Monitoring deliberate self-harm presentations to general hospitals

Monitoring of deliberate self-harm (DSH) presentations to hospitals (and in other settings) is receiving increased attention in many countries. This is due to greater recognition of the size of the problem and awareness of its relevance to suicide prevention policy initiatives, because of the strong association between DSH and suicide. A system for monitoring all DSH presentations has been in place in the general hospital in Oxford for 30 years. Based on our experience, in this paper we describe procedures for monitoring, including case definition and identification, linkage of persons and episodes in order to investigate repetition of DSH and other outcomes (including deaths), and data protection and ethical issues. We also provide details of how to carry out monitoring, including different models of data collection, and what data to collect. Finally we consider the potential uses of the data for both clinical and research purposes, including evaluation of national suicide prevention initiatives.     

Identification of human skeletal remains by comparison of bony details of the cranium using computerized tomographic (CT) scans

A case is described where a cranium from an unknown individual is identified by comparison of antemortem and postmortem computerized tomographic (CT) images of the bony structure of the skull. While on at least one occasion CT scans of individual cranial landmarks have been used to identify unknown remains, this study is remarkable because positive identification of a deceased individual was accomplished by performing a CT scan on an unidentified cranium and comparing multiple landmarks and images with corresponding features in an antemortem CT scan of a missing man. Bony details of the frontal and sphenoid sinuses, ethmoid and mastoid air cells, sagittal cranial suture, and the torcula (the internal occipital protuberance) were exactly the same on both CT scans, confirming them as the same person.     

Book reviews

Sibyl Crowe and Edward Corp, Our Ablest Public Servant, Sir Eyre Crowe GCB, GCMG, KCB, KCMG, 1864-1925 (Braunton Devon: Merlin Books, 1993) £17.95. ISBN 0 86303 607-4.

Richard J. Aldrich, The Key to the South: Britain, the United States, and Thailand during the Approach of the Pacific War, 1929-42 (Kuala Lumpur: Oxford University Press, 1993).

John Saville, The Politics of Continuity: British Foreign Policy and the Labour Government, 1945-46 (London and New York: Verso, 1993). ISBN 0 86091 456 9.

John Kent, British Imperial Strategy and the Origins of the Cold War, 1944-49 (Leicester, London and New York: Leicester University Press, 1993). ISBN 0 7185 1330 4.

Frederick W. Marks III, Power and Peace: The Diplomacy of John Foster Dulles (Westport, CT & London: Praeger, 1993) £45. ISBN 0 275 94497 2.

Charles Grant, Delors: Inside the House that Jacques Built (London: Nicholas Brealey, 1994) pp.305. £12.99. ISBN 1 85788 039 0.     

Expectancy theory in developing nations: Motivating Botswana public servants

The degree to which individuals are motivated to apply themselves depends in part on how far they expect to be able to achieve given goals. This study, based on interviews of local government administrators in Botswana, not only stresses the importance of expectancy in motivation but reports the importance of altruistic goals among these administrators. Among those interviewed there was a strong desire to advance their own careers, both by developing themselves in the job they currently hold, and by advancing through the organizational hierarchy. Employees, however, were also anxious to accomplish concrete objectives in their current jobs and thus to contribute to the development of the nation. Here unless officials have the expectancy of being able to achieve these goals their motivation is affected. Thus emphasis is placed in this article on the need to supplement traditional attention to pay and promotion as devices to improve motivation with a concern to remove road blocks to development. The enquiry thus strengthens the case for the performance improvement programme of the United Nations.