No abstract

Railway suicides account for a minority of <10 per cent of all suicides, although they are considered a major public health issue because of their tremendous consequences on functioning of the transportation system and their deteriorating impact on the mental health of staff and bystanders. Railway suicide is a particularly violent method, and case fatality is 90 per cent of all attempts. However, case fatality in metro systems of >60 per cent are rare. More men than women choose the track as a means of suicide with a trend towards a balanced distribution in metro systems. Victims are predominately young with a median age stratum in the range of 25–34 years. For men, a prevalence peak in April and a low in December has been observed. The weekly distribution shows a peak at the beginning of the week and a low on weekends. Railway suicide behaviour patterns include jumping, lying and wandering, some individuals present deviant behaviour prodromal to the attempt. Attractiveness of the method derives from high levels of opportunity and low levels of self-perceived costs. Prevention may rely on a package of different structural and communicative tools. Inhibiting access to the track, by providing barriers at places of advanced risk and surveillance systems, are among structural means. Inhibiting media coverage and education of gatekeepers to increase awareness and skilfulness in contact with potentially vulnerable subjects on station platforms are among communicative tools. Railway suicide prevention is a realistic option: however, enhancement of research in this field is urgently needed.

The present study revealed sex-specific differences in heavy smoking by age at smoking onset, which was not shown before so far. These findings should be further investigated and addressed in future prevention campaigns.

Despite the efforts to control the epidemic of diabetes the total number of people living with diabetes is still steadily rising. In order to detect people at risk, cost-effective, convenient, and sensitive screening tools to assess the diabetes risk and to detect undiagnosed type 2 diabetes need to be developed and implemented in the primary care setting. To evaluate the combination of the well established FINDRISK questionnaire and HbA1c testing as a potential screening strategy the data obtained from 671 blood donors were analyzed for a potential correlation with the results of an oral glucose tolerance test. Based on the oral glucose tolerance test, 65 blood donors (9.7%) were newly diagnosed with diabetes, 336 (50.1%) with prediabetes, and 270 (40.2%) had a normal test result. Of the 401 blood donors diagnosed with prediabetes or diabetes 322 (80.3%) had a HbA1c between 5.7% and 6.4% and 27 (6.7%) with a HbA1c of 6.5% or greater. The majority of the blood donors newly diagnosed with diabetes or prediabetes (n=327) had a FINDRISK result of 12 points or higher. ROC analyses confirmed that the optimal cut off levels were for FINDRISK ≥ 12 points and for HbA1c ≥ 5.9%. Thus, a 3-step screening strategy applying the FINDRISK questionnaire followed by HbA1c testing and performing an oral glucose tolerance test on selected individuals could be a cost-saving approach for screening large populations and identifying people at risk for diabetes or undiagnosed diabetes.

The present study demonstrates different time trends for suicide methods. Further examinations are recommended in particular concerning possible reasons for the choice of a suicidal method.