Burden of suicide in Poland in 2012: how could it be measured and how big is it?

Objectives

The aim of our study was to estimate the health-related and economic burden of suicide in Poland in 2012 and to demonstrate the effects of using different assumptions on the disease burden estimation.

Methods

Years of life lost (YLL) were calculated by multiplying the number of deaths by the remaining life expectancy. Local expected YLL (LEYLL) and standard expected YLL (SEYLL) were computed using Polish life expectancy tables and WHO standards, respectively. In the base case analysis LEYLL and SEYLL were computed with 3.5 and 0% discount rates, respectively, and no age-weighting. Premature mortality costs were calculated using a human capital approach, with discounting at 5%, and are reported in Polish zloty (PLN) (1 euro = 4.3 PLN). The impact of applying different assumptions on base-case estimates was tested in sensitivity analyses.

Results

The total LEYLLs and SEYLLs due to suicide were 109,338 and 279,425, respectively, with 88% attributable to male deaths. The cost of male premature mortality (2,808,854,532 PLN) was substantially higher than for females (177,852,804 PLN). Discounting and age-weighting have a large effect on the base case estimates of LEYLLs. The greatest impact on the estimates of suicide-related premature mortality costs was due to the value of the discount rate.

Conclusions

Our findings provide quantitative evidence on the burden of suicide. In our opinion each of the demonstrated methods brings something valuable to the evaluation of the impact of suicide on a given population, but LEYLLs and premature mortality costs estimated according to national guidelines have the potential to be useful for local public health policymakers.

     

Hypotension--does it Make Sense in Family Practice?

In general practice many diagnostic labels are used that arerelated to cultural background rather than a scientific basis.To estimate the use of diagnoses like ‘hypotension’and depression, a cross-sectional survey in German and BritishGPs' surgeries was performed. Prevalence of related symptoms,socio-demographic and medical data were recorded as well asactual and previous blood pressure levels. In German generalpractice, where ‘hypotension’ is an establishedentity, 17% of all patients attending were reported as hypotensiveeither by their doctor or by themselves. The proportion wastwice as high among women than among men. It was more commonamong the young. One-quarter of these patients were on medicationto raise their blood pressure. Actual and previous blood pressurelevels failed to explain the occurrence of symptoms like tiredness,dizziness, headache etc. Demographic characteristics of patientsdiagnosed as depressed were similar in both countries. Presumablyfor economic reasons there is a tendency for German GPs to usemore diagnostic labels of any kind. It was concluded that diagnosticlabels attached to vague but frequently presented symptoms varyconsiderably between countries. They often lack a physiologicrationale. Nevertheless they often support the tendency to somatizecommon problems.     

Is technological change in medicine worth it?

Medical technology is valuable if the benefits of medical advances exceed the costs. We analyze technological change in five conditions to determine if this is so. In four of the conditions--heart attacks, low-birthweight infants, depression, and cataracts--the estimated benefit of technological change is much greater than the cost. In the fifth condition, breast cancer, costs and benefits are about of equal magnitude. We conclude that medical spending as a whole is worth the increased cost of care. This has many implications for public policy.     

Strategic market planning in hospitals: is it done? Does it work?

A nationwide survey of strategic market planning within hospitals was conducted. The level of strategic market planning activity performed by hospitals is reported. Level of planning maturity also is determined. Levels of activity and maturity are related to satisfaction with strategic market planning. Results and implications are presented.     

The sector-wide approach in health: what is it? Where is it leading?

This paper describes early experience with the Sector-Wide Approach (SWAp), an emerging trend in development practice in low-income countries. The paper describes what a SWAp is, and why it is now being pursued. The SWAp is characterized as a sustained government-led partnership with donor agencies and other groups. By applying sector-wide policies to an expenditure framework and national implementation systems, explicit health sector reforms are undertaken to meet sectoral and national development objectives. The approach has changed the dynamic between governments and donor agencies, requiring systemic changes in policy-making and management in both governments and donor agencies. With the SWAp, ongoing joint assessment and negotiations around sectoral plans and review of performance replaces the old way of preparing and supervising projects. Early experiences in countries undergoing SWAps are discussed, including the problem of reconciling priority programs and old practices with broader health sector reforms and new ways of managing development assistance. The paper concludes by identifying some of the key challenges for the future of SWAps.     

Trichinellosis in developing countries: is it neglected?

Trichinellosis is a foodborne zoonosis caused by the parasitic nematode Trichinella, which is characterized by an extremely wide host range and geographical distribution. The aim of the present review is to provide epidemiological information on animal and human trichinellosis occurring in developing countries in the different continents, where cooking habits along with poverty and poor sanitary conditions and lack of veterinary controls may facilitate the occurrence of human trichinellosis outbreaks. Countries have been considered according to the six regions designated by the World Health Organization (WHO): 1) WHO African Region, 2) WHO Region of the Americas, 3) WHO South-East Asia Region, 4) WHO European Region, 5) WHO Eastern Mediterranean Region, and 6) WHO Western Pacific Region. For the purposes of this article, developing countries are defined as those not industrialised according to the World Economic Outlook Report of the International Monetary Fund (http://www.imf.org); however, with regard to the European Region of WHO, only those countries that are not member states of the European Union will be considered.     

Measles eradication: is it in our future?

Measles eradication would avert the current annual 1 million deaths and save the $1.5 billion in treatment and prevention costs due to measles in perpetuity. The authors evaluate the biological feasibility of eradicating measles according to 4 criteria: (1) the role of humans in maintaining transmission, (2) the availability of accurate diagnostic tests, (3) the existence of effective vaccines, and (4) the need to demonstrate elimination of measles from a large geographic area. Recent successes in interrupting measles transmission in the United States, most other countries in the Western Hemisphere, and selected countries in other regions provide evidence for the feasibility of global eradication. Potential impediments to eradication include (1) lack of political will in some industrialized countries, (2) transmission among adults, (3) increasing urbanization and population density, (4) the HIV epidemic, (5) waning immunity and the possibility of transmission from subclinical cases, and (6) risk of unsafe injections. Despite these challenges, a compelling case can be made in favor of measles eradication, and the authors believe that it is in our future. The question is when.     

Harm reduction in hospitals: is it time?

Among persons who inject drugs (IDU), illicit drug use often occurs in hospitals and contributes to patient expulsion and/or high rates of leaving against medical advice (AMA) when withdrawal is inadequately managed. Resultant disruptions in medical care may increase the likelihood of several harms including drug resistance to antibiotics as well as costly readmissions and increased patient morbidity. In this context, there remains a clear need for the evaluation of harm reduction strategies versus abstinence-based strategies with respect to addressing ongoing issues related to substance use among addicted hospitalized patients. While hospitalization can be used to stabilize addicted patients as they recover from their acute illness and help them to achieve abstinence, patients unable to maintain abstinence should not be penalized for failing to do so at the expense of their health. This article describes harm reduction activities within hospitals and areas for future investigation.     

DDT and it metabolites in fish in the Gulf of Gdańsk

The residues of DDT and its metabolites (DDTs; p,p'-DDT, o,p'-DDT, p,p'-DDD, o,p'-DDD, p,p'-DDE, o,p'-DDE i p,p'-DDMU) has been determined in ten species of edible fish caught in the Gulf of Gdańsk in 1992. The method of measurement was capillary gas chromatography and low resolution mass spectrometry (HRGC/LRMS) after a nondestructive extraction and clean-up step with a further fractionation of the extract on Florisil column. All fish examined contained detectable residues of DDTs, and the concentrations ranged from 28 to 310 ng/g wet weight. o,p'-DDT accounted from 0.4 to 2.5% to DDTs content. The residue concentration of DDTs in herring (110 ng/g wet weight and 1100 ng/g lipid weight) in 1992 was threefold lower than in the years 1979-1983 and fourteen fold lower than in 1969-1973.     

Obesity: does it occur in African children in a rural community in South Africa?

BACKGROUND: Total body fatness and a centripetal fat patterning are recognized as risk indicators of cardiovascular disease in adulthood. In this study, the development of these risk factors in rural South African children during the preschool years and first years of formal schooling is explored. METHOD: The initial cross-sectional data from the Ellisras Longitudinal Investigations in Rural Community Children Project, ongoing since 1996, were used, involving 684 boys and 652 girls, aged 3-10 years, in the Ellisras rural community. Overweight was measured using the body mass index (BMI) (kg/m2). Overfatness was based on the sum of the triceps and subscapular skinfold thicknesses. A centripetal fat patterning was measured by the sum of trunk skinfolds relative to limb skinfolds and the ratio of the subscapular to triceps skinfold. Further, the ratio of the subscapular to supraspinale skinfold was used as an indicator of lower body fat patterning. The 85th percentiles of the NHANES III were used as cutoff values for overweight, overfatness and a centripetal fat patterning. RESULTS: At ages 7 and 8 years, mean BMI was statistically significantly higher in males compared to females (P < 0.05). The log transformed supraspinale skinfold thickness was larger in females compared to males at ages 4-7 years; the log transformed subscapular skinfold was larger in girls compared to boys aged 7-10 years. Less clear patterns were found for the extremity skinfolds and the skinfold ratios. Very few children (0-2.5% in males and 0-4.3% in females) had BMI values above the NHANES III 85th percentiles, indicating a very low prevalence of overweight children in the area. About 15% of the males showed overfatness at ages 3-4 years, while low prevalence was found at older ages. CONCLUSION: Few Ellisras rural children had above normal values for BMI, indicating a low prevalence of obesity in this population. In the 3- and 4-year-old group more subjects were found to have excessive fat, as indicated by the sum of the triceps and subscapular skinfold thicknesses.