Prevention of mental ill-health and suicide: Public health perspectives

According to the World Health Organization (WHO) estimates for the year 2020, approximately 1.5 million people will commit suicide, and at least 10 times that many will make an attempt. This paper offers a brief overview of the current state of the epidemiology of suicide, a burgeoning public health problem. The information provided is based in large measure on reports of suicide mortality from 130/193 countries. In order to contextualize these data, this paper explores the contribution of both individual and sociocultural factors that influence suicidal behavior, from which much has been learned. Outlining the history of attempts by international and national organizations like WHO, United Nations, member states in the European community and other countries to regularize identification and suicide reporting procedures, this paper also demonstrates that serious knowledge gaps remain. Minimal requirements for successful evidence-based interventions are presented. (C) 2010 Published by Elsevier Masson SAS.

Repetition of Suicide Attempts Data from Emergency Care Settings in Five Culturally Different Low- and Middle-Income Countries Participating in the WHO SUPRE-MISS Study

Background: Attempted suicide is a strong risk factor for subsequent suicidal behaviors. Innovative strategies to deal with people who have attempted suicide are needed, particularly in resource-poor settings. Aims: To evaluate a brief educational intervention and periodic follow-up contacts (BIC) for suicide attempters in five culturally different sites (Campinas, Brazil; Chennai, India; Colombo, Sri Lanka; Karaj, Islamic Republic of Iran; and Yuncheng, People's Republic of China) as part of the WHO Multisite Intervention Study on Suicidal Behaviors (SUPRE-MISS). Methods: Among the 1,867 suicide attempters enrolled in the emergency departments of the participating sites, 922 (49.4%) were randomly assigned to a brief intervention and contact (BIC) group and 945 (50.6%) to a treatment as usual (TAU) group. Repeated suicide attempts over the 18 months following the index attempt - the secondary outcome measure presented in this paper - were identified by follow-up calls or visits. Subsequent completed suicide - the primary outcome measure has been reported in a previous paper. Results: Overall, the proportion of subjects with repeated suicide attempts was similar in the BIC and TAU groups (7.6% vs. 7.5%, chi(2) = 0.013; p = .909), but there were differences in rates across the five sites. Conclusions: This study from five low-and middle-income countries does not confirm the effectiveness of brief educational intervention and follow-up contacts for suicide attempters in reducing subsequent repetition of suicide attempts up to 18 months after discharge from emergency departments.

Diagnostic de sécurité d’une entreprise brésilienne à partir de l’analyse des accidents du travail par la méthode de l’arbre des causes

We present here the results of a study of 21 work-related accidents that occurred in a Brazilian manufacturing company. The aim was to assess the safety level of the company to improve its work accident prevention policy. In the last 6 months of 1992 and 1993, all accidents resulting in 15 days' absence from work, reported for social security purposes, were analyzed using the INRS causal tree method (ADC) and a questionnaire completed on site. Potential risk factors for accidents were identified based on the specific factors highlighted by the ADC. More universal trees were also compiled for the safety assessment. Three hundred and thirty specific accident factors were recorded (mean of 15.71 per accident). This is consistent with there being multiple causes of accidents rather than the assertion of Brazilian business safety departments that accidents are due to dangerous or unsafe behavior. Introducing the idea of culpability into accidents prevents the implementation of an appropriate information feedback process, essential for effective prevention. However, the large number of accidents related to material (78%) and environment (70%) indicates that working conditions are poor. This shows that the technical risks, mostly due to unsafe machinery and equipment are not being dealt with. Seventy-five potential accident factors were identified. Of these, 35% were organizational, a high proportion for the company studied. Improvisation occurs at all levels, particularly at the organizational level. This is thus a major determinant for entire series of, if not most, accident situations. The poor condition of equipment also plays a major role in accidents. The effects of poor equipment on safety exacerbate the organizational shortcomings. The company's safety intervention policy should improve the management of human resources (rules designating particular workers for particular workstations; instructions for the safe operation of machines and equipment; training of operators, etc.) and introduce programs to detect risks and to improve the safety of machines and equipment. We also recommend the establishment of a program to follow the results of any preventive measures adopted.

Suicide nucleophilic attack: Reactions of benzohydroxamate anion with bis(2,4-dinitrophenyl) phosphate

(Chemical Equation Presented) The reaction between the benzohydroxamate anion (BHO-) and bis(2,4-dinitrophenyl)phosphate (BDNPP) has been examined kinetically, and the products were characterized by mass and NMR spectroscopy. The nucleophilic attack of BHO- follows two reaction paths: (i) at phosphorus, giving an unstable intermediate that undergoes a Lossen rearrangement to phenyl isocyanate, aniline, diphenylurea, and O-phenylcarbamyl benzohydroxamate; and (ii) on the aromatic carbon, giving an intermediate that was detected but slowly decomposes to aniline and 2,4-dinitrophenol. Thus, the benzohydroxamate anion can be considered a self-destructive molecular scissor since it reacts and loses its nucleophilic ability. © 2009 American Chemical Society.

Analysis of the procedures used to evaluate suicide crime scenes in Brazil: A statistical approach to interpret reports

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)