not detected with depressive symptoms for this reason. there is evidence supporting that the Nursing Staff is un- der work stress and unfavorable working conditions, displa- ying psychopathology; this study detected the fact that there is at least one hospital area/department which must be studied more thoroughly in order to ind speciic stress factors, because of its connection with operative depression in its Nursing Staff. Just as reported in international litera- ture, this study found an association between smoking and suicide risk. Some of the study’s limitations are the fact that we only considered Zung’s Self-Rating Scale to determi- ne the presence or absence of depression (operative depres- sion higher or equal to 36 points) and we did not perform a structured interview which could deine it in terms relec- ted in the Diagnostic and Statistical Manual of Mental Disor- ders, Fifth Edition (DSM-V) as a persistent depressive disorder with mixed demonstrations. We did not consider work stress factors such as double shifts or working life in the study.
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Suicide risk was assessed through the Plutchik Suicide Risk Scale (PSRS). PSRS is a 15-item self-reported mea- sure that describes the degree to which an individual reveals characteristics similar to those of a suicide prototype (Plut- chik, Van Praag, Conte & Picard, 1989; Rubio et al., 1998). Cut-off is 6 points and discriminates those with suicide risk and a history of suicide attempts (Plutchik, Van Praag, Con- te & Picard, 1989; Rubio et al., 1998). Psychiatric diagno- ses were established based on the MINI International Neu- ropsychiatric Interview (Ferrando, Bobes & Gibert, 2000).
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Thus, secondary suicide prevention (early detection of an adolescent in risk and hidden cases) can be impro- ved with the inclusion of simple and widely used tools that address suicidality indirectly. We hypothesize that HRQL is related to suicide risk (attempt, ideation, and self-aggression) in adolescents since an auto-percep- tion of a physical or psychological health deterioration would be a mediator between previous anxiety and sui- cidal behavior 19,20 ; therefore, the EQ-5D-5L would have
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Suicidal behavior presents important differences between men and women. Men are more prone to completed suicide but women have more frequent suicide attempts. It is nowa- days accepted that this fact is independent of methodological issues. Several hypotheses have been proposed to explain this difference; some of them underline biological aspects, while others focus mainly on the feminine role and psychosocial aspects of gender. In any case, gender is one of the most frequently replicated predictors of suicide, and a detailed analysis of gender differences in suicidal behavior is impor- tant to establish preventive measures and priorities. Besides, suicide risk is not regular along the female lifecycle and the literature revision revealed large cross-national differences. Intervention on suicide must therefore be adapted specifically to the different populations. Studies analyzing the evolution of suicidal behavior in women and associated factors in the most significant milestones of their life history are needed.
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Abstract: Fibromyalgia is associated with an increased rate of mortality from suicide. In fact, this disease is associated with several characteristics that are linked to an increased risk of sui- cidal behaviors, such as being female and experiencing chronic pain, psychological distress, and sleep disturbances. However, the literature concerning suicidal behaviors and their risk factors in fibromyalgia is sparse. The objectives of the present study were to evaluate the prevalence of suicidal ideation and the risk of suicide in a sample of patients with fibromyalgia compared with a sample of healthy subjects and a sample of patients with chronic low-back pain. We also aimed to evaluate the relevance of pain intensity, depression, and sleep quality as variables related to suicidal ideation and risks. Logistic regression was applied to estimate the likelihood of suicidal ideation and the risk of suicide adjusted by age and sex. We also used two logistic regression models using age, sex, pain severity score, depression severity, sleep quality, and disease state as independent variables and using the control group as a reference. Forty-four patients with fibromyalgia, 32 patients with low-back pain, and 50 controls were included. Suicidal ideation, measured with item 9 of the Beck Depression Inventory, was almost absent among the controls and was low among patients with low-back pain; however, suicidal ideation was prominent among patients with fibromyalgia (P,0.0001). The risk of suicide, measured with the Plutchik Suicide Risk Scale, was also higher among patients with fibromyalgia than in patients with low-back pain or in controls (P,0.0001). The likelihood for suicidal ideation and the risk of suicide were higher among patients with fibromyalgia (odds ratios of 26.9 and 48.0, respectively) than in patients with low-back pain (odds ratios 4.6 and 4.7, respectively). Depression was the only factor associated with suicidal ideation or the risk of suicide. Keywords: chronic low-back pain, suicidal risk, depression
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Bariatric surgery is considered the most effective treatment for severe obesity and its benefits include improvement in medical comorbidities. However, a hi- gher rate of suicides after this type of surgery has been reported. We performed a literature review on the subject, and concluded that the mentioned increase in suicide rates, compared to the general population, is probably caused by conditions that the patient had before surgery, especially psychiatric disorders such as depression or eating disorders. These are risk factors for suicide, and are more common in the population with indication for bariatric surgery. Therefore, it is necessary to thoroughly evaluate these patients before surgery searching for suicide risk factors, deriving them to a mental health professional if necessary and follow their mental health after surgery. Considering that the literature on the topic is inconsistent, further research is needed.
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A fully probabilistic seismic risk assessment of Medellín, Colombia, was conducted using a building by building resolution level database with more than 240,000 dwellings. The city is the second with largest population in Colombia with more than 2 million inhabitants in the urban area. For this assessment, a set of stochastic seismic scenarios was generated based on the more recent seismic hazard assessment in Colombia where also, the dynamic soil response was taken into account. A set of building classes was identified and vulnerability functions were developed to calculate the seismic risk in terms of probabilistic metrics using several modules of the CAPRA Platform. Risk premiums by sectors, as well as casualties and other direct effects were calculated on a building by building basis and then aggregated at county level, the analysis unit for the estimation of the USRi. The a holistic risk assessment was performed using the holistic evaluation module of CAPRA to take into account social fragility and lack of resilience conditions in each county that could increase the second order effects in case a strong earthquake strikes the city. These conditions were inferred from a set of indicators that are meant to capture the aggravating conditions of the direct physical impact, the second order effects and the intangible impact of future seismic events. The comprehensive USRi was obtained at county level in order to communicate risk to stakeholders and decision-makers, helping identify areas that would be particularly problematic in terms of vulnerability, both in physical and socioeconomic dimensions. This study constitutes a complete example of how an integrated research on disaster risk reduction has been performed with the aim to decrease the gap between the risk analysis and its relevance for disaster risk management decision-making processes. More details about this assessment can be found in Salgado-Gálvez et al. (2014a; 2014b). As a complement of the holistic risk assessment of the city the RMI was evaluated taking into account the perspective of internal and external stakeholders, providing the main issues to improve the disaster risk management plan with the support of the Administrative Department of Planning of the city. More details of this participative and analytical process of achievements and needs to improvement can be found in López
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While risk scoring, risk matrices and QMRA are approaches that assess the potential risk to human health, epidemiology is the science that attempts to measure the actual distribution and determinants of health events. Epidemiology has particular value in estimating the population incidence of certain diseases and determining the proportion of such cases that are attributable to different exposures. As such, epidemiological studies can provide estimates of the actual disease burden due to various exposures, including disease associated with water exposures (see Blumental et al., 2001; Hunter et al., 2003). However, epidemiological studies are often expensive (requiring the recruitment of large numbers of participants) or time consuming (necessitating follow- up of study participants for months), or both. Therefore, although epidemiological studies provide an essential basis for understanding the actual health outcomes and burden of disease associated with water, such studies are often not applicable to individual local supplies and settings, because the population size is not big enough, because there are too few cases to give sufficient statistical power or because of the cost and effort needed to undertake them. In these contexts, QMRA and other risk assessment techniques are more feasible and may in fact be the only approach open to water supply managers to assess any risk to their consumers. Consequently, this document focuses on the complementary risk assessment approaches that are available for source-to- exposure water safety management.
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Abstract: Adaptive disorder (AD) is one of the most prevalent diagnoses in primary care in the general population, although there is controversy about its diagnostic entity. This type of disorder is associated with an increased suicidal risk, which is associated with different psychosocial factors, including hostility. Therefore, the aim of our study is to analyze suicidal risk and hostility in a sample of men diagnosed with AD. A total sample of 42 men with AT, attended by primary care physicians, was analysed. The hostility scale of SCL-90-R and RS was administered to measure suicidal risk. The results show that there is a high percentage of suicidal risk in this population and that it is higher in mixed AD. Finally, a positive relationship was observed between the hostility shown and suicidal risk. In this way we conclude that it is important to assess suicidal risk in AD and its associated factors. Keywords: adaptive disorder, men, suicide, hostility
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“In the early days,” recalls Crupi, “FHA’s systems and processes functioned as individual silos with each group functioning with its own methods.” Annual audits revealed material weaknesses in FHA’s system environment and internal controls. Further, the U.S. Government Accountability Office (GAO) placed the organization on a list of “high risk” agencies. In 2001, the FHA Comptroller developed a five-year multiphase blueprint to implement an integrated management system. “We did not have the budget or infrastructure for a big all-out implementation,” says Crupi, “so we scoped the project out and rolled out the system in steps, and then built on the success of each step.” To manage complexity, the new system was simple and “plain vanilla,” satisfying all of FHA’s business needs without delving into non-critical add-ons that could delay completion.
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c) Family life: Based on the statistics avail- able to Durkheim (essentially referring to France), he found that being married slightly reduced the frequency of suicide in the case of men, but was actually prejudi- cial in the case of women. Divorce and widowhood alter family life and increase the likelihood of suicide among men; in contrast, these decrease the likelihood of suicide among women. For Durkheim, it was not so much that marital life de- creased the probability of suicide, but that having children and family life with them did. Nine years after the publication of his book on suicide, Durkheim published an article in which he examined the relation- ship between rates of suicide and fertility. His conclusions were very clear: the de- cline in levels of fertility not only harms society, but individuals as well, as it leads to an increase in suicide rates. The more children individuals have, the lower the suicide rate is. Family life, like religion, helps reduce suicide rates because it in- creases the vitality of the social group and, therefore, the integration of its members. d) Political life: Periods of significant social
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Around 450 million people in the world suffer some kind of mental illness (WHO, 2010) and more than 100 million in Latin America and the Caribbean present a prev- alence of 1.6% for nonaffective psychosis and schizophre- nia, 8.7% for serious depression and 1.4% for bipolar dis- order (Kohn et al., 2005), and it has become necessary to begin to address the factors that put these populations at risk for HIV infection. We must remember that the lifetime prevalence for any mental disorder in Mexico is 26.1% and that the psychosocial problems faced daily by people who suffer them are multiple, so it is also important to address them. This is more so if we take into account information indicating that the prevalence of any mental disorder during our life is 26.1% in Mexico (Medina-Mora, Borges, Benjet, Lara & Berglund, 2007).
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Defining optimal capital requirements for health insurers is a matter of interest for policy-makers. They determine the insolvency probability of health insurers and the minimum number of enrolees in order to keep insolvency under control. In this paper we develop a methodology for estimating the expected loss per health insurer after considering their specific risk profile and the capitation formula with which they are paid. We assume the expected loss follows a normal distribution within risk pools consisting of a unique combination of long-term disease, age, gender, and location, and then define the minimum capital requirement as the 1st quantile of the loss distribution. An application is made for insurers in the statutory health care system of Colombia. Our results show that under normal expenditures with ex-ante morbidity risk adjustment using long- term disease groups, if capitation payments were conditional on long-term diseases too, riskier insurers should have significantly higher capital requirements compared to those generated by the current government capitation formula, which reimburses only on demographic variables, while less risky insurers should have lower capital requirements.
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Abstract. The risk identification, assessment and reduction are indispensable steps on the way of the sustainable development of the countries. Risk assessment requires a multidisciplinary approach that takes into account not only the expected physical damage, the number and type of casualties or the economic losses, but also other social, organizational and institutional factors that contribute to risk. At urban level, for example, vulnerability should be related not only to the physical susceptibility of buildings and infrastructure, but also to the social fragility and the lack of resilience of the exposed community. The absence of institutional and community organization, weak preparedness for emergency response, political instability and lack of economic health, which are development problems, contribute to increasing of risk in a geographical area. This article presents and applies a methodology for evaluating risk in urban center using a holistic approach. A multidisciplinary estimation of risk to guide the decision making, that takes into account geophysical and structural aspects, and also social, economic, institutional variables, among others, is considered here as holistic approach, involving all the aspects and comprehensive. The paper includes four case studies, the cities of: Barcelona, Spain; Bogotá and Manizales, Colombia; and Metro- Manila, The Philippines.
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With the rise of freely available software and open source platforms, the potential to streamline slum mapping and include issues of risk and vulnerability in the process have been notably enhanced. The proliferation of handheld Global Positioning System (GPS) devices and open- source technologies that can now be used in mapping, supports the role of communities in data- gathering. Digital enumeration of slums can be undertaken using selected base maps (e.g., Bing Maps) and open source GIS programs which can be downloaded at no cost. The first step would be creating settlement profiles of informal areas which may include: slum address or location, legal status, land ownership, approximate year of establishment, housing conditions, hazards, topography, number of houses, population and population density, services and infrastructure. One tool that could serve as a useful input for cities in implementing the use of such approaches is OpenStreetMap (OSM), a collaborative project to create a free editable map of the world. OSM was established with the aim of encouraging the growth, development and distribution of free geospatial data. The maps are created using data from portable GPS devices, aerial photography, and other sources such as local knowledge. Both rendered images and the vector graphics are available for download.
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Our proposed system, which forms part of a larger integrated system , calculates a daily potential fire-risk index for a specific area based on weather conditions. Once this index has been obtained certain characteristics specific to the area in question (the interpretation context) are taken into consideration so as to refine the said index and ultimately quantify the potential risk of a forest fire.
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Suicidal behavior was widely spread all over the country with very few locations standing out as at higher risk. A national program for suicide prevention, instead of local short-term activities, is needed. Our results may help to substantiate some key points for such preven- tive program. While focusing in preventive activities on more specific groups as detected here, such as the youth, females, single people and those with lower educational attainment may yield better results, efforts to reach ev- eryone are needed. At least one in every four attempts will lead to medical treatment and one in every three attempts is self rated as serious, suggesting that physi- cians and other clinical personnel could be trained as in important gatekeeper to prevent that attempts latter develop into a fatal incident.
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Individuals who had not received a cancer diag- nosis during follow-up contributed person-time to the cancer-free group. Patients with cancer con- tributed person-time to the cancer-free group be- fore diagnosis and to the cancer-diagnosis group from the time of diagnosis onward. From the Causes of Death Register, we identified deaths from suicide or cardiovascular events as the un- derlying cause. We also separately evaluated myo- cardial infarction, other diseases of the heart, embolism or thrombosis, and stroke. To preclude potential misdiagnosis between stroke look-alikes (e.g., brain tumor) and stroke, we excluded stroke from deaths from cardiovascular causes in the analysis of CNS tumors and excluded CNS tu- mors from “any cancer” in the analysis of deaths from cardiovascular causes (termed as “any can- cer but CNS tumors”; 520,707 patients).
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The strength of relational systems is affected by events such as divorce, birth rates, migration, education and population growth and distribution . Among these factors, the likely impact of migration on both total violence and suicide is particularly relevant for this study. In 2013, the number of Salvadorians living in the U.S. was assessed at 1.2 million , equivalent to 19% of El Salvador’s current population. It is estimated that daily, at least 276 Salvadorians try to migrate illegally to the U.S. . Migration causes the separation of families, friends and co-workers, and the weakening of ties in the localities of origin. The families and children left behind by migrants may be initially exposed to stress and other mental pain, which may result in suicide. On the other hand, emigration may improve the quality of life among those left behind in the communities of origin, and might relate to lower suicide rates. Little is known about the impacts of emigration on homicide and suicide in the communities of origin.
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It is also this cultural alteration in the logi- cal-moral order of the analyzed practices that makes us consider the Belgian model as the most plausible legalization model from the social support perspective and the cu- rrent opinion of Spanish society (Molina and Serrano, 2014). All of this allows us to ventu- re that the right to die shall not be promoted if the movements that support it do not fore- go physician-assisted suicide, at least at a preliminary level, and begin to only promote the legalization of euthanasia, given that this will make it easier to receive citizen support. We can clearly contrast this in the hierarchi- cal segmentation tree that is presented here, in which the No-No position (No euthanasia, No PAS) was greater than the Yes-Yes posi- tion but was inferior to the sum of these latter plus the Yes-No (that is, those that only sup- port euthanasia but never, at least at this point in time, shall support physician assis- ted suicide).
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