BACKGROUND: Since the initial report on the negative effects of smoking by the Surgeon General's Advisory Committee, the components of cigarettes and tobacco smoke and the mechanisms by which these cause disease have been studied extensively. Despite the well-documented health consequences associated with tobacco use, nearly 70 million Americans over the age of 12 actively use tobacco products, with 57.5 million of these (22.1% of the U.S. population in this age range) actively smoking cigarettes. Understanding how nicotine addiction develops and reinforces itself is important context for understanding the high prevalence of quit interest among smokers and the high relapse rates associated with quit attempts. While the increased availability of different, clinically proven tobacco cessation aids should lower the barrier associated with tobacco abstinence, the prevalence of quit aid use still remains low among those attempting to quit smoking. This study examines quit interest in active smokers, the quit attempts attempted by current and former smokers, the prevalence of tobacco cessation aid use in these quit attempts, and the perceived efficacy of certain quit aids. METHODS: This study was conducted in the Emergency Departments of ten hospitals nationwide by the National Association of Research Associates Programs in 2012. This study utilized trained research staff to enroll non-emergent patients and visitors over the age of 18 years old, obtaining demographical information and a detailed history of tobacco use from the participant. This included such information as current tobacco use status, how many cigarettes were consumed during a typical day, how many times they had attempted to abstain from tobacco use in the past, if they had used any tobacco cessation aids during those quit attempts, and, if so, how effective they believed these aids were. Participants were also asked to rate their readiness to quit smoking and intent to quit smoking, markers this study used to analyze quit interest. RESULTS: Of those approached, 10,303 study participants were selected for inclusion in this study, reporting tobacco use for longer than one month at any point in their life. 50.5% reported current tobacco use, while 46.8% reported current abstention from smoking. A majority of active smokers expressed interest in initiating tobacco cessation, with 55.2% reporting they were ready to quit smoking, though a smaller majority (51.9%) of active smokers reported that they intended to quit smoking. Most smokers reported at least 1 quit attempt in the past, with 76.5% of former smokers reporting that they quit within 1 to 5 attempts. Only 30.7% of study participants reported ever using some form of tobacco cessation aid in previous quit attempts, with nicotine replacement therapy use being the most commonly reported, and with pharmacological interventions more commonly reported than counseling-based cessation interventions. A majority of participants who reported using nicotine replacement gum and lozenges (57.8% and 49.5%, respectfully) reported that they were not helpful in aiding their cessation attempts, with only 30.1% of gum and 38.7% of lozenge users reporting a positive effect. CONCLUSIONS: The results indicated that among active smokers, smokers that reported smoking less (only some days or fewer cigarettes per day) were more likely to express interest (readiness and intent) in initiating tobacco cessation than those that reported smoking more (every day or more cigarettes per day). Quit interest also appeared to be lowest in 18-25 year olds, with this age group also reporting the lowest proportion of quit attempts, a finding that differed from another national tobacco survey. The prevalence of quit aid use in our study was comparable to another national tobacco survey, but our findings for the prevalence of unassisted quit attempts did not coincide with results found in other studies. These results also indicated that cessation aid use increased with increased number of quit attempts. Though we found that former smokers were more likely to indicate that NRT products were helpful than active smokers were, we were unable to fully analyze the perceived effects of cessation aid use due to the loss of some of this data. In light of the limitations of this study, further study needs to be conducted to better understand the perceived effect of tobacco cessation aids and how this might differ from the efficacy values found in clinical trials. In order to make findings more comparable to other tobacco surveys, future studies should also be designed around clear and common definitions for active tobacco use and quit interest, and a focus on quit attempts should be modulated by some degree of recency (e.g., quit attempts made within the previous year or two years).

Objective: The authors examined trait hope and hopelessness as potential moderators of the association between depressive symptoms and suicidal behavior. Participants: A diverse sample of 372 college students. Methods: Depressive symptoms, hopelessness (Beck Hopelessness Scale), trait hope (Trait Hope Scale), and suicidal behaviors were assessed. Trait hope is defined as confidence in the ability to identify and attain goals, whereas hopelessness encompasses future attitudes and motivation loss. Results: In independent models, low hopelessness buffered the association between depressive symptoms and suicidal behavior for our whole sample, blacks, and whites, whereas trait hope buffered for Hispanics and whites. Examined simultaneously, hope remained a significant moderator only in whites and hopelessness only in blacks. These findings suggest that etiological and outcome correlates of hope and hopelessness may differ by ethnicity. Conclusions: These findings may have implications for development of culturally targeted interventions for college students that strive to simultaneously reduce hopelessness and bolster hopefulness.

Nonsuicidal self-injury (NSSI) involves the deliberate damage of one’s own bodily tissue without suicidal intent. A number of psychological disorders and indicators of distress are correlated with the behavior, including suicidal behaviors (e.g. Whitlock & Knox, 2007), depression (e.g. Ross & Heath, 2002), and anxiety (e.g. Victor & Klonksy, 2014), and yet the research literature has been mixed on whether increased frequency of NSSI is correlated with increased levels of these variables. The present study hypothesized that these relationships are curvilinear. Data from a larger study were analyzed using curvilinear regression analyses, and hypotheses were partially supported. Curvilinear relationships were found between NSSI frequency and both depression and anxiety, such that the relationships were positive until approximately 300 incidents, after which they became negative. The relationship between NSSI and suicide ideation was positive and linear. Among the whole sample, there were curvilinear relationships between both NSSI and suicide attempts as well as NSSI and suicide threats. Among only the portion of the sample who reported a history of these variables, there was no relationship between frequency and suicide attempts, and a curvilinear relationship between frequency and suicide threats that declined after 325 incidents. Results add to the current understanding of NSSI frequency and provide support for evidence that conflict with the proposed frequency criterion for nonsuicidal self-injury disorder.

In developed countries, suicidal behaviour is recognised as a significant public health problem among young people, but there are few studies from developing countries on this subject. The present thesis aims at estimating the extent of the problem and at exploring factors related to suicidal behaviour among young people in a developing country, Nicaragua, using a combined quantitative and qualitative approach. Three studies were conducted between 1999 and 2006. In the first study, all hospital admitted suicide attempt cases in the area of León were assessed over a three year period. Secondly, a qualitative study using individual in-depth interviews was conducted with eight girls aged between 12 and 19 admitted to hospital after attempting suicide. Thirdly, a study using the Attitudes Towards Suicides (ATTS) questionnaire was conducted in a community based sample of 278 young people aged 15-24 years to assess own suicidal behaviours, attitudes towards suicide as well as exposure to suicidal behaviour among significant others. The hospital surveillance showed that suicide attempt rates were highest among females in the age group 15-19 years with a female rate three times that of males (302.9 versus 98.9 per 100,000 inhabits per year). Drug intoxication and pesticides were the most commonly used methods for the attempts. A consistent seasonal variation with peaks in May-June and September-October was found in each of the three years, possibly related to exam periods in schools. Findings in the qualitative approach led to a tentative model for pathways to suicidal behaviour based on four main categories: Structuring conditions, triggering events, emotions and action taken. Dysfunctional families, lack of confidential and trustworthy contacts and interpersonal conflicts followed by emotions of shame and anger were some important components in the model. The community studies showed that suicidal expressions (life-weariness, death wishes, suicidal ideation, suicide plans and suicide attempts) were common among young people where more than 44.8% of males and 47.4% of females reported some kind of suicidal expression. Gender differences were small. Exposure to suicidal behaviour among others was associated with higher levels of self-reported suicidal behaviour. The attitude study showed that boys had less pro-preventive attitudes than girls, possibly indicating their higher risk for completed suicide. Exposure to suicidal behaviour and own suicidal behaviour showed an association with specific patterns of attitudes. The findings should be taken into consideration when planning for prevention of suicidal behaviour among young people in a developing country like Nicaragua.

This thesis analyzes the changes occured in the Iranian education system. The changes occured before and after the Islamic Revolution are main themes. Reform attempts, modernization, westernization, secularization, purification and Islamization of Iranian education system will be discussed along with comments of notable figures. The thesis will also trace the history of modernization and development of Iran as well as introducing political ideas of ruling elites how they defined projects to transform Iranian education system.

Bakgrund: Sjukdom och ohälsa kan orsaka påfrestningar och innebära en omställning för hela familjen, detta blir tydligt då en familjemedlem genomgår återupplivningsförsök. Antalet närstående som önskar närvara vid återupplivningsförsök har ökat, det är därför av stor vikt att möta familjers behov vid återupplivningsförsöket. Samtidigt upplever sjuksköterskor att de inte har kompetens nog eller adekvat utbildning för att göra det. Syfte: Syftet med studien är att beskriva upplevelser av närståendes närvaro vid återupplivningsförsök ur dels sjukvårdspersonals och dels närståendes perspektiv. Metod: En litteraturstudie gjordes på 15 vetenskapliga studier med kvalitativ, kvantitativ och mixad ansats. Resultat: I resultatet framkom att närstående och vårdpersonal upplevde att möjligheten att närvara gav tillfälle att ta farväl på ett värdigt sätt. Vårdpersonal kände sig ansvariga för både patient och familj, men vården av familjen var lägre prioriterat än vården av patienten i den akuta situationen. Både vårdpersonal och närstående upplevde att närstående var delaktiga i vården av patienten genom att ha rollen som informatör, att stötta och trösta patienten, eller att medverka vid beslutsfattning. Närståendes närvaro distraherar vårdpersonalen på olika sätt. I de studier som presenterade negativa upplevelser framgick dels att det saknades riktlinjer och dels att personalen var underbemannade. Slutsats: Det finns många faktorer som påverkar både vårdpersonals och närståendes upplevelser av närståendes närvaro vid återupplivningsförsök, bland annat vårdpersonalens erfarenhet och kompetens. Närstående bör få möjligheten att närvara om resurserna tillåter det. Klinisk relevans: Ökad förståelse för vilka faktorer som styr omhändertagandet av närstående i den akuta situationen, kan göra sjuksköterskan bättre förberedd inför dessa situationer. / Background: Disease and illness can cause stress and lead to a change for the whole family; this becomes evident when a family member is undergoing resuscitation attempts. The number of relatives who wish to be present during resuscitation has increased; it is therefore important to meet the needs of families during resuscitation. At the same time nurses experience that they are not competent enough or have adequate training to do so. Objective: The aim of this study is to describe the experiences of family presence during resuscitation from both health professionals and also relatives’ perspective. Method: A literature review was done on 15 scientific articles with qualitative, quantitative and mixed approach. Results: The results revealed that relatives and healthcare professionals felt that the opportunity to attend provided the opportunity to say goodbye in a dignified manner. Healthcare professionals felt responsible for both patient and family, but the care of the family had lower priority than the care of the patient in the acute situation. Both healthcare professionals and relatives’ experiences showed that relatives were involved in the care of the patient by having the role as an informant, to support and comfort the patient, or to participate in decision making. Family presence distracts medical staff in various ways. In the studies that presented negative experiences it appeared partly because of lack of guidelines and the fact that the healthcare professionals were understaffed. Conclusion: There are many variables that influence both health professionals and relatives experiences of family presence during resuscitation, including health professionals' experience and expertise. Relatives should have the opportunity to attend if resources allow. Clinical relevance: Increased understanding of the variables that determine the care of relatives in the acute situation, can prepare the nurse for these situations.

<p>Finding an indicator that can point to a high risk group for suicide has long been a desirable aid for the prevention of completed suicides. The studies reviewed in this essay presume that a biological aspect can point out the high risk individual. The focus of the studies lies on the serotonin 5-hydroxytryptamine (5-HT) monoamine neurotransmitter and cerebrospinal fluid (CSF) 5-hydroxyindoleacetic acid (5-HIAA) which is the principal metabolite of 5-HT in depression. The studies on 5-HT metabolites have led to the belief that these may play a key role in the neurochemistry of suicidal behaviour. It is suggested that the core behavioural effect of low CSF 5-HIAA concentration might result in an increase in impulsive and violent behaviour to self and others. The predictability is based on the fact that patients with low CSF 5-HIAA are more prone to reattempt and complete suicide by violent means. A number of well-designed studies concerning suicidal individuals and control subjects have however not shown any difference in concentration of CSF 5-HIAA in suicide attempters compared to non-suicide attempters which could be explained by methodological flaws. Low CSF 5-HIAA does seem to characterize the high risk individual, but it is not yet determined what role it plays in actual suicidality.</p>

The present study attempted to identify demographic and psychological variables predictive of adolescent suicidal ideations and attempts. Data from 90 adolescents, who completed an intake form at a university community mental health clinic or were student volunteers, were utilized. Two judges tabulated information regarding age, gender, number of siblings, ethnicity, parental marital status, drug use, depression, suicidal ideation, and previous suicidal attempts. A multiple regression analysis was performed to identify which variables had predictive significance. Depression was the best predictor of both suicidal ideations and attempts. Ethnicity was also predictive; white adolescents were found to be at higher risk for suicide than individuals from other ethnic groups. It is suggested that additional studies be done exploring other predictors of suicide among adolescents.

Bakgrund: Suicidförsök är en medveten handling som görs för att avsluta livet. Detta är ett växande folkhälsoproblem i Sverige men även i världen. Sjuksköterskor i den somatiska akutsjukvården vårdar dessa patienter. Det är viktigt att som sjuksköterska ha kunskap och kunna bemöta dessa patienter för att kunna ge god vård och förebygga ytterligare suicidförsök.  Syfte: Syftet med studien var att undersöka sjuksköterskors upplevelser av det vårdande mötet inom den somatiska akutsjukvården med patienter som utfört ett suicidförsök. Metod: En kvalitativ intervjustudie med induktiv ansats användes. Nio semistrukturerade intervjuer genomfördes och analyserades med kvalitativ innehållsanalys. Etikkommittén Sydost har rådfrågats innan studien genomfördes.  Resultat: Den somatiska akutsjukvården upplevdes inte optimal för patienter som utfört ett suicidförsök och patienterna ansågs inte få optimal vård. Patienter som utfört ett suicidförsök beskrevs som vanligt förekommande och sjuksköterskans bemötande och kommunikation var av betydelse. Känslor såsom otillräcklighet, maktlöshet och hopplöshet kunde uppkomma hos sjuksköterskan. Upplevelserna kunde variera beroende på olika faktorer såsom arbetsmiljö, patientens ålder, patientens beteende och anhöriga. Sjuksköterskornas upplevelse varierade även beroende på vilken kompetensnivå de hade. Erfarenheter och utbildningar bidrog till sjuksköterskornas kompetensutveckling inom ämnet. Slutsats: Den somatiska akutsjukvården borde bli bättre på att vårda patienten i sin helhet och inte endast det somatiska vilket kräver förändringar i verksamheten. Avsaknaden av utbildning inom ämnet leder till att sjuksköterskorna upplever vårdandet begränsande och utmanande. En mer kompetent sjukvårdspersonal kan leda till bättre förebyggande arbete vilket kan leda till minskad psykisk ohälsa och få positiva konsekvenser i hela samhället. / Background: Suicide attempt is a conscious act done with the goal of ending their life. Suicide is a growing public health problem in Sweden but also globally. As a nurse in the somatic emergency department you meet these patient. It is important that the nurse have the knowledge to care and meet these patients in order to provide good care and prevent further suicide attempts.  Aim: The purpose of this study was to examine nurses experiences of the caring meeting in the somatic emergency department with patients who have performed a suicide attempt. Method: A qualitative interview study with an inductive approach was used. Nine semi-structured interviews were conducted and analyzed with a qualitative content analysis. The Southeast Ethics Committee has been consulted before the study was conducted. Results: The somatic emergency department was not considered optimally for patients who had performed a suicide attempt and the patients were not considered to receive optimal care. Patients who had carried out a suicide attempt were described as common and that the nurse´s approach and communication were of importance. The nurses could have feelings such as insufficiency, powerlessness and hopelessness. The experiences of the care could vary depending on various factors such as the patients age, patients behaviour and relatives. The nurses experience varied depending on the level of knowledge they had. Experience and training increased the nurses competence development about the subject. Conclusion: The somatic emergency department should be better at caring for the patient as a whole and not only the medical care and this requires a change in the department. The lack of knowledge in mental illness causes the nurses to feel that the care is limiting and challenging. Competent healthcare personnel can lead to preventative work in the subject, which can lead to reduced mental illness and have positive consequences throughout the society.

Depression and suicide are significant public health concerns for college-age young adults. Meaning-based characteristics, such as forgiveness, a voluntary coping process involving offering, feeling, or seeking a change from negative to positive cognitions, behaviors, and affect toward a transgressor, may buffer such poor mental health outcomes. Utilizing mediation analyses, we examined cross-sectional associations between forgiveness, depression, and suicidal behavior in a diverse student sample reporting mild to severe depressive symptoms. The effect of self-forgiveness on suicidal behavior was fully mediated by depression; self-forgiveness was associated with depression and, in turn, with suicidal behavior. Forgiveness of others was directly associated with suicidal behavior. Prospective research is needed, yet self and other-forgiveness may be appropriate targets for promotion in suicide prevention efforts.