Suicide and meteorological factors in São Paulo, Brazil, 1996-2011: a time series analysis

Objective: Considering the scarcity of reports from intertropical latitudes and the Southern Hemisphere, we aimed to examine the association between meteorological factors and suicide in São Paulo. Method: Weekly suicide records stratified by sex were gathered. Weekly averages for minimum, mean, and maximum temperature (°C), insolation (hours), irradiation (MJ/m2), relative humidity (%), atmospheric pressure (mmHg), and rainfall (mm) were computed. The time structures of explanatory variables were modeled by polynomial distributed lag applied to the generalized additive model. The model controlled for long-term trends and selected meteorological factors. Results: The total number of suicides was 6,600 (5,073 for men), an average of 6.7 suicides per week (8.7 for men and 2.0 for women). For overall suicides and among men, effects were predominantly acute and statistically significant only at lag 0. Weekly average minimum temperature had the greatest effect on suicide; there was a 2.28% increase (95%CI 0.90-3.69) in total suicides and a 2.37% increase (95%CI 0.82-3.96) among male suicides with each 1 °C increase. Conclusion: This study suggests that an increase in weekly average minimum temperature has a short-term effect on suicide in São Paulo.

Suicide and meteorological factors in São Paulo, Brazil, 1996-2011: a time series analysis.

OBJECTIVE:: Considering the scarcity of reports from intertropical latitudes and the Southern Hemisphere, we aimed to examine the association between meteorological factors and suicide in São Paulo. METHOD:: Weekly suicide records stratified by sex were gathered. Weekly averages for minimum, mean, and maximum temperature (°C), insolation (hours), irradiation (MJ/m2), relative humidity (%), atmospheric pressure (mmHg), and rainfall (mm) were computed. The time structures of explanatory variables were modeled by polynomial distributed lag applied to the generalized additive model. The model controlled for long-term trends and selected meteorological factors. RESULTS:: The total number of suicides was 6,600 (5,073 for men), an average of 6.7 suicides per week (8.7 for men and 2.0 for women). For overall suicides and among men, effects were predominantly acute and statistically significant only at lag 0. Weekly average minimum temperature had the greatest effect on suicide; there was a 2.28% increase (95%CI 0.90-3.69) in total suicides and a 2.37% increase (95%CI 0.82-3.96) among male suicides with each 1 °C increase. CONCLUSION:: This study suggests that an increase in weekly average minimum temperature has a short-term effect on suicide in São Paulo.

The impact of changing health indicators on infant mortality rates in Brazil, 2000 and 2005 / Impacto de los cambios en los indicadores de salud sobre las tasas de mortalidad infantil en Brasil, 2000 y 2005

OBJECTIVES: To investigate the associations between changes in indicators of health-related resources and coverage, and variations in infant mortality rates (IMR) in Brazil's 27 states in 2000 and 2005. METHODS: Data were obtained from the Ministry of Health's online database, DATASUS. Stepwise multiple regressions were performed to model changes in IMR and its components (early, late, and post-neonatal mortality), using changes in the selected health indicators as predictors. RESULTS: Regression analysis showed that improving access to prenatal care (B = -0.89 per 1 000; P < 0.001), increasing public expenditure on health as a proportion of gross domestic product (GDP) (B = -0.72 per 1 000; P = 0.031), and increasing access to the water supply (B = -0.22 per 1 000; P = 0.033) were associated with significant reductions in IMR. Declining early neonatal mortality rates were associated with prenatal care (B = -0.14 per 1 000; P = 0.026) and access to sanitation services (B = -0.05 per 1 000; P = 0.026). Reductions in late neonatal mortality rates were associated with prenatal care (B = -0.12 per 1 000; P = 0.003) and inversely correlated to the rate of cesarean deliveries (B = 0.13 per 1 000; P = 0.005). Post-neonatal mortality rate reductions were associated with prenatal care (B = -0.64 per 1 000; P < 0.001), increasing public expenditure on health as a proportion of GDP (B = -0.76 per 1 000; P = 0.005), and access to the water supply (B = -0.17 per 1 000; P = 0.037). CONCLUSIONS: Improving access to prenatal care, increasing public expenditure on health, and access to sanitation and water supply were all independently correlated to declining IMR; however, higher rates of cesarean deliveries were associated with higher late neonatal mortality rates. Continuous collection and analysis of relevant health indicators is recommended for developing evidence-based health policies and accurate predictions of how specific public health interventions...

OBJETIVOS: Investigar las asociaciones entre los cambios en los indicadores de recursos y cobertura relacionados con la salud y las variaciones en las tasas de mortalidad infantil (TMI) en los 27 estados de Brasil entre los años 2000 y 2005. MÉTODOS: Los datos se obtuvieron de la base de datos en línea del Ministerio de Salud, DATASUS. Mediante regresión múltiple paso a paso se modelaron los cambios en la TMI y sus componentes (mortalidades temprana, tardía y posneonatal), utilizando como predictores los cambios en indicadores seleccionados de salud. RESULTADOS: Según el análisis de regresión, el mejoramiento del acceso a la atención prenatal (B = -0,89 por 1 000; P < 0,001) y al suministro de agua (B = -0,22 por 1 000; P = 0,033), y el aumento del gasto público en salud como proporción del producto interno bruto (PIB) (B = -0,72 por 1 000; P = 0,031) se asociaron con reducciones significativas de las TMI. Las reducciones de las tasas de mortalidad neonatal temprana se asociaron con la atención prenatal (B = -0,14 por 1 000; P = 0,026) y el acceso a servicios de saneamiento (B = -0,05 por 1 000; P = 0,026). Las reducciones en las tasas de mortalidad neonatal tardía se asociaron con la atención prenatal (B = -0,12 por 1 000; P = 0,003) e, inversamente, con la tasa de partos por cesárea (B = 0,13 por 1 000; P = 0,005). Las reducciones en las tasas de mortalidad posneonatal se asociaron con la atención prenatal (B = -0,64 por 1 000; P < 0,001), el aumento en el gasto público en salud como proporción del PIB (B = -0,76 por 1 000; P = 0,005) y el acceso a fuentes de agua (B = -0,17 por 1 000; P = 0,037). CONCLUSIONES: El mejoramiento del acceso al cuidado prenatal, el incremento del gasto público en salud y el acceso al saneamiento y a fuentes de agua se correlacionaron independientemente con la reducción en las TMI; mayores tasas de partos por cesárea se asociaron con mayores tasas de mortalidad neonatal tardía. Se recomienda mantener la...

The impact of changing health indicators on infant mortality rates in Brazil, 2000 and 2005.

OBJECTIVES: To investigate the associations between changes in indicators of health-related resources and coverage, and variations in infant mortality rates (IMR) in Brazil's 27 states in 2000 and 2005. METHODS: Data were obtained from the Ministry of Health's online database, DATASUS. Stepwise multiple regressions were performed to model changes in IMR and its components (early, late, and post-neonatal mortality), using changes in the selected health indicators as predictors. RESULTS: Regression analysis showed that improving access to prenatal care (B = -0.89 per 1 000; P < 0.001), increasing public expenditure on health as a proportion of gross domestic product (GDP) (B = -0.72 per 1 000; P = 0.031), and increasing access to the water supply (B = -0.22 per 1 000; P = 0.033) were associated with significant reductions in IMR. Declining early neonatal mortality rates were associated with prenatal care (B = -0.14 per 1 000; P = 0.026) and access to sanitation services (B = -0.05 per 1 000; P = 0.026). Reductions in late neonatal mortality rates were associated with prenatal care (B = -0.12 per 1 000; P = 0.003) and inversely correlated to the rate of cesarean deliveries (B = 0.13 per 1 000; P = 0.005). Post-neonatal mortality rate reductions were associated with prenatal care (B = -0.64 per 1 000; P < 0.001), increasing public expenditure on health as a proportion of GDP (B = -0.76 per 1 000; P = 0.005), and access to the water supply (B = -0.17 per 1 000; P = 0.037). CONCLUSIONS: Improving access to prenatal care, increasing public expenditure on health, and access to sanitation and water supply were all independently correlated to declining IMR; however, higher rates of cesarean deliveries were associated with higher late neonatal mortality rates. Continuous collection and analysis of relevant health indicators is recommended for developing evidence-based health policies and accurate predictions of how specific public health interventions might impact IMR.

An 8-week, open-label trial of duloxetine for comorbid major depressive disorder and chronic headache.

BACKGROUND: Although major depression and chronic headache are strongly associated, there is insufficient evidence for the use of antidepressants for this specific comorbidity. This trial aimed to investigate the efficacy and tolerability of duloxetine for this indication. METHOD: Thirty outpatients with DSM-IV major depressive disorder and concurrent primary chronic headache (chronic migraine, chronic tension-type headache, or both), 18 to 55 years old, were recruited from April 2006 to March 2007, if they scored > 21 on the Montgomery-Asberg Depression Rating Scale (MADRS) and had no other significant clinical condition. Subjects received duloxetine 60 mg/day for 8 weeks. Scores on the MADRS and a visual analog pain scale (VAS) were the co-primary outcome measures. Scores on the brief version of the World Health Organization Quality of Life scale (WHOQoL-BREF) and number of headache days/week were secondary outcome measures. The study was conducted at the Liaison-Psychiatry Service of SOCOR General Hospital, Belo Horizonte, Brazil. RESULTS: Mean +/- SD MADRS scores decreased significantly from baseline to endpoint (29.5 +/- 5.2 to 8.9 +/- 8.7 points, p < .001), and mean +/- SD VAS scores decreased significantly from 5.8 +/- 1.9 to 1.9 +/- 2.5 points (p < .001). Combined intent-to-treat response rate (> 50% reduction on MADRS and > 40% on VAS) was 66.7% (20/30). Significant improvements in both headache and depression were evident after the first week. Mean +/- SD WHOQoL-BREF scores increased (improved) 18.8 +/- 21.9 points (p < .001), and mean +/- SD number of headache days/week decreased from 5.2 +/- 2.0 to 2.9 +/- 2.5 days/week (p < .001). Two subjects discontinued for side effects and 3 for nonadherence. CONCLUSION: In this preliminary open trial, duloxetine 60 mg/day was effective, fast acting, and well tolerated for the treatment of comorbid major depressive disorder and chronic headache.

Manic patients receiving ECT in a Brazilian sample.

BACKGROUND: Characterization of manic inpatients receiving electroconvulsive therapy (ECT) has not been done. METHODS: The charts of 425 consecutive admissions of 269 inpatients treated for manic or mixed episodes, between 1996 and 2000, in a Brazilian private psychiatric hospital were reviewed. A logistic model was built to determine the predictors of use of ECT for mania. Median total length of stay (LOS) and LOS deducted from the delay until ECT was started were compared between ECT and non-ECT admissions. The risk of readmission was estimated using Cox's regression. RESULTS: Significant predictors of ECT prescription were: history of previous admission (OR=4.09), psychotic features (OR=1.60), female gender (OR=2.04), married (OR=1.79), and treatment by a psychiatrist who assisted more than 20 manic inpatients in the index period (OR=1.97). Co-morbidity with cardiovascular disease was negatively associated with ECT use (OR=0.49). Median LOS after starting ECT was similar to that of non-ECT admissions (12 vs. 13 days). ECT reduced (HR=0.678) and previous psychiatric admissions increased (HR=2.320) the risk of readmission after a manic episode. LIMITATIONS: Only one hospital was included in this study. CONCLUSIONS: The presence of psychotic features and violent behavior during manic episodes and indicators of chronicity of bipolar illness (history of previous admissions, duration of disease) were predictors of ECT use for the treatment of mania. Suicidality was not associated with the use of ECT for mania. LOS after ECT was started was similar to LOS of non-ECT admissions. The use of ECT for mania reduced the risk of readmission.