The prevalence of self-harm, defined as any intentional selfpoisoning or self-injury regardless of the degree of suicidal intent, 1 and the high rate of repetition and eventual suicide 2,3 make selfharm a major healthcare problem in many parts of the world. [4][5][6] Despite widespread variation in services and the general trend towards greater inclusion of consumer views in the evaluation of health service outcomes, 7-9 there appears to have been little attempt to draw together the available evidence on people's perceptions of self-harm services. Assembling such information is important in the design and successful implementation of better quality care. 10 We have conducted a systematic review of the international literature on people's attitudes to and satisfaction with health services (specifically medical management, in-hospital psychiatric management and post-discharge management) following selfharm in order to inform the development of improved services. MethodWe sought to identify all relevant qualitative and quantitative studies of participants of either gender or any age who had engaged in self-poisoning or self-injury and had contact with hospital services. We also included studies of patients' friends or relatives. Electronic databases (EMBASE, MEDLINE, PsycINFO, AMED, British Nursing Index, CINAHL, Global Health, HMIC, International Bibliography of the Social Sciences, Sociofile and SIGLE) were searched for any relevant international literature published until June 2006. Search terms relevant to the experiences of care of individuals who self-harm were those used in the National Collaborating Centre for Mental Health 10 report on self-harm (see online supplement). Reference lists of relevant studies were also searched. There were no language restrictions. Experts in the field working in non-English speaking countries were consulted in order to determine whether they knew of any published or unpublished literature concerning attitudes to services among those who self-harm.Research based on quantitative methods was used to provide evidence about the general experiences of a larger population of people who self-harm, with findings from qualitative studies used to extend understanding through the recounting of specific examples and incidents. Data were extracted independently by two reviewers. For studies using qualitative methodology, quotations and themes regarding attitudes and experiences of services were coded using a pen and paper method by a single reviewer (T.T.). The second reviewer (S.F.) extracted data to ensure all relevant quotations and topics were recorded and to reduce possible bias in reporting findings. Similarities and differences between participants' accounts were noted.The quality of all included studies was assessed independently by at least two reviewers using a combination of the Social Care Institute for Excellence's quality assessment tool 11 and the Critical Appraisal Skills Programme's '10 Questions to Help you Make Sense of Qualitative Research'.12 Relevance was assessed usi...

Naturally acquired infection of humans with a marine mammal-associated Brucella sp. has only been reported once previously in a study describing infections of two patients from Peru. We report the isolation and characterization of a strain of Brucella from a New Zealand patient that appears most closely related to strains previously identified from marine mammals. The isolate was preliminarily identified as Brucella suis using conventional bacteriological tests in our laboratory. However, the results profile was not an exact match, and the isolate was forwarded to four international reference laboratories for further identification. The reference laboratories identified the isolate as either B. suis or B. melitensis by traditional bacteriological methods in three laboratories and by a molecular test in the fourth laboratory. Molecular characterization by PCR, PCR-restriction fragment length polymorphism, and DNA sequencing of the bp26 gene; IS711; the omp genes omp25, omp31, omp2a, and omp2b; IRS-PCR fragments I, III, and IV; and five housekeeping gene fragments was conducted to resolve the discrepant identification of the isolate. The isolate was identified to be closely related to a Brucella sp. originating from a United States bottlenose dolphin (Tursiops truncatus) and common seals (Phoca vitulina).Brucellosis is an important zoonotic disease of humans, causing a variety of vague symptoms including undulant fever, fatigue, malaise, joint pain, myalgia, depression, and anorexia (22). Chronic sequelae and recrudescence decades after initial infection also occur. Brucella may be transmitted from animals to humans by direct contact with infected animals, ingestion of infected food products, and inhalation of aerosols. Four species of Brucella are the primary causes of infection in humans. Brucella melitensis is highly infectious and is transmitted from sheep and goats, B. abortus is transmitted from cattle, B. suis is transmitted from pigs and, infrequently, B. canis is transmitted from dogs. Other species of Brucella have been rarely or not reported to infect humans.There are only two reports in the literature of humans infected with marine mammal strains of Brucella. One report was of a laboratory worker who displayed symptoms consistent with brucellosis (4). The infection was confirmed by a positive serological response, isolation, and PCR-restriction fragment length polymorphism (RFLP) identification of a marine Brucella strain. Two patients originating from Peru and diagnosed with neurobrucellosis were also confirmed to be infected with marine mammal strains of Brucella by isolation, PCR, and DNA sequencing (41). The two Peruvian patients were not laboratory workers, and the infection was naturally acquired.Serological evidence and isolation of brucellae have been reported from a variety of marine mammals on numerous occasions from locations in the northern hemisphere. The serological prevalence ranges from 0 to 38% for cetaceans, pinnipeds, and mustelids (6,24,26,29,32,34,43). The largest studies of 1,855 ...

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This article describes a trial of a psychoeducational intervention designed to modify negative attitudes toward flexible sigmoidoscopy screening and thereby increase screening attendance. The intervention materials addressed the multiple barriers shown to be associated with participation in earlier studies. Adults ages 55-64 (N = 2,966), in a "harder-to-reach" group were randomized either to receive an intervention brochure or to a standard invitation group. Attitudes and expectations were assessed by questionnaire, and attendance at the clinic was recorded. Compared with controls, the intervention group had less negative attitudes, anticipated a more positive experience, and had a 3.6% higher level of attendance. These results indicate that psychoeducational interventions can provide an effective means of modifying attitudes and increasing rates of screening attendance.