Local and regional public management reforms in Switzerland

Public management reforms at the local (community) and regional (canton) level in Switzerland almost all embrace elements of the new public management. In addition, in Switzerland, the merging of small communities as well as new developments such as electronic government are becoming apparent. The new public management model has been adapted for Swiss needs according to the perception of decision makers on problems that require solution in a Swiss context. NPM has developed, therefore, into rather different models in practice, aimed at the solution of these diverse problems. Foreign examples, such as the Dutch Tilburg Model and the German Neues Steuerungsmodell , played a major role at the start of this process, but have continuously lost their influence as actual models to be emulated. The most outstanding peculiarities of the Swiss reforms are an early and subsequent outcome focus together with the strong influence of direct democracy.     

Social integration and suicide in South Korea

The increasing suicide rate in South Korea in recent decades was found to be associated with measures of social integration/regulation (birth and divorce rates).     

High rates of suicide and attempted suicide using pesticides in Nickerie, Suriname, South America

Suicide and attempted suicide are identified as a serious mental health problem in Suriname, especially in the district of Nickerie. An epidemiological study in the Nickerie catchment area revealed high rates of suicide (48 per 100,000) and attempted suicide (207 per 100,000) on average in the years 2000-2004. Particularly remarkable is the high number of attempted suicides among males (49%), and the use of pesticides in both fatal (55%) and nonfatal suicidal behavior (44%). Probably this high incidence of suicidal behavior reflects the very poor economic situation of the district, poverty of most of the population, high levels of alcohol misuse, domestic violence, the rigidity of Hindustani culture regarding family traditions, the accessibility of pesticides, and the lack of future perspectives. Health care alone will not be sufficient to tackle this problem. One of the most urgent measures to prevent suicides is to stow away pesticides in locked cabinets with the key held by the proprietor.     

Body mass and suicide risk

Body mass has been neglected as a possible predictor of suicidal behavior. The present investigation explores the association between body mass index and completed suicide. Data are from the National Mortality Followback Survey and refer to 373 suicides, and 518 deaths from motor vehicle accidents as controls. The results of a logistic regression analysis indicated that, for females, the greater the BMI the greater the suicide risk. However, this relationship did not hold up under controls for race and other covariates of BMI. For males, the BMI was not significantly related to suicide risk either at the bivariate or multivariate levels of analysis. The best predictors of suicide were living alone for females, and alcohol abuse for males.     

Risk assessment and suicide prevention in primary care

General practitioners (GPs) are assumed to occupy an important position in the prevention of suicide through the introduction of risk assessment techniques commonly used in psychiatric practice. Despite this theoretical role for primary care services, it remains unclear how frequently GPs implement risk assessment in patients who may be vulnerable to suicide. To address this, a retrospective survey of probable suicides was conducted within a primary care setting utilizing a questionnaire of GPs who had experienced a patient suicide and was augmented by hospital and coroners' records. 85% of questionnaires were returned and 61 deaths were adjudged as suicides during the year long census period. 75% of suicides were male and 54% were aged under 35.28% were in contact with psychiatric services prior to death, although 60% had some diagnosis of mental disorder. GPs had little knowledge of a patient's life circumstances in up to half of cases. Recording of risk assessment occurred in 38% of subjects, was positively associated with prior psychiatric contact (p = 0.001) but negatively associated with presence of physical illness (p = 0.004), older patient age (p = 0.04), and GPs length in practice (p = 0.05). One GP felt their suicide case was preventable. The low rate of risk assessment and limited knowledge of patient lifestyle point to the need for active engagement of GPs in future suicide prevention strategies and should influence the content of training programs in primary care.