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da Silva Araújo PS, da Silveira TB, de Moura FR, Dos Santos Maidana M, de Sousa GRD, de Carvalho Dumith S, da Silva Júnior FMR. Epidemiological profile, temporal analysis, and future projections of suicide cases in rural cities in the extreme south of Brazil. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2023; 86:965-978. [PMID: 37731290 DOI: 10.1080/15287394.2023.2258914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
The present study aimed to verify the time series (2000-2017) of death rates by suicide and its associated factors in 4 municipalities in the extreme south of Brazil. Data were obtained through the analysis of medical reports and police report bulletins at the Instituto Médico Legal, in the city of Rio Grande. The suicide rate in the Rio Grande region varied from 4 to 11 suicides per 100,000 inhabitants and it is estimated that by 2030 this rate could reach 16.5 suicides per 100,000 inhabitants. The rural cities of Santa Vitória do Palmar and Chuí present even higher suicide averages when compared to Rio Grande, the most populous city of the four. The death rate from suicide increased gradually in the period analyzed, with the prevalence rising among the youngest and the elderly population. A more comprehensive understanding of the influences of environmental issues on suicidal decisions constitutes an important action that needs to be taken, both because of regional vulnerabilities and the target population identified. Evidence indicates that knowledge of factors affecting individuals residing in this Brazilian region where increased suicide rates are recorded needs to be recognized as a priority.
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Affiliation(s)
- Paula Santos da Silva Araújo
- Laboratório de Ensaios Farmacológicos e Toxicológicos - LEFT, Instituto de Ciências Biológicas, Universidade Federal do Rio Grande (FURG), Rio Grande-RS, Brasil
| | - Tatiane Britto da Silveira
- Laboratório de Ensaios Farmacológicos e Toxicológicos - LEFT, Instituto de Ciências Biológicas, Universidade Federal do Rio Grande (FURG), Rio Grande-RS, Brasil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande (FURG), Rio Grande-RS, Brasil
| | - Fernando Rafael de Moura
- Laboratório de Ensaios Farmacológicos e Toxicológicos - LEFT, Instituto de Ciências Biológicas, Universidade Federal do Rio Grande (FURG), Rio Grande-RS, Brasil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande (FURG), Rio Grande-RS, Brasil
| | - Merlyn Dos Santos Maidana
- Laboratório de Ensaios Farmacológicos e Toxicológicos - LEFT, Instituto de Ciências Biológicas, Universidade Federal do Rio Grande (FURG), Rio Grande-RS, Brasil
| | - Guaraciaba Ribeiro Duarte de Sousa
- Posto Médico-Legal de Rio Grande, Departamento de Perícias do Interior, Instituto Geral de Perícias, Praça Barão de São José do Norte - Rua Aquidaban - Centro, Rio Grande- RS, Brasil
| | - Samuel de Carvalho Dumith
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande (FURG), Rio Grande-RS, Brasil
| | - Flavio Manoel Rodrigues da Silva Júnior
- Laboratório de Ensaios Farmacológicos e Toxicológicos - LEFT, Instituto de Ciências Biológicas, Universidade Federal do Rio Grande (FURG), Rio Grande-RS, Brasil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande (FURG), Rio Grande-RS, Brasil
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Mendes ADCL, de Souza TA, Medeiros ADA, Barbosa IR. Pneumonia in Children under 5 Years: Temporal Trends and Spatial Patterns of Hospitalizations in Brazil. Am J Trop Med Hyg 2023; 108:916-926. [PMID: 37011891 PMCID: PMC10160880 DOI: 10.4269/ajtmh.21-0664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 05/31/2022] [Indexed: 04/05/2023] Open
Abstract
This study aimed to identify temporal and spatial patterns in the distribution of hospitalization rates for pneumonia in children under 5 years in Brazil. An ecological study was developed using data from the Unified Health System of hospitalizations for pneumonia in children under 5 years in Brazil from 2000 to 2019. Hospitalization rates per 1,000 children were calculated and Joinpoint Regression analyzed the temporal trends. Different spatial analysis techniques were performed. Annual rates of 25 hospitalizations per 1,000 children were observed in 2000 and of 13.83 per 1,000 children in 2019, with a significant downward trend for the country (annual percentage change = -3.4%; 95% confidence interval: -3.8 to -3.0) and for the regions. There was weak spatial autocorrelation; however, there were regions with high rates of hospitalization in the south region and clusters of low rates in the northeast and southeast. Clusters of areas with high hospitalization rates were observed in areas of favorable socioeconomic conditions and provision of health services in the interior of southern Brazil. There is a decreasing trend in hospitalizations for pneumonia in general; however, there are clusters of high rates in the south of Brazil.
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Affiliation(s)
| | - Talita Araujo de Souza
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Arthur de Almeida Medeiros
- Graduate Program in Collective Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Integrated Health Institute, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Isabelle Ribeiro Barbosa
- Graduate Program in Collective Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Martins CDC, Lemos YV, Teodoro MLM, Drummond-Lage AP. Epidemio-toxicological profile of suicide cases: analysis from a forensic unit in Brazil. Forensic Sci Res 2023; 7:643-649. [PMID: 36817255 PMCID: PMC9930856 DOI: 10.1080/20961790.2022.2113622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
The suicide phenomenon involves complex interactions between psychological, biological, cultural and socio-environmental factors. This study aimed to assess the epidemiological and toxicological profiles of officially confirmed suicide victims. A retrospective study was performed using autopsy reports, forensic anthropology examinations and police summaries of all suicide cases that underwent toxicological analysis at an Official Forensic Laboratory (Minas Gerais, Brazil) in 1 year. The sample set was composed of 351 suicide victims, predominantly men (70.32%), most of them were adults between 31 and 64 years old (62.11%), with mixed skin colour (48.89%) and low educational level (66.44%). The most common suicide method was hanging (57.79%), followed by intoxication (30.45%). Most victims presented positive toxicological results (56.41%), especially for the presence of medicines (37.6%), illicit drugs (36.3%) and pesticides (26.1%). Our study corroborated previous data that most suicide victims have low educational levels. The most common toxicological findings were medicines, especially prescription drugs, followed by illicit drugs and pesticides. We hope this study contributes to reflections and planning of preventive suicide programmes, considering the described profiles of victims.
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Affiliation(s)
| | - Yara Viera Lemos
- Department of Forensic Anthropology, Polícia Civil de Minas Gerais, Belo Horizonte, MG, Brazil,School of Medicine, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Ana Paula Drummond-Lage
- Department of Forensic Anthropology, Polícia Civil de Minas Gerais, Belo Horizonte, MG, Brazil,Post-Graduation Department, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil,CONTACT Ana Paula Drummond-Lage
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The application of spatial analysis to understanding the association between area-level socio-economic factors and suicide: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02441-z. [PMID: 36805762 DOI: 10.1007/s00127-023-02441-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 02/02/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND Little is known about what impact the use of different spatial methodological approaches may have on understanding the relationship between area-level socio-economic factors and suicide. METHODS In this systematic review, we searched PubMed, Embase, CINAHL and PsycInfo for original empirical studies examining the relationship between socio-economic factors and suicide with a spatial lens, published up to January 22, 2022. Data on applied spatial methods, indicators of socio-economic factors, and risk of suicide related to socio-economic factors were extracted. The protocol for this systematic review was registered with PROSPERO (CRD42021251387). RESULTS A systematic search yielded 6290 potentially relevant results; 58 studies met the inclusion criteria for review. Of the 58 included studies, more than half of the studies (n = 34; 58.6%) used methods that accounted for spatial effects in analyses of the association between socio-economic factors and suicide or examined spatial autocorrelation, while 24 (41.4%) studies applied univariate and multivariate models without considering spatial effects. Bayesian hierarchical models and spatial regression models were commonly used approaches to correct for spatial effects. The risk of suicide relating to socio-economic factors varied greatly by local areas and between studies using various socio-economic indicators. Areas with higher deprivation, higher unemployment, lower income, and lower education level were more likely to have higher suicide risk. There was no significant difference in results between studies using conventional versus spatial statistic methods. CONCLUSION An increasing number of studies have applied spatial methods, including Bayesian spatial models and spatial regression models, to explore the relationship between area-level socio-economic factors and suicide. This review of spatial studies provided further evidence that area-level socio-economic factors are generally inversely associated with suicide risk, with or without accounting for spatial autocorrelation.
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Leveau CM, Alazraqui M. [Geographies of suicide in Argentina: a spatial ecological study during 1999-2003 and 2008-2012 periods]. Rev Salud Publica (Bogota) 2023; 22:14-26. [PMID: 36753135 DOI: 10.15446/rsap.v22n1.75841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 09/16/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE The aim of this study was to describe the geographical distribution and the role of sociodemographic factors on mortality by suicides, according to sex and age groups, in Argentina during the periods 1999-2003 and 2008-2012. METHODS The role of sociodemographic factors on mortality by suicides and their geographical distribution were analyzed by means of multiple spatial regressions. Three independent variables were included: an index of social fragmentation, a poverty index and population density, as an indicator of the level of rurality. RESULTS Social fragmentation and suicide were directly related in men 10-59 years old and women 10-29 years old during 1999-2003. During 2008-2012, the risk of suicide was higher in areas of low population density, except for women aged 10-29 years. CONCLUSIONS The results obtained in this study support the hypothesis of social fragmentation as a phenomenon associated with the risk of suicide in departments of Argentina, but also support the hypothesis of an increased risk of suicide in rural areas. Suicide prevention measures could focus on policies that promote social integration, especially in the young population, as well as greater cohesion of rural areas.
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Affiliation(s)
- Carlos Marcelo Leveau
- CL: Lic. Geografía. M. Sc. Epidemiología, Gestión y Políticas de Salud. Ph. D. Geografía. Instituto de Salud Colectiva, Universidad Nacional de Lanús. Remedios de Escalada, Lanús, Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Argentina.
| | - Marcio Alazraqui
- MA: MD. M. Sc.; Ph. D. Salud Colectiva. Instituto de Salud Colectiva, Universidad Nacional de Lanús. Remedios de Escalada. Lanús, Argentina.
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da Fonsêca JR, de Oliveira CM, de Castro CCL, da Costa HVV, Galvão PVM, da Costa Ceballos AG, do Bonfim CV. Analysis of the completeness of self-harm and suicide records in Pernambuco, Brazil, 2014-2016. BMC Public Health 2022; 22:1154. [PMID: 35681172 PMCID: PMC9178859 DOI: 10.1186/s12889-022-13455-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 05/18/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Suicides and suicide attempts are major public health problems, and coping strategies are hampered by insufficient or inadequate notifications. Data accuracy influences the formulation of public and mental health policies and suicide prevention strategies. The objective of this study was to analyze the completeness of self-harm and suicide records in the state of Pernambuco, Brazil, 2014-2016. METHODS This is an evaluative study with a descriptive design. The data were collected from suicide attempt records from the Notifiable Diseases Information System and suicide records from the Mortality Information System. Probabilistic linkage was used to relate these databases, and the degree of completeness of the variables was calculated. Completeness was classified into the following categories: good (≥ 75.1%), regular (50.1%-75.0%), low (25.1%-50.0%), and very low (≤ 25.0%). RESULTS In the analyzed period, 1,404 notifications of self-harm were studied, with an overall mean completeness of 86.2%. In addition, 1,050 suicide records were analyzed, with an overall mean completeness of 95.8%. Most variables referring to suicide attempts had good completeness, with the exception of the variables "occupation" and "education." The completeness of all suicide-related variables was rated as good. After linkage, a significant improvement was observed in the degree of completeness of the variable "occupation". CONCLUSION The results of this study showed that the completeness of self-harm and suicide variables improved from the first to the last year. The integration of data from different information systems provides an opportunity to improve suicide prevention programs and the quality of available information. Continuous efforts to increase the completeness and reliability of suicide surveillance systems are fundamental to describe the epidemiological profile and, consequently, plan preventive actions, in addition to contributing to the development and reformulation of strategies aimed at reducing morbidity and mortality related to suicidal behavior.
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Affiliation(s)
| | | | | | | | | | | | - Cristine Vieira do Bonfim
- Directorate of Social Research, Joaquim Nabuco Foundation, Rua Dois Irmãos, 92 - Ed. Anexo Anísio Teixeira - Apipucos, Recife, PE, CEP 52071-440, Brazil.
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Dantas ESO, Farias YMF, Rezende EB, Silva GWDS, Silva PGD, Meira KC. Estimates of suicide mortality in women residents in northeast brazilian states from 1996 to 2018. CIENCIA & SAUDE COLETIVA 2021; 26:4795-4804. [PMID: 34730664 DOI: 10.1590/1413-812320212610.29552020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 08/24/2020] [Indexed: 01/09/2023] Open
Abstract
The objective of this study was to analyze the temporal trend of suicide mortality in women in the states of Northeastern Brazil. This is an ecological study of a time series stratified by states in Northeast Brazil from 1996 to 2018, with data extracted from the Mortality Information System (SIM). The temporal trend was evaluated by negative binomial regression (p values≤0.05). There was a higher proportion of deaths in black and brown women (73.9%), single (57.3%), with the place of death occurring in the home (53.4%). Hanging and strangulation stood out as the perpetration means (47.6%). Most states showed an upward temporal trend, except for Pernambuco, Rio Grande do Norte, Sergipe and Maranhão, which showed a steady trend (p>0.05). An upward temporal trend was identified in the analysis of deaths by suicide in women in five states in northeastern Brazil between 1996 and 2018. The information presented can support planning and decision-making for the prevention of suicide among women in northeastern Brazil.
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Affiliation(s)
- Eder Samuel Oliveira Dantas
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte (UFRN). Av. Nilo Peçanha 620, Petrópolis. 59012-300 Natal RN Brasil.
| | | | | | | | - Pedro Gilson da Silva
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte (UFRN). Av. Nilo Peçanha 620, Petrópolis. 59012-300 Natal RN Brasil.
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Silva PJDC, Feitosa RA, Machado MF, Quirino TRL, Correia DS, Wanderley RDA, Souza CDFD. Perfil epidemiológico e tendência temporal da mortalidade por suicício em adolescentes. JORNAL BRASILEIRO DE PSIQUIATRIA 2021. [DOI: 10.1590/0047-2085000000338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
RESUMO Objetivo Descrever o perfil epidemiológico e analisar a tendência temporal da mortalidade por suicídio entre adolescentes (10-19 anos) do Nordeste brasileiro, no período de 2001 a 2015. Métodos Trata-se de estudo observacional, que teve como cenário a região Nordeste do Brasil. O período de estudo foi de 2001 a 2015. Consideraram-se as mortes por lesão autoprovocada intencionalmente (X60 a X84), intoxicação exógena de intenção indeterminada (Y10 a Y19) e sequela de lesões autoprovocadas intencionalmente (Y87.0), de acordo com a 10ª Revisão da Classificação Internacional de Doenças (CID-10), de adolescentes de 10 a 19 anos. As variáveis analisadas foram: sexo, faixa etária, raça/cor, CID específico, estado de residência e taxa de mortalidade por suicídio/100.000 habitantes. Resultados Foram registrados 3.194 óbitos em decorrência de suicídio na faixa etária estudada, com predomínio do sexo masculino (62,1%; n = 1.984), faixa etária de 15 a 19 anos (84,8%; n = 2.707), raça/cor parda (65,4%; n = 2.090); entre quatro e sete anos de escolaridade (31,7%; n = 1.011) e no CID X70 (47,8%; n = 1.528). A tendência temporal de mortalidade foi crescente de 2001 a 2015 (APC: 2,4%; p < 0,01), com maiores taxas no sexo masculino. Observou-se tendência crescente da taxa de suicídios, no sexo masculino, em todo o período (AAPC: 2,9%; p < 0,01). No sexo feminino, identificou-se tendência decrescente a partir de 2004 (APC: -2,2%; p < 0,01). Conclusão O perfil epidemiológico foi caracterizado pelo sexo masculino, faixa etária de 15-19 anos, cor/raça parda e escolaridade média. A tendência apresentou padrão de crescimento no sexo masculino e declínio no feminino. Recomenda-se que políticas públicas sejam voltadas para a população adolescente.
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Leveau CM, Guevel C, Alazraqui M. [Intra-urban differentials of suicide: the role of social fragmentation in Argentina]. CIENCIA & SAUDE COLETIVA 2021; 26:2345-2354. [PMID: 34231744 DOI: 10.1590/1413-81232021266.22892019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 08/28/2019] [Indexed: 11/21/2022] Open
Abstract
El suicidio constituye una de las principales causas de muerte por lesiones en Argentina y existen pocos estudios que analicen las variaciones geográficas intra-urbanas en países en desarrollo. El objetivo de este estudio fue analizar la relación entre el suicidio y el nivel socioeconómico y la fragmentación social en áreas pequeñas de la Ciudad Autónoma de Buenos Aires (CABA) durante el período 2011-2015. Se realizó un estudio ecológico utilizando datos sobre registros de suicidio en población residente de la CABA disponibles en el Ministerio de Seguridad de la Nación. Se llevó a cabo una regresión múltiple espacial para poner a prueba la relación entre el suicidio e indicadores de nivel socioeconómico y de fragmentación social por área. El riesgo de suicidio estuvo asociado positivamente a mayores índices de fragmentación social, mientras no mostró relación con el índice de pobreza. Los resultados de este estudio apoyan la hipótesis de fragmentación social como un factor asociado positivamente al aumento del suicidio a nivel intra-urbano en ciudades de países en desarrollo.
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Affiliation(s)
- Carlos Marcelo Leveau
- Instituto de Producción, Economía y Trabajo, Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional de Lanús. 29 de Septiembre 3901, Remedios de Escalada. B1824PJU Provincia de Buenos Aires Argentina.
| | - Carlos Guevel
- Instituto de Producción, Economía y Trabajo, Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional de Lanús. 29 de Septiembre 3901, Remedios de Escalada. B1824PJU Provincia de Buenos Aires Argentina.
| | - Marcio Alazraqui
- Instituto de Producción, Economía y Trabajo, Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional de Lanús. 29 de Septiembre 3901, Remedios de Escalada. B1824PJU Provincia de Buenos Aires Argentina.
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Macedo HKDS, Souza TAD, Bezerra HDS, Fernandes FCGDM, Barbosa IR, Silva JAD. Internações por diabetes mellitus em idosos no Brasil de 2001 a 2020: tendência temporal e padrões espaciais. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2021. [DOI: 10.1590/1981-22562021024.210107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Analisar padrões temporais e espaciais na distribuição das taxas de internação por diabetes mellitus em pessoas idosas (60 anos ou mais) no Brasil. Método Estudo ecológico com dados do Sistema de Informação de Hospitalizações do Sistema Único de Saúde acerca de internações por diabetes em pessoas idosas ocorridas no Brasil de 2001 a 2020. Foi calculada a taxa de internação/100.000 idosos e analisada a tendência temporal pela Regressão Joinpoint. Foram construídos mapas MoranMap univariado e bivariado e aplicada a técnica Skater para analisar a associação entre as taxas de internação e variáveis contextuais por Regiões Imediatas de Articulação Urbana. Resultados Taxas anuais mostram que o Brasil registrou 43,78 internações por diabetes/100.000 idosos no ano 2001 e 21,55/100.000 idosos no ano de 2020, com tendência de redução significativa (AAPC=-3,4% IC95% -4,5; -2,3). Houve autocorrelação espacial média pelo Moran global (I<0,3) no último quinquênio com regiões de elevadas taxas de internação no Norte e Nordeste do Brasil. A análise bivariada mostrou a formação de clusters de altas taxas de internação onde havia elevada cobertura da Estratégia de Saúde da Família e oferta de profissionais, porém, em áreas com piores indicadores sociais. O mapa Skater mostrou clusters de áreas de baixas taxas de internação em áreas de condições sociais favoráveis no Sudeste do Brasil. Conclusão A expansão de políticas governamentais de proteção à saúde do idoso marcou um compromisso nacional com o envelhecimento saudável da população, o reflexo disso é o declínio das taxas de internações por diabetes em idosos no Brasil.
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Baldaçara L, Rocha GA, Leite VDS, Porto DM, Grudtner RR, Diaz AP, Meleiro A, Correa H, Tung TC, Quevedo J, da Silva AG. Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 1. Risk factors, protective factors, and assessment. ACTA ACUST UNITED AC 2020; 43:525-537. [PMID: 33111773 PMCID: PMC8555650 DOI: 10.1590/1516-4446-2020-0994] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/21/2020] [Indexed: 12/28/2022]
Abstract
Suicide is a global public health problem that causes the loss of more than 800,000 lives each year, principally among young people. In Brazil, the average mortality rate attributable to suicide is approximately 5.23 per 100,000 population. Although many guidelines have been published for the management of suicidal behavior, to date, there are no recent guidelines based on the principles of evidence-based medicine that apply to the reality of suicide in Brazil. The objective of this work is to provide key guidelines for managing patients with suicidal behavior in Brazil. This project involved 11 Brazilian psychiatry professionals selected by the Psychiatric Emergencies Committee (Comissão de Emergências Psiquiátricas) of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. For the development of these guidelines, 79 articles were reviewed (from 5,362 initially collected and 755 abstracts). In this review, we present definitions, risk and protective factors, assessments, and an introduction to the Safety Plan. Systematic review registry number: CRD42020206517
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Affiliation(s)
- Leonardo Baldaçara
- Universidade Federal do Tocantins, Palmas, TO, Brazil.,Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
| | - Gislene A Rocha
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Hospital Universitário Clemente de Faria, Universidade Estadual de Montes Claros, Montes Claros, MG, Brazil.,Serviço Especializado em Reabilitação em Deficiência Intelectual, Associação de Pais e Amigos dos Excepcionais, Montes Claros, MG, Brazil
| | - Verônica da S Leite
- Universidade Federal do Tocantins, Palmas, TO, Brazil.,Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Secretaria Municipal de Saúde de Palmas, Palmas, TO, Brazil
| | - Deisy M Porto
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Associação Catarinense de Psiquiatria, Florianópolis, SC, Brazil
| | - Roberta R Grudtner
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Núcleo de Dor e Neuromodulação, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Secretaria Estadual da Saúde, Porto Alegre, RS, Brazil
| | - Alexandre P Diaz
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | | | - Humberto Correa
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Teng C Tung
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Instituto de Psiquiatria (IPq), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.,Serviços de Pronto Socorro e Interconsultas, IPq, HCFMUSP, São Paulo, SP, Brazil
| | - João Quevedo
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | - Antônio G da Silva
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Asociación Psiquiátrica de América Latina (APAL)
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Sy KTL, Shaman J, Kandula S, Pei S, Gould M, Keyes KM. Spatiotemporal clustering of suicides in the US from 1999 to 2016: a spatial epidemiological approach. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1471-1482. [PMID: 31177308 PMCID: PMC6858930 DOI: 10.1007/s00127-019-01736-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 06/03/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aims to describe and characterize the spatial and temporal clustering patterns of suicide in the ten states with the greatest suicide burden in the United States from 1999 to 2016. METHODS All suicide deaths from January 1, 1999 to December 31, 2016 in the United States were identified using data from the Wide-ranging Online Data for Epidemiologic Research (WONDER) dataset. The ten states with the highest age-adjusted suicide rates were Montana, Alaska, Wyoming, New Mexico, Nevada, Utah, Idaho, Colorado, Arizona, and Oklahoma. A spatiotemporal scan statistic using a discrete Poisson model was employed to retrospectively detect spatiotemporal suicide clusters. RESULTS From 1999 to 2016, a total of 649,843 suicides were recorded in the United States. Nineteen statistically significant spatiotemporal suicide mortality clusters were identified in the states with the greatest suicide rates, and 13.53% of the suicide cases within these states clustered spatiotemporally. The risk ratio of the clusters ranged from 1.45 to 3.64 (p < 0.001). All states had at least one cluster, with three clusters spanning multiple states, and four clusters were found in Arizona. While there was no clear secular trend in the average size of suicide clusters, the number of clusters increased from 1999 to 2016. CONCLUSIONS Hot spots for suicidal behavior in the United States warrant public health intervention and continued surveillance. As suicide rates in the US continue to increase annually, public health efforts could be maximized by focusing on regions with substantial clustering.
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Affiliation(s)
- Karla Therese L Sy
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
| | - Jeffrey Shaman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sasikiran Kandula
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sen Pei
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Madelyn Gould
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Alarcão AC, Dell' Agnolo CM, Vissoci JR, Carvalho ECA, Staton CA, de Andrade L, Fontes KB, Pelloso SM, Nievola JC, Carvalho MD. Suicide mortality among youth in southern Brazil: a spatiotemporal evaluation of socioeconomic vulnerability. BRAZILIAN JOURNAL OF PSYCHIATRY 2019; 42:46-53. [PMID: 31433002 PMCID: PMC6986484 DOI: 10.1590/1516-4446-2018-0352] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/17/2019] [Indexed: 11/22/2022]
Abstract
Objective: To conduct a geospatial analysis of suicide deaths among young people in the state of Paraná, southern Brazil, and evaluate their association with socioeconomic and spatial determinants. Methods: Data were obtained from the Mortality Information System and the Brazilian Institute of Geography and Statistics. Data on suicide mortality rates (SMR) were extracted for three age groups (15-19, 20-24, and 25-29 years) from two 5-year periods (1998-2002 and 2008-2012). Geospatial data were analyzed through exploratory spatial data analysis. We applied Bayesian networks algorithms to explore the network structure of the socioeconomic predictors of SMR. Results: We observed spatial dependency in SMR in both periods, revealing geospatial clusters of high SMR. Our results show that socioeconomic deprivation at the municipality level was an important determinant of suicide in the youth population in Paraná, and significantly influenced the formation of high-risk SMR clusters. Conclusion: While youth suicide is multifactorial, there are predictable geospatial and sociodemographic factors associated with high SMR among municipalities in Paraná. Suicide among youth aged 15-29 occurs in geographic clusters which are associated with socioeconomic deprivation. Rural settings with poor infrastructure and development also correlate with increased SMR clusters.
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Affiliation(s)
- Ana C Alarcão
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Maringá (UEM), Maringá, PR, Brazil
| | | | - João R Vissoci
- Departamento de Medicina, UEM, Maringá, PR, Brazil.,Global Neurosurgery and Neuroscience Division, Duke Global Health Institute, Duke University, Durham, North California, USA
| | - Elias C A Carvalho
- Núcleo de Processamento de Dados (NPD), UEM, Maringá, PR, Brazil.,Descoberta de Conhecimento e Aprendizagem de Máquina (DCAM), Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, PR, Brazil.,Programa de Pós-Graduação em Informática (PPGIa), PUCPR, Curitiba, PR, Brazil
| | - Catherine A Staton
- Department of Surgery, Duke Global Health Institute, Duke University, Durham, North California, USA
| | - Luciano de Andrade
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Maringá (UEM), Maringá, PR, Brazil.,Departamento de Medicina, UEM, Maringá, PR, Brazil
| | - Kátia B Fontes
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Maringá (UEM), Maringá, PR, Brazil
| | - Sandra M Pelloso
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Maringá (UEM), Maringá, PR, Brazil
| | - Júlio C Nievola
- Programa de Pós-Graduação em Informática (PPGIa), PUCPR, Curitiba, PR, Brazil
| | - Maria D Carvalho
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Maringá (UEM), Maringá, PR, Brazil
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Pearson DR, Werth VP. Geospatial Correlation of Amyopathic Dermatomyositis With Fixed Sources of Airborne Pollution: A Retrospective Cohort Study. Front Med (Lausanne) 2019; 6:85. [PMID: 31069228 PMCID: PMC6491706 DOI: 10.3389/fmed.2019.00085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 04/04/2019] [Indexed: 11/28/2022] Open
Abstract
Objective: Dermatomyositis (DM) may result from exogenous triggers, including airborne pollutants, in genetically susceptible individuals. The United States Environmental Protection Agency's 2011 National Air Toxics Assessment (NATA) models health risks associated with airborne emissions, available by ZIP code tabulation area (ZCTA). Important contributors include point (fixed), on-road, and secondary sources. The objective of this study was to investigate the geospatial distributions of DM and subtypes, classic DM (CDM) and clinically amyopathic DM (CADM), and their associations with airborne pollutants. Methods: This retrospective cohort study identified 642 adult DM patients from 336 unique ZCTAs. GeoDa v.1.10 was used to calculate global and local Moran's indices and generate local indicator of spatial autocorrelation (LISA) maps. All Moran's indices and LISA maps were permuted 999 times. Results: Univariate global Moran's indices for DM, CDM, and CADM prevalence were not significant, but LISA maps demonstrated differential local spatial clustering and outliers. CADM prevalence correlated with point sources (bivariate global Moran's index 0.071, pseudo-p = 0.018), in contrast to CDM (−0.0053, pseudo-p = 0.46). Bivariate global Moran's indices for DM, CDM, and CADM prevalence did not correlate with other airborne toxics, but bivariate LISA maps revealed local spatial clustering and outliers. Conclusion: Prevalence of CADM, but not CDM, is geospatially correlated with fixed sources of airborne emissions. This effect is small but significant and may support the hypothesis that triggering exposures influence disease phenotype. Important limitations are NATA data and ZCTA population estimates were collected from 2011 and ZCTA of residence may not have been where patients had greatest airborne pollutant exposure.
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Affiliation(s)
- David R Pearson
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Victoria P Werth
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States.,Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Carpena MX, Martins-Silva T, Costa FS, Darley R, Loret de Mola C. Contextual risk factors of depression and suicidal thoughts in Brazilian adults: a multilevel analysis. ACTA ACUST UNITED AC 2019; 41:433-436. [PMID: 30994857 PMCID: PMC6796826 DOI: 10.1590/1516-4446-2018-0315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 12/26/2018] [Indexed: 11/21/2022]
Abstract
Objective: To evaluate the association between social and health contextual variables, and between major depressive episodes (MDE) and suicidal thoughts in Brazilian adults. Methods: This population-based cross-sectional study used data from the 2013 National Health Survey (Pesquisa Nacional de Saúde). The Patient Health Questionnaire was used to evaluate the presence of MDE and suicidal thoughts. We used number of Family Health Strategy teams (FHS) per 20,000 state population, number of Psychosocial Care Centers (Centros de Atenção Psicossocial [CAPS]) per 1,000 state population, gross domestic product (GDP), and Gini index for each Brazilian state as contextual variables. Multilevel logistic regression models were used to calculate OR and the intraclass correlation coefficient (ICC). Results: Prevalence of MDE and suicidal thoughts was 4.1% (95%CI 3.8-4.4) and 3.8% (95%CI 3.5-4.1), respectively. Multilevel regression models showed an ICC of 1.1% for MDE (95%CI 0.5-2.3) and 1.3% for suicidal thoughts (95%CI 0.6-2.6). Neither GDP, Gini, FHS, or CAPS showed evidence of association with the outcomes. Conclusions: In general, contextual variables, within each Brazilian state, do not seem to affect the prevalence of MDE and suicidal thoughts.
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Affiliation(s)
- Marina X Carpena
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas (UFPel), Pelotas, RS, Brazil
| | - Thais Martins-Silva
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas (UFPel), Pelotas, RS, Brazil
| | - Francine S Costa
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas (UFPel), Pelotas, RS, Brazil
| | | | - Christian Loret de Mola
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas (UFPel), Pelotas, RS, Brazil.,Universidade Federal do Rio Grande (FURG), Rio Grande, RS, Brazil
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Rodrigues CD, de Souza DS, Rodrigues HM, Konstantyner TC. Trends in suicide rates in Brazil from 1997 to 2015. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2019; 41:380-388. [PMID: 30785540 PMCID: PMC6796812 DOI: 10.1590/1516-4446-2018-0230] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/26/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To analyze time trends of suicide rates in Brazil overall and in Brazilian states and compare the estimated suicide rates projected for 2020 with the World Health Organization (WHO) Mental Health Action Plan target. METHODS This was an ecological time-series study from 1997 to 2015, stratified by Brazilian states, specific age groups, and sex. Data were obtained from the Mortality Information System (Sistema de Informações sobre Mortalidade [SIM]) of the Brazilian Ministry of Health. Polynomial regression models were used to analyze the trends in suicide rates and to project suicide rates for 2020. RESULTS Considering 224 units of analysis, 21 (9.4%) showed a decreasing trend, 108 (48.2%) were stable, and 95 (42.4%) showed an increasing trend. Thus, 67% of units of analysis will not meet the WHO target in 2020. Mean suicide rates were higher in males than in females. People aged 60 years and older presented the highest suicide rates, while 84.7% of total deaths by suicide occurred among 15-to-59-year-olds. CONCLUSION Overall, 90.6% of units of analysis had a stable or increasing trend in suicide rates from 1997 to 2015. If these trends remain, most of Brazil will fail to achieve the WHO-recommended reduction in suicide rates by 2020.
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Affiliation(s)
- Cássio D. Rodrigues
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Débora S. de Souza
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Henrique M. Rodrigues
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Scaini G, Quevedo J. Suicide rates in the United States continue to rise. Are rates in Brazil underestimated? REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2018; 40:347-348. [PMID: 30156656 PMCID: PMC6899371 DOI: 10.1590/1516-4446-2018-4004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Giselli Scaini
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, UTHealth, Houston, TX, USA
| | - João Quevedo
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, UTHealth, Houston, TX, USA
- Neuroscience Graduate Program, The University of
Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Santos EGDO, Oliveira YOMDC, Azevedo UND, Nunes ADDS, Amador AE, Barbosa IR. Spatial temporal analysis of mortality by suicide among the elderly in Brazil. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2017. [DOI: 10.1590/1981-22562017020.170115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Abstract Objective: to perform spatiotemporal analysis of suicide mortality in the elderly in Brazil. Methods: a mixed ecological study was carried out in which deaths from suicide among the elderly were analyzed using data from the Mortality Information System (MIS) and socio-demographic variables, from 2000 to 2014, with a trend analysis of this period. Univariate and bivariate spatial analysis was performed using the Moran Global and Moran Map index to evaluate the intensity and significance of spatial clusters. Results: there were 19,806 deaths due to suicide among the elderly in Brazil between 2000 and 2014. The ratio of male and female mortality rates was 4:1, with increasing trends for both genders (R2>0.8), but with greater intensity among men (p=0.0293). There was a moderate autocorrelation for men (I>0.40), with clusters forming for both genders in the south of Brazil. Bivariate analysis showed the formation of clusters in the southern region with the Human Development Index and aging variables and in the north and northeast regions based on dependence and illiteracy ratio. Conclusions: mortality due to suicide among the elderly has a tendency to increase and is unequally distributed in Brazil.
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