A decision support tool to inform local suicide prevention activity in Greater Western Sydney (Australia).

OBJECTIVES: This study describes the development of a decision support tool to identify the combination of suicide prevention activities and service priorities likely to deliver the greatest reductions in suicidal behaviour in Western Sydney (Australia) over the period 2018-2028. METHODS: A dynamic simulation model for the WentWest - Western Sydney Primary Health Network population-catchment was developed in partnership with primary health network stakeholders based on defined pathways to mental health care and suicidal behaviour, and which represented the current incidence of suicide and attempted suicide in Western Sydney. A series of scenarios relating to potential suicide prevention activities and service priorities identified by primary health network stakeholders were investigated to identify the combination of interventions associated with the largest reductions in the forecast number of attempted suicide and suicide cases for a 10-year follow-up period. RESULTS: The largest number of cases averted for both suicide and attempted suicide was associated with (1) post-suicide attempt assertive aftercare (6.1% for both attempted suicide and suicide), (2) improved community support and reductions in psychological distress in the community (5.1% for attempted suicide and 14.8% for suicide), and (3) reductions in the proportion of those lost to services following a mental health service contact (10.5% for both attempted suicide and suicide). In combination, these interventions were forecast to avert approximately 29.7% of attempted suicides and 37.1% of suicides in the primary health network catchment over the 10-year period. CONCLUSION: This study demonstrates the utility of dynamic simulation models, co-designed with multi-disciplinary stakeholder groups, to capture and analyse complex mental health and suicide prevention regional planning problems. The model can be used by WentWest - Western Sydney Primary Health Network as a decision support tool to guide the commissioning of future service activity, and more efficiently frame the monitoring and evaluation of interventions as they are implemented in Western Sydney.

A spatial analysis of referrals to a primary mental health programme in Western Sydney from 2012 to 2015.

Access to Allied Psychological Services is a primary mental health programme targeting hard-to-reach populations throughout Australia. This research aims to identify patterns of referrals to the programme in the Western Sydney Primary Health Network region from 2012 to 2015. The referral rates were analysed by using spatial autocorrelation indexes and spatial regression. The study area was described through the identification of the most disadvantaged areas and through consideration of three socio-economic indicators: percentage of Aboriginal and Torres Strait Islander Australians, low educational attainment and low weekly incomes. A large hot spot (identifying high referral rates) was located across the duration of the study in the south-western urban area that partially covered a disadvantaged area. The main cold spot (identifying low referral rates) was located in the south-eastern urban area, covering another disadvantaged area, however critically this association disappeared over time. Our modelling showed that the referral rates had a direct association with the percentage of Aboriginal and Torres Strait Islander peoples with low incomes, and an indirect association with low educational attainment. The results and technique are useful in monitoring and addressing inequality in health planning and policy.

Medición y comparación del nivel de equilibrio en alumnos (as) de 1º y 2º básico por tipo de establecimiento educacional y por sexo / Measurement and comparison of the equilibrium level of 1st and 2nd grade students, by type of educational establishment and sex

El presente estudio determinó si existe diferencia en el nivel de equilibrio en alumnos (as) de 1º y 2º básico por tipo de establecimiento y por sexo. Para esto, la muestra estuvo constituida por 316 alumnos (as), de los cuales 145 son mujeres y 171 son hombres, y 110 alumnos (as) representan a establecimien-tos municipales y 206 alumnos (as) representan a establecimientos particulares subvencionados de la comuna de La Granja. Los resultados muestran que existen diferencias en el equilibrio estático donde se ven favorecidos los establecimientos municipales, y por sexo las mujeres presentan un mejor nivel de equilibrio estático que los hombres. En equilibrio dinámico los establecimientos municipales presentan ventajas sobre los particulares subvencionados, y por sexo los varones presentan una leve ventaja sobre las mujeres. Es pertinente realizar una nueva investigación para comprobar si mediante un plan de ejercicios mejorará el nivel de equilibrio estático y dinámico de los alumnos (as) de 1º y 2º básico por tipo de establecimiento y por sexo.

The present study determined whether there was a difference in the equilibrium level of 6 to 7 year old students, depending on their educational establishment and their sex. The sample was made up of 316 students, of which 145 are women, 171 are men, and 110 students represent municipal establishments and 206 students represent private/subsidized establishments in the commune of La Granja, Chile. Results show that there are differences between static equilibrium by type of educational establishment, where municipal establishments fared better; In terms of sex, females demonstrated to have a better level of static equilibrium than males. In dynamic equilibrium, municipal establishments showed an advantage over private/subsidized ones, and as for sex, males fared slightly better than females. It is pertinent to carry out new research in order to verify if using an exercise plan actually improves the level of static and dynamic equilibrium in 6 to 7 year olds, depending on their educational establishment and sex.

Síndrome de Rapunzel / Rapunzel Syndrome

Se reporta el caso de una niña de 12 años con historia de problemas de aprendizaje y tricofagia de 2 años de evolución, hepatoesplenomegalia y anemia ferropénica. Se requirió manejo quirúrgico se encontró un tricobezoar que se extendía a duodeno. El síndrome de Rapunzel consiste en un tricobezoar que se extiende hacia el intestino delgado, su sintomatología usualmente es inespecífica y por lo general su evolución es benigna. Los bezoares gástricos pueden ocurrir en estómagos normales a causa de la ingestión de objetos que no atraviesan el píloro. Actualmente, la mayoría de bezoares ocurren como complicación de cirugía gástrica, donde hay una función alterada del píloro hipoperistalsis y bajas concentraciones de ácido gástrico. El tricobezoar suele se presentarse en mujeres jóvenes, por la ingesta voluntaria y compulsiva de pelos (trigofagia), a menudo reflejo de un desajuste de la personalidad.