Incidence of Suicide Attempts in Madrid: Characteristics of the Attempts and Response of the Health System

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
M. Miret ◽  
C. Morant ◽  
R. Nuevo ◽  
M. Jiménez ◽  
M. Reneses ◽  
...  
Keyword(s):  
Public Health ◽  
Suicidal Ideation ◽  
Health System ◽  
Suicide Attempts ◽  
Public Health Problem ◽  
Public Hospitals ◽  
Prevention Measures ◽  
The Public ◽  
Emergency Units

Background:Suicide is a serious public health problem. In 2005, 793 people were hospitalized in Madrid due to suicide attempt. However, most of the attempts do not require hospitalization and patients are discharged after the intervention in the emergency units. With the aim to implement local policies to prevent suicide, it is important to know the whole spectrum of suicide attempts that contact emergency units in Madrid.Aims:To explore the incidence of suicide attempts assisted in the public health system in Madrid and to analyze their characteristics and the response of the health system.Method:Clinical reports of all patients attempting suicide were analyzed during 4 months in 4 general public hospitals (covering 44.7% of the whole population) in the Community of Madrid.Results:1009 suicide attempts committed by 921 people (66.2% women) were collected, with an incidence of 34.3 people per 100.000 in 4 months. 57 people (6.2%) committed more than one attempt (range 2 to 10, mean=2.5 ± 1.3). After the emergency intervention 71.9% of the patients were discharged, 25.3% hospitalized, 2.6% fled, and 0.2% died. Regarding suicidal ideation, 7.5% presented very high levels during evaluation, while 13.1% had high levels, 20.3% moderate and 47.3% had no suicidal ideation.Conclusion:Compared with other European countries, our findings show moderate incidence of suicide attempts, most of which were mild, treated in the emergency units and derived to outpatient psychiatric follow-up. These results suggest places to develop and implement prevention measures.Funded by Instituto de Salud Pública de Madrid.

Substance Abuse and Drug-Related Death, Suicidal Ideation, and Suicide: A Review

Crisis ◽  
1999 ◽  
Vol 20 (1) ◽  
pp. 28-35 ◽  
Author(s):  
Annie Mino ◽  
Arnaud Bousquet ◽  
Barbara Broers
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Substance Abuse ◽  
Suicidal Ideation ◽  
Family Support ◽  
Drug Users ◽  
Suicide Attempts ◽  
Public Health Problem ◽  
Major Public Health Problem ◽  
Hiv Epidemic

The high mortality rate among drug users, which is partly due to the HIV epidemic and partly due to drug-related accidental deaths and suicides, presents a major public health problem. Knowing more about prevalence, incidence, and risk factors is important for the development of rational preventive and therapeutic programs. This article attempts to give an overview of studies of the relations between substance abuse, suicidal ideation, suicide, and drug-related death. Research in this field is hampered by the absence of clear definitions, and results of studies are rarely comparable. There is, however, consensus about suicidal ideation being a risk factor for suicide attempts and suicide. Suicidal ideation is also a predictor of suicide, especially among drug users. It is correlated with an absence of family support, with the severity of the psychosocial dysfunctioning, and with multi-drug abuse, but also with requests for treatment. Every clinical examination of a drug user, not only of those who are depressed, should address the possible presence of suicidal ideation, as well as its intensity and duration.

Fostering healthcare innovation in public hospitals: the Queensland experience

2019 ◽  
Vol 43 (6) ◽  
pp. 672
Author(s):  
Linda Mundy ◽  
Sarah Howard ◽  
Liam McQueen ◽  
Jacqui Thomson ◽  
Kaye Hewson
Keyword(s):  
Public Health ◽  
Clinical Practice ◽  
Health System ◽  
Real World ◽  
Public Health System ◽  
Public Hospitals ◽  
Policy Makers ◽  
The Public ◽  
Health Technologies ◽  
Healthcare Technologies

Faced with scarce resources and a demand for health care that exceeds supply, health policy makers at all levels of government need to adopt some form of rationing when deciding which health services should be funded in the public health system. With a relatively small investment, programs such as Queensland Health’s New Technology Funding Evaluation Program (NTFEP) fosters innovation by providing funding and pilot studies for new and innovative healthcare technologies. The NTFEP assists policy makers to make informed decisions regarding investments in new safe and effective technologies based on available evidence gathered from real-world settings relevant to Queensland patients and clinicians. In addition, the NTFEP allows appropriate patient access, especially in rural and remote locations, to potentially beneficial technologies and acts a gatekeeper, protecting them from technologies that may be detrimental or harmful. What is known about the topic? Jurisdictions have struggled to identify ways to manage the introduction of new and innovative health technologies into clinical practice. The 2009 review of health technology in Australia recommended better assessment and appraisal by ensuring real-life practices in hospitals and community settings were considered, with a consumer and patient focus. What does this paper add? Queensland Health’s NTFEP provides a robust and transparent mechanism to manage the introduction of innovative healthcare technologies into clinical practice, providing an opportunity to collect real-world data outside of formal clinical trials. These data can not only be used to inform clinical, but also purchasing, decision-making within the public health system. This model of investment and innovation has the potential to be implemented in other jurisdictions and provide opportunities to share learnings. What are the implications for practitioners? Programs such as the NTFEP provide reassurance to practitioners and patients alike that innovative healthcare technologies are adopted in public hospitals using an evidence-based approach after demonstrating that they are not only safe and clinically effective, but represent value for money and improved patient outcomes in a public health system.

scholarly journals Outcomes of COVID-19 Admissions in the New York City Public Health System and Variations by Hospitals and Boroughs During the Initial Pandemic Response

2021 ◽  
Vol 9 ◽  
Author(s):  
Anant Dinesh ◽  
Taha Mallick ◽  
Tatiana M. Arreglado ◽  
Brian L. Altonen ◽  
Ryan Engdahl
Keyword(s):  
Public Health ◽  
New York ◽  
New York City ◽  
Health System ◽  
York City ◽  
Public Health System ◽  
Public Hospitals ◽  
Mortality Trends ◽  
The Public ◽  
Pandemic Response

Introduction: In the initial pandemic regional differences may have existed in COVID-19 hospitalizations and patient outcomes in New York City. Whether these patterns were present in public hospitals is unknown. The aim of this brief study was to investigate COVID-19 hospitalizations and outcomes in the public health system during the initial pandemic response.Methods: A retrospective review was conducted on COVID-19 admissions in New York City public hospitals during the exponential phase of the pandemic. All data were collected from an integrated electronic medical records system (Epic Health Systems, Verona, WI). Overall, 5,422 patients with at least one admission each for COVID-19 were reviewed, with a study of demographic characteristics (including age, gender, race, BMI), pregnancy status, comorbidities, facility activity, and outcomes. Data related to hospitalization and mortality trends were also collected from City of New York website. These data often involved more than one facility and/or service line resulting in more location or treatment facility counts than patients due to utilization of services at more than one location and transfers between locations and facilities.Results: Higher mortality was associated with increasing age with the highest death rate (51.9%) noted in the age group >75 years (OR 7.88, 95%CI 6.32–10.08). Comorbidities with higher mortality included diabetes (OR 1.5, 95% CI 1.33–1.70), hypertension (OR 1.62, 95% CI 1.44–1.83), cardiovascular conditions (OR 1.66, 95% CI 1.47–1.87), COPD (OR 1.86, 95% CI 1.39–2.50). It was deduced that 20% of all New York City COVID-19 positive admissions were in public health system during this timeframe. A high proportion of admissions (21.26%) and deaths (19.93%) were at Elmhurst Hospital in Queens. Bellevue and Metropolitan Hospitals had the lowest number of deaths, both in borough of Manhattan. Mortality in public hospitals in Brooklyn was 29.9%, Queens 28.1%, Manhattan 20.4%.Conclusion: Significant variations existed in COVID-19 hospitalizations and outcomes in the public health system in New York City during the initial pandemic. Although outcomes are worse with older age and those with comorbidities, variations in hospitals and boroughs outside of Manhattan are targets to investigate and strategize efforts.

scholarly journals Access to colposcopy in the State of São Paulo, Brazil: probabilistic linkage study of administrative data

2022 ◽  
Vol 38 (1) ◽  
Author(s):  
Lewis Fletcher Buss ◽  
Lise Cury ◽  
Caroline Madalena Ribeiro ◽  
Gulnar Azevedo e Silva ◽  
José Eluf Neto
Keyword(s):  
Public Health ◽  
Cervical Cancer ◽  
Health System ◽  
Public Health System ◽  
Sao Paulo ◽  
The State ◽  
São Paulo ◽  
The Public ◽  
Reference Cohort

Cervical cancer screening is a multistage process, therefore access to both the primary test and subsequent diagnostic procedures is essential. Considering women undergoing screening on the public health system in the State of São Paulo, Brazil, we aimed to estimate the proportion of women accessing colposcopy within six months of an abnormal smear result. We retrieved records from two administrative databases, the Information System on Uterine Cervical Cancer (SISCOLO) that contains smear results and the Outpatient Information System of the Brazilian Unified National Health System (SIA/SUS) that records colposcopies. A reference cohort consisted of women, aged 25 years or older, with an abnormal smear result between May 1, 2014, and June 30, 2014. We excluded prevalent cases. We linked the reference cohort and records in the SIA/SUS extending to December 31, 2014. After excluding prevalent cases, 1,761 women with abnormal cytology results were left. A total of 700 (39.8%) women were linked to a colposcopy record within the follow-up period; this dropped to 671 (38.1%) women when follow-up was censored at six months. We could notice a slightly higher attendance in women living in the metropolitan region of São Paulo compared with residents of the rest of the state. We found no association between colposcopy attendance and age or cytology class. These results emphasize that access to colposcopy in the public health system in São Paulo is limited. This compromises the quality of screening, and the issue needs to be prioritized in service planning.

Psychiatric follow up after a suicide attempt

2016 ◽  
Vol 33 (S1) ◽  
pp. s271-s271
Author(s):  
D. de la Vega Sánchez ◽  
M. Reina Domínguez ◽  
S. Fernández León
Keyword(s):  
Public Health ◽  
Suicide Attempt ◽  
Emergency Service ◽  
Suicide Attempts ◽  
Public Health Problem ◽  
Global Public Health ◽  
The Mean ◽  
Competing Interest ◽  
Global Public Health Problem

IntroductionSuicide is a global public health problem. More than 800,000 people die due to suicide every year according to the WHOM. In Spain, about 9 people die due to suicide every day, and the rates increase every year. The presence of previous suicide attempts is one of the strongest risk factors for suicide consumption. Nevertheless, patients sometimes do not receive a correct assistance after a suicide attempt.ObjectiveTo study the follow-up of patients, without previous psychiatrichistory, who commit a first suicide attempt in the area of Huelva (Spain).MethodRetrospective review of the electronic clinical histories of patients attended in the Emergency service of Juan Ramón Jiménez Hospital after a first suicide attempt during the first six months of 2015.ResultsFrom January to June of 2015 we collected a total of 159 patients who committed a firs suicide attempt in our area. A total of 69.18% were women and 30.82 were men. In both sex the mean age was 39 years. Out of the 159 attended after a first suicide attempt, only 54% were referred to the Psychiatry service to be followed up. Out of those referred, only 62% actually attended and only half of them really staying treatment.ConclusionsAn adequate psychiatric follow up after a suicide attempt is needed to reduce the risk of more suicide attempts or consumption. A minority (30.8%) of the patients attended in our area after a first suicide attempt received an adequate attention.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Research as the gatekeeper: introduction ofrobotic-assisted surgery into the public sector

2019 ◽  
Vol 43 (6) ◽  
pp. 676
Author(s):  
Kate E. McBride ◽  
Daniel Steffens ◽  
Michael J. Solomon ◽  
Teresa Anderson ◽  
Jane Young ◽  
...  
Keyword(s):  
Public Health ◽  
Health System ◽  
Public Health System ◽  
Research Training ◽  
New Technology ◽  
Public Hospitals ◽  
Tertiary Referral Hospital ◽  
Governance Framework ◽  
Surgical Technology ◽  
The Public

Objective Within Australia, robotic-assisted surgery (RAS) has largely been undertaken within the private sector, and predominately based within urology. This is rapidly developing, with RAS becoming increasingly prevalent across surgical specialties and within public hospitals. At this point in time there is a need to consider how this generation of the technology can be appropriately and safely introduced into the public health system given its prohibitive costs and lack of high-level long-term evidence. Methods This paper describes a unique approach used to govern the establishment of a new RAS program within a large public tertiary referral hospital in Australia. This included the creation of a comprehensive governance framework that covered research, training and operational components, with research being the ultimate gatekeeper to accessing the technology. Results Taking this novel approach, both benefits and challenges were encountered. Although initially there was a trade-off of activity to enable time for the research program to be developed, it was found the model strengthened patient safety in introducing the technology, fostered a breadth of surgical speciality involvement, ensured uniformity of data collection and, in the longer term, will enable a significant contribution to be made to the evidence regarding the appropriateness of RAS being used across several surgical specialties. Conclusions There is potential for this comprehensive governance framework to be transferred to other public hospitals commencing or with existing RAS programs and to be applied to the introduction of other new and expensive surgical technology. What is known about the topic? RAS is rapidly evolving and becoming increasingly prevalent across surgical specialities in major public hospitals. Consequently, it is important that this new technology is safely and appropriately implemented into the public health system. What does this paper add? This article describes the benefits and implementation challenges of a novel RAS approach, including a comprehensive governance framework that covered research, training and operational components, with research being the ultimate gatekeeper to accessing the technology. What are the implications for practitioners? This comprehensive governance framework can be transferred to other public hospitals introducing, or already using, new and expensive surgical technology.

scholarly journals Correctional Work: Reflections Regarding Suicide

2021 ◽  
Vol 18 (8) ◽  
pp. 4280
Author(s):  
Christine Genest ◽  
Rosemary Ricciardelli ◽  
R. Nicholas Carleton
Keyword(s):  
Public Health ◽  
Suicidal Ideation ◽  
Family Doctor ◽  
Public Health Problem ◽  
Health Agency ◽  
Life Time ◽  
Psychological Theory ◽  
Small Sample ◽  
Employee Assistance Program ◽  
Assistance Program

The Public Health Agency of Canada declared suicide a public health problem in Canada (2016). Employees working in correctional services, researchers find, experience high rates of life-time suicidal ideation in comparison to other public safety professionals and the general population. Suicide behaviours (i.e., ideation, planning, attempts, death) are a multifactorial phenomenon, explained in part by the Interpersonal-Psychological Theory of Suicide that suggests attempted suicide is facilitated by perceived burdensomeness, a lost sense of belonging, a feeling of hopelessness, and a progressively reduced fear of death, as well as capacity and planning to engage a lethal attempt. In the current study, we unpack the factors that can influence suicide behaviours as reported by correctional workers. Our intent is to make explicit the experiences of a small sample (n = 25) of correctional workers in relation to suicidal behaviours, highlighting stories of recovery and acknowledging the importance of facilitating psychologically safe workplaces. Analysis entailed an inductive semi-grounded emergent theme approach. Participants identified certain risk factors as being able to induce suicidal ideation, such as marital or family problems as well as difficulties at work (i.e., bullying or difficult working conditions). Having children and a partner may act as factors preventing suicide for those with ideation. Participants sought help from professionals, such as their family doctor, a psychologist, or the Employee Assistance Program (EAP); however, the lack of perceived organisational supports and recognition of the issue of suicide by the employer are two elements that can hinder the search for help.

scholarly journals The potential dangers of not understanding COVID-19 public health restrictions in dementia: “It’s a groundhog day – every single day she does not understand why she can’t go out for a walk”

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Clarissa Giebel ◽  
Kerry Hanna ◽  
Manoj Rajagopal ◽  
Aravind Komuravelli ◽  
Jacqueline Cannon ◽  
...  
Keyword(s):  
Public Health ◽  
Cognitive Deficits ◽  
Third Sector ◽  
Cognitive Capacity ◽  
The Public ◽  
Health Measures ◽  
Third Sector Organisations ◽  
The Uk ◽  
Second Wave

Abstract Background Sudden public health restrictions can be difficult to comprehend for people with cognitive deficits. However, these are even more important for them to adhere to due to their increased levels of vulnerability, particularly to COVID-19. With a lack of previous evidence, we explored the understanding and changes in adherence to COVID-19 public health restrictions over time in people living with dementia (PLWD). Methods Unpaid carers and PLWD were interviewed over the phone in April 2020, shortly after the nationwide UK lockdown, with a proportion followed up from 24th June to 10th July. Participants were recruited via social care and third sector organisations across the UK, and via social media. Findings A total of 70 interviews (50 baseline, 20 follow-up) were completed with unpaid carers and PLWD. Five themes emerged: Confusion and limited comprehension; Frustration and burden; Putting oneself in danger; Adherence to restrictions in wider society; (Un) changed perceptions. Most carers reported limited to no understanding of the public health measures in PLWD, causing distress and frustration for both the carer and the PLWD. Due to the lack of understanding, some PLWD put themselves in dangerous situations without adhering to the restrictions. PLWD with cognitive capacity who participated understood the measures and adhered to these. Discussion In light of the new second wave of the pandemic, public health measures need to be simpler for PLWD to avoid unwilful non-adherence. Society also needs to be more adaptive to the needs of people with cognitive disabilities more widely, as blanket rules cause distress to the lives of those affected by dementia.

scholarly journals Retrospective study of the distribution of doctors in municipalities of extreme poverty in Brazil

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
B L O Luizeti ◽  
E M M Massuda ◽  
L F G Garcia
Keyword(s):  
Public Health ◽  
Health System ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Extreme Poverty ◽  
The Public ◽  
The North ◽  
Unified Health System ◽  
Shortage Of Doctors ◽  
Demographic Distribution

Abstract In view of the national scenario of scarcity of material and human resources in public health in Brazil, the survey verified the demographics of doctors who attend the Unified Health System (SUS) in municipalities of extreme poverty. An observational, analytical and cross-sectional study was carried out, based on secondary quantitative data from the Department of Informatics of the SUS using the TABNET of December 2019. The care networks variable was restricted to infer the number of physicians who attend the SUS in extreme poverty municipalities in Brazil. Municipalities of extreme poverty are those that at least 20% of the population have a household income of up to 145 reais per capita monthly. In Brazil, there are 1526 municipalities in extreme poverty, 27.4% of the country's total municipalities. 14,907 doctors linked to SUS work in this condition, 3.19% of the total of these professionals in Brazil. There is still disproportion between regions: North concentrates 11.2% of the municipalities in extreme poverty and 8.61% of the total number of doctors; Northeast, with 61.33% of these municipalities, for 61.5% of doctors; Southeast, with 15.46% of the municipalities in this condition, has 20.6% of doctors; South concentrates 10.87% of the municipalities under discussion with 5.61% of doctors and the Midwest, with 4.87% of these municipalities, has 3.54% of doctors. Between 2009 and 2018, there was a 39% increase in the number of doctors in these locations, however, for 2019, there was a decrease of 3.89%. The medical demographic distribution in Brazil is uneven, especially in the North. There is also the vulnerability of this population in view of the observed reduction in the number of professionals between 2018 and 2019 in municipalities of extreme poverty, for political reasons. It is evident the need to restructure the health system to guarantee access to health for this population, through the attraction and fixation of doctors in needy regions in Brazil. Key messages Shortage of doctors in extreme poverty municipalities reinforces the health vulnerability of the population in Brazil. The uneven medical demography in Brazil requires restructuring in the public health system.

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