Resumen de Evidencia para Política Implementación de estrategias de prevención del suicidio / Summary of Evidence for Policy Implementation of suicide prevention strategies

DEFINICIÓN DEL PROBLEMA: El suicidio es un fenómeno que ha estado presente en todo tipo de culturas a lo largo de la historia de la humanidad (1). Es definido por la Organización Mundial de la Salud (OMS), como el acto de quitarse la vida deliberadamente (2) y constituye un grave problema de salud pública mundial. Se estima que a nivel mundial mueren anualmente cerca de 700.000 personas por esta causa, lo que representó cerca del 1,3% de las muertes globales en 2019 (3). En ese sentido, muere más gente por suicidio que por malaria, VIH, cáncer de mama, guerra u homicidio (3). En relación con factores de riesgo, se observa que durante el periodo 2010-2019, la mortalidad por suicidio fue mayor en hombres que en mujeres, en una relación cercana 4 es a 1, mientras que el grupo etario que presenta la mayor cantidad de defunciones fue el ubicado entre los 25 a 29 años (4). Respecto al año 2023, un informe de epidemiología del MINSAL realizado a mayo del presente año, informa que se presentaron 677 defunciones por esta causa lo que significa un aumento de 1,2% respecto al mismo periodo del año pasado. Observándose una tasa cruda de 3,6 por 100.000 habitantes, significando una disminución de un 1,2% respecto al año anterior en el mismo periodo(6). IDENTIFICACIÓN Y SELECCIÓN DE OPCIONES DE S

Reporting of patients' characteristics in rehabilitation trials: an analysis of publications of RCTs in major clinical rehabilitation journals.

BACKGROUND: The reporting of patients' characteristics in randomized-controlled trials (RCTs) is one important dimension to improve the clinical replicability or transferability of study results into clinical practice. AIM: Based on a previously developed framework for reporting on patient characteristics, the aim of this study was to determine whether and how patients' characteristics are presented in RCTs of major rehabilitation journals. DESIGN: A literature search in eight high-impact medical rehabilitation journals was conducted. SETTING: Any setting. POPULATION: A rehabilitation patient group. METHODS: Papers were included if they presented results on a RCT on rehabilitation patients. We excluded pilot or feasibility studies. We extracted information related to the description of personal, clinical and diagnosis-specific characteristics, comorbidities, and functioning according to the ICF (body functions and structures, activities and participation and context personal/environmental factors). RESULTS: From a total of 129 papers initially identified we finally included 100 papers. Patient groups were almost exclusively defined by clinical diagnostic groups. Age and gender were the most prominent persons' characteristics (100% / 99% reported), followed by marital (22%), educational (15%) and occupational status (14%). Clinical characteristics usually relate to the respective diagnosis; general characteristics were reported on the duration of illness or symptoms (62%), to a lesser degree on BMI (45%) and/or weight (32%) and height (27%). One out of five papers report on comorbidities of the patients (20%). Information of body functions were present in almost every paper (98%), and nearly two third reported at least some aspect of activities and participation at baseline (63%). CONCLUSIONS: The present analysis shows that there is a need to further the development of appropriate standards for the reporting of patient characteristics in rehabilitation trials. CLINICAL REHABILITATION IMPACT: In future it should help rehabilitation practitioners to decide whether the patients in a study and their own patients share features similar enough to allow for transferability of results.

Crowding and the shape of COVID-19 epidemics.

The coronavirus disease 2019 (COVID-19) pandemic is straining public health systems worldwide, and major non-pharmaceutical interventions have been implemented to slow its spread1-4. During the initial phase of the outbreak, dissemination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was primarily determined by human mobility from Wuhan, China5,6. Yet empirical evidence on the effect of key geographic factors on local epidemic transmission is lacking7. In this study, we analyzed highly resolved spatial variables in cities, together with case count data, to investigate the role of climate, urbanization and variation in interventions. We show that the degree to which cases of COVID-19 are compressed into a short period of time (peakedness of the epidemic) is strongly shaped by population aggregation and heterogeneity, such that epidemics in crowded cities are more spread over time, and crowded cities have larger total attack rates than less populated cities. Observed differences in the peakedness of epidemics are consistent with a meta-population model of COVID-19 that explicitly accounts for spatial hierarchies. We paired our estimates with globally comprehensive data on human mobility and predict that crowded cities worldwide could experience more prolonged epidemics.

Reconstructing prehistoric demography: What role for extant hunter-gatherers?

Demography is central to biological, behavioral, and cultural evolution. Knowledge of the demography of prehistoric populations of both Homo sapiens and earlier members of the genus Homo is, therefore, key to the study of human evolution. Unfortunately, demographic processes (fertility, mortality, migration) leave little mark on the archeological and paleoanthropological records. One common solution to this issue is the application of demographic data from extant hunter-gatherers to prehistory. With the aim of strengthening this line of enquiry, here we outline some pitfalls and their interpretative implications. In doing so, we provide recommendations about the application of hunter-gatherer data to the study of demographic trends throughout human evolution. We use published demographic data from extant hunter-gatherers to show that it is the diversity seen among extant hunter-gatherers-both intra- and inter-population variability-that is most relevant and useful for understanding past hunter-gatherer demography.

Integrated estimation of the demographic situation in ukraine - forecast for the future.

OBJECTIVE: Introduction: The demographic situation in the country is largely due to the state of the economy and reflects the medical and social conditions of the population, which in turn testify to the state of the economy, the health care system, education, culture, and other factors. The aim: Analysis and comparison of the demographic situation in Ukraine with the EU countries, forecast for the future. PATIENTS AND METHODS: Materials and methods: The statistical materials of the Center for Medical Statistics of the Ministry of Health of Ukraine 2012-2016 were processed. A medical-statistical analysis of the system's performance indicators for the five components carried out; an assessment of the performance of the health system according to the WHO approach with certain modifications used. RESULTS: Review: Having analyzed the statistics of the last years in Ukraine, the birth rate in 2017 decreased as compared to 2016, in January-April 2017 there was a natural decrease in the population, while migration processes in Ukraine exceeded immigration beyond its borders. In connection with the antiterrorist operation in the east of the country and the beginning of active hostilities in the region, the population was significantly reduced to 43 million people. Life expectancy has also changed, and today the average life expectancy in Ukraine is 71 years (66 years are men, 75 are women). CONCLUSION: Conclusions: It is necessary to concentrate efforts on solving current problems - economic birth control, adequate social protection of families with children and the elderly, promoting a healthy lifestyle, ensuring the availability of quality medical care and education, which in turn will ensure an increase in the duration of a full active life.

Performance comparison of first-order conditional estimation with interaction and Bayesian estimation methods for estimating the population parameters and its distribution from data sets with a low number of subjects.

BACKGROUND: Exploratory preclinical, as well as clinical trials, may involve a small number of patients, making it difficult to calculate and analyze the pharmacokinetic (PK) parameters, especially if the PK parameters show very high inter-individual variability (IIV). In this study, the performance of a classical first-order conditional estimation with interaction (FOCE-I) and expectation maximization (EM)-based Markov chain Monte Carlo Bayesian (BAYES) estimation methods were compared for estimating the population parameters and its distribution from data sets having a low number of subjects. METHODS: In this study, 100 data sets were simulated with eight sampling points for each subject and with six different levels of IIV (5%, 10%, 20%, 30%, 50%, and 80%) in their PK parameter distribution. A stochastic simulation and estimation (SSE) study was performed to simultaneously simulate data sets and estimate the parameters using four different methods: FOCE-I only, BAYES(C) (FOCE-I and BAYES composite method), BAYES(F) (BAYES with all true initial parameters and fixed ω 2 ), and BAYES only. Relative root mean squared error (rRMSE) and relative estimation error (REE) were used to analyze the differences between true and estimated values. A case study was performed with a clinical data of theophylline available in NONMEM distribution media. NONMEM software assisted by Pirana, PsN, and Xpose was used to estimate population PK parameters, and R program was used to analyze and plot the results. RESULTS: The rRMSE and REE values of all parameter (fixed effect and random effect) estimates showed that all four methods performed equally at the lower IIV levels, while the FOCE-I method performed better than other EM-based methods at higher IIV levels (greater than 30%). In general, estimates of random-effect parameters showed significant bias and imprecision, irrespective of the estimation method used and the level of IIV. Similar performance of the estimation methods was observed with theophylline dataset. CONCLUSIONS: The classical FOCE-I method appeared to estimate the PK parameters more reliably than the BAYES method when using a simple model and data containing only a few subjects. EM-based estimation methods can be considered for adapting to the specific needs of a modeling project at later steps of modeling.

An assessment of treatment guidelines, clinical practices, demographics, and progression of disease among patients with amyotrophic lateral sclerosis in Japan, the United States, and Europe.

BACKGROUND: There is an increasing clinical research focus on neuroprotective agents in amyotrophic lateral sclerosis (ALS). However, it is unclear how generalisable clinical study trial results are between different countries and regions. OBJECTIVE: To assess similarities and differences in clinical practice and treatment guidelines for ALS, and also to compare the demographics and rate of progression of disease in patients with ALS enrolled in clinical trials in Japan, the US, and Europe. METHODS: We performed a review of clinical studies published since 2000 to compare the demographics and characteristics of patients with ALS. Progression of ALS disease was assessed in patients receiving placebo. The changes per month in ALSFRS-R score were calculated and compared between the studies. RESULTS: Overall, diagnostic criteria, recognition of ALS symptoms, comorbidities, use of riluzole, and nutritional, and respiratory support were similar. Regarding demographics and characteristics, there were no clear differences in the incidence of sporadic ALS (range 91-98%), bulbar onset (range 11-41%), and median time from onset to diagnosis (range 9-14 months) among the populations despite the difference in race between regions. However, use of tracheostomy-based invasive respiratory support was higher in Japan (29-38%) than in the US (4%) and Europe (1-31%). Rate of progression of disease was similar between the US and Europe study populations (range -0.89 to -1.60 points/month), and the Japanese study populations (range -1.03 to -1.21 points/month). CONCLUSION: There is evidence to support the generalisability of data from the Japanese ALS trial experience to the US and Europe populations in early to mid-stage of ALS.

Child anthropometry data quality from Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and National Nutrition Surveys in the West Central Africa region: are we comparing apples and oranges?

BACKGROUND: There has been limited work comparing survey characteristics and assessing the quality of child anthropometric data from population-based surveys. OBJECTIVE: To investigate survey characteristics and indicators of quality of anthropometric data in children aged 0-59 months from 23 countries in the West Central Africa region. METHODS: Using established methodologies and criteria to examine child age, sex, height, and weight, we conducted a comprehensive assessment and scoring of the quality of anthropometric data collected in 100 national surveys. RESULTS: The Multiple Indicator Cluster Surveys (MICS) and Demographic and Health Surveys (DHS) collected data from a greater number of younger children than older children while the opposite was found for the National Nutrition Surveys (NNS). Missing or implausible height/weight data proportions were 12% and 8% in MICS and DHS compared to 3% in NNS. Average data quality scores were 14 in NNS, 33 in DHS, and 41 in MICS. CONCLUSIONS: Although our metric of data quality suggests that data from the NNS appear more consistent and robust, it is equally important to consider its disadvantages related to access and lack of broader socioeconomic information. In comparison, the DHS and MICS are publicly-accessable for research and provide socioeconomic context essential for assessing and addressing the burden of undernutrition within and between countries. The strengths and weaknesses of data from these three sources should be carefully considered when seeking to determine the burden of child undernutrition and its variation within countries.

A Normative Baseline for the Srs-22 From Over 1000 Healthy Adolescents in India: Which Demographic Factors Affect Outcome?

STUDY DESIGN: A prospective analysis. OBJECTIVE: This study aims to 1) establish a baseline for the SRS-22 in South East Asia and 2) evaluate the influence of patient demographics on the SRS-22. SUMMARY OF BACKGROUND DATA: Previous studies have established a baseline for the SRS-22 in the US and described the impact of patient demographics. While the SRS-22 is used internationally, limited normative data are available. METHODS: After approval from the local hospital and school board, 1200 adolescents (age 10-18 years) were asked to anonymously complete the SRS-22 in English. The following demographic factors were assessed: height, weight, age, gender, household income (range <$30K to >$200K), and household status (single/dual parent income). Participants with a prior spine history or active medical problems were excluded. Statistical analysis was done with a Pearson correlation followed by an analysis of variance (ANOVA). RESULTS: One thousand nineteen unaffected adolescents completed the SRS-22 (mean age 14.4 ±â€Š1.6 years). Demographics were as follows: gender (42%F, 58%M), household status (640 single/379 dual), height (157 ±â€Š12 cm), weight (46 ±â€Š11.2 kg), body mass index (BMI; 18.5 ±â€Š3.6). SRS-22 score for all patients and by gender: Mean [4.0 ±â€Š0.4, (F)4.0 ±â€Š0.4, (M)3.9 ±â€Š0.4, P < 0.0001], Activity [3.9 ±â€Š0.4, (F)4.0 ±â€Š0.5, (M)3.9 ±â€Š0.6], Pain [4.3 ±â€Š0.6; (F)4.4 ±â€Š0.6, (M)4.2 ±â€Š0.7, P < 0.001], Image [3.9 ±â€Š0.6, (F)3.9 ±â€Š0.6, (M)3.9 ±â€Š0.6], and Mental [3.7 ±â€Š0.6, (F)3.8 ±â€Š0.6, (M)3.7 ±â€Š0.6, P < 0.001]. Male gender was associated with worse pain (-0.15), mental health (-0.11), and overall SRS-22 score (-0.11). Age was correlated with a worse image (r = -0.17, P = < 0.000), while higher BMI was associated with less pain (0.07/0.02). CONCLUSION: Younger age, female gender, and higher BMI correlated with a better SRS-22 score. Income and household status did not affect SRS-22. These findings contrast data gathered in the US but should be considered in conjunction with the minimal clinically important difference (MCID). This study establishes the first normative baseline for the SRS-22 in SE Asia and analyzed the effect of demographics on the outcome score. LEVEL OF EVIDENCE: 2.

Estimating the absolute wealth of households.

OBJECTIVE: To estimate the absolute wealth of households using data from demographic and health surveys. METHODS: We developed a new metric, the absolute wealth estimate, based on the rank of each surveyed household according to its material assets and the assumed shape of the distribution of wealth among surveyed households. Using data from 156 demographic and health surveys in 66 countries, we calculated absolute wealth estimates for households. We validated the method by comparing the proportion of households defined as poor using our estimates with published World Bank poverty headcounts. We also compared the accuracy of absolute versus relative wealth estimates for the prediction of anthropometric measures. FINDINGS: The median absolute wealth estimates of 1,403,186 households were 2056 international dollars per capita (interquartile range: 723-6103). The proportion of poor households based on absolute wealth estimates were strongly correlated with World Bank estimates of populations living on less than 2.00 United States dollars per capita per day (R(2) = 0.84). Absolute wealth estimates were better predictors of anthropometric measures than relative wealth indexes. CONCLUSION: Absolute wealth estimates provide new opportunities for comparative research to assess the effects of economic resources on health and human capital, as well as the long-term health consequences of economic change and inequality.

Demographic factors and hospital size predict patient satisfaction variance--implications for hospital value-based purchasing.

BACKGROUND: Hospital Value-Based Purchasing (HVBP) incentivizes quality performance-based healthcare by linking payments directly to patient satisfaction scores obtained from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Lower HCAHPS scores appear to cluster in heterogeneous population-dense areas and could bias Centers for Medicare & Medicaid Services (CMS) reimbursement. OBJECTIVE: Assess nonrandom variation in patient satisfaction as determined by HCAHPS. DESIGN: Multivariate regression modeling was performed for individual dimensions of HCAHPS and aggregate scores. Standardized partial regression coefficients assessed strengths of predictors. Weighted Individual (hospital) Patient Satisfaction Adjusted Score (WIPSAS) utilized 4 highly predictive variables, and hospitals were reranked accordingly. SETTING: A total of 3907 HVBP-participating hospitals. PATIENTS: There were 934,800 patient surveys by the most conservative estimate. MEASUREMENTS: A total of 3144 county demographics (US Census) and HCAHPS surveys. RESULTS: Hospital size and primary language (non-English speaking) most strongly predicted unfavorable HCAHPS scores, whereas education and white ethnicity most strongly predicted favorable HCAHPS scores. The average adjusted patient satisfaction scores calculated by WIPSAS approximated the national average of HCAHPS scores. However, WIPSAS changed hospital rankings by variable amounts depending on the strength of the predictive variables in the hospitals' locations. Structural and demographic characteristics that predict lower scores were accounted for by WIPSAS that also improved rankings of many safety-net hospitals and academic medical centers in diverse areas. CONCLUSIONS: Demographic and structural factors (eg, hospital beds) predict patient satisfaction scores even after CMS adjustments. CMS should consider WIPSAS or a similar adjustment to account for the severity of patient satisfaction inequities that hospitals could strive to correct.

Epidemic models for complex networks with demographics.

In this paper, we propose and study network epidemic models with demographics for disease transmission. We obtain the formula of the basic reproduction number R0 of infection for an SIS model with births or recruitment and death rate. We prove that if R0 ≤ 1 , infection-free equilibrium of SIS model is globally asymptotically stable; if R0 > 1 , there exists a unique endemic equilibrium which is globally asymptotically stable. It is also found that demographics has great effect on basic reproduction number R0. Furthermore, the degree distribution of population varies with time before it reaches the stationary state.

Reconciling discrepancies between registration-based and survey-based estimates of fertility in Mongolia.

The two main data sources for the estimation of total fertility in Mongolia give figures that differ by between one-half and one child per woman. We investigated two possible explanations for these discrepancies: (i) that data on births collected in the vital registration system are incomplete and under-estimate fertility; and (ii) that fertility is over-estimated when estimates are based on data from sample surveys. We find that the under-counting of single women is the main source of the discrepancies. After adjustment, survey-based fertility estimates are very close to the figures based on data from the vital registration system. The analysis underscores the risks of taking survey-based demographic indicators as the 'Gold Standard'. Demographers need to undertake more systematic studies on this important issue.

The INDEPTH standard population for low- and middle-income countries, 2013.

Crude rates such as the crude death rate are functions of both the age-specific rates and the age composition of a population. However, differences in the age structure between two populations or two time periods can result in specious differences in the corresponding crude rates making direct comparisons between populations or across time inappropriate. Therefore, when comparing crude rates between populations, it is desirable to eliminate or minimize the influence of age composition. This task is accomplished by using a standard age structure yielding an age-standardized rate. This paper proposes an updated International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) standard for use in low- and middle-income countries (LMICs) based on newly available data from the health and demographic surveillance system site members of the INDEPTH network located throughout Africa and southern Asia. The updated INDEPTH standard should better reflect the age structure of LMICs and result in more accurate health indicators and demographic rates. We demonstrate use of the new INDEPTH standard along with several existing 'world' standards and show how resulting age-standardized crude deaths rates differ when using the various standard age compositions.

Enhancing information pertaining to client characteristics to facilitate evidence-based practice.

OBJECTIVE: Evidence-based practice (EBP) includes utilization of empirically supported treatments, application of clinical expertise, and consideration of client characteristics. The following brief report aims to elucidate barriers in the study and dissemination of research regarding these client characteristics. DESIGN: Authors examined empirical papers cited on psychologicaltreatments.org (N = 338) and categorized each according to efficacy evidence available pertaining to gender, race/ethnicity, and socioeconomic status (SES). RESULTS: Gender was most commonly considered (7% of studies), with less than 2% of studies analyzing efficacy in relation to race/ethnicity or SES. CONCLUSIONS: Available findings are summarized according to disorder. Researchers are encouraged to attend to client variables in efficacy studies and suggestions are offered for training students to include client variables in EBP.

[Development of national and international standards of population age distribution for medical statistics, health-demographic analysis and risk assessment].

The current European standard (CES) and the World population age distribution standard is widely used in medical and demographic studies, performed by international (WHO, etc.) and national organizations. The Russian Federal Service of States Statistics (RosStat) uses CES in demographic yearbooks and other publications. The standard is applied in calculation of the standardized mortality rate (SMR) of the population in different countries and territories. Risk assessment is also used CES. In the basis of the standards there has been laid the idea to assess mortality according to uniform standard, so to get possibility to compare the mortality rate of the population in different countries and regions, different genders and different calendar years. Analysis of the results of test calculations of the values of the SMR for the population of Russia and other countries with the use of current standards has revealed serious shortcomings of the latters and set up the task of improving them. A new concept of the development of standards based on the use of the concept of stable equilibrium of the age distribution of the population and survivorship function is proposed.

How have administrative sources been used to adjust population estimates and set plausibility ranges?

This article reviews existing methods employed by various countries in the use of administrative data to make adjustments to, or set plausibility ranges around, population estimates or census data. The work was carried out to explore techniques that could be used by the ONS in application with population estimates. An annex also covers benefits and difficulties that have been experienced when producing a register-based census, or population estimates.

Using the life history model to set the stage(s) of growth and senescence in bioarchaeology and paleodemography.

Paleodemography, the study of demographic parameters of past human populations, relies on assumptions including biological uniformitarianism, stationary populations, and the ability to determine point age estimates from skeletal material. These assumptions have been widely criticized in the literature and various solutions have been proposed. The majority of these solutions rely on statistical modeling, and have not seen widespread application. Most bioarchaeologists recognize that our ability to assess chronological age is inherently limited, and have instead resorted to large, qualitative, age categories. However, there has been little attempt in the literature to systematize and define the stages of development and ageing used in bioarchaeology. We propose that stages should be based in the human life history pattern, and their skeletal markers should have easily defined and clear endpoints. In addition to a standard five-stage developmental model based on the human life history pattern, current among human biologists, we suggest divisions within the adult stage that recognize the specific nature of skeletal samples. We therefore propose the following eight stages recognizable in human skeletal development and senescence: infancy, early childhood, late childhood, adolescence, young adulthood, full adulthood, mature adulthood, and senile adulthood. Striving toward a better prediction of chronological ages will remain important and could eventually help us understand to what extent past societies differed in the timing of these life stages. Furthermore, paleodemographers should try to develop methods that rely on the type of age information accessible from the skeletal material, which uses life stages, rather than point age estimates.

Standardizing data collection in traumatic brain injury.

Collaboration among investigators, centers, countries, and disciplines is essential to advancing the care for traumatic brain injury (TBI). It is thus important that we "speak the same language." Great variability, however, exists in data collection and coding of variables in TBI studies, confounding comparisons between and analysis across different studies. Randomized controlled trials can never address the many uncertainties concerning treatment approaches in TBI. Pooling data from different clinical studies and high-quality observational studies combined with comparative effectiveness research may provide excellent alternatives in a cost-efficient way. Standardization of data collection and coding is essential to this end. Common data elements (CDEs) are presented for demographics and clinical variables applicable across the broad spectrum of TBI. Most recommendations represent a consensus derived from clinical practice. Some recommendations concern novel approaches, for example assessment of the intensity of therapy in severely injured patients. Up to three levels of detail for coding data elements were developed: basic, intermediate, and advanced, with the greatest level of detail attained in the advanced version. More detailed codings can be collapsed into the basic version. Templates were produced to summarize coding formats, explanation of choices, and recommendations for procedures. Endorsement of the recommendations has been obtained from many authoritative organizations. The development of CDEs for TBI should be viewed as a continuing process; as more experience is gained, refinement and amendments will be required. This proposed process of standardization will facilitate comparative effectiveness research and encourage high-quality meta-analysis of individual patient data.