BackgroundAlcohol misuse is a significant risk factor for both self-harm and suicide, and alcohol is often involved in self-harm acts and present at time of deaths by suicide. This study sought to identify factors associated with alcohol consumption in both non-fatal self-harm presentations and cases of suicide.MethodsThis study included suicides in Cork, Ireland between September 2008 and June 2012 and self-harm presentations from January 2007 to December 2013. 8145 Emergency Department presentations involving self-harm during this period were recorded by the National Registry of Deliberate Self-Harm. Alcohol involvement in self-harm presentations was ascertained from medical notes. 307 cases of suicide during this period were recorded by the Suicide Support and Information System. Alcohol involvement in suicides was ascertained from toxicology results.ResultsAlcohol consumption was evident in 21% of self-harm presentations and in 44% of suicide cases. Univariate analysis indicated that variables associated with having consumed alcohol in a self-harm presentation were: gender, age, method of self-harm, type of aftercare received and timing of the presentation. In a multivariate model, a number of variables remained significant. Self-harm patients who consumed alcohol at time of presentation were more likely to be male (OR = 1.24, 95% CI: 1.10–1.40) and least likely to present with self-cutting (OR = 0.45, 95% CI: 0.38–0.54). Presentations with alcohol involved were less likely to be admitted to a psychiatric ward (OR = 0.60, 95% CI: 0.44–0.81) and less likely to present during the daytime (OR = 0.50, 95% CI: 0.43–0.58), and at the weekend (OR = 1.23, 95% CI: 1.09–1.40). For suicide cases, univariate analyses indicated that the only variable associated with having consumed alcohol was younger age (>65 years = ref: <25 years OR = 8.61, 95% CI: 2.35–31.55; 25–44 years OR = 11.05, 95% CI: 3.16–38.73; 45–64 years OR = 4.23, 95% CI: 1.19–15.09); male gender approached statistical significance (OR = 1.80, 95% CI: 0.98–3.29). All other variables (marital status, living arrangements, suicide note, method of suicide, drugs in toxicology) had no significant association with alcohol consumption among suicides.ConclusionThis study underlines the high frequency of alcohol involvement among those engaging in fatal and non-fatal suicidal behaviour. Alcohol involvement was associated with male gender in both suicides and self-harm presentations. Public health measures to restrict access to alcohol may be used to enhance suicide prevention, given that ecological studies show reduced suicide rates following measures to restrict access to alcohol. Active consultation and collaboration between the mental health services and addiction treatment services should be arranged in the best interests of those who present with dual diagnosis.

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International League Against Epilepsy (ILAE) epidemiologic guidelines [2]. Definite and probable cases of seizures and epilepsy were classified according to 2017 ILAE classification systems as focal, generalized or unknown [3, 4]. Data were analysed using SPSS, version 24. Results From a population of 542,869 adults and children, 1942 potential cases were identified, of whom 611 were excluded as neonatal or febrile seizures, did not meet the geographic criteria or had a previous diagnosis of seizures or epilepsy. Incidence rates of first seizure (both provoked and unprovoked) was 102 per 100,000 population, of new diagnosis of epilepsy was 64 per 100,000, and of seizure mimics was 96 per 100,000. In concordance with most international studies, age-specific incidence rates for both first seizures and new diagnosis of epilepsy demonstrated a bimodal distribution, with highest rates in the very young and in later life. As expected, the most commonly encountered seizure mimic was syncope (30%). Conclusion We applied a rigorous study protocol for investigation of the incidence of first seizures, new diagnosis of epilepsy and seizure mimics in a geographically defined region which is adherent to recently published international guidelines for epidemiological studies and epilepsy classification. This study highlights the significant burden that seizure mimics place on diagnostic services given that they occur as frequently as first seizures.

Background Perinatal mortality has decreased in high-resource countries but cause of death, especially for stillbirths, is often unexplained. The Irish National Perinatal Epidemiology Centre (NPEC) established a national clinical audit on perinatal deaths to better identify causes of death and associated risk factors. Methods After piloting the NPEC Perinatal Death Notification Form and Classification System in three maternity units in 2010, the national audit was initiated and all 20 Irish maternity units have provided anonymised data on perinatal deaths since 2011. Results For 2011, 491 perinatal deaths were reported – 318 (65%) stillbirths, 138 (28%) early neonatal deaths and 35 (7%) late neonatal deaths – giving a perinatal mortality rate of 6.1/1,000 births, stillbirth rate of 4.3/1,000 births and early neonatal death rate of 1.9/1,000 live births. Fourfold variation in the perinatal mortality rate was observed across the 20 maternity units. The common causes of death in stillbirth were congenital anomaly (26%), placental conditions (17%) and ante/intrapartum haemorrhage (11%), 20% were unexplained. Early neonatal deaths were generally due to congenital anomaly (51%) or respiratory disorder (33%) – primarily severe pulmonary immaturity. Just 4% were unexplained. Low birthweight was common, below normal range for 53% of stillbirths and 40% of early neonatal deaths. In most cases of early neonatal death, spontaneous respiratory activity was absent or ineffective five minutes following delivery (63%) and death occurred within 24 h (62%). Conclusion This audit enhances clinical interpretation of perinatal deaths which will inform clinical practice, public health interventions and counselling of prospective parents.

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