Suicide attempts in the adult Mexican population: an analysis of sociodemographic characteristics and associated factors

OBJECTIVE

Suicide is the culmination of a process or continuum known as suicidal behavior that proceeds from ideation and planning to attempt. The objective was to estimate the prevalence of suicide attempts in the adult Mexican population and to analyze their main associated factors.

METHODS

We conducted an observational, cross-sectional, and descriptive study with information from the National Health and Nutrition Survey (2018). Self-reported lifetime suicide attempt was used in the analysis. We analyzed depression, obesity, tobacco smoking, and alcohol consumption as suicide attempt-associated factors using a multivariate logistic regression model.

RESULTS

The prevalence of adult suicide attempt was 2.0% (95%CI 1.8-2.2) and it was higher among women (2.4%; 95%CI 2.2-2.8) and young people (2.9%; 95%CI 2.4-3.4). Low education (OR=1.6; 95%CI 1.2-2.2), being single (OR=1.3; 95%CI 1.0-1.6), having obesity (OR=1.4; 95%CI 1.1-1.8), consumption of alcohol (OR=2.4; 95%CI 1.7-3.4) or tobacco smoking (OR=1.8; 95%CI 1.4-2.4), and having strong symptoms of depression (OR=10.1; 95%CI 6.2-16.3) were associated with a higher prevalence of suicide attempts.

CONCLUSION

These results help better understand suicidal behavior in Mexico and identify the factors that increase the likelihood of suicide attempts, which is essential to help reduce suicide mortality. This research is crucial for developing early interventions and prevention programs aimed at reducing suicide's public health burden.

Child maltreatment and resilience in adulthood: a protocol for a systematic review and meta-analysis

Background: Although child maltreatment (CM) has been linked to health problems and poor psychosocial functioning, not all individuals exposed to CM develop or experience negative consequences later in life. This suggests that some individuals show resilience after being exposed to CM. However, conclusions have been limited by inconsistent findings across different CM subtypes and resilience domains.Objective: To develop a protocol for conducting a systematic review and meta-analysis to quantify associations between CM (overall and its subtypes) and resilience (global and its multiple domains) in adulthood, and to examine moderators and mediators of these associations.Method: PubMed, PsycINFO, Embase, Scopus, and Web of Science will be searched to identify relevant studies on the association between CM (exposure) and resilience (outcome) in adults (≥ 18 years). Data will be screened and extracted by at least two independent reviewers. The methodological quality of the included studies will be independently assessed with a modified version of the Newcastle-Ottawa Scale (NOS). If deemed viable, a meta-analysis will be conducted using a random effects model. Heterogeneity of evidence will be estimated with the I2 statistic, and publication bias will be assessed. The effects of potential moderators (e.g. timing and severity of CM, age, sex, family cohesion, socio-economic status, country/region) will be analysed using meta-regression and subgroup analyses, and meta-analytical structural equation modelling will be employed to synthesise indirect mediation effects. Candidate moderators and mediators (e.g. genetic factors, brain functioning, attachment style, personality traits, physical activity, and social support) will be also examined qualitatively.Conclusions: This protocol will facilitate a systematic review and meta-analysis that has the potential to enhance our knowledge about the association between CM exposure in early life and resilience in adulthood. Understanding associations and underlying mechanisms between CM and resilience is potentially important in informing prevention and interventions to sustain health and improve outcomes among adults with a history of CM.PROSPERO registration: CRD42023394120.

[Telephone Survey of Risk Factors for Chronic Noncommunicable Diseases During the Pandemic (Covitel): methodological aspects]

This study describes the methodology of the Telephone Survey of Risk Factors for Chronic Noncommunicable Diseases During the Pandemic (Covitel), conducted in Brazil in 2022. Covitel is a population-based survey representing Brazil and its five macroregions (Central-West, Northeast, North, Southeast, and South) and providing information on the impact of the main risk factors for chronic noncommunicable diseases (NCDs) on the adult population aged 18 years or above who live in households served by fixed and mobile telephone lines. This study aims to contribute to the development and monitoring of public policies to promote the population's health and obtain results to contribute to the knowledge of the influence of COVID-19 on risk factors for NCDs in the country. We evaluated 9,000 individuals and collected information on their diet, physical activity, mental health, health status, hypertension, diabetes, depression, and alcohol and tobacco consumption, comparing the pre-pandemic moments and the first quarter of 2022. We also collected information about the population's vaccination schedule and COVID-19 infection history.

Association between Arterial Hypertension and Laboratory Markers, Body Composition, Obstructive Sleep Apnea and Autonomic Parameters in Obese Patients

BACKGROUND

Systemic arterial hypertension (SAH) is a multifactorial disease, highly prevalent and associated with health risks.

OBJECTIVE

The purpose of this study was to investigate the association between SAH and laboratory, anthropometric, heart rate variability (HRV), and obstructive sleep apnea markers and, secondarily, to analyze the sensitivity and specificity of the variables that are independent factors in the association.

METHODS

Cross-sectional study with 95 obese patients treated at an obesity referral clinic in Salvador, BA, Brazil. SAH data were obtained from electronic medical records. The sample was stratified in the Normotensive Group (NG) and the Hypertensive Group (HG), and laboratory markers, body composition, polysomnography, and HRV were measured to evaluate the association of SAH with the predictor variables. For the analysis, p<0.05 was adopted.

RESULTS

The average age of the NG was 36.3 ± 10.1 and HG 40.4 ± 10.6 years; 73.7% were women in the NG and 57.9% in HG; 82.4% in HG had insulin resistance. In the multivarious logistics regression model with adjustments in age, sex, height, and oxyhemoglobin saturation, SAH was inversely associated with fasting plasma glucose mg/dL (odds ratio [OR] = 0.96; 95% confidence interval [CI] = 0.92-0.99) and visceral fat area (VFA) cm2(OR = 0.98; 95% CI = 0.97-0.99). The area under the VFA curve was 0.728; CI 95% (0.620-0.836); fasting plasma glucose 0.693;CI 95% (0.582-0.804).

CONCLUSIONS

Lower VFA and fasting plasma glucose concentrations were inversely associated with SAH. In addition, fasting plasma glucose and VFA showed a high sensitivity for SAH screening.

[Angelman syndrome in adulthood]

INTRODUCTION

Angelman syndrome (AS) is widely described in childhood, but few studies have been conducted in adulthood and most of them report a small number of patients or specific conditions, such as epilepsy or sleep.

AIM

The aim of this study is to describe AS in adulthood in our centre, the special needs it requires, and the medical and social support to improve care and to provide a better transition from the paediatric service to units for adults.

PATIENTS AND METHODS

We collected patients with genetically confirmed AS, and described demographic, medical and social data by reviewing medical records, telephone interviews with the primary caregiver and three standardised sleep, dependency and quality of life scales.

RESULTS

Thirty patients with a median age of 22.7 years were included: 22 were deletions, 27 had a history of epilepsy and 13 were on treatment involving at least two antiepileptic drugs. The most frequent comorbidities after epilepsy were psychiatric symptoms, scoliosis, overweight, constipation and ophthalmological problems. Forty per cent required hospital admissions in adulthood, five were institutionalised and 24 received non-medical therapies. The doctor in charge was the neurologist in most cases, followed by the neuropaediatrician.

CONCLUSIONS

Studies that examine the natural history beyond childhood are warranted. This is the first Spanish review of adults with AS that covers a broad spectrum of social and medical conditions of these patients.

IR-7641. Cobertura vacunal antineumocócica en pacientes mayores de 65 años hospitalizados por la enfermedad de SARS-CoV-2

El neumococo es el principal responsable de neumonía comunitaria y de enfermedad neumocócica invasiva en el adulto. El objetivo del estudio es evaluar el estado de vacunación antineumocócica en los hospitalizados por la enfermedad de SARS-CoV-2 mayores de 65 años previo y posterior al ingreso tras una infección respiratoria grave.

Métodos

Se realizó un estudio descriptivo observacional retrospectivo. Se incluyeron los pacientes hospitalizados por enfermedad SARS-CoV-2 mayores de 65 años con pauta de primovacunación completa contra COVID-19 durante el primer trimestre de 2022 en un hospital de tercer nivel. Se analizó la cobertura vacunal antineumocócica en situación pre- y postingreso, sin intervenciones de mejora aplicadas.

Resultados

Se analizaron 123 pacientes siendo 56,9% hombres y la media de edad 83,41 años (rango 66-100). Se notificaron 34 fallecimientos durante el ingreso y el primer mes de postingreso. La cobertura vacunal antineumocócica secuencial completa previa al ingreso fue del 23,6%, n = 29 (antineumocócica 13-valente 27,6%, n = 34 y antineumocócica 23-valente 73,2%, n = 90). No se encontró mejora en las pautas de inmunización tras un periodo mínimo de 3 meses posterior al ingreso.

Conclusiones

Este estudio muestra tasas bajas de inmunización completa contra neumococo en mayores de 65 años. No se observó un incremento en la cobertura vacunal antineumocócica en este subgrupo, a pesar de haber padecido una infección respiratoria grave. Sería recomendable implementar estrategias vacunales de forma oportunista e individualizada en estos pacientes, a través de una coordinación entre diferentes niveles asistenciales.

Clustering and switching in verbal fluency: a comparison between control and individuals with brain damage

PURPOSE

The aim of this study is to analyze and compare the performance and strategies used by control subjects and patients with unilateral brain damage on phonemic and semantic Verbal Fluency tasks.

METHODS

The sample consisted of 104 participants divided into four groups (26 with left hemisphere damage and aphasia- LHDa, 28 with left hemisphere damage and no aphasia- LHDna, 25 with right hemisphere damage- RHD and 25 neurologically healthy control subjects). All participants were administered the phonemic ("M" letter-based) and semantic (animals) verbal fluency tasks from the Montreal-Toulouse Language Assessment Battery (MTL-BR).

RESULTS

Patients in the LHDa group showed the worst performance (fewer words produced, fewer clusters and switches) in both types of fluency task. RHD group showed fewer switching productions when compared with controls and LHDna had fewer words productions than controls in the first 30 seconds block.

CONCLUSION

Our findings suggest that the LHDa group obtained lower scores in most measures of SVF and PVF when compared to the other groups.

Cost-Utility Study of PCV13 Versus PPSV23 in Adults in Chile

INTRODUCTION

Pneumococcal infections are a public health problem in older adults. In Chile there are two vaccines at this time, PPSV23 and PCV13. The first has lower immunogenicity and effectiveness in preventing pneumococcal pneumonia and a lower cost than PCV13.

OBJECTIVE

To determine the cost-effectiveness of PCV13 versus PPSV23 in adults 18 years old and over in the Chilean Health System.

MATERIAL AND METHOD

A cost-utility study was performed using the Markov model (population data for a time horizon of 10 years). Utilities and epidemiological data were obtained from the literature and costs from the Chilean Public sector. Vaccine's costs and quality-adjusted life years (QALYs) were determined and compared.

RESULTS

PCV13 vaccination program in adults (≥18 years), generated savings of $42,195 USD and an increase of 6,820 QALYs, avoiding 107 cases of bacteremia, 13 meningitis, 6,706 inpatient pneumonia, 4,509 outpatient pneumonia and 1,189 deaths compared to PPSV23 without variation on sensitivity analysis on high impact variables. For the subgroup of patients over 65 years old PCV13 generates savings of $ 32,105.94USD and produces 5,430 QALYs more compared to PPSV23.

CONCLUSION

PCV13 is dominant. A PCV13 vaccination program saves costs to the public system, reduces mortality and morbidity; these results are robust.

Effect of cotrimoxazole prophylaxis on malaria occurrence among HIV-infected adults in West Africa: the MALHIV Study

INTRODUCTION

Cotrimoxazole (CTX) should be given to all HIV-infected adults with mild or severe HIV-disease or those with CD4 counts below 350/mm³ according to 2006 WHO guidelines. We assessed the impact of CTX prophylaxis on the risk of malaria episodes in HIV-1-infected adults from four West African countries with different patterns of malaria transmission.

METHOD

Multicentric cohort study, conducted between September 2007 and March 2010 in four West African cities. Antiretroviral therapy (ART) naïve HIV-infected adults started CTX at enrolment (CTX group) if they had CD4 < 350 cells/mm³ or were at WHO clinical stage ≥2. For patients who did not start CTX at enrolment (non-CTX group) and started CTX afterwards, follow-up was censored at CTX initiation. We used Cox's proportional hazard model to compare the risk of malaria between CTX groups.

RESULTS

A total of 514 participants (median CD4 count 238 cells/mm³ ) were followed for a median of 15 months. At enrolment, 347 started CTX, and 261 started ART. During the follow-up, 28 started CTX. The incidence of malaria was 8.7/100 PY (95%CI 6.3-11.5) overall, 5.2/100 PY (95%CI 3.1-8.3) in the CTX group and 15.5/100 PY (95%CI 10.3-22.1) in the non-CTX group. In multivariate analysis, CTX led to a 69% reduction in the risk of malaria (aHR 0.31, 95%CI 0.10-0.90).

CONCLUSION

Patients in the CTX group had an adjusted risk of malaria three times lower than those in the non-CTX group. The prolonged large-scale use of CTX did not blunt the efficacy of CTX to prevent malaria in this region.

Decreased renal function and associated factors in cities, towns and rural areas of Tanzania: a community-based population survey

OBJECTIVES

Data on renal dysfunction in sub-Saharan Africa, comparing urban and rural areas, have not yet been reported. Therefore, we aimed to determine the distribution of low estimated glomerular filtration rates (eGFRs) in urban and rural Tanzania, to describe factors associated with low eGFR and to quantify fractions attributable to common risk factors.

METHODS

We conducted a community-based survey of 1095 randomly selected Tanzanian adults (≥18 years). A structured questionnaire and examinations were used to document sociodemographic characteristics, diet, physical activity, anthropomorphic measurements and blood pressure. Blood tests were performed for HIV infection, diabetes mellitus and creatinine. eGFR was calculated using two equations recommended for African adults.

RESULTS

Serum creatinine was available for 1043 participants: 170 in Mwanza city, 326 in district towns and 547 in rural areas. Mean age was 35.5 years and 54% were females. The prevalence of eGFR < 60 ml/min/1.73 m(2) in these 3 strata was 2.3% (95% CI = 0.8-6.6%), 7.5% (4.7-11.8%) and 7.4% (5.1-10.6%), respectively. When age standardised to the WHO world population, prevalences were 3.8%, 10.1% and 8.1%. Factors associated with low eGFR included district town residence, older age, greater wealth, less physical activity and hypertension. Only 21% of cases with eGFR < 60 ml/min/1.73 m(2) were attributable to HIV, hypertension or diabetes.

CONCLUSIONS

Decreased renal function is common in Tanzania, particularly in district towns, and unique risk factors for kidney disease may exist in this population. Population-specific strategies for prevention, early diagnosis and treatment of kidney disease are needed for Africa.

[Population study of the prevalence of anaemia in the adult population of Buenos Aires, Argentina]

OBJECTIVE

To determine the prevalence and causes of anaemia among adults in Buenos Aires, Argentina.

DESIGN

Community-based, cross-sectional, quantitative study, with descriptive and analytic stages.

SETTING

Study conducted in La Plata, Buenos Aires, Argentina.

PARTICIPANTS

Rigorous selection from randomised sampling, with 3-stage stratification: geographical area, health aspects, and social/economic status. Adults >18 years old. RESULTS AND MAIN MEASUREMENTS: Social-economic and nutritional data and blood samples were obtained from each participant. If anaemia was detected, either treatment was given until complete recovery or further studies were conducted until definitive diagnosis was reached. Weight, height, haemoglobin, erythrocytes, haematocrit, transferrin, iron and ferritin levels, daily intake of calories, carbohydrates, lipids, proteins, calcium, iron, and vitamin C were measured. One thousand and thirty-six patients out of 1200 selected were analyzed. The prevalence of anemia in adults was 26.3%. Variables such as low social/economic status, nutritional questions, and frequency of doctor's consultation were associated with risk of anaemia. However, basic unsatisfied needs--a variable consisting of precarious housing and low educational level--, female sex, and living in slums were significant in the multivariate analysis (OR>2.5).

CONCLUSIONS

One in 4 adults has anaemia, with iron deficiency as the major cause. Anaemia diagnosis is mainly associated with social and gender questions and the area of residence. This information, if used by the State to plan appropriate and focused preventive measures, could benefit not just adults but the entire community that depends on them.