Suicidality among South Brazilian tobacco growers.

OBJECTIVE: To assess prevalence of suicidal ideation and suicide attempt among South Brazilian tobacco growers and to analyze the associated factors related to the suicidal ideation. METHODS: A cross-sectional study was conducted in 2011 with a random sample of 2469 tobacco growers in São Lourenço do Sul/RS. Suicidal ideation was characterized by the question "Has the thought of ending your life been on your mind?". Suicide attempt was assessed by the question "Have you ever tried to kill yourself?". Investigation of factors associated with suicidal ideation was done by means of Poisson regression. RESULTS: Prevalence of suicidal ideation and suicide attempt was 2.5 % and 1.2 % respectively. In the adjusted analysis, suicidal ideation was associated with being female, older age, moderate participation in religious activities and difficulty in paying debts. Those who worked in activities that required inadequate postures (hunched over or other forced positions), as well as farmers who performed 6-9 pesticide-related tasks demonstrated greater risk of suicidal ideation. Regarding health conditions, medical diagnosis of asthma, chronic low back pain, number of lifetime green tobacco sickness episodes and lifetime pesticide poisoning were positively associated with suicidal ideation. CONCLUSION: Suicidal thoughts and attempts are relevant mental health problems among tobacco growers. Reducing pesticide use, as well as exposure to nicotine and improving socio-economic conditions, can reduce suicidal ideation and improve the mental health of exposed workers.

Penetrating Trauma Rapid Estimated Disability Scale: Assessing Facial Self-Inflicted Gunshot Wounds.

Objectives: Self-inflicted facial gunshot wounds (GSWs) result in complex but consistent injuries that are often survivable. We suggest a novel method for rapid stratification into groups that may be associated with hospital course and cost after self-inflicted facial GSWs. Methods: This is retrospective review of self-inflicted facial GSWs between January 1, 2009, and December 31, 2018, at a tertiary academic center. Patients were given a penetrating trauma rapid estimated disablity (PRED) score (1-4) based solely on radiologic imaging injury patterns. Clinicopathologic factors were then compared between groups. Results: There were 2 PRED 1 patients (15.1%), 8 PRED 2 patients (29.6%), 5 PRED 3 patients (18.5%), and 12 PRED 4 patients (44.4%). An increased PRED score was statistically associated with increasing mean days in intensive care unit (2.5 PRED 1, 4.2 PRED 2, 6 PRED 3, 11.6 PRED 4, p = 0.001), mean length of hospitalization (5.5 PRED 1, 13.1 PRED 2, 25.6 PRED 3, 39.8 PRED 4, p = 0.007), and mean cost ($) of hospitalization (22,000 PRED 1, 29,000 PRED 2, 37,000 PRED 3, 63,000 PRED 4, p = 0.01). Conclusions and Relevance: The PRED score for self-inflicted GSWs to the face is strongly associated with length of hospital stay and cost of hospitalization.

Association between cumulating substances use and cumulating several school, violence and mental health difficulties in early adolescents.

Multiple substances (alcohol, tobacco, cannabis and other illicit drugs (OID)) have been frequently used in early adolescents maybe due to school, violence and mental-health difficulties. We investigated the associations between substance-use patterns and related difficulties among 1559 middle-school adolescents from north-eastern France (mean age 13.5 ±â€¯1.3). They completed a questionnaire including socioeconomic features, school, violence and mental-health difficulties (school grade repetition, sustained physical/verbal violence, sexual abuse, perpetrated violence, poor social support, depressive symptoms and suicide attempt; cumulated number noted SVMDscore) and the time of their first occurrence during the life course. Data were analyzed using logistic and negative binomial regression models. Alcohol, tobacco, cannabis and OID use affected 35.2, 11.2, 5.6 and 2.8% of the subjects respectively. The risk of using tobacco only, alcohol and tobacco, alcohol plus tobacco and cannabis, or all alcohol, tobacco, cannabis and OID strongly increased with the SVMDscore (socioeconomic features-adjusted odds ratio reaching 85). The risk began in early years in middle schools and then steadily increased, more markedly for elevated SVMDscore. Exposure to several SVMDs may be a transmission vector towards the substance use, starting mostly with alcohol/tobacco, and then shifting to cannabis/OID. These findings help to understand substance-use risk patterns and identify at-risk adolescents.

Direct and indirect cost of attempted suicide in a general hospital: cost-of-illness study / Custo direto e indireto de tentativas de suicídio em um hospital geral: estudo de custo de doença

CONTEXT AND OBJECTIVE: Knowledge of socioeconomic impact of attempted suicide may sensitize managers regarding prevention strategies. There are no published data on this in Brazil. The aim here was to describe the direct and indirect costs of care of hospitalized cases of attempted suicide and compare these with the costs of acute coronary syndrome cases. DESIGN AND SETTING: Cost-of-illness study at a public university hospital in Brazil. METHOD: The costs of care of 17 patients hospitalized due to attempted suicide were compared with those of 17 acute coronary syndrome cases at the same hospital, over the same period. The direct costs were the summation of the hospital and out-of-hospital costs resulting from the event, determined from the medical records. The indirect costs were estimated through the human capital lost. The Mann-Whitney test and analysis of covariance (ANCOVA) with transformation adjusted for age were used for comparisons. RESULTS: The average costs per episode of attempted suicide were: direct cost, US$ 6168.65; indirect cost, US$ 688.08; and total cost, US$ 7163.75. Comparative analysis showed a difference between the indirect costs to family members, with significantly higher costs in the attempted suicide group (P = 0.0022). CONCLUSION: The cost of care relating to attempted suicide is high and the indirect cost to family members reinforces the idea that suicidal behavior not only affects the individual but also his social environment. .

CONTEXTO E OBJETIVO: O conhecimento do impacto socioeconômico das tentativas de suicídio pode sensibilizar gestores para programas de prevenção. No Brasil, não há dados publicados a esse respeito. O objetivo foi descrever os custos direto e indireto dos cuidados com as tentativas de suicídio de pacientes internados no hospital de uma universidade pública, e compará-los aos custos de casos de síndrome coronariana aguda. TIPO DE ESTUDO E LOCAL: Estudo de custo de doença em hospital universitário público no Brasil. MÉTODO: Os custos dos cuidados de 17 pacientes hospitalizados por tentativas de suicídio foram comparados aos custos de 17 síndromes coronarianas agudas de pacientes internados no mesmo hospital, no mesmo período. Os custos diretos foram o somatório de custos hospitalares e extra-hospitalares decorrentes do evento, determinados por registro hospitalar. Os custos indiretos foram estimados através da perda de capital humano. Teste de Mann-Whitney e análise da covariância (ANCOVA) com transformação por idade foram utilizados para comparação. RESULTADOS: As médias de custos por episódio de tentativa de suicídio foram: custo direto individual, US$ 6168,65; custo indireto individual, US$ 688,08; e custo total, US$ 7163,75. A análise comparativa indica diferença entre os custos indiretos a familiares dos dois fenômenos, com custos significativamente mais elevados no grupo de tentativas de suicídio (P = 0,0022). CONCLUSÃO: O custo dos cuidados com tentativa de suicídio é elevado e o custo indireto a familiares reforça a ideia de que o comportamento suicida não afeta apenas o indivíduo, mas também seu ambiente social. .

Cost-effectiveness of a rapid response team intervention for suicidal youth presenting at an emergency department.

OBJECTIVE: To investigate the cost-effectiveness of a rapid response team (RRT), compared with usual care (UC), for treating suicidal adolescents. METHODS: Suicidal adolescents (n = 286) presenting at an emergency department were enrolled in a trial to compare UC with enhanced outpatient care provided by an RRT of health professionals. Functioning (Child Global Assessment Scale) and suicidality (Spectrum of Suicidal Behavior Scale) scores were measured at baseline and 6 months later. Resource use and cost data were collected from several sources during the same period. RESULTS: As previously reported, there was no statistically or clinically significant difference in either functioning or suicidality between the groups. Costs of the RRT were lower by $1886, thus -$1886 (95% CI -$4238 to $466), from the perspective of the treating hospital, and by $991, thus -$991 (95% CI -$5580 to $3598), from the perspective of society. If decision makers are not willing to pay for any improvement in functioning or suicidality, the RRT has a 95% probability of being cost-effective from the perspective of the treating hospital. From the point of view of society, the probability of the intervention being cost-effective is about 70% for functioning and 63% for suicidality. The difference between the 2 perspectives is mainly attributable to the cost of hospitalizations outside the treating hospital. CONCLUSIONS: An RRT intervention appears to be cost-effective, compared with UC, from the point of view of the treating hospital, but there is no difference from the point of view of society.

Characteristics, procedural differences, and costs of inpatients with drug poisoning in acute care hospitals in Japan.

OBJECTIVES: This study aimed to describe the clinical and procedural characteristics of drug poisoning, to examine procedural differences between drug poisoning repeaters and non-repeaters, and to estimate the costs of drug poisoning. METHODS: A retrospective cohort study of a nationally representative sample of 6585 inpatients with drug poisoning was conducted, using the administrative database of the Diagnosis Procedure Combination/Per-Diem Payment System in 2008. RESULTS: Although only 3% of patients required surgery and 65% were discharged from the hospitals within 3 days, greater than 30% were admitted to tertiary emergency care (i.e., high-level emergency care) centers that provide care to severely ill and trauma patients who require intensive care. Only 30% of patients received psychiatric consultation during hospitalization. In addition, repeaters were less likely to be admitted to hospitals by ambulance (67% vs. 76%) and more likely to be discharged within 3 days (77% vs. 65%) than non-repeaters. The annual economic burden of drug poisoning in Japan was $66 million (¥7.7 billion), with the population aged 20-39 years accounting for 50% of these costs. CONCLUSION: This study highlights the need for optimally allocating resources and improving prevention strategies.

Societal economic costs and benefits from death: another look.

B. Yang and D. Lester (2007) have produced an innovative contribution to the relevant literature. Unlike previous studies, they incorporate estimates of cost savings from suicide. Their argument could be strengthened in 3 ways. First, they may have underestimated some of the cost savings by relying on inflated estimates of mental health usage by suicidal persons. The present analysis shows that only 20% of suicidal individuals see a mental health professional during the last year of life, much lower than previous estimates. Further, persons dying of cancer are 4 times more likely than suicides to report high usage of medical services. Second, our economy relies heavily on the health care sector for job creation, so that we need to exercise caution in interpreting savings in medical care; such savings may also represent costs in employment opportunities for nurses, doctors, and other medical personnel. Third, an anticipated criticism, the costs of the grieving of significant others, needs to be considered. Suicidal persons are shown to have less dense social networks, a sign of fewer potential grievers than in the case of natural deaths. Future work is needed to adjust lost earnings for the lower occupational status of suicides; this is another reason why Yang and Lester may be underestimating cost savings from suicide.

Perfil socioeconómico del paciente con intento de suicidio / Socioeconomic characteristics of patients with suicide attempt

Antecedentes. El intento de suicidio es una de las 10 principales causas de ingreso a una sala de urgencias. En nuestro hospital hemos encontrado que constituye una de las causas primordiales de morbilidad en pacientes jóvenes, que afectan sobre todo a mujeres entre los 15 y los 24 años. Objetivo. Determinar las características socioeconómicas del paciente adulto con intento de suicidio, que ingresa a la sala de urgencias de acuerdo con edad y sexo. Material y métodos. Se incluyeron en el estudio 101 pacientes que intentaron suicidarse; dicho grupo de estudio se conformó de hombres y mujeres mayores de 15 años que ingresaron entre el primero de marzo de 1996 al 15 de septiembre de 1997. En forma individual se les aplicó la cédula de Mad Master para estudio socieconómico de pacientes con intento suicida, una vez recabados los datos se procedió a analizarlos. Resultados. Se estudiaron 101 pacientes, 71 mujeres y 30 hombres, cuya edad promedio fue de 39.5 años. En 76 casos constituyó el primer episodio, en 22 de ellos , se detectó como segundo o tercer reintento y tres consumaron el acto. El método más utilizado en hombre y en mujeres fue la ingestión de medicamentos. En este grupo predominaron los solteros y casados en comparación con los viudos, divorciados y en los que vivían unión libre. La mayoría de los sujetos eran estudiantes con un grado máximo de estudios de bachillerato. En cuanto a las características de la familia, la mayoría provenía de una familia nuclear, pero con un patron de autoridad rígido y con comunicación oscura y enmascarada. El déficit económico que se encontró se estimó entre 20 y 30 por ciento, y la mayor parte de las familias percibía entre tres y cuatro salarios mínimos. El factor emocional fue el que originó el intento suicida. Conclusiones. El número de casos por intento de suicidio se ha incrementado con los últimos cinco años. Nuestra población de estudio en su mayoría conrrespondió a mujeres de la tercera década de la vida, estudiante de bachillerato, soltera, provenientes de familia nuclear, cuya autoridad intrafamiliar era rígida y con comunicación oscura y enmascarada, lo que originó el conflicto y la desintegración de ésta. Todos los pacientes utilizaron como método para el intento ingestión de medicamentos