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1.
JAMA ; 323(5): 444-454, 2020 02 04.
Artículo en Inglés | MEDLINE | ID: mdl-32016308

RESUMEN

Importance: Neurological disorders have been linked to suicide, but the risk across a broad spectrum of neurological disorders remains to be assessed. Objectives: To examine whether people with neurological disorders die by suicide more often than other people and to assess for temporal associations. Design, Setting, and Participants: Nationwide, retrospective cohort study on all persons 15 years or older living in Denmark, from 1980 through 2016 (N = 7 300 395). Exposures: Medical contact for head injury, stroke, epilepsy, polyneuropathy, diseases of myoneural junction, Parkinson disease, multiple sclerosis, central nervous system infections, meningitis, encephalitis, amyotrophic lateral sclerosis, Huntington disease, dementia, intellectual disability, and other brain diseases from 1977 through 2016 (n = 1 248 252). Main Outcomes and Measures: Death by suicide during 1980-2016. Adjusted incidence rate ratio (IRRs) were estimated using Poisson regressions, adjusted for sociodemographics, comorbidity, psychiatric diagnoses, and self-harm. Results: Of the more than 7.3 million individuals observed over 161 935 233 person-years (49.1% males), 35 483 died by suicide (median duration of follow-up, 23.6 years; interquartile range, 10.0-37.0 years; mean age, 51.9 years; SD, 17.9 years). Of those, 77.4% were males, and 14.7% (n = 5141) were diagnosed with a neurological disorder, equivalent to a suicide rate of 44.0 per 100 000 person-years compared with 20.1 per 100 000 person-years among individuals not diagnosed with a neurological disorder. People diagnosed with a neurological disorder had an adjusted IRR of 1.8 (95% CI, 1.7-1.8) compared with those not diagnosed. The excess adjusted IRRs were 4.9 (95% CI, 3.5-6.9) for amyotrophic lateral sclerosis, 4.9 (95% CI, 3.1-7.7) for Huntington disease, 2.2 (95% CI, 1.9-2.6) for multiple sclerosis, 1.7 (95% CI, 1.6-1.7) for head injury, 1.3 (95% CI, 1.2-1.3) for stroke, and 1.7 (95% CI, 1.6-1.8) for epilepsy. The association varied according to time since diagnosis with an adjusted IRR for 1 to 3 months of 3.1 (95% CI, 2.7-3.6) and for 10 or more years, 1.5 (95% CI, 1.4 to 1.6, P < .001). Compared with those who were not diagnosed with a neurological disorder, those with dementia had a lower overall adjusted IRR of 0.8 (95% CI, 0.7-0.9), which was elevated during the first month after diagnosis to 3.0 (95% CI, 1.9-4.6; P < .001). The absolute risk of suicide for people with Huntington disease was 1.6% (95% CI, 1.0%-2.5%). Conclusions and Relevance: In Denmark from 1980 through 2016, there was a significantly higher rate of suicide among those with a diagnosed neurological disorder than persons not diagnosed with a neurological disorder. However, the absolute risk difference was small.


Asunto(s)
Enfermedades del Sistema Nervioso/psicología , Suicidio/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Esclerosis Amiotrófica Lateral/psicología , Traumatismos Craneocerebrales/psicología , Dinamarca/epidemiología , Femenino , Humanos , Enfermedad de Huntington/psicología , Masculino , Persona de Mediana Edad , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/psicología , Suicidio/psicología , Adulto Joven
2.
Harefuah ; 159(1): 72-73, 2020 02.
Artículo en Hebreo | MEDLINE | ID: mdl-32048482
3.
Epidemiol Psychiatr Sci ; 29: e94, 2020 Jan 24.
Artículo en Inglés | MEDLINE | ID: mdl-31973775

RESUMEN

AIMS: Previous studies analysing blood alcohol concentration (BAC) at the time of suicide have primarily focused on sociodemographic factors. Limited research has focused on psychosocial factors and co-ingestion of other substances to understand the mechanisms of how alcohol contributes to death by suicide. The aim was to examine time trends, psychosocial factors related to acute alcohol use and co-ingestion of alcohol and other substances before suicide. METHODS: The Queensland Suicide Register in 2004-2015 was utilised and analysed in 2019. The cut-off point for positive BAC was set at ⩾0.05 g/dl. Substances were categorised as medicines, illegal drugs and other. Medicines were coded by the Anatomical Therapeutic Chemical (ATC) classification system. Joinpoint regression, univariate odds ratios, age and sex-adjusted odds ratios and Forward Stepwise logistic regression were performed. RESULTS: BAC information was available for 6744 suicides, 92% of all cases in 2004-2015. The final model showed that independent factors distinguishing BAC+ from BAC- were: age group 25-44 years, Australian Indigenous background, being separated or divorced, hanging, diagnosis of substance use, lifetime suicidal ideation, relationship and interpersonal conflict, not having psychotic and other psychiatric disorder, and no nervous system drugs or any other substances in blood at the time of suicide. CONCLUSIONS: Our findings suggest that people who die by suicide while under the influence of alcohol are more likely to be under acute stress (e.g. separation) and not have earlier psychiatric conditions, except substance use. This highlights the importance of more strict alcohol policies, but also the need to improve substance use treatment.


Asunto(s)
Consumo de Bebidas Alcohólicas/sangre , Nivel de Alcohol en Sangre , Sistema de Registros/estadística & datos numéricos , Suicidio/estadística & datos numéricos , Adulto , Anciano , Consumo de Bebidas Alcohólicas/epidemiología , Australia/epidemiología , Femenino , Humanos , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Trastornos Relacionados con Sustancias/epidemiología , Suicidio/psicología
4.
MMWR Morb Mortal Wkly Rep ; 69(3): 57-62, 2020 Jan 24.
Artículo en Inglés | MEDLINE | ID: mdl-31971929

RESUMEN

In 2017, nearly 38,000 persons of working age (16-64 years) in the United States died by suicide, which represents a 40% rate increase (12.9 per 100,000 population in 2000 to 18.0 in 2017) in less than 2 decades.* To inform suicide prevention, CDC analyzed suicide data by industry and occupation among working-age decedents presumed to be employed at the time of death from the 32 states participating in the 2016 National Violent Death Reporting System (NVDRS).†,§ Compared with rates in the total study population, suicide rates were significantly higher in five major industry groups: 1) Mining, Quarrying, and Oil and Gas Extraction (males); 2) Construction (males); 3) Other Services (e.g., automotive repair) (males); 4) Agriculture, Forestry, Fishing, and Hunting (males); and 5) Transportation and Warehousing (males and females). Rates were also significantly higher in six major occupational groups: 1) Construction and Extraction (males and females); 2) Installation, Maintenance, and Repair (males); 3) Arts, Design, Entertainment, Sports, and Media (males); 4) Transportation and Material Moving (males and females); 5) Protective Service (females); and 6) Healthcare Support (females). Rates for detailed occupational groups (e.g., Electricians or Carpenters within the Construction and Extraction major group) are presented and provide insight into the differences in suicide rates within major occupational groups. CDC's Preventing Suicide: A Technical Package of Policy, Programs, and Practices (1) contains strategies to prevent suicide and is a resource for communities, including workplace settings.


Asunto(s)
Industrias/estadística & datos numéricos , Ocupaciones/estadística & datos numéricos , Suicidio/estadística & datos numéricos , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos , Adulto Joven
5.
JAMA Netw Open ; 3(1): e1919935, 2020 Jan 03.
Artículo en Inglés | MEDLINE | ID: mdl-31995212

RESUMEN

Importance: Understanding suicide ideation (SI) during combat deployment can inform prevention and treatment during and after deployment. Objective: To examine associations of sociodemographic characteristics, lifetime and past-year stressors, and mental disorders with 30-day SI among a representative sample of US Army soldiers deployed in Afghanistan. Design, Setting, and Participants: In this survey study, soldiers deployed to Afghanistan completed self-administered questionnaires in July 2012. The sample was weighted to represent all 87 032 soldiers serving in Afghanistan. Prevalence of lifetime, past-year, and 30-day SI and mental disorders was determined. Logistic regression analyses examined risk factors associated with SI. Data analyses for this study were conducted between August 2018 and August 2019. Main Outcomes and Measures: Suicide ideation, lifetime and 12-month stressors, and mental disorders were assessed with questionnaires. Administrative records identified sociodemographic characteristics and suicide attempts. Results: A total of 3957 soldiers (3473 [weighted 87.5%] male; 2135 [weighted 52.6%] aged ≤29 years) completed self-administered questionnaires during their deployment in Afghanistan. Lifetime, past-year, and 30-day SI prevalence estimates were 11.7%, 3.0%, and 1.9%, respectively. Among soldiers with SI, 44.2% had major depressive disorder (MDD) and 19.3% had posttraumatic stress disorder in the past 30-day period. A series of analyses of the 23 grouped variables potentially associated with SI resulted in a final model of sex; race/ethnicity; lifetime noncombat trauma; past 12-month relationship problems, legal problems, and death or illness of a friend or family member; and MDD. In this final multivariable model, white race/ethnicity (odds ratio [OR], 3.1 [95% CI, 1.8-5.1]), lifetime noncombat trauma (OR, 2.1 [95% CI, 1.1-4.0]), and MDD (past 30 days: OR, 31.8 [95% CI, 15.0-67.7]; before past 30 days: OR, 4.9 [95% CI, 2.5-9.6]) were associated with SI. Among the 85 soldiers with past 30-day SI, from survey administration through 12 months after returning from deployment, 6% (5 participants) had a documented suicide attempt vs 0.14% (6 participants) of the 3872 soldiers without SI. Conclusions and Relevance: This study suggests that major depressive disorder and noncombat trauma are important factors in identifying SI risk during combat deployment.


Asunto(s)
Personal Militar/psicología , Trastornos por Estrés Postraumático/psicología , Ideación Suicida , Suicidio/psicología , Adaptación Psicológica , Adulto , Campaña Afgana 2001- , Factores de Edad , Femenino , Humanos , Masculino , Personal Militar/estadística & datos numéricos , Resiliencia Psicológica , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , Trastornos por Estrés Postraumático/epidemiología , Suicidio/estadística & datos numéricos , Adulto Joven
6.
Forensic Sci Int ; 306: 110093, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31816483

RESUMEN

Studies on the mortalities of drug abusers in China are scarce. This study explores the deaths of methamphetamine, opioid, and ketamine abusers in Shanghai (2004-2017) and Wuhan (2005-2017). Chi-square/Fisher's exact tests were used to compare the differences in terms of region, gender, age, cause of death, and the method used in the last drug abuse. Poisson regression models were used to estimate the rate ratios ("RRs") and annual percentage changes ("APCs"). 314 heroin, 43 methamphetamine, and 4 ketamine abusers were included. Furthermore, simultaneously, 6 abusers used heroin and methamphetamine, and 7 abusers used methamphetamine and ketamine. Heroin-related deaths have declined in Shanghai (APC, -16.1; 95 % CI, -18.4 to -11.3) and Wuhan (APC, -16.0; 95 % CI, -18.9 to -10.6), whereas methamphetamine-related deaths have increased in Wuhan (APC, 12.8; 95 % CI, 0.0 to 29.2). On the whole, in the two cities, males were more frequently observed than females in heroin-related deaths (4.4, 230/52). However, the gender ratios for methamphetamine- (1.8, 34/19) and ketamine-related deaths (1.2, 6/5) were close to one. In view of the mortality rates of the drug abusers in most Chinese cities were still unclear, it is thus important to improve mortality surveillance of the drug abusers at the national level.


Asunto(s)
Analgésicos Opioides/envenenamiento , Ketamina/envenenamiento , Metanfetamina/envenenamiento , Trastornos Relacionados con Sustancias/mortalidad , Adolescente , Adulto , Distribución por Edad , Analgésicos Opioides/efectos adversos , Intoxicación por Monóxido de Carbono/mortalidad , China/epidemiología , Femenino , Heroína/efectos adversos , Heroína/envenenamiento , Humanos , /envenenamiento , Ketamina/efectos adversos , Masculino , Metanfetamina/efectos adversos , Persona de Mediana Edad , Distribución por Sexo , Suicidio/estadística & datos numéricos , Adulto Joven
7.
J Forensic Sci ; 65(1): 103-111, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31404476

RESUMEN

This study analyzes postmortem records from 260 homicide cases autopsied by the Department of Forensic Medicine in Rome from 2000 to 2014. The victims were mainly males (74%) and young (61% aged from 21 to 50 years). Although the victims were mostly Italians, the number of foreign victims (33%) has increased since 1990, primarily due to immigration. The offenders frequently used firearms (39%), particularly in multiple murders. An increase in blunt (20%) and sharp force (32%) weapons was also seen. The primary crime scene was residential (42%), and the head was the most frequently injured body region. Male victims occurred frequently in the context of organized crime (7.6%). In family or intimate-sexual relationships, women were the majority of victims (8%). Forensic pathologists play an important role during investigation. They should consider all the information available to them, including autopsy information, crime scene information, and crime investigation data.


Asunto(s)
Víctimas de Crimen/estadística & datos numéricos , Homicidio/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Emigrantes e Inmigrantes/estadística & datos numéricos , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Motivación , Distribución por Sexo , Suicidio/estadística & datos numéricos , Armas/estadística & datos numéricos , Heridas y Traumatismos/mortalidad , Adulto Joven
9.
Anaesthesia ; 75(1): 96-108, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31729019

RESUMEN

Anaesthetists are thought to be at increased risk of suicide amongst the medical profession. The aims of the following guidelines are: increase awareness of suicide and associated vulnerabilities, risk factors and precipitants; to emphasise safe ways to respond to individuals in distress, both for them and for colleagues working alongside them; and to support individuals, departments and organisations in coping with a suicide.


Asunto(s)
Anestesistas/psicología , Anestesistas/estadística & datos numéricos , Trastornos Mentales/diagnóstico , Estrés Psicológico/diagnóstico , Suicidio/prevención & control , Suicidio/psicología , Guías como Asunto , Humanos , Trastornos Mentales/complicaciones , Trastornos Mentales/psicología , Factores de Riesgo , Estrés Psicológico/complicaciones , Estrés Psicológico/psicología , Suicidio/estadística & datos numéricos , Reino Unido
10.
Forensic Sci Int ; 307: 110101, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31865266

RESUMEN

Flualprazolam is a novel designer benzodiazepine, structurally related to alprazolam, flubromazolam and triazolam. In the last couple of years, it has been frequently detected in seizures and in forensic cases in Sweden and Finland. However, there is a lack of published blood concentrations for the drug, which presents difficulties when assessing its relevance for the cause of death. A quantitative method for the determination of flualprazolam in post-mortem blood was developed and validated, and subsequently used to analyse samples from 33 deaths previously screened as testing positive for flualprazolam in Sweden and Finland. Most of the cases in the study were accidental deaths (61 %) or suicides (18 %). The median (range) flualprazolam concentration was 18.0 (3.0-68) ng/g. The majority of the deceased were male (82 %) and the median age was 30 years. The median age in the Swedish cases was significantly higher (35 years) than in the Finnish cases (23 years) (p< 0.05). Poly-drug use and particularly the concomitant use of flualprazolam and opioids were very common in the study population. Most of the cases that were positive for flualprazolam were fatal poisonings by a drug (N=23), and in 13 cases, flualprazolam was implicated in the cause of death. Combining the resources of two countries in which all post-mortem toxicology is centralised provided a more comprehensive insight into the toxicology of flualprazolam. Research on novel psychoactive substances, such as flualprazolam, is required in order to be able to provide scientific evidence on the risks of these new substances for drug administration and potential users.


Asunto(s)
Benzodiazepinas/sangre , Drogas Diseñadas/análisis , Psicotrópicos/sangre , Triazolam/sangre , Accidentes/mortalidad , Adolescente , Adulto , Distribución por Edad , Anciano , Benzodiazepinas/envenenamiento , Drogas Diseñadas/química , Drogas Diseñadas/envenenamiento , Femenino , Finlandia/epidemiología , Toxicología Forense , Cromatografía de Gases y Espectrometría de Masas , Humanos , Masculino , Persona de Mediana Edad , Estructura Molecular , Psicotrópicos/química , Psicotrópicos/envenenamiento , Distribución por Sexo , Trastornos Relacionados con Sustancias/mortalidad , Suicidio/estadística & datos numéricos , Suecia/epidemiología , Triazolam/envenenamiento , Adulto Joven
11.
Rev Bras Epidemiol ; 22Suppl 3(Suppl 3): e190011.supl.3, 2019.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31800850

RESUMEN

BACKGROUND: Unspecified causes of death are among the traditional indicators of quality of information. OBJECTIVE: To verify the performance of the 60 cities in the Data for Health Initiative project and to analyze the reclassification of unspecified external causes of death (UEC). METHODS: Using the 2017 records from the Mortality Information System, the proportion and percent change in UEC were compared after investigation between project cities and other cities, and the percent of reclassification to specific external causes was calculated. RESULTS: The project cities comprised 52% (n = 11,759) of the total UEC in Brazil, of which 64.5% were reclassified after investigation, whereas the other cities reclassified 31% of UEC. Results were similar for men, youth, blacks, metropolitan cities, the Southeast region, and deaths attested by forensic institutes. In the project cities, pedestrian traffic accidents were external causes with greater reclassification. In men, the UEC was reclassified to homicides (23.8%) and accident of terrestrial transportation (ATT) (11.1%), with motorcyclists (4.4%) and pedestrians (4.3%) being the most prominent. In women, these causes were changed to other accident causes (20.8%), ATT (10.6%) and homicides (7.9%). UEC changed to ATT (18.3%) in the age groups of 0-14 years old and to homicides (32.5%) in the age groups of 15-44 years. CONCLUSION: The project cities obtained better results after investigation of UEC, enabling analysis of the reclassification to specific causes by sex and age groups.


Asunto(s)
Causas de Muerte , Certificado de Defunción , Sistemas de Información/normas , Accidentes/mortalidad , Accidentes de Tránsito/mortalidad , Adolescente , Adulto , Distribución por Edad , Anciano , Brasil/epidemiología , Niño , Preescolar , Ciudades/epidemiología , Exactitud de los Datos , Femenino , Homicidio/estadística & datos numéricos , Humanos , Lactante , Masculino , Registros Médicos , Persona de Mediana Edad , Distribución por Sexo , Suicidio/estadística & datos numéricos , Violencia/estadística & datos numéricos , Adulto Joven
12.
RECIIS (Online) ; 13(4): 754-767, out.-dez. 2019. ilus
Artículo en Portugués | LILACS | ID: biblio-1047537

RESUMEN

Este artigo objetiva analisar o fomento do debate público promovido pela cobertura jornalística on-line sobre a questão do suicídio de adolescentes e jovens negros no Brasil. Para isso, foram selecionadas três reportagens de três veículos de comunicação: G1 ­ Ciência e Saúde (ligado às Organizações Globo), Nexo (jornal digital independente) e o Alma Preta (agência de jornalismo especializada na temática étnica do Brasil). Com o uso de teorias sobre prática jornalística, opinião pública e silêncio, além do emprego da hermenêutica de profundidade, este estudo concluiu que a mídia não promove integralmente o debate público sobre a questão. O G1 ­ Ciência e Saúde reproduziu o discurso da mídia hegemônica, não dando voz para os negros; o Nexo foi o jornal que tratou o tema de forma mais completa, com uso de dados e fontes, sendo negra uma delas; e o Alma Preta foi o que menos abriu espaço para identificação do público negro, com a ausência de fontes e falta de representação.


This article aims to analyze the public debate at online journalistic coverage on the issue of suicide among black teenagers and young people in Brazil. For this, three news from three media were selected: G1 Ciência e Saúde (linked to Globo Organizations), Nexo (independent digital newspaper) and Alma Preta (journalism agency specializing in ethnic issues in Brazil). Using theories of journalistic practice, public opinion and silence, as well as the use of deep hermeneutics, this study concluded that the media does not fully promote public debate on the issue. G1 ­ Ciência e Saúde reproduced the hegemonic media discourse, giving no voice to blacks; Nexo was the newspaper that dealt with the theme most completely, using data and sources, one of them being black; and Alma Preta was the least open to the identification of the black public, with the absence of sources and lack of representation.


Este artículo tiene como objetivo analizar el debate público a través de la cobertura periodística online sobre el tema del suicidio entre adolescentes y jóvenes negros en Brasil. Para esto se seleccionaron tres medios: G1 ­ Ciência e Saúde (vinculado a Organizaciones Globo), Nexo (periódico digital independiente) y Alma Preta (agencia de periodismo especializada em temas étnicos en Brasil). Utilizando teorías de práctica periodística, opinión pública y silencio, así como el uso de una hermenéutica profunda, este estudio concluyó que los medios no promueven completamente el debate público sobre el tema. G1 ­ Ciência e Saúde reprodujo el discurso de los medios hegemónicos, sin dar voz a los negros; Nexo fue el periódico que trató el tema más completamente, utilizando datos y fuentes; y Alma Preta fue la menos abierta a la identificación del público negro, con la ausencia de fuentes y la falta de representación.


Asunto(s)
Humanos , Suicidio/prevención & control , Adolescente , Periodismo , Grupo de Ascendencia Continental Africana , Salud de las Minorías Étnicas , Política de Salud , Opinión Pública , Suicidio/estadística & datos numéricos , Brasil , Medios de Comunicación , Muerte , Poblaciones Vulnerables , Prevención de Enfermedades , Medios de Comunicación Sociales , Racismo , Hermenéutica
13.
Rev. bras. cir. plást ; 34(4): 509-516, oct.-dec. 2019. ilus, tab
Artículo en Inglés, Portugués | LILACS | ID: biblio-1047916

RESUMEN

Introdução: O suicídio é um sério problema de saúde pública. Estima-se que para cada óbito existam 10 tentativas. Dentre os meios utilizados, as queimaduras têm destaque devido à gravidade das lesões, a alta taxa de letalidade e os grandes prejuízos funcionais, estéticos e psicológicos. As mulheres, por constituírem a maioria dos pacientes com história de tentativa de suicídio e morte por queimaduras, representam um grupo vulnerável que merece recorte para aprofundamento do estudo. Métodos: Estudo retrospectivo, de caráter descritivo de série temporal. Foi desenvolvido na Unidade Tratamento de Queimados e no Instituto de Medicina Legal em Brasília (DF), entre os anos de 2010 e 2015. Resultados: Foram identificadas 42 mulheres com história de suicídio por queimaduras, tentado ou consumado. Houve 15 óbitos relacionados diretamente à lesão térmica. Houve um predomínio da faixa etária entre 30 e 44 anos, seguida por 15 a 29 anos. Em 64,3% dos casos o evento aconteceu no DF. Em relação aos agentes etiológicos, o mais comum foi o álcool (71,4%). A média de superfície corporal queimada foi de 34,38%, sendo que as pacientes que faleceram apresentaram áreas queimadas maiores (59,53%) do que as que sobreviveram (20,4%). Conclusão: Os dados obtidos no DF corroboram informações da literatura. Apesar do progresso envolvendo manejo e tratamento dos pacientes queimados, a prevenção continua sendo a melhor atitude.


Introduction: Suicide is a serious public health problem. For every death, there are an estimated 10 suicide attempts. Among the means of suicide, burns are prominent due to the lesion severity, the high mortality rate, and the severe functional, aesthetic, and psychological damage. Women comprise the majority of patients with a history of attempting suicide and death by burns and represent a vulnerable group that deserves attention. Methods: This retrospective descriptive time-series study was performed in the Burn Treatment Unit at the Institute of Legal Medicine in Brasília, Distrito Federal (DF) between 2010 and 2015. Results: A total of 42 women with a history of suicide by burns, attempted or consummated, were identified; 15 deaths were directly related to the thermal injury. Suicide by burns was the most predominant among patients aged 30 to 44 years was observed, followed by those aged 15 to 29 years. In 64.3% of cases, the event occurred in the Brasília, Distrito Federal (DF). Alcohol was the most common etiological agent (71.4%). The average burned body surface area was 34.38%, and the patients who died presented larger burned areas (59.53%) than that in those who survived (20.4%). Conclusion: The data obtained from the Brasília, Distrito Federal (DF) corroborate information from the literature. Despite progress involving the management and treatment of burn patients, prevention remains the best strategy.


Asunto(s)
Humanos , Femenino , Adolescente , Adulto , Historia del Siglo XXI , Suicidio , Intento de Suicidio , Unidades de Quemados , Quemaduras , Salud Pública , Funciones Esenciales de la Salud Pública , Suicidio/estadística & datos numéricos , Intento de Suicidio/psicología , Intento de Suicidio/estadística & datos numéricos , Unidades de Quemados/normas , Unidades de Quemados/estadística & datos numéricos , Quemaduras/mortalidad , Quemaduras/psicología , Quemaduras/terapia
14.
Environ Health Perspect ; 127(11): 117007, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31769300

RESUMEN

BACKGROUND: Previous literature suggests that higher ambient temperature may play a role in increasing the risk of suicide. However, no multi-country study has explored the shape of the association and the role of moderate and extreme heat across different locations. OBJECTIVES: We examined the short-term temperature-suicide relationship using daily time-series data collected for 341 locations in 12 countries for periods ranging from 4 to 40 y. METHODS: We conducted a two-stage meta-analysis. First, we performed location-specific time-stratified case-crossover analyses to examine the temperature-suicide association for each location. Then, we used a multivariate meta-regression to combine the location-specific lag-cumulative nonlinear associations across all locations and by country. RESULTS: A total of 1,320,148 suicides were included in this study. Higher ambient temperature was associated with an increased risk of suicide in general, and we observed a nonlinear association (inverted J-shaped curve) with the highest risk at 27°C. The relative risk (RR) for the highest risk was 1.33 (95% CI: 1.30, 1.36) compared with the risk at the first percentile. Country-specific results showed that the nonlinear associations were more obvious in northeast Asia (Japan, South Korea, and Taiwan). The temperature with the highest risk of suicide ranged from the 87th to 88th percentiles in the northeast Asian countries, whereas this value was the 99th percentile in Western countries (Canada, Spain, Switzerland, the UK, and the United States) and South Africa, where nearly linear associations were estimated. The country-specific RRs ranged from 1.31 (95% CI: 1.19, 1.44) in the United States to 1.65 (95% CI: 1.40, 1.93) in Taiwan, excluding countries where the results were substantially uncertain. DISCUSSION: Our findings showed that the risk of suicide increased with increasing ambient temperature in many countries, but to varying extents and not necessarily linearly. This temperature-suicide association should be interpreted cautiously, and further evidence of the relationship and modifying factors is needed. https://doi.org/10.1289/EHP4898.


Asunto(s)
Calor/efectos adversos , Suicidio/estadística & datos numéricos , Brasil/epidemiología , Canadá/epidemiología , Ciudades , Humanos , Japón/epidemiología , Filipinas/epidemiología , República de Corea/epidemiología , Riesgo , Sudáfrica/epidemiología , España/epidemiología , Suiza/epidemiología , Taiwán/epidemiología , Reino Unido/epidemiología , Estados Unidos/epidemiología , Vietnam/epidemiología
15.
MMWR Morb Mortal Wkly Rep ; 68(46): 1050-1056, 2019 Nov 22.
Artículo en Inglés | MEDLINE | ID: mdl-31751321

RESUMEN

Traumatic brain injury (TBI) affects the lives of millions of Americans each year (1). To describe the trends in TBI-related deaths among different racial/ethnic groups and by sex, CDC analyzed death data from the National Vital Statistics System (NVSS) over an 18-year period (2000-2017). Injuries were also categorized by intent, and unintentional injuries were further categorized by mechanism of injury. In 2017, TBI contributed to 61,131 deaths in the United States, representing 2.2% of approximately 2.8 million deaths that year. From 2015 to 2017, 44% of TBI-related deaths were categorized as intentional injuries (i.e., homicides or suicides). The leading category of TBI-related death varied over time and by race/ethnicity. For example, during the last 10 years of the study period, suicide surpassed unintentional motor vehicle crashes as the leading category of TBI-related death. This shift was in part driven by a 32% increase in TBI-related suicide deaths among non-Hispanic whites. Firearm injury was the underlying mechanism of injury in nearly all (97%) TBI-related suicides among all groups. An analysis of TBI-related death rates by sex and race/ethnicity found that TBI-related deaths were significantly higher among males and persons who were American Indians/Alaska Natives (AI/ANs) than among all other groups across all years. Other leading categories of TBI-related deaths included unintentional motor vehicle crashes, unintentional falls, and homicide. Understanding the leading contributors to TBI-related death and identifying groups at increased risk is important in preventing this injury. Broader implementation of evidence-based TBI prevention efforts for the leading categories of injury, such as those aimed at stemming the significant increase in TBI-related deaths from suicide, are warranted.


Asunto(s)
Lesiones Traumáticas del Encéfalo/mortalidad , Accidentes de Tránsito/estadística & datos numéricos , Lesiones Traumáticas del Encéfalo/etnología , Lesiones Traumáticas del Encéfalo/etiología , Grupos de Población Continentales/estadística & datos numéricos , Grupos Étnicos/estadística & datos numéricos , Femenino , Armas de Fuego/estadística & datos numéricos , Humanos , Intención , Masculino , Factores de Riesgo , Distribución por Sexo , Suicidio/etnología , Suicidio/estadística & datos numéricos , Estados Unidos/epidemiología
16.
Am J Forensic Med Pathol ; 40(4): 312-317, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31688052

RESUMEN

BACKGROUND: Schizophrenia is a detrimental psychiatric disorder, with an increased mortality from natural and nonnatural causes. METHODS: This study was a retrospective review of autopsy cases of all the individuals with history of schizophrenia investigated by the Office of the Chief Medical Examiner, State of Maryland, for a 5-year period from 2008 to 2012. RESULT: A total of 391 schizophrenia patients were autopsied at the Office of the Chief Medical Examiner because they died suddenly and unexpectedly. Their age ranged from 15 to 100 years with the mean age of 49.5 years. Of the 391 deaths, 191 (48.8%) were white, 185 (47.3%) were African American, and 15 (3.9%) were either Hispanic or Asian. The male and female ratio was 1.5:1. The majority of deaths (64.2%) were caused by natural diseases, 12.0% deaths were accidents, 11.5% deaths were suicides, and 9.7% deaths were homicides. The manner of death remained undetermined in 38 cases (9.7%). Of the 251 natural deaths, 198 cases (78.9%) were owing to cardiovascular diseases. Cause of death was listed as cardiac arrhythmia in 11 cases. This diagnosis of cardiac arrhythmia was made by exclusion based on death scene investigation, review of medical history, complete autopsy, and toxicological tests. Drug intoxication was the second most common cause of death. CONCLUSIONS: The study shows high fatality caused by cardiovascular diseases and drug intoxication among schizophrenia patients, which calls attention of the medical community to closely monitor the high risk factors of sudden death among schizophrenia patients.


Asunto(s)
Muerte Súbita/epidemiología , Esquizofrenia/epidemiología , Accidentes/mortalidad , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/mortalidad , Grupos de Población Continentales/estadística & datos numéricos , Médicos Forenses , Femenino , Homicidio/estadística & datos numéricos , Humanos , Masculino , Maryland/epidemiología , Persona de Mediana Edad , Envenenamiento/mortalidad , Estudios Retrospectivos , Distribución por Sexo , Suicidio/estadística & datos numéricos , Adulto Joven
17.
Psychiatr Danub ; 31(4): 397-404, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31698395

RESUMEN

BACKGROUND: The suicide rate of the youth in South Korea has been increasing, and suicide of the youth still has been the most common cause of death since 2007. We aimed to determine the trends and the regional risk factors of youth suicide in South Korea from 2001 to 2010. SUBJECTS AND METHODS: We used the data from the National Statistical Office to calculate the standardized suicide rates and various regional data including population census, employment, and labor. To calculate the effect of individual risk factors, we used the data from the fourth Korean Youth Risk Behavior Web-based Survey (KYRBWS-VI). Conditional autoregressive model for regional standardized mortality ratio (SMR) using inter-regional spatial information was fitted. RESULTS: Suicide rates of adolescents aged 12 to 18 was from 3.5 per 100,000 people in 2001 and 5.3 per 100,000 in 2010. There were no significant gender difference in suicide rates, however, the number of suicides among adolescents aged 15-18 accounted for four times than those of adolescents ages 12-14. High proportion of late adolescents, higher number of recipients of national basic livelihood, and higher number of adolescents who treated with depression were related to elevated suicide rate of adolescent. Total sleep time of adolescents and regional unemployment rate were negatively associated with the suicide risk of respective regions. CONCLUSIONS: Age distribution, economic status, total sleep time, and the number of adolescent patients with depression were different between those in low and in high adolescent suicidal regions in Korea. Our findings suggest that preferential appliance of adolescent suicide prevention program for regions by considering those factors may be important steps to reduce adolescent suicide in Korea.


Asunto(s)
Suicidio/psicología , Suicidio/estadística & datos numéricos , Adolescente , Conducta del Adolescente , Niño , Depresión/epidemiología , Humanos , República de Corea/epidemiología , Factores de Riesgo , Ideación Suicida
18.
Lancet Psychiatry ; 6(12): 1021-1030, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31706930

RESUMEN

BACKGROUND: Self-harm is the strongest risk factor for subsequent suicide, but risk may vary. We compared the risk of suicide following hospital presentation for self-harm according to patient characteristics, method of self-harm, and variations in area-level socioeconomic deprivation, and estimated the incidence of suicide by time after hospital attendance. METHODS: In this ongoing Multicentre Study of Self-harm in England, the study population consists of individuals aged at least 15 years who had attended the emergency department of five general hospitals in Oxford, Manchester, and Derby after non-fatal self-harm between Jan 1, 2000, and Dec 31, 2013. Information on method of self-harm was obtained through systematic monitoring in hospitals. Level of socioeconomic deprivation was based on the Index of Multiple Deprivation (IMD) characterising the area where patients lived, grouping them according to IMD quintiles. Mortality follow-up was up to Dec 31, 2015, resulting in up to 16 years of follow-up. We calculated incidence of suicide since first hospital presentation by follow-up period and estimated the association between individual factors (age, gender, method of self-harm, IMD, and number of non-fatal self-harm presentations to hospital) and suicide using mixed-effect models. FINDINGS: Between Jan 1, 2000, and Dec 31, 2013, there were 92 177 presentations to the study hospitals by 51 108 individuals. 1325 patients involved in 1563 self-harm episodes were excluded from the study because they had missing information on gender, age, or mortality. The resulting study sample consisted of 90 614 hospital presentations by 49 783 individuals. By the end of follow-up on Dec 31, 2015, 703 patients had died by suicide. The overall incidence of suicide was 163·1 (95% CI 151·5-175·6) per 100 000 person-years, and 260·0 (237·4-284·8) per 100 000 person-years in men and 94·6 (83·3-107·4) per 100 000 person-years in women. The incidence of suicide was highest in the year following discharge from hospital (511·1 [451·7-578·2] per 100 000 person-years), particularly in the first month (1787·1 [1423·0-2244·4] per 100 000 person-years). Based on all presentations to hospital, men were three times more likely than women to die by suicide after self-harm (OR 3·36 [95% CI 2·77-4·08], p<0·0001). Age was positively related to suicide risk in both genders, with a 3% increase in risk for every one-year increase in age at hospital presentation (OR 1·03 [1·03-1·04], p<0·0001). Relative to hospital presentations after self-poisoning alone, presentations involving both self-injury and self-poisoning were associated with higher suicide risk (adjusted OR 2·06 [95% CI 1·42-2·99], p<0·0001], as were presentations after self-injury alone (adjusted OR 1·36 [1·09-1·70], p=0·007). Similarly, relative to self-harm by self-poisoning alone, attempted hanging or asphyxiation (adjusted OR 2·70 [1·53-4·78], p=0·001) and traffic-related acts of self-injury (adjusted OR 2·99 [1·17-7·65], p=0·022) were associated with greater risk of suicide. Self-cutting combined with self-poisoning was also associated with increased suicide risk (adjusted OR 1·36, [1·08-1·71], p=0·01). Compared with those patients living in the most deprived areas, those who lived in the least deprived areas (first national IMD quintile) had a greater risk of dying by suicide (adjusted OR 1·76 [1·32-2·34], p<0·0001) after adjusting for gender, age, previous self-harm, and psychiatric treatment, as did those living in the second least deprived areas (adjusted OR 1·64 [1·20-2·25], p=0·002). INTERPRETATION: Patients attending hospital for self-harm are at high risk of suicide, especially immediately after hospital attendance. Certain patient characteristics and methods of self-harm, together with living in areas of low socioeconomic deprivation, can increase patients' subsequent suicide risk. However, while specific risk factors can be usefully integrated into the assessment process, individual factors have poor utility in predicting suicide, so the needs and risks of all patients should be assessed to develop appropriate aftercare plan, including early follow-up. FUNDING: UK Department of Health and Social Care.


Asunto(s)
Alta del Paciente/estadística & datos numéricos , Conducta Autodestructiva/epidemiología , Suicidio/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Inglaterra/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Factores de Riesgo , Factores Sexuales , Factores Socioeconómicos , Adulto Joven
19.
Orv Hetil ; 160(47): 1864-1871, 2019 Nov.
Artículo en Húngaro | MEDLINE | ID: mdl-31736345

RESUMEN

Introduction: The analysis of the mortality data of patients is important. Aim: Examination of data from patients treated in the Addictological Out-patient Clinic in Józsefváros and deceased between 2001 and 2018. Method: Patients' data originated from medical records. The national and Budapest data were from the publications of the Hungarian Central Statistical Office. Results: The age of patients was 52.85 ± 11.81 years for women and 51.99 ± 12.47 years for men. Two-thirds, regardless of gender, were alcoholic. There were many violent deaths. A new phenomenon was the high number of drug- and murder-associated deaths. The former group was dominated by men. The latter group showed female dominance. The completed suicide rate was 14.6%. Suicide attempts occurred in 22.4% of patients. The majority of patients were skilled workers. Conclusion: Data support the view that addict patients die earlier. Leading deaths, unlike previous investigations, were violent deaths. The rate of suicide was higher than the national rate, but it was the same as previously reported, indicating a high risk of this population. Gender differences were observed with regard to violent death, requiring further elucidation. Orv Hetil. 2019; 160(47): 1864-1871.


Asunto(s)
Alcoholismo/mortalidad , Pacientes Ambulatorios/estadística & datos numéricos , Trastornos Relacionados con Sustancias/mortalidad , Suicidio/estadística & datos numéricos , Adulto , Anciano , Alcoholismo/etnología , Instituciones de Atención Ambulatoria , Femenino , Homicidio , Humanos , Hungría/epidemiología , Masculino , Persona de Mediana Edad , Distribución por Sexo , Intento de Suicidio , Violencia/estadística & datos numéricos
20.
Lancet ; 394(10211): 1827-1835, 2019 11 16.
Artículo en Inglés | MEDLINE | ID: mdl-31668728

RESUMEN

BACKGROUND: Systematic reviews have consistently shown that individuals with mental disorders have an increased risk of premature mortality. Traditionally, this evidence has been based on relative risks or crude estimates of reduced life expectancy. The aim of this study was to compile a comprehensive analysis of mortality-related health metrics associated with mental disorders, including sex-specific and age-specific mortality rate ratios (MRRs) and life-years lost (LYLs), a measure that takes into account age of onset of the disorder. METHODS: In this population-based cohort study, we included all people younger than 95 years of age who lived in Denmark at some point between Jan 1, 1995, and Dec 31, 2015. Information on mental disorders was obtained from the Danish Psychiatric Central Research Register and the date and cause of death was obtained from the Danish Register of Causes of Death. We classified mental disorders into ten groups and causes of death into 11 groups, which were further categorised into natural causes (deaths from diseases and medical conditions) and external causes (suicide, homicide, and accidents). For each specific mental disorder, we estimated MRRs using Poisson regression models, adjusting for sex, age, and calendar time, and excess LYLs (ie, difference in LYLs between people with a mental disorder and the general population) for all-cause mortality and for each specific cause of death. FINDINGS: 7 369 926 people were included in our analysis. We found that mortality rates were higher for people with a diagnosis of a mental disorder than for the general Danish population (28·70 deaths [95% CI 28·57-28·82] vs 12·95 deaths [12·93-12·98] per 1000 person-years). Additionally, all types of disorders were associated with higher mortality rates, with MRRs ranging from 1·92 (95% CI 1·91-1·94) for mood disorders to 3·91 (3·87-3·94) for substance use disorders. All types of mental disorders were associated with shorter life expectancies, with excess LYLs ranging from 5·42 years (95% CI 5·36-5·48) for organic disorders in females to 14·84 years (14·70-14·99) for substance use disorders in males. When we examined specific causes of death, we found that males with any type of mental disorder lost fewer years due to neoplasm-related deaths compared with the general population, although their cancer mortality rates were higher. INTERPRETATION: Mental disorders are associated with premature mortality. We provide a comprehensive analysis of mortality by different types of disorders, presenting both MRRs and premature mortality based on LYLs, displayed by age, sex, and cause of death. By providing accurate estimates of premature mortality, we reveal previously underappreciated features related to competing risks and specific causes of death. FUNDING: Danish National Research Foundation.


Asunto(s)
Trastornos Mentales/mortalidad , Indicadores de Calidad de la Atención de Salud , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Causas de Muerte , Estudios de Cohortes , Dinamarca/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos del Humor/mortalidad , Mortalidad Prematura , Sistema de Registros , Trastornos Relacionados con Sustancias/mortalidad , Suicidio/estadística & datos numéricos , Adulto Joven
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