1,086, 25%) was lowest in the youngest age groups (10% for 16- to 19-year-olds; 23% for 20- to 24-year-olds). Study limitations include the fact that information on veterans was obtained from administrative databases and the role of pre-service vulnerabilities and other factors that may have influenced later suicide risk could not be explored. In addition, information on contact with support services was only available for veterans in contact with specialist NHS mental health services and not for those in contact with other health and social care services., Conclusions: In this study, we found suicide risk in personnel leaving the UKAF was not high but there are important differences according to age, with higher risk in young men and women. We found a number of factors which elevated the risk of suicide but deployment was associated with lower risk. The focus should be on improving and maintaining access to mental health care and social support for young service leavers, as well as implementing general suicide prevention measures for all veterans regardless of age., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: PT, LA and NK are contracted by the Healthcare Quality Improvement Partnership (HQIP) to deliver the Mental Health Clinical Outcome Review Programme (MHCORP); LA is the Chair of the National Suicide Prevention Strategy Advisory Group (England), Department of Health and Social Care; NK is a member of the National Suicide Prevention Strategy Advisory Group (England), Department of Health and Social Care and chaired the 2022 guideline development group for the National Institute for Health and Care Excellence (NICE) depression in adults’ guidelines and was the a topic advisor for the 2022 National Institute for Health and Care Excellence (NICE) self-harm guidelines. Members of the study team (KH, and HD and AB) were are employees of the MoD and NHSE at the time of the study., (Copyright: © 2023 Rodway et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Reducing suicide risk in middle-aged males (40-54 years) is a national priority. People have often presented to their GP within 3 months before suicide thus highlighting an opportunity for early intervention., Aim: To describe the sociodemographic characteristics and identify antecedents in middle-aged males who recently consulted a GP before dying by suicide., Design and Setting: This study was a descriptive examination of suicide in a national consecutive sample of middle-aged males in 2017 in England, Scotland, and Wales., Method: General population mortality data were obtained from the Office for National Statistics and National Records of Scotland. Information was collected about antecedents considered relevant to suicide from data sources. Logistic regression examined associations with final recent GP consultation. Males with lived experience were consulted during the study., Results: In 2017, a quarter ( n = 1516) of all suicide deaths were in middle-aged males. Data were attained on 242 males: 43% had their last GP consultation within 3 months of suicide; and a third of these males were unemployed and nearly half were living alone. Males who saw a GP recently before suicide were more likely to have had recent self-harm and work-related problems than males who had not. Having a current major physical illness, recent self-harm, presenting with a mental health problem, and recent work-related issues were associated with having a last GP consultation close to suicide., Conclusion: Clinical factors were identified that GPs should be alert to when assessing middle-aged males. Personalised holistic management may have a role in preventing suicide in these individuals., (© The Authors.)

The COVID-19 pandemic has harmed many people's mental health globally. Whilst the evidence generated thus far from high-income countries regarding the pandemic's impact on suicide rates is generally reassuring, we know little about its influence on this outcome in lower- and middle-income countries or among marginalised and disadvantaged people. There are some signals for concern regarding the pandemic's potentially unequal impact on suicide rates, with some of the affected demographic subgroups and regions being at elevated risk before the pandemic began. However, the evidence-base for this topic is currently sparse, and studies conducted to date have generally not taken account of pre-pandemic temporal trends. The collection of accurate, complete and comparable data on suicide rate trends in ethnic minority and low-income groups should be prioritised. The vulnerability of low-income groups will likely be exacerbated further by the current energy supply and cost-of-living crises in many countries. It is therefore crucial that reassuring messaging highlighting the stability of suicide rates during the pandemic does not lead to complacency among policymakers.

Background: Allergic reactions to Hymenoptera stings can have varying levels of severity, according to the Müller grading system., Methods: By an epidemiological concept, this is a retrospective cohort study. The observed cohort was represented by patients referred to the University Clinic Golnik due to Hymenoptera allergic reaction in the period from 1997 to 2015. From the immunological database of the University Clinic Golnik, we obtained laboratory data (sIgE, skin tests and basophil activation test). The clinical characteristics of patients were obtained from BIRPIS. With the help of a questionnaire, which was sent to each patient in the period from May 2019 to April 2021, we obtained epidemiological data. For the assessment of the association between the severity of allergic reaction for the observed outcome, the severity of the first allergic reaction after Hymenoptera sting was used. Other variables were grouped according to risk factors., Discussion: We will identify the risk factors that could play an important role in a severe systemic reaction: the aetiology of the Hymenoptera sting, sex, age, history and severity of previous systemic reactions, being re-stung in an interval of two months, the frequency of re-stings, atopy, genetic predisposition, preventive medication use, other medication use, beekeeping or living next to beehives and why immunotherapy was not taken. Laboratory data will also be analysed to determine if there is any association with laboratory tests and the severity of the allergic reactions after Hymenoptera stings., Conclusions: Several new approaches are introduced in the study design. The most important is that the protocol covers epidemiological data gained from the questionnaire, as well as clinical data gained from the Immunological database and BIRPIS database. We expect to obtain significant results that will explain the risk factors for the natural history of Hymenoptera sting allergic reactions and will help allergologists, as well as general doctors, when facing those patients allergic to Hymenoptera venom without immunotherapy.

The use of Open Science practices is often proposed as a way to improve research practice, especially in psychology. Open Science can increase transparency and therefore reduce questionable research practices, making research more accessible to students, scholars, policy makers, and the public. However, little is known about how widespread Open Science practices are taught and how students are educated about these practices. In addition, it remains unknown how informing students about Open Science actually impacts their understanding and adoption of such practices. This registered report proposes the validation of a questionnaire. The aim is to survey how much psychology students know about Open Science and to assess whether knowledge of and exposure to Open Science in general-be it through university curricula or social media-influences attitudes towards the concept and intentions to implement relevant practices., Competing Interests: The authors have declared that no competing interests exist.

Google search trends have shown promise for predicting suicide deaths. We examined the relationship between search trends data for suicide-related search terms and monthly suicide deaths (2014-2018) in Croatia. We identified two suicide prevention search terms, samoubojstvo and suicid (engl. suicide), where an increase in searches preceded a decrease in suicides, and one suicide risk term, kako se ubiti (engl. how to kill yourself), where an increase in searches preceded an increase in suicides. On webpages elicited by suicide-related search terms, factual information about suicide was most common. Results imply the need for a comprehensive online suicide prevention strategy.

Background: Surveillance of temporal trends in clinically treated self-harm is an important component of suicide prevention in the dynamic context of COVID-19. There is little evidence beyond the initial months following the onset of the pandemic, despite national and regional restrictions persisting to mid-2021., Methods: Descriptive time series analysis utilizing de-identified, primary care health records of 2.8 million patients from the Greater Manchester Care Record. Frequencies of self-harm episodes between 1st January 2019 and 31st May 2021 were examined, including stratification by sex, age group, ethnicity, and index of multiple deprivation quintile., Findings: There were 33,444 episodes of self-harm by 13,148 individuals recorded during the study period. Frequency ratios of incident and all episodes of self-harm were 0.59 (95% CI 0.51 to 0.69) and 0.69 (CI 0.63 to 0.75) respectively in April 2020 compared to February 2020. Between August 2020 and May 2021 frequency ratios were 0.92 (CI 0.88 to 0.96) for incident episodes and 0.86 (CI 0.84 to 0.88) for all episodes compared to the same months in 2019. Reductions were largest among men and people living in the most deprived neighbourhoods, while an increase in all-episode self-harm was observed for adolescents aged 10-17., Interpretation: Reductions in primary care-recorded self-harm persisted to May 2021, though they were less marked than in April 2020 during the first national lockdown. The observed reductions could represent longer term reluctance to seek help from health services. Our findings have implications for the ability for services to offer recommended care for patients who have harmed themselves., Competing Interests: NK reports grants and personal fees from the UK Department of Health and Social Care, the National Institute of Health Research (NIHR), the National Institute for Health and Care Excellence (NICE), and the Healthcare Quality and Improvement Partnership, outside the submitted work; works with NHS England on national quality improvement initiatives for suicide and self-harm; is a member of the advisory group for the National Suicide Prevention Strategy of the Department of Health and Social Care; has chaired NICE guideline committees for Self-harm and Depression; and is currently the Topic Advisor for the new NICE Guidelines for self-harm. All other authors report no conflicts of interest., (© 2021 The Author(s).)

Pervading global narratives suggest that political polarization is increasing, yet the accuracy of such group meta-perceptions has been drawn into question. A recent US study suggests that these beliefs are inaccurate and drive polarized beliefs about out-groups. However, it also found that informing people of inaccuracies reduces those negative beliefs. In this work, we explore whether these results generalize to other countries. To achieve this, we replicate two of the original experiments with 10,207 participants across 26 countries. We focus on local group divisions, which we refer to as fault lines. We find broad generalizability for both inaccurate meta-perceptions and reduced negative motive attribution through a simple disclosure intervention. We conclude that inaccurate and negative group meta-perceptions are exhibited in myriad contexts and that informing individuals of their misperceptions can yield positive benefits for intergroup relations. Such generalizability highlights a robust phenomenon with implications for political discourse worldwide., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Homelessness in England and Wales is on the rise together with the mortality rate among homeless people. Many homeless people have a mental illness, which is a risk factor for suicide., Aims: This study used data from the National Confidential Inquiry into Suicide and Safety in Mental Health to examine demographic and clinical characteristics of homeless people who died by suicide and were in recent contact with mental health services., Method: We have compared 514 patients (2% of the total sample) who died by suicide and who were reported as being homeless or having no fixed abode by their clinicians with patients in stable accommodation between 2000 and 2016 to identify differences in sociodemographic characteristics and clinical care., Results: Our analysis suggests that homeless patients who died by suicide had more acute (alcohol: 47% v. 25%, P < 0.01, drug: 39% v. 15%, P < 0.01) and chronic (alcohol: 72% v. 44%, P > 0.01, drug: 64% v. 31%) substance misuse issues than patients in stable accommodation. Homeless patients were also more likely to die as in-patients (21% v. 10%, P < 0.01) or within 3 months of discharge (32% v. 19%, P < 0.01)., Conclusions: Homeless patients who died by suicide more often had known risk factors for suicide than patients in stable accommodation. As a result of the higher percentages of post-discharge and in-patient suicides in homeless patients as well as the high prevalence of substance misuse, this study recommends closer integration of services as well as awareness of risks during in-patient admission and in the weeks immediately after discharge.

Parricide is a rare type of homicide in which mental illness is often an important factor. The aims of this study were (a) to describe the characteristics of parricide offenders with a focus on mental illness and clinical care and (b) to examine Heide's widely used typology of parricide through a data-driven approach. We analyzed all homicides in England and Wales between 1997 and 2014. Parricide offenders in our sample were most often male, unmarried, and unemployed, with a third of offenders diagnosed with schizophrenia; 28% had been in contact with mental health services before the offense. The latent class analysis resulted in three types of parricide offenders: middle-aged with affective disorder, previously abused, and seriously mentally Ill, which confirmed, to an extent, Heide's typology. Health and social care services should actively engage with carers of people with mental illness and support to those caring for older relatives and victims of abuse., (© 2020 The Authors. Aggressive Behavior Published by Wiley Periodicals LLC.)

Studies on suicide by recently discharged mental health patients have reported a high number of deaths in the early post-discharge period, which has led to recommendations of follow-up within 7 days (d). More recently, the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) proposed a more "stringent" follow-up period of 2-3 days (d) after discharge. Patients who died within this early time-frame post-discharge were more likely to die before the follow-up appointment occurred. They more often had a primary diagnosis of a personality disorder, self-discharged, and had a higher frequency of death by jumping from a height or in front of the vehicle compared to later deaths. This study provides practical implications for post-discharge management and safety planning. Clinicians should be aware of (1) the increased risk of immediate suicide in the post-discharge period by people with a diagnosis of personality disorder, (2) immediate suicide risk in patients who initiate their own discharge, and (3) the increased risk of death by jumping from a height or in front of the vehicle in the immediate post-discharge period. Our findings support the recent recommendation from NCISH that follow-up should occur within 3 d of discharge from in-patient care., (Copyright © 2020 Bojanić, Hunt, Baird, Kapur, Appleby and Turnbull.)

Introduction: Antibiotics are indispensable to maintaining human health; however, their overuse has resulted in resistant organisms, increasing morbidity, mortality and costs. Increasing antimicrobial resistance (AMR) is a major public health threat, resulting in multiple campaigns across countries to improve appropriate antimicrobial use. This includes addressing the overuse of antimicrobials for self-limiting infections, such as upper respiratory tract infections (URTIs), particularly in lower- and middle-income countries (LMICs) where there is the greatest inappropriate use and where antibiotic utilization has increased the most in recent years. Consequently, there is a need to document current practices and successful initiatives in LMICs to improve future antimicrobial use. Methodology: Documentation of current epidemiology and management of URTIs, particularly in LMICs, as well as campaigns to improve future antimicrobial use and their influence where known. Results: Much concern remains regarding the prescribing and dispensing of antibiotics for URTIs among LMICs. This includes considerable self-purchasing, up to 100% of pharmacies in some LMICs. However, multiple activities are now ongoing to improve future use. These incorporate educational initiatives among all key stakeholder groups, as well as legislation and other activities to reduce self-purchasing as part of National Action Plans (NAPs). Further activities are still needed however. These include increased physician and pharmacist education, starting in medical and pharmacy schools; greater monitoring of prescribing and dispensing practices, including the development of pertinent quality indicators; and targeted patient information and health education campaigns. It is recognized that such activities are more challenging in LMICs given more limited resources and a lack of healthcare professionals. Conclusion: Initiatives will grow across LMICs to reduce inappropriate prescribing and dispensing of antimicrobials for URTIs as part of NAPs and other activities, and these will be monitored.

Introduction: There are increasing concerns world-wide with growing rates of antibiotic resistance necessitating urgent action. There have been a number of initiatives in the Republic of Srpska in recent years to address this and improve rational antibiotic prescribing and dispensing despite limited resources to fund multiple initiatives. Objective: Analyse antibiotic utilization patterns in the Republic of Srpska following these multiple initiatives as a basis for developing future programmes in the Republic if needed. Methods: Observational retrospective study of total outpatient antibiotic utilization from 2010 to 2015, based on data obtained from the Public Health Institute, alongside documentation of ongoing initiatives to influence utilization. The quality of antibiotic utilization principally assessed according to ESAC, ECDC, and WHO quality indicators and DU 90% (the drug utilization 90%) profile as well as vs. neighboring countries. Results: Following multiple initiatives, antibiotic utilization remained relatively stable in the Republic at 15.6 to 18.4 DIDs, with a decreasing trend in recent years, with rates comparable or lower than neighboring countries. Amoxicillin and the penicillins accounted for 29-40 and 50% of total utilization, respectively. Overall, limited utilization of co-amoxiclav (7-11%), cephalosporins, macrolides, and quinolones, as well as low use of third and fourth generation cephalosporins vs. first and second cephalosporins. However, increasing utilization of co-amoxiclav and azithromycin, as well as higher rates of quinolone utilization compared to some countries, was seen. Conclusions: Multiple interventions in the Republic of Srpska in recent years have resulted in one of the lowest utilization of antibiotics when compared with similar countries, acting as an exemplar to others. However, there are some concerns with current utilization of co-amoxiclav and azithromycin which are being addressed. This will be the subject of future research activities.

Objective: Irrational use of antimicrobials is a major driver of antimicrobial resistance, exacerbated by dispensing antibiotics without a prescription. Our previous study suggested this was a problem in the Republic of Srpska despite legislation. Since then, a number of activities have been initiated. Consequently, the study aimed to ascertain whether these multiple initiatives had reduced this., Methods: Patients visiting all community pharmacies in the Republic from October 2014 to July 2015 presenting with symptoms typical of an acute, viral, and mostly uncomplicated upper respiratory tract infection, with results compared to the previous study. If an antibiotic was suggested, the maximum allowance was €3/pack., Findings: Self-medication with antibiotics significantly decreased from 58% to 18.5% of pharmacies. In both studies, most patients were offered over-the-counter medication. The most common reason for not dispensing an antibiotic was "antibiotics can be dispensed with a prescription only." The penicillins were the most dispensed antibiotic. Fewer patients than the previous study were given instructions about antibiotic use and no discussion on their side effects., Conclusion: While encouraging that self-medication decreased significantly, 18.5% were disappointing given recent initiatives. Fewer instructions about antibiotics if an antibiotic was dispensed were also disappointing. This suggests the need for even stronger enforcement of the laws as well as further training of pharmacy personnel to ensure the future appropriate use of medicines., Competing Interests: There are no conflicts of interest.

The Normacog Brief Battery (NBB) provides a comprehensive overview of an individual's cognitive functioning within a short amount of time. It was originally developed for the Spanish population in Spain. However, there is a considerable need for brief batteries in clinical neuropsychological assessment, especially in eastern European countries. Cultural background and other individual characteristics-such as age, level of education, and sex-are shown to influence both cognition and patients' performance on neuropsychological tests. Therefore, it is important to develop understanding of how and why culture impacts on cognitive testing and determine which sociodemographic variables affect cognitive performance. The current study aims to translate, adapt, and standardize the NBB in Bulgaria, Croatia, and the Netherlands, and to analyze the effect of sex, age, and education level on cognitive performance between these three countries. This brief battery assesses eleven cognitive domains, including those most currently relevant in cognition such as premorbid intelligence, attention, executive function, processing speed, and memory. The translation and adaptation of the battery for different cultures will be done using the back-translation process. After exclusion criteria, the current study will include a total sample of 300 participants (≥18 years old). The samples of 100 participants per country will be balanced through the consideration of their age and level of education. Effects of the sociodemographic variables (age, level of education, and sex) on cognitive performance are expected. Furthermore, this relationship is expected to differ across countries. A multivariate hierarchical linear regression will be used and exploratory analysis will be carried out to investigate further effects. The results will be particularly valuable for future research and assessment in cognitive performance. The growing demand for accurate and fast neuropsychological assessment shows the importance of creating a universal brief assessment tool for wider cross-cultural application.