Seasonality of suicide: a multi-country multi-community observational study.

AIMS: We aimed to investigate the heterogeneity of seasonal suicide patterns among multiple geographically, demographically and socioeconomically diverse populations. METHODS: Weekly time-series data of suicide counts for 354 communities in 12 countries during 1986-2016 were analysed. Two-stage analysis was performed. In the first stage, a generalised linear model, including cyclic splines, was used to estimate seasonal patterns of suicide for each community. In the second stage, the community-specific seasonal patterns were combined for each country using meta-regression. In addition, the community-specific seasonal patterns were regressed onto community-level socioeconomic, demographic and environmental indicators using meta-regression. RESULTS: We observed seasonal patterns in suicide, with the counts peaking in spring and declining to a trough in winter in most of the countries. However, the shape of seasonal patterns varied among countries from bimodal to unimodal seasonality. The amplitude of seasonal patterns (i.e. the peak/trough relative risk) also varied from 1.47 (95% confidence interval [CI]: 1.33-1.62) to 1.05 (95% CI: 1.01-1.1) among 12 countries. The subgroup difference in the seasonal pattern also varied over countries. In some countries, larger amplitude was shown for females and for the elderly population (≥65 years of age) than for males and for younger people, respectively. The subperiod difference also varied; some countries showed increasing seasonality while others showed a decrease or little change. Finally, the amplitude was larger for communities with colder climates, higher proportions of elderly people and lower unemployment rates (p-values < 0.05). CONCLUSIONS: Despite the common features of a spring peak and a winter trough, seasonal suicide patterns were largely heterogeneous in shape, amplitude, subgroup differences and temporal changes among different populations, as influenced by climate, demographic and socioeconomic conditions. Our findings may help elucidate the underlying mechanisms of seasonal suicide patterns and aid in improving the design of population-specific suicide prevention programmes based on these patterns.

Litter assessment on 99 Cuban beaches: A baseline to identify sources of pollution and impacts for tourism and recreation.

Litter presence was assessed on the entire Cuban coastline, and includes 99 beaches from all Cuban regions, during field work carried out in 2012 and 2015. A standard method verified in several countries was applied, which classified beaches for nine types of litter into four grades (A-excellent to D-poor). Almost half of the Cuban beaches obtained excellent cleanliness scores, although many needed to be better managed. In this baseline, the most common types of residue were general litter (8% grade D and 35% grades B/C) and potentially harmful litter (<68% with grade A). Resort beaches and those with international visitors showed the best litter management. Tourism Impacts seems to be related to visitor origin therefore choices to develop sustainable tourism in rural and village beaches (64%) appears low, if beach cleaning gross investment is focused on resort beaches (24%). Finally, this paper highlights geographical distribution and types of litter patterns.

[Design of a risk matrix to assess sterile formulations at health care facilities]. / Diseño de una matriz de riesgo para la valoración de los preparados estériles en los centros sanitarios.

OBJECTIVE: To design a matrix allowing classifying sterile formulations prepared at the hospital with different risk levels. MATERIAL AND METHODS: i) Literature search and critical appraisal of the model proposed by the European Resolution CM/Res Ap(2011)1, ii) Identification of the risk associated to the elaboration process by means of the AMFE methodology (Modal Analysis of Failures and Effects), iii) estimation of the severity associated to the risks detected. After initially trying a model of numeric scoring, the classification matrix was changed to an alphabetical classification, grading each criterion from A to D.Each preparation assessed is given a 6-letter combination with three possible risk levels: low, intermediate, and high. This model was easier for risk assignment, and more reproducible. RESULTS: The final model designed analyzes 6 criteria: formulation process, administration route, the drug's safety profile, amount prepared, distribution, and susceptibility for microbiological contamination.The risk level obtained will condition the requirements of the formulation area, validity time, and storing conditions. CONCLUSIONS: The matrix model proposed may help health care institutions to better assess the risk of sterile formulations prepared,and provides information about the acceptable validity time according to the storing conditions and the manufacturing area. Its use will increase the safety level of this procedure as well as help in resources planning and distribution.

Objetivo: Diseñar una matriz que permita la clasificación de los preparadosestériles que se elaboran en el hospital en diferentes nivelesde riesgo.Material y métodos: i) Revisión bibliográfica y lectura crítica delmodelo propuesto por la resolución europea CM/ResAp(2011)1, ii)Identificación de los riesgos asociados al proceso de elaboración,mediante metodología AMFE (Análisis Modal de Fallos y Efectos),iii) estimación de la gravedad asociada a los riesgos detectados.Tras probar inicialmente un modelo de puntuación numérica, semodificó la matriz a una clasificación alfabética, graduando cadacriterio de la A a la D. Cada preparación evaluada obtiene unacombinación de 6 letras, que lleva a tres posibles niveles de riesgo:bajo, medio y alto. Este modelo presentó menor dificultad a la horade asignar riesgos, así como mayor reproducibilidad.Resultados: El modelo final diseñado analiza 6 criterios: proceso depreparación, vía de administración, perfil de seguridad del medicamento,cantidad preparada, distribución y susceptibilidad de contaminaciónmicrobiológica. El nivel de riesgo obtenido condicionarálos requerimientos de la zona de elaboración, plazo de validezy las condiciones de conservación.Conclusiones: El modelo de matriz propuesta puede ayudar a lasinstituciones sanitarias a discernir el riesgo de las preparacionesestériles que se realizan, aportando información sobre el plazo devalidez aceptable en función de las condiciones de conservación yel lugar de fabricación. Su aplicación conllevará un incremento enla seguridad de este proceso, a la vez que puede ayudar a la planificacióny distribución de recursos.

[PET-CT with ¹8F-FDG in the diagnosis of Takayasu's arteritis and the assessment of response to therapy]. / PET-TAC con ¹8F-FDG en el diagnóstico de la arteritis de Takayasu y la valoración del tratamiento.

We present a patient without specific symptoms of vasculitis, with normal acute phase reactants, but with the pathological diagnosis of Takayasu' arteritis that was referred for a PET-CT with (18)F-FDG. Scan findings showed inflammatory activity in the vessel walls of the aorta and after the appropriate treatment, a second scan with (18)F-FDG, correctly assessed the therapeutic response. We discuss the contributions of PET-CT with (18)F-FDG in the management of this pathological entity.

Producción investigativa de grupos colombianos reconocidos por Colciencias en temas de gestión, políticas y sistemas de salud, entre 1994 y 2004 / Investigative production of colombian research groups recognized by Colciencias in matters of health mangement, policies and system between 1994 and 2004

Objetivo: identificar las investigaciones sobre gestión, políticas y sistemas de salud que se realizaron entre 1994 y 2004 por parte de los grupos de investigación reconocidos por Colciencias con el fin de proveer una panorámica general sobre la investigación en estos temas y partiendo de que la investigación en gestión, políticas y sistemas de salud es una prioridad nacional e internacional en el contexto de la reforma sectorial. Métodos: Mediante consulta de las bases GrupoLac y CvLac de Colciencias, vigentes en el 2004, se identificaron los grupos de investigación que tenían registradas investigaciones en temas relacionados con gestíón, políticas y sistemas de salud. De los registros se tomaron en cuenta el objeto de estudio, los ambitos local regional o nacional involucrados y el enfoque metodológico utilizado; finalmente, los productos se agruparon por grandes temáticas. Resultados: Se identificaron 27 grupos de investigación con 292 productos , 158 de los cuales eran investigaciones; de estas se analizaron 97, dado que las 61 restantes no aportaron datos completos según requerimientos del estudio. La información sugiere que ha habido un desarrollo muy limitado de la investigación en estos temas en Colombia, por lo que se requiere de un fortalecimiento de las políticas y mecanismos de investigación en este campo, fundamentales para la toma de decisiones en los diferentes ambitos del sistema de salud.

Effectiveness assessment of otosclerosis surgery.

CONCLUSIONS: The epidemiological characteristics of otosclerosis and its treatment in Andalusia resemble those of other populations with similar socioeconomic levels. Two complementary approaches, such as questionnaires and pure-tone audiometry, are required to assess the effectiveness of otosclerosis surgery (OS) reliably and precisely. OBJECTIVES: We describe a new method to assess effectiveness in OS. It is based on the results of pure-tone audiometry and a specially designed quality of hearing questionnaire (QHQ). The objectives of the study are: (i) to report the general epidemiologic profile of otosclerosis in Andalusia; (ii) to study the effectiveness of OS in our community using conventional methods; and (iii) to study the outcomes of OS using the QHQ and to compare them to those obtained using conventional methods. MATERIAL AND METHODS: All 31 hospitals in the public healthcare system of Andalusia were studied. They were graded into four groups using a specially designed grouping system. The data were obtained from the minimum basic dataset. The prevalence of otosclerosis in Andalusia was calculated from the incidence data, the duration of the disease and life expectancy. To assess the effectiveness of OS, 475 clinical records from 15 hospitals representing all 4 groups were analysed. Effectiveness was assessed by conventional methods, using data obtained from pure-tone audiometry, and by using version 1.02 p of the QHQ. RESULTS: The incidence of clinical otosclerosis was 5.67 patients/100,000 inhabitants/year. The calculated prevalence was 0.287%. The number of cases increased progressively during the study period (p<0.001). The 15-45-year age group was the largest (62.2%) and 68.4% of patients were females. The most frequent type of otosclerosis was estapediovestibularis (fenestral), non-obliterative (91.8%). Only 48 cases (2.3%) of cochlear and 45 (2.2%) of obliterative otosclerosis were reported. The most frequently employed therapeutic procedures were stapedectomy and stapedotomy (75.70%). The average total and preoperative lengths of stay were 3.59 and 1.04 days, respectively. There were significant differences between the different types of otosclerosis. Improvement in the air-bone gap was 15.37+/-1.19 dB (n=164) and the overclosure or operative damage was 0.49+/-0.85 dB (n=164). A gap improvement of 10-40 dB was observed in 61.4% of patients. The > 65 years age group showed the best gap improvement but the largest variability. The quality of hearing measured by the QHQ showed that, in general, a better gap improvement was associated with a higher quality of hearing (Pearson correlation r=0.183; p<0.05). The 15-45-year age group had the worst gap improvement but, in contrast, the better quality of hearing.

[Do women demand to be assisted at medical clinics more often than men?]. / Solicitan las mujeres más consultas al área médica que los hombres?

BACKGROUND: Different features of the users of the Spanish Public Health System have been previously assessed, specially in General Practice and Hospital Emergency Departments. Nevertheless, the epidemiological characteristics of those patients who attend to specialised clinics have not been so thoroughly evaluated. PATIENTS AND METHODS: The referee of the demand, the place of residence, the age and the sex of patients were all analysed for the ,first visits, at the Medical Department clinics (Internal Medicine, Cardiology, Gastroenterology, Pneumology) in our hospital, during 2002. RESULTS: A total of 7,486 demands for attention (53.3% were women) were asked for by 5,841 patients (52.8%) were women. When analysing the variable, place of residence, we find women asked for more frequently than men, in the categories of General Practice Department and age less than 60 years. Those patients coming from urban areas were more in percentage than those coming from rural areas. Whereas the, index of frequency, was higher in women than in men, however, there were no differences between urban and rural areas. CONCLUSION: In our targeted population we have observed a higher demand for medical clinics in women, though the actual demand will depend on factors such as age, place of residence and the referee.

Patient-doctor communication in cross-national perspective. A study in Mexico.

The authors assessed the cross-national replicability previously used to study medical encounters in the United States by adapting them to Mexico. The main research questions focused on information-giving, gender and social class differences in communication, and attention to socioemotional concerns in primary encounters. Sixty-two primary care encounters were audiotaped. Questionnaires were translated into Spanish, then translated back into English. Coding and transcription techniques were taught to Spanish-speaking researchers. Measures of communication were treated as dependent variables and were related by nonparametric statistical analyses to characteristics of physicians, patients, and clinical settings. Doctors in Mexico spent an average of 2.1 minutes (+/- 1.7 standard deviation [SD]), or 16.7% (+/- 10.7 SD) of total interaction time, in information-giving. Mexican doctors asked an average of 27.3 questions per encounter (+/- 18.0 SD), whereas patients asked an average of 1.5 questions (+/- 2.0 SD). Substantial interphysician variability was observed in total time of interaction (Kruskal-Wallis analysis of variance, chi-square = 27.2, P = 0.000), physician time in information giving (chi-square = 16.4, P = 0.022), and physician questions (chi-square = 36.7, P = 0.000). Patient characteristics associated with physician information-giving included male gender (chi-square = 4.1, P = 0.04) and age (Kendall's tau-b = .17, P = 0.05) but not education (tau-b = .08, P = 0.41). Information-giving in public clinics did not differ from that in private practices (chi-square = 0.0, P = 0.91). A bootstrap approach to multiple nonlinear regression permitted additional analysis of physicians', patients', and situational characteristics in explaining measures of patient-doctor communication; this analysis further demonstrated the importance of interphysician variability in communicative behavior. Previous methods for studying patient-doctor communication can be adapted and replicated in a non-English-speaking society. With certain exceptions, findings from Mexico were similar to those obtained in the United States.

[Angioplasty of a stenosed Blalock-Taussig shunt. Its long-term assessment]. / Angioplastia del Blalock-Taussig estenótico. Valoración a largo plazo.

A Blalock-Taussig shunt was performed in a child of 14 months diagnosed with tetralogy of Fallot associated with a complete atrioventricular defect. Seven months later, a balloon dilatation was performed because the shunt was stenosed in the site of the distal anastomosis. Repeat angiography we proved the patency of the shunt without restenosis 4 year later.

Identification and rejection of outliers in enzyme kinetics.

A program (AICOUT) for the correct choice of the experimental value and weight for replicate enzyme kinetic determinations is given. It is based on the method of identification of outliers proposed by Kitagawa (Technometrics, 21 (1979) 193-199). The program is written in BASIC and FORTRAN77. The FORTRAN77 version of AICOUT program coupled to a FORTRAN77 version of the non-linear regression program previously published by Canela (Int J Biomed Comput, 15 (1984) 121-130) is given. This joint program leads to an improvement of precision and confidence in the estimated parameters when the suitable strategy is used. This strategy is as follows: (i) the experimental points are selected, (ii) several replicates of each point are performed, (iii) data are analyzed and outliers are rejected, (iv) normal or biweighted regression is carried out.

[Nutritional evaluation and use of a nutritional complement in children undergoing periodical hemodialysis]. / Valoración nutricional y uso de un complemento alimenticio en niños en hemodiálisis periódica

Six uremic dhildren in periodic hemodialysis with protein-calorie malnutrition were studied. Three of them were given diet supplementation with a compound constituted by carbohydrates and essential amino acids. Evaluation at ,3 and 6 months with somatometry, rutine laboratory analysis, intravenous glucose tolerance test and plasma amino acid determinations, showed that patients with diet supplementation had a slight increase in height and body weight, improved glucose in tolerance, that was initialy detected, and an abnormal pattern of plasma amino acids not modified during the study. Patients without diet supplementation showed no changes in height, body weight, glucose tolerance and plasma amino acids. These results suggest that diet supplementation with carbohydrates and amino acids is useful to improve nutrition in uremic children on hemodialysis, but it is neccesary to study more patients.