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Daybook, Medicine, Quotage

Saturday Morning Journal Club.

Let’s start with a low prevalence event that should never occur, unless we end up with multidrug resistant syphilis. Babies are being born stillborn because of it.

The current funding system where a lead maternal carer (generally a midwife) is funded for all antenatal care instead of a shared care model removes redundancy and allows such to happen. it should not.

Since 2017, there have been four cases of syphilis being passed onto babies from their mothers, as well as one probable case, NZME reports. Two of last year’s cases were stillbirths.

The Ministry of Health is currently investigating two possible further cases and has set up a group to tackle the issue.

All pregnant women are meant to undergo a blood test to check for the infection early in their term. If found early, syphilis can be treated with antibiotics.

Waikato DHB Hamilton Sexual Health clinic director Dr Jane Morgan told NZME the increase in these cases is a clear message our healthcare system is failing.

NewsHub

It appears that simple interventions may help with suicidality. Such as phone calls (which is what SPI is: find the reasons for risk behaviour, make a safety plan and follow it up). however note that this is a VA population which is high risk and generally underserved. I note that the Australians have a new public campaign in place, trying to get people to question, support and refer. It is the followup that may matter.

?To our knowledge, this is the first large-scale study to demonstrate the association of SPI+ with decreased suicidal behavior and increased behavioral health treatment engagement following ED discharge for suicide-related concerns. The SPI+ was associated with about 50% fewer suicidal behaviors over a 6-month follow-up and more than double the odds of engaging in outpatient behavioral health care. The significant decrease in suicidal behavior underscores the utility of SPI+ as an effective prevention strategy in EDs. Interestingly, our mediation analysis demonstrated that the association with suicidal behavior was not attributable to the increased treatment engagement in the intervention group nor was it accounted for by the number of follow-up calls. This finding suggests that SPI+ has a positive association with suicidal behavior apart from attendance in outpatient behavioral health care. We chose attendance at more than 1 outpatient appointment as our outcome because the principal difficulty with suicidal patients is that they tend to not attend a first appointment. Because patients admitted to inpatient units were not included, the range of suicidality in our sample is restricted to a lower-risk population.

Stanley B, Brown GK, Brenner LA, et al. Comparison of the Safety Planning Intervention With Follow-up vs Usual Care of Suicidal Patients Treated in the Emergency Department. JAMA Psychiatry. Published online July 11, 2018. doi:10.1001/jamapsychiatry.2018.1776

One of the things about Saturday is that — though I collect papers during the week — at home I try to stick to open access papers so that people can find the text. The final paper today is about personality disorders and work function. Firstly, the model: note that this is a Dutch community psychiatric survey, and CMD is a common mental disorders ie depression and anxiety.

In this community-based sample of 3672 working people, 72.8% had no symptoms of borderline personality, 23.8% had 1–2 symptoms, 2.7% had 3–4 symptoms, and 0.7% had ?5 symptoms (mean 0.45 (SE?=?0.02)) (not in table). Younger age, lower education, living without a partner and the co-occurrence of any CMD were significantly associated with a higher number of borderline personality symptoms

Borderline personality symptoms were associated with less decision latitude, less job security and less co-worker support. These associations persisted after adjustment for sociodemographic characteristics and CMD’s. Higher number of borderline personality symptoms was incrementally associated with poorer job quality, indicated by a higher number of adverse working conditions.

Borderline personality symptoms among workers were associated with impaired work performance, assessed in total work loss days. The mean of total work loss days was 2.0 (SE?=?0.1) (not in table). The number of borderline personality symptoms was consistently associated with impaired work performance, in both categories of work loss (0.1–5 and?>?5.1 days), also after adjustment for sociodemographic characteristics, CMD and type or number of adverse working conditions

Trees T. Juurlink and others. Borderline personality symptoms and work performance: a population-based survey BMC Psychiatry201818:202 https://doi.org/10.1186/s12888-018-1777-9

Note the rate of symptoms. They fit neatly with clinical experience that severe emotional dysregulation is rate. it is also crippling. And these people are disabled, because their interpersonal skillset is limited, their coping skills deficient, and we are, for better or worse, a social species.

No man is an island, and the personality disorders prove it.

One Comment

  1. Listen and listen well. Most business owners don’t ask customers what features they want to see in their products.

    Wrong. Those who want to survive do market research, and make sure that their products can sell. If you don’t sell, you don’t make money, make payroll, or survive. I have seen businesses fail despite good staff because poor market research.

    The better question is Who is your customer? It may not be client. It will be who pays — often an insurance agent or an agent of the government.

    The US DMC — trust me, it can and is done better — or TSA, or ICE — again other countries do it far better — survives because their client is the state: congress and the judiciary. Not the citizens. And it shows.

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