Políticas Públicas de Prevenção do Suicídio no Brasil: uma revisão sistemática

O presente trabalho reflete sobre a negligência histórica da prevenção do suicídio como objeto de políticas públicas no Brasil, a partir de elementos teóricos do processo de formação de agenda e formulação. Foram realizadas entrevistas semi-estruturadas com especialistas (da área da psicologia clínica e da gestão de políticas municipais de saúde) e pesquisa de dados secundários (bibliografia especializada na área da Saúde Pública). Analisa-se neste trabalho as dificuldades para que a questão da prevenção do suicídio seja valorizada como objeto organizador de um vetor de ação no campo da saúde, como tem potencial epidemiológico para ser. Argumentase que problemas como o tabu, a subnotificação, o atendimento, a abordagem da mídia, o acesso aos métodos, o abuso de substâncias químicas, entre outros, estão na raiz do processo da negligência do tema no sistema de saúde

Suicide rates and trends in Sao Paulo, Brazil, according to gender, age and demographic aspects: a joinpoint regression analysis

Objective: To evaluate suicide rates and trends in Sao Paulo by sex, age-strata, and methods. Methods: Data was collected from State registry from 1996 to 2009. Population was estimated using the National Census. We utilized joinpoint regression analysis to explore temporal trends. We also evaluated marital status, ethnicity, birthplace and methods for suicide. Results: In the period analyzed, 6,002 suicides were accrued with a rate of 4.6 per 100,000 (7.5 in men and 2.0 in women); the male-to-female ratio was around 3.7. Trends for men presented a significant decline of 5.3% per year from 1996 to 2002, and a significant increase of 2.5% from 2002 onwards. Women did not present significant changes. For men, the elderly (> 65 years) had a significant reduction of 2.3% per year, while younger men (25-44 years) presented a significant increase of 8.6% from 2004 onwards. Women did not present significant trend changes according to age. Leading suicide methods were hanging and poisoning for men and women, respectively. Other analyses showed an increased suicide risk ratio for singles and foreigners. Conclusions: Specific epidemiological trends for suicide in the city of Sao Paulo that warrant further investigation were identified. High-risk groups - such as immigrants - could benefit from targeted strategies of suicide prevention

ESTUDO ECOLÓGICO SOBRE SUICÍDIO E HOMICÍDIO NO ESTADO DE MINAS GERAIS, BRASIL

Suicide and homicide are known public health problem. The objective was to evaluate correlations between suicide, homicide and sociodemographic variables through an ecological study. Mortality and sociodemographic data were collected from the Ministry of Health and the National Census, aggregated by micro-regions. The data were analyzed using correlation and multiple linear regression. Suicide rates for the total population, men and women were 5.7; 9.0 and 2.4 per 100 000 inhabitants, respectively. Suicide rates for the total population were higher in the central and southern regions. The suicide ranged from 1.2 (Nanuque) to 16.3 (Diamantina). Homicide rates for the total population, men and women were 18.6; 33.6 and 4.0 per 100 000, respectively. The homicide rates for the total population ranged from 1.9 (Sao Lourenço) to 41.8 (Mantena). The highest rates occur in the northwest and northeast regions. Among men, suicide and homicide were negatively correlated (r -0.28, p<0.05). Different sociodemographic variables were found to be associated with suicide and homicide in the regressions. Suicide showed a spatial pattern suggesting that it is related to high socioeconomic status. Homicide presented the inverse spatial pattern. New researches at different levels and states are needed to elucidate these phenomena.Suicídio e homicídio são conhecidos problemas de saúde pública. O objetivo desse trabalho foi avaliar a relação entre suicídio, homicídio e variáveis sociodemográficas num estudo ecológico em Minas Gerais. Os dados foram coletados pelo Ministério da Saúde e pelo Censo Nacional, agregados por microrregiões. Utilizaram-se correlação e regressão linear múltipla na análise. As taxas de suicídio para a população total, homens e mulheres foram 5,7; 9,0 e 2,4 por 100 mil habitantes, respectivamente. O suicídio apresentou maiores taxas na região central e sul. As taxas de suicídio para população total variaram de 1,2 (Nanuque) a 16,3 (Diamantina). As taxas de homicídio para a população total, homens e mulheres foram 18,6; 33,6 e 4,0 por 100 000 habitantes, respectivamente. As taxas de homicídio para a população total variaram de 1,9 (São Lourenço) a 41,8 (Mantena). As maiores taxas ocorrem na região noroeste e nordeste. Entre os homens, suicídio e homicídio foram negativamente correlacionados (r -0,28, p<0,05). Diferentes variáveis sociodemográficas foram associadas ao suicídio e homicídio nas regressões. Suicídio apresentou um padrão espacial, sugerindo que ele está relacionado com alto nível socioeconômico. Homicídio apresentou o padrão inverso. Novos estudos em outros níveis e estados são necessários para esclarecer esses fenômenos

The ASTRO-H X-ray Observatory

The joint JAXA/NASA ASTRO-H mission is the sixth in a series of highly successful X-ray missions initiated by the Institute of Space and Astronautical Science (ISAS). ASTRO-H will investigate the physics of the high-energy universe via a suite of four instruments, covering a very wide energy range, from 0.3 keV to 600 keV. These instruments include a high-resolution, high-throughput spectrometer sensitive over 0.3-2 keV with high spectral resolution of Delta E < 7 eV, enabled by a micro-calorimeter array located in the focal plane of thin-foil X-ray optics; hard X-ray imaging spectrometers covering 5-80 keV, located in the focal plane of multilayer-coated, focusing hard X-ray mirrors; a wide-field imaging spectrometer sensitive over 0.4-12 keV, with an X-ray CCD camera in the focal plane of a soft X-ray telescope; and a non-focusing Compton-camera type soft gamma-ray detector, sensitive in the 40-600 keV band. The simultaneous broad bandpass, coupled with high spectral resolution, will enable the pursuit of a wide variety of important science themes.Comment: 22 pages, 17 figures, Proceedings of the SPIE Astronomical Instrumentation "Space Telescopes and Instrumentation 2012: Ultraviolet to Gamma Ray

Hitomi (ASTRO-H) X-ray Astronomy Satellite

The Hitomi (ASTRO-H) mission is the sixth Japanese x-ray astronomy satellite developed by a large international collaboration, including Japan, USA, Canada, and Europe. The mission aimed to provide the highest energy resolution ever achieved at E  >  2  keV, using a microcalorimeter instrument, and to cover a wide energy range spanning four decades in energy from soft x-rays to gamma rays. After a successful launch on February 17, 2016, the spacecraft lost its function on March 26, 2016, but the commissioning phase for about a month provided valuable information on the onboard instruments and the spacecraft system, including astrophysical results obtained from first light observations. The paper describes the Hitomi (ASTRO-H) mission, its capabilities, the initial operation, and the instruments/spacecraft performances confirmed during the commissioning operations for about a month

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase&nbsp;1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation&nbsp;disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age&nbsp; 6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score&nbsp; 652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc&nbsp;= 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N&nbsp;= 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in&nbsp;Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in&nbsp;Asia&nbsp;and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Spatial patterns of suicide in the city of São Paulo and its socioeconomic-cultural correlates

O presente estudo tem o objetivo de analisar os padrões espaciais das ocorrências de suicídio no município de São Paulo, no período de 1996 a 2005, e verificar a sua associação com variávies socioeconômico-culturais (estado civil, renda, instrução, religião, migração). A escolha das variáveis analíticas foi baseada nos fatores de risco ao suicídio levantados pela OMS, OPAS e na teoria sobre o suicídio de Durkheim. Os dados socioeconômicos utilizados foram provenientes do IBGE e os dados de mortalidade do PRO-AIM. Para a identificação do padrão espacial das taxas de suicídio foi utilizado o teste de varredura espacial. Para a verificação da associação com as variáveis socioeconômicas e culturais foi utilizada análise de regressão logísica. No período estudado ocorreram 4275 óbitos por suicídio no município de São Paulo, com uma taxa média de 4,1/100 mil hab/ano. O primeiro teste de varredura espacial, considerando-se 50% da população total como tamanho máximo do agrupamento, identificou 2 agrupamentos significativos, um de risco (RR = 1,66) composto por 18 distritos da região central, centro-sul e centrooeste da cidade (Alto de Pinheiros, Barra Funda, Bela Vista, Bom Retiro, Brás, Cambuci, Consolação, Itaim Bibi, Jardim Paulista, Liberdade, Moema, Morumbi, Pinheiros, Perdizes, República, Santa Cecília, Sé, Vila Mariana) e um de proteção (RR = 0,78) formado por 14 distritos da região sul (Campo Grande, Campo Limpo, Capão Redondo, Cidade Ademar, Cidade Dutra, Grajaú, Jardim Ângela, Jardim São Luís, Santo Amaro, Socorro, Pedreira, Raposo Tavares, Vila Andrade, Vila Sônia). O teste considerando-se 5% da população total como tamanho máximo do agrupamento, encontrou 2 agrupamentos significativos. Nesse teste, o agrupamento de risco do primeiro teste foi desmembrado em dois agrupamentos menores, ambos de risco. O agrupamento primário apresentou RR = 1,92 em 9 distritos centrais, o agrupamento secundário RR = 1,58 em 6 distritos da região centro-sul. Para a análise de regressão logística, o agrupamento de risco identificado no primeiro teste de varredura espacial (18 distritos) e os demais 78 distritos (contraste) foram definidos como variáveis dependentes e as variáveis socioeconômicoculturais independentes. O primeiro modelo ajustado na regressão multivariada identificou as seguintes variáveis como risco: solteiros (OR = 2,36); migrantes (OR = 1,49); católicos (OR = 1,36); elevada renda (OR = 1,05). O segundo modelo multivariado identificou as seguintes variáveis como proteção: casados (OR = 0,48); evangélicos (0,60). Os resultados podem ser explicados pelos fatores de risco da literatura, pela teoria de Durkheim adaptada à realidade paulistana e pela diferença entre suicídio e homicídio.The present study aims to analyse the space patterns of suicide occurence in the city of São Paulo, in the period from 1996 to 2005, and check its association with the socioeconomic-cultural variables (marital status, income, education, religion, migration). The choice of the analytical variables was based on the suicide risk factors lifted by the WHO and OPAS, and in the Durkheim´s suicide theory. The socioeconomic data used were originated from the IBGE and the mortality data from the PRO-AIM. The spatial scan test was applied to identify space patterns of suicide rates. In order to check the association with the socioeconomic-cultural variables, the logistic regression analysis was used. In the studied period, 4275 suicide deaths took place in the city of São Paulo, with a mean rate of 4,1/100 thousand inhabitant/year. The first spatial scan test, considering 50% of the total population as the maximum cluster size, identified 2 significant clusters, one of risk (RR = 1,66) composed by 18 districts of the central region, south-center and western-center of the city (Alto de Pinheiros, Barra Funda, Bela Vista, Bom Retiro, Brás, Cambuci, Consolação, Itaim Bibi, Jardim Paulista, Liberdade, Moema, Morumbi, Pinheiros, Perdizes, República, Santa Cecília, Sé, Vila Mariana) and one of protection (RR = 0,78) formed by 14 districts of the south region (Campo Grande, Campo Limpo, Capão Redondo, Cidade Ademar, Cidade Dutra, Grajaú, Jardim Ângela, Jardim São Luís, Santo Amaro, Socorro, Pedreira, Raposo Tavares, Vila Andrade, Vila Sônia). The test considering 5% of the total population as the maximum cluster size, found 2 significant clusters. In this test, the risk cluster of the first test was dismembered in two minor clusters, both of risk. The primary cluster presented RR = 1,92 in 9 central districts the secondary cluster RR = 1,58 in 6 districts of the south-centre. To the logistic regression analysis, the risk cluster identified in the first spatial scan test (18 districts) and the others 78 districts (contrast) were defined as dependent variables and the socioeconomic-cultural variables as independent. The first adjusted model in the multivaried regression identified these variables like risk: singles (OR = 2,36); migrant (OR = 1,49); catholics (OR = 1,36); high income (OR = 1,05). The second multivaried model identified these variables like protection: married (OR = 0,48); evangelic (0,60). The results can be explained by the literature risk factors, the Durkheim´s theory well-adjusted for the reality of São Paulo and by the difference between suicide and homicide

Seasonality, ephemerides and mortality from coronary heart disease, stroke, heart failure, traffic accidents, suicide and homicide in the city of São Paulo

INTRODUÇÃO: O presente estudo teve como objetivo principal avaliar o impacto dos feriados do Natal e Ano Novo na mortalidade por doença coronariana, AVC, insuficiência cardíaca, acidente de transporte, suicídio e homicídio na cidade de São Paulo, 1996 a 2009. Os objetivos secundários foram investigar outras efemérides, como carnaval, copa do mundo e rebaixamento de times paulistas (Corinthians e Palmeiras), ataque do PCC no ano de 2006. Além disso, foram investigadas associações entre variáveis ambientais, culturais com a mortalidade, como sazonalidade, dia da semana, atributos do clima e poluentes atmosféricos. MÉTODOS: Estudo ecológico e retrospectivo. Os dados diários de mortalidade foram obtidos pelo PRO-AIM. O estudo realizou três tipos de análise: (1) comparação de médias; (2) tendência; (3) regressão linear. Análise de variância (ANOVA) com teste post hoc de Bonferroni foi utilizada para comparar a média de mortes entre as estações do ano e entre os dias da semana. O nível de significância adotado foi de 0,05. No caso das efemérides, foi utilizado o mesmo teste (ANOVA) para comparar com a média de mortes da data controle. A análise de tendência foi realizada pelo programa joinpoint regression. Foi considerada a média de mortes por semana epidemiológica ao longo do ano (53 semanas) bem como os dias próximos ao Natal e Ano novo. O objetivo dessa análise foi identificar alguma alteração das mortes no período do Natal e Ano novo. Para a análise da associação entre mortalidade e variáveis ambientais, foram escolhidos dois períodos do ano: 24 de dezembro a 1 de janeiro e 24 de junho a 2 de julho. Foram calculadas as médias anuais para cada causa de morte bem como de cada variável ambiental, ano a ano. Foi utilizado teste para o coeficiente de correlação e regressão linear para estimar as associações. RESULTADOS: Foi identificado um excesso de homicídio no período do Natal e Ano novo para o sexo masculino e total. Considerando-se apenas o feriado (25 de dezembro e 1 de janeiro) o excesso de homicídio foi de 7,81 (p<0,01) mortes para o total. As demais efemérides não apresentaram diferença significativa em relação às respectivas datas de controle. A análise de variância, para o grupo de doenças cardiovasculares, identificou um pico significativo de mortes no inverno. Suicídio e homicídio apresentaram picos nas estações quentes. Acidente de transporte não apresentou padrão definido. Quanto ao dia da semana, doença coronariana apresentou excesso de mortes na segunda-feira, insuficiência na terça-feira. AVC não apresentou padrão definido. Homicídio e acidente de transporte apresentaram maior frequência de mortes aos finais de semana. Suicídio apresentou picos no domingo e segunda-feira. A análise de tendência identificou um pico no meio do ano, correspondente ao inverno, para mortes por doenças cardiovasculares. Acidente de transporte apresentou queda no período do Natal e Ano novo. Considerando-se os dias próximos ao Natal e Ano novo, não foi identificada nenhuma alteração da tendência. Na análise de regressão, para doença coronariana, foi identificada associação negativa com a temperatura mínima e positiva com NO2, para o total e sexo masculino. CONCLUSÃO: Foi identificado um pico significativo de homicídios no Natal e Ano novo, que pode ser explicado parcialmente pela teoria de atividade de rotina. Quanto à sazonalidade os resultados condizem com a literatura, ou seja, mortes por doenças cardiovasculares mais frequentes no inverno, suicídio e homicídio no verão. Em relação ao dia da semana foram identificados alguns resultados diferenciados, como maior ocorrência de mortes por insuficiência cardíaca as terças-feiras e suicídio aos domingos e segundas-feirasINTRODUCTION: This study aimed to evaluate the impact of the Christmas and New Years holidays in the mortality from coronary heart disease, stroke, heart failure, traffic accidents, suicide and homicide in the city of São Paulo, 1996 to 2009. Secondary objectives were to investigate other ephemerides, like carnival, world cup and demotion of the football teams (Corinthians and Palmeiras), PCC attack in 2006. In addition, we investigated associations between environmental and cultural variables with mortality, as seasonality, day of week, weather and air pollutants. METHODS: An ecological and retrospective study. The daily mortality data were obtained through PRO-AIM. The study conducted three types of analysis: (1) comparison of means, (2) trend, (3) linear regression. Analysis of variance (ANOVA) with Bonferroni post hoc test was used to compare the average number of deaths between seasons and between the day of the week. The level of significance was 0.05. In the case of the ephemeris, we used the same test (ANOVA) to compare with the deaths with the control period. A trend analysis was performed by the joinpoint regression program. It was considered the average of deaths per epidemiological week throughout the year (53 weeks) and the days near Christmas and New Year. The purpose of this analysis was to identify any changes in the deaths during this period. For the analysis of association between mortality and environmental variables were chosen two periods of the year: December 24 to January 1 and June 24 to July 2. Annual averages were calculated for each cause of death as well as each environmental variable from year to year. Test was used for the coefficient of correlation and linear regression to estimate associations. RESULTS: An excess of homicide in the period around Christmas and New Year was identified for males and total. Considering only the holiday (December 25 and January 1) the excess of homicide was 7.81 (p <0.01) for total deaths. Other ephemerides did not differ significantly from their respective control dates. The analysis of variance for the group of cardiovascular disease, identified a significant peak of deaths in winter. Suicide and homicide peaked in the warm seasons. Transport accident showed no definite pattern. Considering the day of the week, coronary heart disease showed an excess of deaths on Monday, heart failure on Tuesday. Stroke showed no definite pattern. Homicide and transport accident deaths were more frequent on weekends. Suicide peaks were on Sunday and Monday. Trend analysis identified a peak in the middle of the year, corresponding to winter, only to deaths from cardiovascular disease. Traffic accidents decreased during the Christmas and New Year. Considering the days near Christmas and New Year, no change was identified. In regression analysis, coronary heart disease was negatively associated with minimum temperatura and positively with NO2, for the total and male. CONCLUSION: We identified a significant spike of homicides in the Christmas and New Year, which can be partially explained by the theory of routine activity. The seasonality results consistent with the literature, ie, deaths from cardiovascular disease more common in winter, suicide and homicide in the summer. Regarding the day of the week have been identified differing results, as higher incidence of deaths from heart failure on Tuesdays and suicide on Sunday and Monda