A influência do transtorno afetivo bipolar (TB) no comportamento do indivíduo pode interferir significativamente no funcionamento familiar. Em uma perspectiva sistêmica, o funcionamento familiar diz respeito à forma como a família proporciona o ambiente adequado para o desenvolvimento e a sobrevivência dos membros da família nos níveis biológico, psicológico e social. Estudos que avaliaram o funcionamento familiar em famílias de pacientes com TB utilizando o Inventário de Avaliação Familiar (IAF) sugerem que o funcionamento familiar é globalmente pior quando comparado a famílias de indivíduos saudáveis. Entre todos os transtornos psiquiátricos, o TB caracteriza-se por uma das mais altas taxas de tentativas de suicídio e mortalidade por suicídio. Estudos recentes em transtorno depressivo maior sugerem que existe uma associação entre pior funcionamento familiar e comportamento suicida. No entanto, a associação entre funcionamento familiar e tentativa de suicídio em pacientes com TB tem sido pouco estudada. Hipótese: Famílias de pacientes portadores de TB que tenham apresentado pelo menos uma tentativa de suicídio na vida apresentam um pior funcionamento familiar quando comparadas a famílias de pacientes portadores de TB que nunca tentaram suicídio. Métodos: Sessenta e dois pacientes com TB (trinta e um com histórico de pelo menos uma tentativa de suicídio na vida, trinta e um sem histórico de tentativas de suicídio na vida) e sessenta familiares de pacientes com TB (vinte e nove familiares de pacientes com TB com história de pelo menos uma tentativa de suicídio na vida e trinta e um familiares de pacientes com TB sem histórico de tentativas de suicídio na vida) foram avaliados através do IAF. Escores médios de funcionamento familiar foram comparados entre os grupos, bem como correlações entre escores da IAF e sintomas de humor ou de ideação suicida. Resultados: Pacientes com TB e história de tentativa de suicídio apresentaram um número significativamente maior de hospitalizações psiquiátricas (p=0,029), de frequência de sintomas psicóticos (p=0,037), e médias mais elevada nas escalas de mania (p=0,026), de depressão (p=0,005) e de ideação suicida (p=0,041) do que pacientes com TB sem tentativas de suicídio. Pacientes com TB com história de tentativa de suicídio apresentaram escores mais elevados e estatisticamente significativos em vários domínios da escala de funcionamento familiar, incluindo Funcionamento Geral (p=0,025), Comunicação (p=0,009), Papéis (p=0,005), Resposta Afetiva (p=0,041) e Solução de problemas (p=0.036) do que pacientes com TB sem tentativas de suicídio. Os familiares de pacientes com história de tentativa de suicídio, quando comparados com os familiares de pacientes sem histórico de tentativa de suicídio apresentaram escores significativamente maiores da IAF no que diz respeito a Comunicação (p=0,012), Papéis (p=0,020), Resposta Afetiva (p=0,001) e Funcionamento Geral (p=0,025). Houve correlações positivas estatisticamente significativas em todos os domínios da IAF entre pacientes e familiares. Conclusão: História de tentativa de suicídio em pacientes com TB esta associada a escores mais elevados em diferentes domínios da IAF. Isto sugere um pior funcionamento familiar nas áreas de Funcionamento Geral, Comunicação, Papéis, Resposta Afetiva e Solução de Problemas. Estudos prospectivos podem ajudar a confirmar essa associação, e esclarecer se intervenções terapêuticas familiares podem ajudar a mitigar comportamentos suicidas no TB / The influence of bipolar disorder (BD) on the patient\'s behavior might interfere significantly with family functioning. From a systemic perspective, family functioning is about the way that family provides the appropriate environment for biologic, psychological and social development and survival for each family member. Studies evaluating family functioning in BD using the Family Assessment Device (FAD) suggest that family functioning is worse in families of BD patients when compared with control families. Considering all psychiatric disorders, BD is characterized by the highest rates of suicide attempts and mortality by suicide. Recent studies in major depression disorder suggest that there is an association between worse family functioning and suicidal behavior. The association between family functioning and suicide attempts in BD patients has been poorly investigated. Hypothesis: Families of BD patients with history of suicide attempts will present worse family functioning when compared with families of BD patients without suicide attempts. Methods: Sixty two BD patients (thirty-one BD I patients with lifetime history of suicide attempts and thirty-one BD I patients with no lifetime history of SA) and 61 first degree relatives (father, mother, brother, sister, daughter, son, or spouse) (twenty-nine relatives of BD I patients with lifetime history of suicide attempts and thirty-one relatives of BD I patients with no lifetime history of SA) were assessed using the Family Assessment Device (FAD). Family functioning scores were compared between both groups as correlation between FAD scores and mood symptoms and suicide ideation. Results: BD patients with history of suicide attempts presented significantly more psychiatric hospitalization (p=0,029), higher frequency of psychotic symptoms (p=0,037), and higher scores on depressive (p=0,026), manic (p=0,005), and suicidal ideation scores (p=0,041) than BD patients without suicide attempts. BD patients with history of suicide attempts presented significantly higher scores in several subscales of the FAD, including General Functioning (p=0,025), Communication (p=0,009), Roles (p=0,005), Affective Responsiveness (p=0,041) and Problem Solving (p=0.036) when compared with BD patients without suicide attempts. Relatives of BD patients with history of suicide attempts presented significantly higher scores in FAD domains such as Communication (p=0,012), Roles (p=0,020), Affective Response (p=0,001) and General Functioning (p=0,025) compared to relatives of BD patients without suicide attempts. There were significantly positive correlations in all FAD domains between patients and caregivers. Conclusion: History of suicide attempts in BD is associated with higher scores in family functioning in several domains of family functioning. This suggests a worse family functioning in several areas including Problem Solving, Communication, Roles, and Affective Responsiveness. Prospective studies might help to confirm this association, and clarify if therapeutics family interventions might help mitigate suicidal behaviors in BD patients

Varje dag väljer minst tre personer i Sverige att avsluta sina liv. Antalet personer som överlever ett suicidförsök är desto fler. Dessa personer kommer i kontakt med hälso- och sjukvård på olika sätt och möts ofta av stigmatisering och tystnad. Forskning visar att sjuksköterskan upplever en osäkerhet i mötet med patienten efter ett suicidförsök. För att bidra till en värdig vård behöver vi förstå vad patienten kan uppleva i vården. Syftet med litteraturstudien är därför att belysa upplevelsen av att vårdas efter ett suicidförsök ur ett patientperspektiv. Flera artikelsökningar resulterade i åtta kvalitativa artiklar vilka analyserades och sammanställdes i denna litteraturstudies resultat. Att vårdas efter ett suicidförsök förklaras i resultatet utifrån fem huvudteman där vårdarens bemötande ses som en central del. Patienten är också i behov av att få befinna sig på en trygg plats, där hen kan finna balans då patienten ofta tappat tilltron till sig själv. Det finns också en längtan efter att få dela sina tankar och planer på suicid med vårdpersonal. För att patienten ska få dessa behov tillgodosedda krävs en professionell och kompetent vårdare. Tyvärr visar forskning att vårdaren inte alltid lyckas tillgodose patientens basala behov. / At least three people commit suicide in Sweden every day. The numbers of the people who survive a suicide attempt are way more. These people get in touch with professional healthcare in different ways. Sadly they are often met with stigmatization and silence. Research shows that nurses often feel insecure when caring for these patients. To contribute to a meaningful care professional caregivers have to understand what these patients might experience. The purpose of this study is therefore to highlight the experiences of patients being cared for after a suicide attempt. Eight qualitative studies was selected and analysed. The result suggests how care after a suicide attempt can be understood throughout five themes: To be met in the right way, to feel safe, to find balance, to talk about suicide and to not trust in yourself. To be met by a professional caregiver was seen as the most important part of being cared for. There is also a longing to talk about the suicide attempt and the patient is in need of a safe place where he or she gets the opportunity to find balance. Lack of self-trust is also seen as a result of the suicide attempt. To be able to provide what the patient is in need of the caregiver has to be professional and competent. Unfortunately caregivers don’t always succeed in providing the care that the patient is in need of.

Abstract Bullying behaviour is present in the daily life of many adolescents, but research into the serious problems related to this behaviour is still scarce. The aim of this work was to investigate the putative associations of bullying behaviour with psychiatric disorders, substance use, suicidality and criminal offences in a sample of under-age adolescent inpatients in Northern Finland. The epidemiologically unselected sample of 12–17-year-old inpatients in need of acute psychiatric hospitalization in a closed ward consisted of 508 adolescents admitted to Unit 70 in Oulu University Hospital during a defined 5-year period. These subjects were interviewed during their hospitalization using the diagnostic semi-structured Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL), to identify their psychiatric disorders in terms of DSM-IV and to obtain data on bullying behaviour, substance use, suicidality and somatic diseases. Data on possible criminal offences were extracted from the criminal records of the Finnish Legal Register Centre. Being a bully and a bully-victim (i.e. a person who bullies others and is also bullied) increased the likelihood of externalizing disorders in general, and more specifically of conduct disorders, by over 14-fold in the boys and over 10-fold in the girls. Among the boys being a victim of bullying elevated the risk of internalizing disorders in general, and more specifically of anxiety disorders, by over 3-fold. Also, being a victim of bullying was statistically significantly associated with chronic somatic diseases (e.g. allergy, asthma and epilepsy), but only among the boys, the odds ratio (OR) being over 2-fold. Furthermore, being a bully increased the likelihood of substance-related disorders by over 2-fold in the boys and over 5-fold in the girls. In addition, examination of the use of substances of various types showed that being a bully increased the risk of regular daily smoking and alcohol use in both sexes and also led to more severe substance use such as cannabis and hard drugs among girls. Being a victim of bullying and bullying others both increased the risk of serious suicide attempts in the girls by over 2 and 3-fold respectively. Furthermore, bullying behaviour was also associated with violent crimes, but not with non-violent crimes, but psychiatric disorders were significant mediating factors in this association of bullying behaviour with criminality, however. The findings imply that involvement in bullying behaviour is more likely to be a risk factor for inward-directed harmful behaviour than outward-directed aggression, and also suggest that victimized boys are in general more vulnerable than victimized girls, whereas bullying girls have more problems than bullying boys. / Tiivistelmä Kiusaaminen on hyvin yleinen ilmiö nuorten keskuudessa, mutta siihen mahdollisesti liittyviä vakavia ongelmia on tutkittu vähän. Tässä tutkimuksessa analysoitiin kiusaamiskäyttäytymisen yhteyttä mielenterveyshäiriöihin, itsetuhoisuuteen ja rikollisuuteen psykiatrisessa osastohoidossa olleiden alaikäisten nuorten keskuudessa. Kiusaamiskäyttäytymistermi kattaa sekä kiusaajien, kiusattujen että kiusaaja-kiusattujen toiminnan. Tutkimusaineistoon kuului 508 12–17 -vuotiasta nuorta, jotka olivat hoidossa suljetulla psykiatrisella akuuttihoito-osastolla Oulun yliopistollisessa sairaalassa 1.4.2001 ja 31.3.2006 välisenä aikana. Osastohoidon aikana nuoret tutkittiin käyttäen puolistrukturoitua K-SADS-PL -haastattelua, jonka avulla määritettiin nuorten mielenterveyshäiriöt DSM-IV -diagnoosiluokituksen mukaisesti ja saatiin tiedot nuorten kiusaamiskäyttäytymisestä, päihteiden käytöstä, itsetuhoisuudesta ja somaattisista sairauksista. Oikeusrekisterikeskuksen rikosrekisteristä saatiin tutkittavien rikosrekisteritiedot. Tämä tutkimus osoitti, että nuorilla, jotka ovat kiusaajia tai kiusaaja-kiusattuja, on yli kymmenkertainen riski käytöshäiriöihin verrattuna nuoriin, jotka eivät ole osallistuneet kiusaamiskäyttäytymiseen. Kiusatuilla pojilla on yli kolminkertainen riski ahdistuneisuushäiriöihin. Lisäksi kiusatuksi joutuminen on pojilla yhteydessä kroonisiin somaattisiin sairauksiin kuten allergiaan, astmaan ja epilepsiaan. Tytöillä, jotka kiusaavat, on yli viisinkertainen riski päihdehäiriöihin. Pojilla, jotka kiusaavat, vastaava riski on kaksinkertainen. Molemmilla sukupuolilla toisten kiusaaminen on yhteydessä säännölliseen tupakointiin sekä alkoholin käyttöön ja tytöillä myös kannabiksen ja muiden huumeiden käyttöön. Tytöillä, jotka ovat kiusattuja tai kiusaavat, on yli kaksinkertainen riski vakaviin itsemurhayrityksiin. Lisäksi tämä tutkimus osoitti, että kiusaaminen on yhteydessä väkivaltarikollisuuteen, mutta tätä selittävät merkittävästi nuorten mielenterveyshäiriöt. Tämän tutkimuksen tulokset viittaavat siihen, että nuorilla, jotka altistuvat kiusaamiskäyttäytymiselle, on muita suurempi riski itsensä vahingoittamiseen useilla eri tavoilla. Sen sijaan kiusaamisen ja toisiin kohdistuvan väkivallan yhteys on lievempi. Sukupuolten välisiä eroja tarkasteltaessa havaittiin, että haavoittuvaisimpia ovat kiusaavat tytöt ja kiusatut pojat.

Previous studies have shown that bisexual women experience the lowest psychological well-being among the LGBTQ+ community. Bisexuality has been questioned as being a legitimized sexual orientation, both among the heterosexual group, as well within the LGBTQ+ community. Social media has brought on multiple benefits for LGBTQ+ people. One of those benefits is the ability to join groups specifically for LGBTQ+ people and in turn meet other people within the community. However, navigating some platforms have shown to be more problematic. Studies have shown that Facebook pose problems for LGBTQ+ people making their sexual orientation visible because of the different types of people that can partake in the content. The purpose of this study is to investigate potential differences or similarities between bisexual and lesbian women / nonbinary people's sense of security and attitude towards making one's sexual orientation visible on Facebook and Instagram. The study uses a quantitative method in form of a Google Forms survey sent out in Facebook groups, and published on Tumblr as well as on a Reddit forum. Hogan’s exhibitional approach is used as the study’s theoretical framework. The exhibitional approach focuses on how we modify our content on social media in consideration of the consumers, the algorithms and how our data is stored on social media platforms. There was a low response frequency among the respondents which led to a bias between the number of lesbians and bisexuals. The result showed that there wasn’t any statistical correlation between the variables visibility attempts of sexual orientation and being bisexual or lesbian. There was however a correlation between low identity uncertainty and being bisexual or lesbian. Studies on bisexuals show that there is a demand for continuous research on different aspects of bisexual women’s situation in society.

Cada día existen más productos en diferentes categorías del mercado con grandes similitudes. La poca diferenciación entre el reconocimiento de las marcas de estos contribuye al rápido cambio de intención de compra entre productos de la competencia. Por ello, es relevante que el diseño del packaging sea el correcto y garantice la atención del consumidor y su intención de compra hacia el producto objetivo. El packaging está compuesto por elementos visuales como color, forma, tamaño, imágenes y gráficos y elementos verbales como la información del producto y el lenguaje. Además, cabe resaltar que el presente trabajo de investigación consta de un estudio de tipo cuantitativo, donde se realizaron encuestas a una muestra de 250 personas de nuestro público objetivo en Lima Metropolitana. / Every day there are more products in different categories on the market with great similarities. The little differentiation between the recognition of their brands contributes to the rapid change of purchase intention between competing products. For this reason, it is important that the packaging design is correct and guarantees the consumer's attention and purchase intention towards the target product. Packaging is made up of visual elements such as color, shape, size, images and graphics, and verbal elements such as product information and language. In addition, it should be noted that this research work consists of a quantitative study, where surveys were conducted on a sample of 250 people from our target audience in Metropolitan Lima. / Trabajo de investigación

The Unfit Preparation and Attempt of Criminal Offence Abstract The topic of the unfit preparation and attempt of criminal offence is one of the most disputable domains of criminal law. The conflict concerns mainly punishability of an act, which cannot really result in committing a crime, and punishment of perpetrator. In the study of criminal law, two basic approaches have developed. Other theories are derived from them. The first od basic approaches is the subjective theory, which emphasizes a malice of the perpetrator. In its radical form, it omits completely an act in the world. The second approach is represented by the objective theory, which constitutes the opposite of the subjective theory. This theory emphasizes mainly dangerousness of the perpetrator's act for society. The preference of theories has been changing, that is also represented by the difference of laws. The unfit attempt can be divided in three basic groups according to what is unfit: attempt on unfit object, attempt with unfit tools, attempt by unfit subject. The thesis is divided into several parts. In the first part, the unfit preparation and the unfit attempt are introduced as evolutional stadiums of a criminal act mainly from the point of view of current law. Than unfit forms and detailed explanation of both theory follow. Also such...

Bakgrund: Över 700 000 människor dör varje år till följd av suicid runt om i världen och den största riskfaktorn för att begå suicid är tidigare suicidförsök. Forskning visar att människor som begår suicid ofta söker till akutmottagningar en eller flera gånger innan de tar sitt liv. Akutmottagningar är därför en viktig plats för förebyggandet av suicid. Forskning visar att suicidförsök och självskadebeteende blir allt vanligare samt att självskadebeteende är en viktig riskfaktor för suicid. Sjuksköterskor på akutmottagningar möter ofta patienter med självskadebeteenden, patienter som genomgått suicidförsök och patienter som funderar på att ta sitt liv. Syfte: Syftet var att beskriva akutsjuksköterskors upplevelser och erfarenheter av att vårda patienter som inkommit till akutmottagningar till följd av självskadebeteenden och suicidförsök, samt beskriva akutsjuksköterskors attityder gentemot dessa patienter. Metod: En systematisk litteraturöversikt med integrativ design. Systematiska artikelsökningar har utförts i tre medicinska databaser med hjälp av PEO-modellen. Tio inkluderade vetenskapliga artiklar av kvalitativ, kvantitativ och mixad metod har granskats och analyserats. Resultat: I resultatet framkom följande fem teman: I. Sjuksköterskors attityder; II. Sjuksköterskors prioritering av fysisk framför psykisk hälsa; III. Arbetslivserfarenhet på akutmottagningen; IV. Barriärer inom akutmottagningens kontext; och V. Sjuksköterskors upplevda kompetenser & färdigheter. Slutsats: Då resultatet visar att många akutsjuksköterskor uppger osäkerhet och otrygghet vid vården av patienter med självskadebeteende och patienter som begått suicidförsök, bör mer utbildning erbjudas på akutmottagningar kring just dessa tillstånd. För att kunna bedriva en mer hållbar och patientsäker vård bör även akutmottagningar försöka behålla och rekrytera kompetenta och erfarna sjuksköterskor. / Background: Each year, more than 700 000 people around the world die because of suicide, and the biggest risk factor for committing suicide is previous suicide attempts. Research shows that people who commit suicide often visit the emergency department one, up to several times before taking their own lives. Emergency departments are therefore an important place for preventing suicide. Research shows that suicide attempts and self-harming behavior are becoming more common, and that selfharming behavior is an important risk factor for suicide. In emergency departments, nurses often meet patients with self-harming behaviors, patients who have attempted suicide and patients with suicidal ideation. Aim: The aim was to describe the emergency nurses’ experiences of caring for patients who have been admitted to emergency rooms because of self-harming behaviors and suicide attempts, and to describe emergency nurses' attitudes towards these patients Method: A systematic literature review with integrative design. Systematic searches have been conducted in three medical databases using the PEO model. Ten included scientific articles of qualitative, quantitative, and mixed method designs have been reviewed and analyzed. Results: The results highlight five main themes: I. Nurses’ attitudes; II. Nurses’ treatment of physical over mental health; III. Work experience in the emergency department; IV. Barriers in the context of the emergency department; and V. Nurses’ perceived competencies and skills. Conclusions: As the result show that many emergency nurses' report insecurity in the care of patients with self-harming behavior and patients who have attempted suicide, more training should be offered in emergency departments around these conditions. Emergency departments should also try to retain and recruit competent and experienced nurses, to provide more sustainable and patient-safe care.

Low cholesterol concentrations and cholesterol-lowering therapies have been suggested to be associated with increased suicidality. This article examined the association of cholesterol, triglycerides, and body-mass index (BMI) with suicidal ideation and suicide attempts. Findings are based on a nationally representative community sample of n = 4,181 subjects (18–65 years) examined with a standardized diagnostic interview (CIDI) for (DSM-IV) mental disorders. Controlling for age and gender the study revealed a moderate positive association between cholesterol, triglycerides, BMI, and suicide attempts in subjects with depressive symptoms during the past 12 months (n = 1,205). The results of this study are compatible with two recent epidemiological cohort studies showing a positive association between cholesterol and completed suicide.

No description available.

世界衛生組織表示「先前有過自殺行為的人，再度自殺的機率比一般人高」，因此如何針對自殺企圖者提供即時的關懷與介入服務，是世界各國重要的自殺防治策略之一。本研究希望針對曾有過自殺企圖的個案，經由統計模型的配適來找出自殺企圖個案的「自殺危險因子」，區別出再度自殺的高危險個案，以方便將人力及醫療資源投入到最需要被協助的個案上。 本研究的反應變項為「重複自殺企圖次數」，但是由於資料中「零值」的人數相當多，此外也呈現出變異數大於平均數的現象，因此我們採用可以同時處理Zero-inflated及Over-dispersion情況的廣義Zero-inflated卜瓦松迴歸模型 (Generalized Zero-inflated Poisson Regression Model)來進行資料的配適。我們得知重複自殺企圖之高風險因子有「65歲以上」、「曾患有精神疾病」、「不確定是否曾患有精神疾病」及「離婚」之個案，而「治癒」可能性較高的因子為「45~64歲」、「因情感因素自殺」、「已婚」之個案。藉由模型也可以進一步估計自殺企圖個案之再企圖機率，並且對自殺企圖個案進行分層，以進行不同程度的關懷與訪視，藉以提昇關懷的即時性及有效性。 / World Health Organization (WHO) has indicated that suicide attempt rate is much higher among those who have ever had suicide attempts. Hence, how to express concerns and provide timely consultations for suicide reattempters has become one of the key issues in suicide prevention. In this study, we try to identify the risk factors associated with suicide reattempters, and predict high-risk cases so that the limited resources can be distributed effectively. The primary variable of interest is the number of repeated suicide attempt for a suicide attempter after his/her index attempt. However, there are more zeros and greater variability in the data than that would be predicted by a Poisson model. We hence fit the data using a zero-inflated generalized Poisson regression model, a model that is frequently used for modeling over-dispersed count data with too many zeros. We find that the risk factors for repeated suicide attempts are those who are 65 or older, those who are classified as psychiatric disorders and those diagnostically uncertain cases, and those who are divorced. We also find that non-repeaters are more likely among those who are between 45 to 65 of age, married, and having a suicide attempt history due to an emotional reason. Through the use of the model, we can also estimate a subject’s reattempt probability, classify them, and provide them with suitable care and attention accordingly.