El suicidio es un acto complejo en el que se pueden identificar al menos tres elementos: ocurre un deceso, la muerte se ve ocasionada por la misma persona que muere, y el acto es intencional, es decir, la persona suicida está plenamente consciente de las consecuencias de su acto (1). La mortalidad por suicidios se ha convertido en un problema de prioridad para la salud pública, La mortalidad por suicidios: México 1990-2001Esteban Puentes-Rosas, 1 Leopoldo López-Nieto 1 y Tania Martínez-Monroy 1 tanto a escala nacional como internacional. A pesar de que la muerte por suicidio es solo la parte más visible de un problema que tiene amplias conexiones sociales, psicológicas y personales, y de que frecuentemente se ha argumentado que los registros habituales de suicidios tienden a subestimar el problema (2), la mayor parte de las conclusiones que se pueden sacar a partir de las cifras oficiales son esencialmente correctas (3). El incremento en la frecuencia de suicidios está asociado con diversos factores que varían en dependencia del grupo de edad estudiado. Entre los jóvenes influyen la depresión, el aumento del consumo de drogas y de alcohol; en los adultos mayores, las enfermedades que generan gran dolor o discapacidad; y en los grupos de edad laboralmente activos, otros factores de índole laboral y económica (4, 5). Un estudio realizado en adolescentes que residían en la ciudad de México mostró una asociación entre la ideación suicida en los adolescentes y vivir en hogares donde estaba presente solo uno de los padres, situación que es cada vez más frecuente en México (6). Objetivo. Describir la mortalidad por suicidios en México en 2001, así como los principales cambios en los métodos de suicidio y en la estructura por edades y sexos que se han presentado desde 1990, tanto a escala nacional como por entidad federativa. Métodos. Para este estudio descriptivo se utilizaron como fuentes de información los registros oficiales de mortalidad del Instituto Nacional de Estadística, Geografía e Informática para el período de 1990 a 2001. Para calcular las tasas de mortalidad se usaron las poblaciones estimadas por el Consejo Nacional de Población en 2002. Se describieron la mortalidad por sexo, por grupo de edad y por entidad federativa, así como los cambios observados en el período de 1990-2001 en las tasas y los métodos de suicidio. Para estandarizar las tasas se empleó el método directo, y como estándar se tomaron los datos de población del año 2000. Las comparaciones estadísticas de las tendencias según el grupo de edad y elDurante mucho tiempo, México presentó una de las tasas de mortalidad por suicidios más bajas de América Latina. Sin embargo, en los últimos años la mortalidad por esta causa se ha incrementado progresivamente en este país a un ritmo más acelerado que en otros países de la Región (7).Teniendo en cuenta que el trabajo publicado más recientemente sobre la mortalidad por suicidios en México se basa en datos obtenidos hasta 1994 (8), se hace necesario actualizar la información acerca de este tema. El ob...
Introduction Influenza morbidity and mortality are significant in the countries of South America, yet influenza vaccination is as low as 56.7% among pregnant women, reaching 76.7% of adults with chronic diseases. This article measures the relative values for the vaccination hesitancy indicators of confidence, complacency and convenience by risk-groups in urban areas of five countries of South America with contrasting vaccination rates, analyzing their association with sociodemographic variables and self-reported immunization status. Methods An exit survey was applied to 640 individuals per country in Brazil, Chile, Paraguay, Peru and Uruguay, distributed equally across risk groups of older adults, adults with risk factors, children ≤6 and pregnant women. Indicators were constructed for vaccine confidence, complacency and convenience. Analysis of variance and multiple logistic analysis was undertaken. Results Adults with risk factors are somewhat more confident of the influenza vaccine yet also more complacent. Convenience is higher for mothers of minors. Children and older adults report higher levels of vaccination. The 3Cs are more different across countries than across risk groups, with values for Chile higher for confidence and those for Uruguay the lowest. Complacency is lower in Brazil and higher in Uruguay. Results suggest that confidence and complacency affect vaccination rates across risk groups and countries. Conclusions Influenza vaccine confidence, complacency and convenience have to be bolstered to improve effective coverage across all risk groups in the urban areas of the countries studied. The role played by country contextual and national vaccination programs has to be further researched in relation to effective coverage of influenza vaccine.
Dengue remains an unmet public health burden. We determined risk factors for dengue in-hospital mortality in Brazil. Of 326,380 hospitalised dengue cases in 9-45-year-old individuals, there were 971 deaths. Risk of dying was 11-times higher in the presence of underlying common comorbidities (renal, infectious, pulmonary disease and diabetes), similar to the risk of dying from severe dengue and much higher with the combination. Ensuring access to integrated dengue preventative measures in individuals aged ≥ 9 years including those with comorbidities may help achieve the WHO objective of 50% reduction in mortality and 25% reduction in morbidity due to dengue by 2020.
PurposeThe incidence of infection-associated cancers and lethality of cancers amenable to treatment are closely correlated with the income of countries. We analyzed a core part of this global cancer divide—the distribution of premature mortality across country income groups and cancers—applying novel approaches to measure avoidable mortality and identify priorities for public policy.MethodsWe analyzed avoidable cancer mortality using set lower- and upper-bound age limits of 65 and 75 years (empirical approach), applying cancer-specific and country income group–specific ages of death (feasibility approach), and applying cancer-specific ages of death of high-income countries to all low- and middle-income countries (LMICs; social justice approach). We applied these methods to 2015 mortality data on 16 cancers for which prevention is possible and/or treatment is likely to result in cure or significant increase in life expectancy.ResultsAt least 30% and as much as 50% of cancer deaths are premature, corresponding to between 2.6 and 4.3 million deaths each year, and 70% to 80% are concentrated in LMICs. Using the feasibility approach, 36% of cancer deaths are avoidable; with the social justice approach, 45% of cancer deaths are avoidable. Five cancer types—breast, colorectal, lung, liver, and stomach—account for almost 75% of avoidable cancer deaths in LMICs and worldwide.ConclusionEach year, millions of premature cancer deaths could be avoided with interventions focused on four priority areas: infection-associated cancers, lifestyle and risk factors, women’s cancers, and children’s cancers. Our analysis of the global burden and the specific cancer types associated with avoidable cancer mortality suggests significant opportunities for health systems to redress the inequity of the global cancer divide.
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