The use of the internet is a promising approach in preventing suicide on the individual as well as the population level. However, this promise remains to be proven in trials and in practice.
The national Dutch suicide prevention platform113Online offers a 24/7 online anonymous mental health care programme. This includes crisis resolution, guided self help, and online psychotherapy. This programme is provided by professionals in close cooperation with volunteers staffing chat- and telephone helplines.
In this presentation philosophy, structure, methods, cost, and preliminary results of the first two years of 113Online are presented.
What You Haven't Heard (Yet) About Cloud SecurityCloudPassage
Did you know that 4 out of 5 companies are using cloud architectures? Did you also know that 22% of cloud hosting users believe that their cloud service provider is responsible for the security of their cloud server instances, yet 38% have a high level of concern with losing control of their servers and data in public cloud environments?
Join Andrew Hay, Chief Evangelist at CloudPassage, and Wendy Nather, Research Director at 451 Research, as they dive into these and other findings from the CloudPassage 2012 Security and the Cloud survey. Wendy Nather will also discuss cloud security related trends and observations from 451 Research's findings.
During this live 30-minute webinar, you will learn about:
-The challenges and fears identified by individuals looking to embrace cloud architectures
-Current cloud adoption trends and future individual and organizational expansion plans
-How people are securely delivering applications using cloud architectures
What You Haven't Heard (Yet) About Cloud SecurityCloudPassage
Did you know that 4 out of 5 companies are using cloud architectures? Did you also know that 22% of cloud hosting users believe that their cloud service provider is responsible for the security of their cloud server instances, yet 38% have a high level of concern with losing control of their servers and data in public cloud environments?
Join Andrew Hay, Chief Evangelist at CloudPassage, and Wendy Nather, Research Director at 451 Research, as they dive into these and other findings from the CloudPassage 2012 Security and the Cloud survey. Wendy Nather will also discuss cloud security related trends and observations from 451 Research's findings.
During this live 30-minute webinar, you will learn about:
-The challenges and fears identified by individuals looking to embrace cloud architectures
-Current cloud adoption trends and future individual and organizational expansion plans
-How people are securely delivering applications using cloud architectures
Clair is an open-source container image security analyzer and was recently launched by CoreOS for production workloads. This is a powerful and extensible tool that inspects container images for known security flaws and enables developers to build services that scan containers for security threats and vulnerabilities.
En la página 42 puedes encontrar un estupendo artículo sobre betiOn.
Senior Class da el salto a Bizkaia y Gipuzkoa con el número que tienes en tus manos, que ve la calle coincidiendo con la entrada de la primavera. En esta estación, identificada con la renovación de la naturaleza, la publicación sale a la calle con nuevos contenidos destinados a las personas mayores de 55 años que viven en Euskadi.
La revista Senior Class ofrece a sus lectores informaciones relacionadas con las más diversas temáticas, entre las que podemos encontrar planes de ocio y cultura para todos los gustos y en diferentes destinos de nuestra geografía. Además, un grupo de especialistas de la salud, nutrición, sexualidad, belleza, cocina y de la fotografía nos darán su particular visión como expertos, cada uno en su ámbito correspondiente. La publicación incluye en sus páginas una entrevista a un personaje vasco, con el fin de subrayar la trayectoria profesional y personal de nuestros hombres y mujeres. Todo ello junto a reportajes e informaciones de interés entre las que se alternan páginas de opinión. Senior Class es un soporte vivo e interactivo, destinado a un colectivo que crece de manera significativa en la sociedad, con peso y capacidad para tomar decisiones, con ganas de ser parte activa en ella. Y en esa tarea estamos todos involucrados. Senior Class, por su parte, ofrece sus páginas a todas aquellas personas interesadas en construir un lugar de encuentro entre las diferentes sensibilidades, gustos e intereses de los vascos que tienen más de 55 años.
Dr. Martin Mocker, Scientist, MIT, über Erkenntnisse der Spitzenforschung in der Entwicklung von IT-Organisationen, die helfen werden, über mögliche Modelle der Zukunft nachzudenken.
Reto Solèr, Fachmann Nachhaltige Entwicklung für Berggebiete solèr projektmanagement Zürich, Switzerland
Sanfte Mobilität kann einen wichtigen Beitrag zu einer hohen Aufenthaltsqualität und damit zum touristischen Erfolg einer Destination leisten. Der Workshop zeigt auf, wie sich die Förderung der sanften Mobilität positiv auf die nachhaltige Entwicklung einer Tourismusdestination auswirkt. Aus dem Handbuch “Sanfte Mobilität für alpine Destinationen“ werden erfolgreiche Praxisbeispiele aus den Bereichen Angebotsgestaltung, An- und Abreise sowie Kommunikation präsentiert. Dazu gehören beispielsweise Angebote für die bedarfsgerechte Erschliessung der ersten und letzten Meile, wie beim Gepäcktransport, oder auch die Förderung der „Human Powered Mobility“ und der Elektromobilität in den Destinationen. Die Präsentation erfolgt mittels Power Point und in der zweiten Hälfte in einem Kurzfilm. Im mittleren Block werden die brennenden Themen und Fragen der Teilnehmenden aufgegriffen. Der Workshop vermittelt so Anregungen für nachhaltige Mobilitätslösungen.
TpM2016: http://etourism-monitor.ch/tpm
Stellen Sie sich vor, Sie veranstalten eine Party und niemand geht hin. Ein schickes Intranet, eine innovative MAZ, ein lang organisiertes Betriebsfest – in die Sie viel Mühe, Zeit und Ideen gesteckt haben, aber der gewünschte Erfolg bleibt aus. Oder Ihre Gäste stehen in der Ecke und beobachten das ganze erst mal misstrauisch. Wie schaffen Sie als interner Kommunikator die Beteiligung der Mitarbeiter am Kommunikationsgeschehen oder gar den Dialog? Über Erwartungen der Mitarbeiter an die Interne Kommunikation sowie über Dialog und Einbindung geht es in der aktuellen Ausgabe von IK im Fokus im Interveiw mit Sonja Horner (ÖBB-Holding), Dr. Kathi Wimmer (Styrolution) und Tim Scholz (DLR).
Wie Sie mit Geschichten den Weg in die Herzen und Köpfe der Mitarbeiter bahnen, verrät Oliver Chaudhuri in seinem Beitrag über digitales Storytelling in der Internen Kommunikation. Anja Dornheim und Sabine Krippl liefern zudem Checklisten, mit deren Hilfe Ihre Onlinetexte den Leser erreichen. Wie Führungskräfte ihre Führung im Sinne der Unternehmensmarke stärken, erfahren Sie im Beitrag Leadership Branding von Holger Schmitz.
123people.com and meinungsraum.at conducted a survey regarding online privacy for Data Privacy Day on January 28th 2011. 90% of the respondents feel their personal information is at risk online.
Clair is an open-source container image security analyzer and was recently launched by CoreOS for production workloads. This is a powerful and extensible tool that inspects container images for known security flaws and enables developers to build services that scan containers for security threats and vulnerabilities.
En la página 42 puedes encontrar un estupendo artículo sobre betiOn.
Senior Class da el salto a Bizkaia y Gipuzkoa con el número que tienes en tus manos, que ve la calle coincidiendo con la entrada de la primavera. En esta estación, identificada con la renovación de la naturaleza, la publicación sale a la calle con nuevos contenidos destinados a las personas mayores de 55 años que viven en Euskadi.
La revista Senior Class ofrece a sus lectores informaciones relacionadas con las más diversas temáticas, entre las que podemos encontrar planes de ocio y cultura para todos los gustos y en diferentes destinos de nuestra geografía. Además, un grupo de especialistas de la salud, nutrición, sexualidad, belleza, cocina y de la fotografía nos darán su particular visión como expertos, cada uno en su ámbito correspondiente. La publicación incluye en sus páginas una entrevista a un personaje vasco, con el fin de subrayar la trayectoria profesional y personal de nuestros hombres y mujeres. Todo ello junto a reportajes e informaciones de interés entre las que se alternan páginas de opinión. Senior Class es un soporte vivo e interactivo, destinado a un colectivo que crece de manera significativa en la sociedad, con peso y capacidad para tomar decisiones, con ganas de ser parte activa en ella. Y en esa tarea estamos todos involucrados. Senior Class, por su parte, ofrece sus páginas a todas aquellas personas interesadas en construir un lugar de encuentro entre las diferentes sensibilidades, gustos e intereses de los vascos que tienen más de 55 años.
Dr. Martin Mocker, Scientist, MIT, über Erkenntnisse der Spitzenforschung in der Entwicklung von IT-Organisationen, die helfen werden, über mögliche Modelle der Zukunft nachzudenken.
Reto Solèr, Fachmann Nachhaltige Entwicklung für Berggebiete solèr projektmanagement Zürich, Switzerland
Sanfte Mobilität kann einen wichtigen Beitrag zu einer hohen Aufenthaltsqualität und damit zum touristischen Erfolg einer Destination leisten. Der Workshop zeigt auf, wie sich die Förderung der sanften Mobilität positiv auf die nachhaltige Entwicklung einer Tourismusdestination auswirkt. Aus dem Handbuch “Sanfte Mobilität für alpine Destinationen“ werden erfolgreiche Praxisbeispiele aus den Bereichen Angebotsgestaltung, An- und Abreise sowie Kommunikation präsentiert. Dazu gehören beispielsweise Angebote für die bedarfsgerechte Erschliessung der ersten und letzten Meile, wie beim Gepäcktransport, oder auch die Förderung der „Human Powered Mobility“ und der Elektromobilität in den Destinationen. Die Präsentation erfolgt mittels Power Point und in der zweiten Hälfte in einem Kurzfilm. Im mittleren Block werden die brennenden Themen und Fragen der Teilnehmenden aufgegriffen. Der Workshop vermittelt so Anregungen für nachhaltige Mobilitätslösungen.
TpM2016: http://etourism-monitor.ch/tpm
Stellen Sie sich vor, Sie veranstalten eine Party und niemand geht hin. Ein schickes Intranet, eine innovative MAZ, ein lang organisiertes Betriebsfest – in die Sie viel Mühe, Zeit und Ideen gesteckt haben, aber der gewünschte Erfolg bleibt aus. Oder Ihre Gäste stehen in der Ecke und beobachten das ganze erst mal misstrauisch. Wie schaffen Sie als interner Kommunikator die Beteiligung der Mitarbeiter am Kommunikationsgeschehen oder gar den Dialog? Über Erwartungen der Mitarbeiter an die Interne Kommunikation sowie über Dialog und Einbindung geht es in der aktuellen Ausgabe von IK im Fokus im Interveiw mit Sonja Horner (ÖBB-Holding), Dr. Kathi Wimmer (Styrolution) und Tim Scholz (DLR).
Wie Sie mit Geschichten den Weg in die Herzen und Köpfe der Mitarbeiter bahnen, verrät Oliver Chaudhuri in seinem Beitrag über digitales Storytelling in der Internen Kommunikation. Anja Dornheim und Sabine Krippl liefern zudem Checklisten, mit deren Hilfe Ihre Onlinetexte den Leser erreichen. Wie Führungskräfte ihre Führung im Sinne der Unternehmensmarke stärken, erfahren Sie im Beitrag Leadership Branding von Holger Schmitz.
123people.com and meinungsraum.at conducted a survey regarding online privacy for Data Privacy Day on January 28th 2011. 90% of the respondents feel their personal information is at risk online.
Mobile Health: Pamf engagement mobile health stanford 2011 05-16 albertschan
How PAMF has achieved significant patient engagement with My Health Online. Over 72% of the active adult patients at PAMF use My Health Online, our implementation of Epic's MyChart.
This webinar designed for Safe Place Coordinators and CASA personnel. It will provide an introduction and brief overview of the Safe Place and CASA program, discuss the goals of the partnership between the two national organizations and provide an overview of the specific partnership opportunities and benefits at the local level.
Suicidal people are reluctant helpseekers. 113Online aims at lowering help seeking tresholds by offering a 24/7 online anonymous mental health care programme, including crisis support, guided self help, and online therapy. This programme is provided by professionals in close cooperation with volunteer staffed helplines by chat and telephone. In this presentation philosophy, structure, methods and preliminary results of 113Online are presented, including some of the dilemma's and problems we encountered implementing the online care programme.
This Webinar was presented as the first in a series exploring issues important to youth mentoring programs on August 17, 2010. Social media and networking offer numerous ways to professionally engage with youth, serving both program needs and youth adaptability. However, technology can also bring up questions about safety, boundaries, and appropriateness. Social Media and Mentoring: Policies, Gaps, and Boundaries explores social media and networking options and provides space for dialogue to explore safety and ethical considerations.
Dr. Charles Jennissen, of the University of Iowa Department of Emergency Medicine presented this at CPSC's ATV Safety Summit Oct. 12, 2012. The study objective was to determine the ATV anticipatory guidance practices of primary care providers, as well as their attitudes, knowledge, and the barriers faced in educating families about the risk of ATV use. Methods: An electronic survey was administered to primary care providers belonging to Iowa state medical societies. Results: More than 60% of respondents (N=218) believed that providing ATV anticipatory guidance was important. However, 78% gave ATV safety counseling less than 10% of the time during regular pediatric exams, and only 12% did so greater than 25% of the time. Families rarely ask providers for advice on ATV safety issues; 84% of providers were asked once a year or less. ATV knowledge scores were low (median score 2 of 12); however, those with previous ATV exposure had significantly higher scores. Many respondents affirmed insufficient knowledge (47%) and inadequate resources (63%), but the most commonly identified barrier was that it was not a routine part of their practice.
Telehealth – the ability of patients to connect with their health care providers via video and phone – has taken off during the COVID-19 pandemic. Community Health Center, Inc. and its research arm, the Weitzman Institute, commissioned Sacred Heart University’s Institute for Public Policy to survey 1,000 Connecticut residents on their views about this emerging, and now essential, technology.
The purpose of this presentation is to provide a deeper understanding of the attitudes and opinions of students on dictaphones and derive relevant marketing recommendations for decision-makers. The findings are based on a quantitative study conducted with students living in Austria.
Understanding the new paradigm: How to incorporate mobile research into our i...Merlien Institute
Presented by Melissa Gil, Director, Customer Intelligence, SingTel
& Bruce Wells, Managing Director and President, Asia, Vision Critical
at Market Research in the Mobile World Asia-Pacific
30-31 January 2013, Kuala Lumpur, Malaysia
This event is proudly organised by Merlien Institute
Check out our upcoming events by visiting http://www.mrmw.net
Quality In Action webinar series hosted by Mentoring Partnership of Minnesota. August 4, 2010, 12-1:30pm CST. Going Beyond the Background Check: Incorporating SAFE Practices in Volunteer Programs Features Sarah Kremer of Friends For Youth.
Narrative review: Is it rational to pursue Zero Suicides among patients in he...Jan Mokkenstorm
Suicide prevention is a major health care responsibility in need of new perspectives. This study reviews Zero Suicide, an emerging approach to suicide prevention that embraces the aspirational goal of zero suicides among patients treated in health care systems or organizations. Zero Suicide is gaining international
momentum while at the same time evoking objections and concerns. Fundamental to Zero Suicide is a multilevel system view on suicide prevention, with three core elements: a direct approach to suicidal behaviors; continual improvement of the quality and safety of care processes; and an organizational commitment to the aspirational goal of zero suicides. The rationale and evidence
for these components are clarified and discussed against the backdrop of concerns and objections that focus on possible undesired consequences of the pursuit of zero suicide, in particular for clinicians and for those who are bereaved by suicide. It is concluded that it is rational to pursue zero suicides as
an aspirational goal, provided the journey toward zero suicides is undertaken in a systemic and sustained manner, in a way that professionals feel supported, empowered, and protected against blame and inappropriate guilt.
National Suicide Prevention Approaches in the Netherlands. World Psychiatric ...Jan Mokkenstorm
This presentation covers large scale Suicide Prevention programs in the Netherlands; their ambition, tactics and elements and process. Takeaway: prevention is about the hearts and minds. And bringing persons, systems and society beyond the tipping point that keep them from doing the right thing. Things can change if we work together. What used to be the Berlin Wall now is an art gallery.
Lessons learned by listening: the imperative for improvement and Zero Suicide...Jan Mokkenstorm
The anonymous users and visitors of the National Dutch Suicide Prevention platform give important clues to improve online suicide prevention. In addition they tell us about mental health care being unable to respond to their suicidal thoughts adequately/effectively. This underscores the need for Zero Suicide approaches in health care.
In vakgenoten blad De Psychiater interview met Klaas Bets, voorzitter SUPRANET GGZ en met mij over innovatieve suïcide preventie binnen de GGZ waarbij instellingen hun suïcide data en -preventie best practices vertrouwelijk met elkaar delen binnen SUPRANET GGZ (SUïcide PReventie Actienetwerk GGZ).
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
113 online suicide prevention: First two year results presented at the ESSSB14 Tel Aviv sept 2012
1. Jan. K. Mokkenstorm M.D.,
psychiatrist
Director 113 Online
j.mokkenstorm@113online.nl
mokkenstorm@gmail.com
info@113online.nl
www.113online.nl 01-09-12
2. 113Online
First two year results
• Background: why online help may benefit suicide
prevention
• Outline of the online services
• Preliminary results: help seeker characteristics, site
use, service use, application of railway suicide
prevention
• Conclusion
Presentatie titel 2 01-09-12
3. The problem
• Netherlands: 16 million inhabitants
• 1600 suicides per year
• 96.000 attempts registered
• > 500.000 individuals
with death wish or suicidal ideation> 2 weeks
• 40 % of attempters no treatment sought <1 year
• 33% of attempters no treatment sought ever
(Ten Have et al 2011 NEMESIS 2 Results of the Netherlands Mental Health
Survey and Incidence Study)
www.113online.nl 3 01-09-12
4. Help seeking barriers
(Pagura et al 2009, Bruffaerts et al 2011)
• Low perceived need
• Wish for autonomy, control
• Stigma
• Structural & financial barriers
• Negative experiences with regular care?
Presentatie titel 4 01-09-12
5. Unmet needs and
expectations in regular care
(Pirkis et al 2001, Taylor et al 2009)
– Specific competence & knowledge
– Empathy and respect
– Shared decision making
– Open communication
Presentatie titel 5 01-09-12
6. Why online help may
benefit suicide prevention
• Reach: large scale dissemination
• Low treshold and easy acces
• Autonomy and control of the help seeker
• Online disinhibition effects enhance therapeutic
processes
• Online interventions are effective
www.113online.nl
6 01-09-12
11. Stage 3 Multi level
online platform
Education
Direct Self Test
Referral
Advice
Brief
Online
Therapy
Acute Peer
chat support
Hotline Self Help
Course
Presentatie titel 11 01-09-12
12. Site stats
Site usage 5 / 10 / 09-20 / 03 /12 Average per day
Sitevisits 730
Unique visitors 367
Pageviews 6,2
Visit Duration 00:03:053
Visitors Yough<18 yr Adult 18+ Total
Suicidal 14,8% 53,8% 68,6%
Concerned 5,8% 17,6% 23,4%
Bereaved 1,4% 6,7% 8,0%
Total 21,9% 78.1% 100%
www.113online.n 12 01-09-12
13. Selftests & Autoreplies
Selftest Age< 23 SIQ J Age 23+: BSI
(0-72) (0-39)
Average tests per day 6 10
Age 19,2 (sd 6,7) 36,6 (sd 11,8)
% Female 72% 60%
Average Score 40,7 (sd 20,7) 20,5 (sd 8,5)
Autoreply Advice Age<23 Age 23+
Absent-Low 10% 5%
Mild 5% 2%
Suicidal 8% 38%
Severely Suicidal 78% 55%
www.113online.n 13 01-09-12
14. Acute chat calls:
use and satisfaction
• DEMAND>> Supply
• Av. duration: 61 min (sd 39 min).
• 48% female, 15 % male, 37% ?. Av. 25,6
• 46% of callers in a form of mental health treatment
• Content: 41% psychiatric symptoms and treatment
• 63 % of callers thanked the helper spontaneously
• 15 % dissatisfied
www.113online.n 14 01-09-12
16. Online Psychotherapy by
chat or e-mail
• Anonymous, free
• Solution Focused; CBT/DBT/ACT elements
• Treatment manual
• Trained & supervised psychologists
• Brief: max 8 sessions/exchanges
• Average number sessions = 5
• Av. number of completed therapies = 25/week
www.113online.nl 16 01-09-12
19. Railway related
content acute chats
• 260 of 2443 unique acute chat callers (10,6%) refer to
the railways as a means of suicide. In 16 cases this
related to someone else. There were 3 direct and
positive references tot the “ I Listen” signs
Situation Number % of 260
On the railway now 10 3,8%
Today-yesterday 19 7,3%
This week 10 3,8%
Ever 27 10,3%
Urge or a plan now 64 24,6%
Decided against rail suicide 32 12,3%
Ambivalent on rail suicide 23 8,8%
Presentatie titel 19 01-09-12
20. Adverse events
• We know of 3 suicides, in 2 cases the client was
in regular treatment as well.
• Suicide attempts occur during calls or sessions
and have been dealt with by emergency services
if caller/client revealed location.
• Management received 3 formal complaints
regarding unmet expectations.
www.113online.nl 20 01-09-12
21. Conclusion
• 113Online reaches a large number of (very)
suicidal, concerned or bereaved individuals.
• A substantial number did not seek help otherwise.
• 113Online meets needs and expectations
(partially) unmet in regular care.
• Effectivity remains to be proven
• Less than expected adverse events.
Presentatie titel 21 01-09-12
22. Acknowledgments and thanks
• Professionals and Volunteers of 113Online and Ex6
• Management and volunteers of Sensoor Helpline
• Mady Samuels; Netherlands Ministry of Health Care (VWS)
• ProRail
• Prof. Ad Kerkhof
• Prof. Brian Mishara
• Prof. Jan Smit
• Dr. Annemiek Huisman
• Lucy Stut
• Anouk Romers
• Merijn Eikelenboom
• Dr. Bregje van Spijker
• Leo Wijnbelt
• Ed Claasens
• Age Nils Holstein
Presentatie titel 22 01-09-12
23. References
• Bruffaerts,R., Demyttenaere, K., Hwang, I., Chiu, W.T. Sampson, N. ,Kessler, R.C.,
Alonso, J., Borges, G., Girolamo, G de , Graaf, R. de, Florescu, S, Gureye, O., Hu,
C., Karam, E.G., Kawakami, N., Kostyuchenko, S., Kovess-Mastety, V., Lee, S.,
Levingson, D., Matschinger, H., Posada-Villa, J., Sagar, R., Scott, K.M., Stein, D.J.,
Tomov, T., Viana, M.C., Nock, M.K. Treatment of suicidal people around the world
BJP 2011; 199(1): 64–70.
• Krysinska, K.E. and D. De Leo, Telecommunication and suicide prevention: hopes
and challenges for the new century. Omega - Journal of Death & Dying, 2007. (3): p.
237-53.
• Mishara BL, Chagnon F, Daigle M, Balan B, Raymond S, Marcoux I, et al. Which
helper behaviors and intervention styles are related to better short-term outcomes in
telephone crisis intervention? Results from a silent monitoring study of calls to the
U.S. 1-800- SUICIDE network. Suicide Life Threat Behav 2007a; 37: 291-307.
• Pagura J, Fotti S, Katz LY, Sareen J. Help seeking and percieved need for mental
health care among individuals in Canada with suicidal behaviors. Psychiatr Serv
2009; 60: 943-49.
• Pirkis J, Burgess P, Meadows G, Dunt D. Self-reported needs for care among
persons who have suicidal ideation or who have attempted suicide. Psychiatr Serv
2001; 52: 381-83.
• Taylor, T.L., Hawton,K., Fortune, S., Kapur, N. Attitudes towards clinical services
among people who self-harm: systematic review Br.J.Psych (2009) 194, 104–110.
24. Thank You
www.113online.nl
www.113online.nl 24 01-09-12