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Buoyancy-driven exchange flows in geophysical contexts often exhibit significant interfacial turbulence leading to a partially mixed intermediate layer between two counterflowing layers. In this paper we perform a three-layer hydraulic analysis of such flows, highlighting the dynamical importance of the middle mixed layer. Our analysis is based on the viscous, shallow water, Boussinesq equations and includes the effects of mixing as a non-hydrostatic pressure forcing. We demonstrate the superior predictive accuracy of three-layer hydraulics over the more classical two-layer approach by applying it to direct numerical simulation data in stratified inclined duct exchange flows where turbulence is controlled by a modest slope of the duct. The three-layer model predicts a region bounded by two control points in the middle of the duct, linked to the onset of instability and turbulence, whereas a two-layer model only predicts one control point. We show that the nonlinear characteristics of the three-layer model correspond to linear long waves perturbing a three-layer mean flow. We also provide the first evidence of long-wave resonance, as well as resonance between long and short waves, and their connection to turbulence. These results challenge current parameterisations for turbulent transport, which typically overlook long waves and internal hydraulics induced by streamwise variations of the flow.
The significance of human milk in an infant’s diet is well-established, yet accurately measuring human milk intake remains challenging. Current methods are either unsuitable for large-scale studies, such as the dose-to-mother stable isotope technique, or rely on set amounts of human milk, regardless of known variability in individual intake(1). There is a paucity of data on how much infants consume, particularly in later infancy (>6 months) when complementary foods have been introduced. This research aimed to estimate human milk intakes and total infant milk intakes (including infant formula) in New Zealand infants aged 7-10 months, explore factors that predict these intakes, and develop and validate equations to predict human milk intake using simple measures. Human milk intake data were obtained using the dose-to-mother stable isotope technique in infants aged 7-10 months and their mothers as part of the First Foods New Zealand study (FFNZ)(2). Predictive equations were developed using questionnaire and anthropometric data (Model 1) and additional dietary data from diet recalls (Model 2)(3). The validity of existing methods to estimate human milk intake (NHANES and ALSPAC studies) was compared against the dose-to-mother results. FFNZ included 625 infants, with 157 mother-infant dyads providing complete data for determining human milk volume. Using the dose-to-mother data, the measured mean (SD) human milk intake was 785 (264) g/day. Older infants had lower human milk and total milk intakes, male infants consumed more total milk. The strongest predictors of human milk intake were infant age, infant body mass index, number of breastfeeds a day, infant formula consumption, and energy from complementary food intake. When the predictive equations were tested, mean (95% CI) differences in predicted versus measured human milk intake (mean, [SD]: 762 [257] mL/day) were 0.0 mL/day (-26, 26) for Model 1 and 0.5 mL/day (-21, 22) for Model 2. In contrast, the NHANES and ALSPAC methods underestimated intake by 197 mL/day (-233, -161) and 175 mL/day (-216, -134), respectively. The predictive equations are presented as the Human Milk Intake Level Calculations (HuMILC) tool, designed for use in large-scale studies to more accurately estimate human milk intakes of infants. The use of objective quantifiable assessment methods enhances our understanding of infant human milk intakes, improving our ability to accurately assess nutritional adequacy in infants.
Current evidence underscores a need to transform how we do clinical research, shifting from academic-driven priorities to co-led community partnership focused programs, accessible and relevant career pathway programs that expand opportunities for career development, and design of trainings and practices to develop cultural competence among research teams. Failures of equitable research translation contribute to health disparities. Drivers of this failed translation include lack of diversity in both researchers and participants, lack of alignment between research institutions and the communities they serve, and lack of attention to structural sources of inequity and drivers of mistrust for science and research. The Duke University Research Equity and Diversity Initiative (READI) is a program designed to better align clinical research programs with community health priorities through community engagement. Organized around three specific aims, READI-supported programs targeting increased workforce diversity, workforce training in community engagement and cultural competence, inclusive research engagement principles, and development of trustworthy partnerships.
The Australian SKA Pathfinder (ASKAP) offers powerful new capabilities for studying the polarised and magnetised Universe at radio wavelengths. In this paper, we introduce the Polarisation Sky Survey of the Universe’s Magnetism (POSSUM), a groundbreaking survey with three primary objectives: (1) to create a comprehensive Faraday rotation measure (RM) grid of up to one million compact extragalactic sources across the southern $\sim50$% of the sky (20,630 deg$^2$); (2) to map the intrinsic polarisation and RM properties of a wide range of discrete extragalactic and Galactic objects over the same area; and (3) to contribute interferometric data with excellent surface brightness sensitivity, which can be combined with single-dish data to study the diffuse Galactic interstellar medium. Observations for the full POSSUM survey commenced in May 2023 and are expected to conclude by mid-2028. POSSUM will achieve an RM grid density of around 30–50 RMs per square degree with a median measurement uncertainty of $\sim$1 rad m$^{-2}$. The survey operates primarily over a frequency range of 800–1088 MHz, with an angular resolution of 20” and a typical RMS sensitivity in Stokes Q or U of 18 $\mu$Jy beam$^{-1}$. Additionally, the survey will be supplemented by similar observations covering 1296–1440 MHz over 38% of the sky. POSSUM will enable the discovery and detailed investigation of magnetised phenomena in a wide range of cosmic environments, including the intergalactic medium and cosmic web, galaxy clusters and groups, active galactic nuclei and radio galaxies, the Magellanic System and other nearby galaxies, galaxy halos and the circumgalactic medium, and the magnetic structure of the Milky Way across a very wide range of scales, as well as the interplay between these components. This paper reviews the current science case developed by the POSSUM Collaboration and provides an overview of POSSUM’s observations, data processing, outputs, and its complementarity with other radio and multi-wavelength surveys, including future work with the SKA.
The use of explosive weapons in populated areas (EWIPA) has a disproportionate impact on civilians. Many humanitarian organizations utilize varying sheltering guidelines to recommend safe positions for civilians affected by explosive threats. It is not known whether these recommendations are standardized or derived from evidence. This study aimed to identify existing recommendations and potential gaps in literature relevant to sheltering guidelines for civilians during explosive events.
Methods
A scoping review was conducted of the literature including indexed databases and grey literature to identify reports that described sheltering guidelines for civilians during explosive events. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) methodology was followed.
Results
The search identified 3582 peer-reviewed records. After title/abstract and full text screening, only 2 peer-reviewed reports remained eligible. These were combined with 13 gray literature reports obtained from humanitarian organizations and internet searches. The peer-reviewed reports included mine and unexploded ordnance guidelines, not guidelines for EWIPA or aerial bombardments. There is a substantial knowledge gap and heterogeneity in existing sheltering guidelines from explosive events, particularly those appropriate for protection from EWIPA.
Conclusions
Findings from this scoping review demonstrate a need for the creation and standardization of evidence-based civilian sheltering guidelines to mitigate the threat of explosive weapons to civilians in conflict.
This study uses established procedures to estimate the effects of changes in mortality and growth implant protocols on feedlot net returns (NRs). We then propose new methods for estimating concurrent impacts to feedlot greenhouse gas emissions intensity. Reducing mortality consistently increases NRs and reduces greenhouse gas emissions intensity in the feedlot regardless of sex or placement weight. Results indicate that use of two implants in the feedlot may increase NRs and reduce greenhouse gas emissions per pound of dressed beef produced, compared to just one growth implant.
Emergency psychiatric care, unplanned hospital admissions, and inpatient health care are the costliest forms of mental health care. According to Statistics Canada (2018), almost 18% (5.3 million) of Canadians reported needing mental health support. However, just above half of this figure (56.2%) have reported their needs were fully met. To further expand capacity and access to mental health care in the province, Nova Scotia Health has launched a novel mental health initiative, the Rapid Access, and Stabilization Program (RASP).
Objectives
This study evaluates the effectiveness and impact of the RASP on high-cost health services utilization (e.g. ED visits, mobile crisis visits, and inpatient treatments) and related costs. It also assesses healthcare partners’ (e.g. healthcare providers, policymakers, community leaders) perceptions and patient experiences and satisfaction with the program and identifies sociodemographic characteristics, psychological conditions, recovery, well-being, and risk measures in the assisted population.
Methods
This is a hypothesis-driven program evaluation study that employs a mixed methods approach. A within-subject comparison will examine health services utilization data from patients attending RASP, one year before and one year after their psychiatry assessment at the program. A controlled between-subject comparison will use historical data from a control population will examine whether possible changes in high-cost health services utilization are associated with the intervention (RASP). The primary analysis involves extracting secondary data from provincial information systems, electronic medical records, and regular self-reported clinical assessments. Additionally, a qualitative sub-study will examine patient experience and satisfaction, and examine health care partners’ impressions.
Results
The results for the primary, secondary, and qualitative outcome measures to be available within 6 months of study completion. We expect that RASP evaluation findings will demonstrate a minimum 10% reduction in high-cost health services utilization and corresponding 10% cost savings, and also a reduction in the wait times for patient consultations with psychiatrists to less than 30 calendar days. In addition, we anticipate that patients, healthcare providers, and healthcare partners would express high levels of satisfaction with the new service.
Conclusions
This study will demonstrate the results of the Mental Health and Addictions Program (MHAP) efforts to provide stepped-care, particularly community-based support, to individuals with mental illnesses. Results will provide new insights into a novel community-based approach to mental health service delivery and contribute to knowledge on how to implement mental health programs across varying contexts.
Although food insecurity affects a significant proportion of young children in New Zealand (NZ)(1), evidence of its association with dietary intake and sociodemographic characteristics in this population is lacking. This study aims to assess the household food security status of young NZ children and its association with energy and nutrient intake and sociodemographic factors. This study included 289 caregiver and child (1-3 years old) dyads from the same household in either Auckland, Wellington, or Dunedin, NZ. Household food security status was determined using a validated and NZ-specific eight-item questionnaire(2). Usual dietary intake was determined from two 24-hour food recalls, using the multiple source method(3). The prevalence of inadequate nutrient intake was assessed using the Estimated Average Requirement (EAR) cut-point method and full probability approach. Sociodemographic factors (i.e., socioeconomic status, ethnicity, caregiver education, employment status, household size and structure) were collected from questionnaires. Linear regression models were used to estimate associations with statistical significance set at p <0.05. Over 30% of participants had experienced food insecurity in the past 12 months. Of all eight indicator statements, “the variety of foods we are able to eat is limited by a lack of money,” had the highest proportion of participants responding “often” or “sometimes” (35.8%). Moderately food insecure children exhibited higher fat and saturated fat intakes, consuming 3.0 (0.2, 5.8) g/day more fat, and 2.0 (0.6, 3.5) g/day more saturated fat compared to food secure children (p<0.05). Severely food insecure children had lower g/kg/day protein intake compared to food secure children (p<0.05). In comparison to food secure children, moderately and severely food insecure children had lower fibre intake, consuming 1.6 (2.8, 0.3) g/day and 2.6 (4.0, 1.2) g/day less fibre, respectively. Severely food insecure children had the highest prevalence of inadequate calcium (7.0%) and vitamin C (9.3%) intakes, compared with food secure children [prevalence of inadequate intakes: calcium (2.3%) and vitamin C (2.8%)]. Household food insecurity was more common in those of Māori or Pacific ethnicity; living in areas of high deprivation; having a caregiver who was younger, not in paid employment, or had low educational attainment; living with ≥2 other children in the household; and living in a sole-parent household. Food insecure young NZ children consume a diet that exhibits lower nutritional quality in certain measures compared to their food-secure counterparts. Food insecurity was associated with various sociodemographic factors that are closely linked with poverty or low income. As such, there is an urgent need for poverty mitigation initiatives to safeguard vulnerable young children from the adverse consequences of food insecurity.
Cathodes with recessed sample surfaces have several benefits in cesium sputter ion sources, including higher output, more efficient use of sample material, and improved focusing of the extracted ion beam. However, the Ionplus MICADAS uses cathodes with a graphite surface that is essentially flush with the sample holder. To evaluate the performance of recessed graphite with the MICADAS and determine the optimal surface depth, we tested four different depths, including the standard (flush) pressing method, 0.5 mm, 1.0 mm, and 1.5 mm. We found that recessed depths of 1.0 and 1.5 mm resulted in 20% higher ion beam current compared to the standard method under the same source conditions. The results are consistent with the beam produced from the recessed targets being more narrowly focused with a lower emittance, resulting in better transmission through the accelerator. Small graphite samples (200 µg C) with recessed surfaces produced higher currents for longer, leading to a 2–3× increase in sample ionization efficiency. Additionally, there was some evidence that isotopic ratio measurements of recessed samples were more stable over time. Overall, samples recessed to 1 mm depth offered numerous advantages over the standard pressing method and we have subsequently started pressing all MICADAS graphite using this approach.
OBJECTIVES/GOALS: Developing pharmacokinetic (PK) models to guide selective serotonin reuptake inhibitor (SSRI) dosing in youth is costly, time-intensive, and requires large numbers of participants. We evaluated the use of remnant blood samples from SSRI-treated youth and developed precision PK dosing strategies. METHODS/STUDY POPULATION: Following IRB approval, we used a clinical surveillance platform to identify patients with routine phlebotomy within 24 hours of escitalopram or sertraline dosing. Remnant blood samples were obtained from youth aged 5–18 years, escitalopram and sertraline concentrations were determined, and clinical characteristics (e.g., age, sex, weight, concomitant medications that inhibit sertraline or escitalopram metabolism) and phenotypes for CYP2C19, the predominant enzyme that metabolizes these SSRIs, were extracted from the electronic medical record (EMR). A population PK analysis of escitalopram and sertraline was performed using NONMEM. The influence of clinical variables, CYP2C19, and dosing was evaluated from simulated concentration-time curves. RESULTS/ANTICIPATED RESULTS: Over 21 months, we collected315 samples from escitalopram-treated patients (N=288) and 265 samples from sertraline-treated patients (N=255). In youth, escitalopram and sertraline exposure (concentrations over time) and specific pharmacokinetic parameters (e.g., clearance) were influenced by CYP2C19 phenotype, concomitant CYP2C19 inhibitors, and patient-specific characteristics. Escitalopram and sertraline concentrations from remnant blood samples were 3.98-fold higher and 3.23-fold higher, respectively, in poor metabolizers compared to normal metabolizers (escitalopram, p<0.001) and compared to normal, rapid, and ultrarapid metabolizers combined (sertraline, p<0.001). DISCUSSION/SIGNIFICANCE: Combining remnant blood sampling with pharmacogenetic-integrated EMR data can facilitate large-scale population PK analyses of escitalopram and sertraline in youth. This real-world approach can be used to rapidly develop precision SSRI dosing strategies, including slower titration and reduced target doses in CYP2C19 poor metabolizers.
Incarceration is a significant social determinant of health, contributing to high morbidity, mortality, and racialized health inequities. However, incarceration status is largely invisible to health services research due to inadequate clinical electronic health record (EHR) capture. This study aims to develop, train, and validate natural language processing (NLP) techniques to more effectively identify incarceration status in the EHR.
Methods:
The study population consisted of adult patients (≥ 18 y.o.) who presented to the emergency department between June 2013 and August 2021. The EHR database was filtered for notes for specific incarceration-related terms, and then a random selection of 1,000 notes was annotated for incarceration and further stratified into specific statuses of prior history, recent, and current incarceration. For NLP model development, 80% of the notes were used to train the Longformer-based and RoBERTa algorithms. The remaining 20% of the notes underwent analysis with GPT-4.
Results:
There were 849 unique patients across 989 visits in the 1000 annotated notes. Manual annotation revealed that 559 of 1000 notes (55.9%) contained evidence of incarceration history. ICD-10 code (sensitivity: 4.8%, specificity: 99.1%, F1-score: 0.09) demonstrated inferior performance to RoBERTa NLP (sensitivity: 78.6%, specificity: 73.3%, F1-score: 0.79), Longformer NLP (sensitivity: 94.6%, specificity: 87.5%, F1-score: 0.93), and GPT-4 (sensitivity: 100%, specificity: 61.1%, F1-score: 0.86).
Conclusions:
Our advanced NLP models demonstrate a high degree of accuracy in identifying incarceration status from clinical notes. Further research is needed to explore their scaled implementation in population health initiatives and assess their potential to mitigate health disparities through tailored system interventions.
A key book on the debates surrounding the knowledge economy and decolonialization of African studies, that brings the subject up to date for the twenty-first century.
Therapeutics targeting frontotemporal dementia (FTD) are entering clinical trials. There are challenges to conducting these studies, including the relative rarity of the disease. Remote assessment tools could increase access to clinical research and pave the way for decentralized clinical trials. We developed the ALLFTD Mobile App, a smartphone application that includes assessments of cognition, speech/language, and motor functioning. The objectives were to determine the feasibility and acceptability of collecting remote smartphone data in a multicenter FTD research study and evaluate the reliability and validity of the smartphone cognitive and motor measures.
Participants and Methods:
A diagnostically mixed sample of 207 participants with FTD or from familial FTD kindreds (CDR®+NACC-FTLD=0 [n=91]; CDR®+NACC-FTLD=0.5 [n=39]; CDR®+NACC-FTLD>1 [n=39]; unknown [n=38]) were asked to remotely complete a battery of tests on their smartphones three times over two weeks. Measures included five executive functioning (EF) tests, an adaptive memory test, and participant experience surveys. A subset completed smartphone tests of balance at home (n=31) and a finger tapping test (FTT) in the clinic (n=11). We analyzed adherence (percentage of available measures that were completed) and user experience. We evaluated Spearman-Brown split-half reliability (100 iterations) using the first available assessment for each participant. We assessed test-retest reliability across all available assessments by estimating intraclass correlation coefficients (ICC). To investigate construct validity, we fit regression models testing the association of the smartphone measures with gold-standard neuropsychological outcomes (UDS3-EF composite [Staffaroni et al., 2021], CVLT3-Brief Form [CVLT3-BF] Immediate Recall, mechanical FTT), measures of disease severity (CDR®+NACC-FTLD Box Score & Progressive Supranuclear Palsy Rating Scale [PSPRS]), and regional gray matter volumes (cognitive tests only).
Results:
Participants completed 70% of tasks. Most reported that the instructions were understandable (93%), considered the time commitment acceptable (97%), and were willing to complete additional assessments (98%). Split-half reliability was excellent for the executive functioning (r’s=0.93-0.99) and good for the memory test (r=0.78). Test-retest reliabilities ranged from acceptable to excellent for cognitive tasks (ICC: 0.70-0.96) and were excellent for the balance (ICC=0.97) and good for FTT (ICC=0.89). Smartphone EF measures were strongly associated with the UDS3-EF composite (ß's=0.6-0.8, all p<.001), and the memory test was strongly correlated with total immediate recall on the CVLT3-BF (ß=0.7, p<.001). Smartphone FTT was associated with mechanical FTT (ß=0.9, p=.02), and greater acceleration on the balance test was associated with more motor features (ß=0.6, p=0.02). Worse performance on all cognitive tests was associated with greater disease severity (ß's=0.5-0.7, all p<.001). Poorer performance on the smartphone EF tasks was associated with smaller frontoparietal/subcortical volume (ß's=0.4-0.6, all p<.015) and worse memory scores with smaller hippocampal volume (ß=0.5, p<.001).
Conclusions:
These results suggest remote digital data collection of cognitive and motor functioning in FTD research is feasible and acceptable. These findings also support the reliability and validity of unsupervised ALLFTD Mobile App cognitive tests and provide preliminary support for the motor measures, although further study in larger samples is required.
We introduce a geometric analysis of turbulent mixing in density-stratified flows based on the alignment of the density gradient in two orthogonal bases that are locally constructed from the velocity gradient tensor. The first basis connects diapycnal mixing to rotation and shearing motions, building on the recent ‘rortex–shear decomposition’ in stratified shear layers (Jiang et al., J. Fluid Mech., vol. 947, 2022, A30), while the second basis connects mixing to the principal axes of the viscous dissipation tensor. Applying this framework to datasets taken in the stratified inclined duct laboratory experiment reveals that density gradients in locations of high shear tend to align preferentially (i) along the direction of minimum dissipation and (ii) normal to the plane spanned by the rortex and shear vectors. The analysis of the local alignment across increasingly turbulent flows offers new insights into the intricate relationship between the density gradient and dissipation, and thus diapycnal mixing.
Medulloblastoma is the most common pediatric malignant brain tumor. Approximately 29% of medulloblastoma patients experience postoperative posterior fossa syndrome (PFS) characterized by impairments in speech, motor, and mood. An interdisciplinary rehabilitation approach is associated with greater rehabilitation gains than a single discipline approach for brain injury patients with significant rehabilitation needs. However, literature regarding the feasibility and utility of this approach within a tertiary care pediatric hematology/oncology setting is lacking. The Acute Neurological Injury (ANI) service was developed to coordinate care for neurologically complex hematology/oncology patients receiving active cancer treatment, including those with PFS. ANI care coordination includes bimonthly interdisciplinary team meetings, interdisciplinary goal implementation for each patient, parent psychoeducation about applicable brain-behavior relationships (including PFS) at treatment initiation, neuropsychological assessment at transition times throughout treatment, cognitive remediation, and coordinated end of treatment transition planning. We gathered caregiver perspective on this approach within a tertiary care pediatric hematology/oncology setting.
Participants and Methods:
Parents of children and young adults (ages 4-20) with PFS after medulloblastoma resection who received coordinated care as part of the ANI program (n=20) were interviewed at least 4 months following completion of cancer treatment. 75% experienced postoperative mutism while the remainder experienced significantly decreased speech without mutism. All received cranial-spinal irradiation and focal boosts to tumor sites followed by chemotherapy per multi-institutional treatment protocol. Caregivers were interviewed regarding perceived feasibility and utility of ANI program components including parent psychoeducation, neuropsychological assessment, cognitive remediation, and interdisciplinary team coordination/goal setting, as well as parental supports. Yes/no responses were gathered as well as responses regarding the perceived utility of aspects of the interdisciplinary ANI program approach via a five-point Likert scale.
Results:
Surveys were completed by 66% of families contacted. Mean age at first contact with neuropsychology as part of the ANI program was 9.45 years (SD=4.4 years). Mean time between end of treatment and parent interview was 3.20 years (SD=2.01 years). Most parents reported that initial psychoeducation about PFS helped to decrease their concerns (81%) and increased their understanding of their child’s functioning in the context of PFS (88%). They reported benefit from neuropsychological assessment reports prior to initiating adjuvant treatment (92%), at end of treatment (90%), and one year following initiation of cancer treatment (100%), though they perceived less benefit from assessments intended to inform provider interventions during treatment (81% and 66%). Reports were shared most often with schools (75%), behavioral therapists (50%), physicians (50%), and rehabilitation specialists (25%). Parents indicated that the interdisciplinary ANI program approach was helpful (94%) and the coordinated interdisciplinary goal was beneficial (92%). Most parents favored the weekly frequency of cognitive remediation sessions (83%). Much interest was voiced in establishing a formal mentoring program to offer peer support by parents whose children have previously experienced PFS to those acutely managing a new PFS diagnosis (95%). Of note, all participants indicated that they would be willing to serve in a peer mentor role (100%).
Conclusions:
The interdisciplinary ANI program approach is feasible with perceived benefits to families managing new PFS and medulloblastoma diagnoses and receiving active cancer treatment.
The stratified inclined duct (SID) sustains an exchange flow in a long, gently sloping duct as a model for continuously forced density-stratified flows such as those found in estuaries. Experiments have shown that the emergence of interfacial waves and their transition to turbulence as the tilt angle is increased appears to be linked to a threshold in the exchange flow rate given by inviscid two-layer hydraulics. We uncover these hydraulic mechanisms by (i) using recent direct numerical simulations (DNS) providing full flow data in the key flow regimes (Zhu et al., J. Fluid Mech., vol. 969, 2023, A20), (ii) averaging these DNS into two layers, and (iii) using an inviscid two-layer shallow-water and instability theory to diagnose interfacial wave behaviour and provide physical insight. The laminar flow is subcritical and stable throughout the duct and hydraulically controlled at the ends of the duct. As the tilt is increased, the flow becomes supercritical everywhere and unstable to long waves. An internal jump featuring stationary waves first appears near the centre of the duct, then leads to larger-amplitude travelling waves, and to stronger jumps, wave breaking and intermittent turbulence at the largest tilt angle. Long waves described by the (nonlinear) shallow-water equation are interpreted locally as linear waves on a two-layer parallel base flow described by the Taylor–Goldstein equation. This link helps us to interpret long-wave instability and contrast it with short-wave (e.g. Kelvin–Helmholtz) instability. Our results suggest a transition to turbulence in SID through long-wave instability relying on vertical confinement by the top and bottom walls.
Suicide is one of the leading causes of mortality worldwide, and the majority of suicide deaths occur in low- and middle-income countries.
Aims
To evaluate the demographic and clinical characteristics of individuals who have presented to health services following self-harm in Pakistan.
Method
This study is a cross-sectional baseline analysis of participants from a large multicentre randomised controlled trial of self-harm prevention in Pakistan. A total of 901 participants with a history of self-harm were recruited from primary care clinics, emergency departments and general hospitals in five major cities in Pakistan. The Beck Scale for Suicide Ideation (BSI), Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS) and Suicide Attempt Self Injury Interview assessment scales were completed.
Results
Most participants recruited were females (n = 544, 60.4%) in their 20s. Compared with males, females had lower educational attainment and higher unemployment rates and reported higher severity scores on BSI, BDI and BHS. Interpersonal conflict was the most frequently cited antecedent to self-harm, followed by financial difficulties in both community and hospital settings. Suicide was the most frequently reported motive of self-harm (N = 776, 86.1%). Suicidal intent was proportionally higher in community-presenting patients (community: N = 318, 96.9% v. hospital: N = 458, 79.9%; P < 0.001). The most frequently reported methods of self-harm were ingestion of pesticides and toxic chemicals.
Conclusions
Young females are the dominant demographic group in this population and are more likely to attend community settings to seek help. Suicidal intent as the motivator of self-harm and use of potentially lethal methods may suggest that this population is at high risk of suicide.