APSI: a proposed integrative model for suicide prevention.

BACKGROUND: Deaths by suicide have been increasing in recent years in Ireland, many of whom have co-morbid mental health difficulties and/or have attended primary care services 1 month before death. Aims To profile how 'Access to Psychological Services Ireland' (APSI) provides stepped-care therapies for mild-to-moderate adult mental health presentations and the potential effectiveness of this model based on comparison to a review of evidence-based strategies in suicide prevention. A secondary aim is to highlight how APSI has the potential to target those at risk of suicide and provide an integrative after-care service to complement secondary care mental health services. Findings In a context of inter-agency working, APSI provides an integrated continuum of suicide prevention interventions that map onto or intervene across the continuum of suicide behaviour. Hence, APSI appears to implement what the literature suggests will work in preventing suicide. However, outcome research is needed to establish APSI's impact in preventing suicide. Recommendations It is recommended that Irish-based research is conducted to establish APSI's impact in preventing suicide with a view to rolling out APSI as a national mental health clinical care programme.

Universal antenatal screening for hepatitis C.

The aims of this study were to pilot universal antenatal HCV screening and to determine the true seroprevalence of HCV infection in an unselected antenatal population. A risk assessment questionnaire for HCV infection was applied to all women booking for antenatal care over a 1-year period. In addition the prevalence of anti-HCV antibody positive serology in this population was determined. Over the course of the year, 9121 women booked for antenatal care at the Rotunda and 8976 women agreed to take part in the study, representing an uptake of 98.4%. 78 (0.9%) women were diagnosed as anti-HCV positive, the majority of whom were Irish (60.3%) or from Eastern Europe (24.4%). 73% of anti-HCV positive women reported one or more known risk factor with tattooing and a history of drug abuse the most commonly reported. 27% (n = 21) of anti-HCV positive women had no identifiable risk factors. Due to selective screening, seroprevalence of HCV is impossible to accurately calculate. However the universal screening applied here and the high uptake of testing has allowed the prevalence of anti-HCV among our antenatal population to be calculated at 0.9%. A significant proportion (27%) of anti-HCV positive women in this study reported no epidemiological risk factors at the time