Means restriction for suicide prevention

Limitation of access to lethal methods used for suicide--so-called means restriction--is an important population strategy for suicide prevention. Many empirical studies have shown that such means restriction is effective. Although some individuals might seek other methods, many do not; when they do, the means chosen are less lethal and are associated with fewer deaths than when more dangerous ones are available. We examine how the spread of information about suicide methods through formal and informal media potentially affects the choices that people make when attempting to kill themselves. We also discuss the challenges associated with implementation of means restriction and whether numbers of deaths by suicide are reduced.     

Aspirin for primary prevention of atherosclerotic disease in Japan

Atherosclerotic disease is the most prevalent cause of death worldwide. The ratio of coronary heart disease/cerebrovascular disease differs between Japan and Western countries and the incidence of hemorrhagic stroke and gastrointestinal bleeding is higher in Japan. Thus, the threshold for aspirin administration for primary prevention has been controversial in Japan. Much anecdotal data from Western countries and from Japan has implied that the threshold for administering aspirin to those with risk factors for coronary heart disease is higher than that recommended in Western countries, and that the potential candidates for primary prevention in Japan seem to be diabetic patients. The Japanese primary Prevention of atherosclerosis with Aspirin for Diabetes (JPAD) trial involving 2,530 patients with type 2 diabetes started in December 2002. Compared to other primary prevention trials, this trial offered an acceptable sample size, a standard aspirin dosage, and gender balance. Because stroke is the most significant component of all atherosclerotic diseases in Japan, the impact of primary prevention with aspirin on stroke should be understood. Thus, the JPAD trial should generate reliable data on primary prevention with aspirin for diabetic patients that would also be relevant to other countries.     

The identifiability for depressive symptoms of different methods in suicide prevention research

正Objective To compare the identifiability for depressive symptoms using different instruments while interviewing with different respondents in suicide prevention research in China.Methods One hundred and fifty-one suicide death cases(suicide group)and one hundred and twenty suicide attempt cases(attempt group)were recruited.For each identified cases,one family member proxy     

Integrated prevention and control strategy for dengue in Mesoamerica

Dengue in the Americas is a public health problem in ascent. The control strategies have not been effective when sustained in the intensive use of insecticides and poor community participation. The Mesoamerican Initiative for the Prevention and the Integrated Control of Dengue synthesizes the works generated by the Integrated Strategy of the Pan-American Health Organization (PAHO) and the risks stratification strategy designed by the countries of the Mesoamerican region. The objective is to progressively reduce the incidence of dengue cases until a 50% reduction is reached over a five years period. This document describes the elements for the risk stratification, the activities for prevention and control organized by levels of intensity and frequency and the indicators used to pursuit the objectives. To face the dispersion of the problem a concentration of efforts for control in the areas of greater risk is presented; the opportunity in the detection of cases is highlighted to tackle the fast dissemination of the infection; focus on the most productive breeding sites is proposed to battle against the vast dissemination of the breeding sites; and the severity of the infection must be addressed by capable clinical human resources. This strategy was designed along with the national representatives of the control programs to create master plans that provided the basis for the integrated prevention and control of dengue in the Mesoamerican region.     

老年人的抑郁症及自杀的防治

老年期抑郁症是指首次发病于老年期，以持久的抑郁心境为主要表现，情绪低落、焦虑、迟滞及诸多躯体不适主诉为主。这些精神障碍不能归因于躯体疾病或脑器质性病变，且具有缓解和复发倾向，部分患者预后不良。抑郁症是老年期最常见的功能性精神障碍之一。65岁以上发生抑郁症者，据国外统计占总人口的7％～10％，老年人患有躯体疾病时，     

National suicide rates as an indicator of the effect of suicide on premature mortality

The health strategies of many nations include targets to reduce suicide rates. In several countries, because suicide rates are rising in young men but falling or unchanging in most other groups, achievement of target reductions might mask rises in potential years of life lost (PYLL). Analysis of routine mortality and census data for England and Wales, UK, shows that although age-standardised suicide rates fell by 18% (95% CI 15-21) between 1981 and 1998, the PYLL before age 65 years increased by 5% (4-6). National suicide reduction targets should focus on PYLL and overall suicide rates.     

Fall prevention strategy for elderly women wishing to attend community fall prevention programs

AIM: Fall prevention programs for community-dwelling elderly people are carried out as part of disability-postponing programs in Japanese municipalities. This study examined how to design a fall prevention program for community health fair based on the characteristics of fall prevention strategies adopted by community-dwelling elderly women before attending community fall prevention programs. METHODS: One hundred and four community-dwelling elderly women (71.7 +/- 6.3 years old) who were attending community fall prevention programs for the first time were asked about their strategies for fall prevention. Age, regular attendance at outpatient programs, the Tokyo Metropolitan Institute of Gerontology Index, and Timed Up&Go were determined as factors related to whether or not the women had strategies for fall prevention. RESULTS: Sixty-four participants had their own strategies for fall prevention. Multiple logistic regression analysis showed that age (OR = 1.10, 95% CI:1.00-1.21) and regular attendance at outpatient programs (OR = 4.77, 95% CI:1.75-12.98) were significantly related to having fall prevention strategies. Timed Up&Go (OR = 1.42, 95% CI: 0.95-2.13) had a weak relationship to having such strategies (P = 0.085). The most common strategy was behavior such as lifting the toe when walking (n=38, 59.4%), followed by doing regular exercise (n=16, 25.0%). Few of the participants modified their environment (n=2, 3.1%). CONCLUSION: Community fall prevention programs for community-dwelling elderly women can motivate participants to develop interdisciplinary and comprehensive practices for fall prevention.     

Outcomes of community-based screening for depression and suicide prevention among Japanese elders

PURPOSE: In this study we evaluate outcomes of a community-based program to prevent suicide among elderly individuals aged 65 and older. DESIGN AND METHODS: We used a quasi-experimental design with intervention and referent municipalities. The program included a 7-year implementation of depression screening with follow-up by general practitioners and a 10-year implementation of public education conducted in Yasuzuka (population 4,940; elderly suicide rate for women, 275/100,000; for men, 323/100,000). We estimated changes in the risk of completing suicide before and after the 10-year implementation by the incidence-rate ratio (IRR). RESULTS: The risk for women in the intervention area was reduced by 64% (age-adjusted IRR=0.36; 95% confidence interval=0.14-0.93), whereas there was no significant change in the risk for men in the intervention area and either men or women in the referent municipalities. A ratio of the IRR for women aged 65 to 74 in the intervention area to that in its prefecture was estimated at 0.23 (90% confidence interval=0.05-0.99), showing that the risk reduction was greater than the secular trend. IMPLICATIONS: The management of depression by use of community resources involving public health and primary care physicians is effective in the prevention of suicide for elderly women but uncertain for men.