Suicide in Brazilian indigenous communities: clustering of cases in children and adolescents by household

ABSTRACT OBJECTIVE To estimate age and sex-specific suicide rates, compare suicide rates between indigenous communities, and quantify the frequency of intrafamilial suicide clustering. METHODS We performed a retrospective cohort study involving 14,666 indigenous individuals in reservations in Dourados, state of Mato Grosso do Sul, Brazil, from 2003 through 2013 using national and local census. RESULTS The overall suicide rate was 73.4 per 100,000 person-years. Adolescent males aged 15-19 and girls aged 10-14 had the highest rates for each sex at 289.3 (95%CI 187.5-391.2) and 85.3 (95%CI 34.9-135.7), respectively. Comparing the largest reservations, Bororo had a higher suicide rate than Jaguapiru (RR = 4.83, 95%CI 2.85-8.16) and had significantly lower socioeconomic indicators including income and access to electricity. Nine of 19 suicides among children under 15 occurred in household clusters. Compared with adult suicides, a greater proportion of child (OR = 5.12, 95%CI 1.89-13.86, p = 0.001) and adolescent (OR = 3.48, 95%CI 1.29-9.44, p = 0.017) suicides occurred within household clusters. CONCLUSIONS High rates of suicide occur among children and adolescents in these indigenous reservations, particularly in poor communities. Nearly half of child suicides occur within household clusters. These findings underscore the need for broad public health interventions and focused mental health interventions in households following a suicide.

Inserção dos fonoaudiólogos no SUS/MG e sua distribuição no território do estado de Minas Gerais / Insertion of speech therapists in SUS/MG and their distribution in Minas Gerais state

OBJETIVO: investigar a distribuição dos fonoaudiólogos no estado de Minas Gerais, sua inserção no SUS e as variações geográficas dessa distribuição e suas desigualdades. MÉTODO: análise dos Cadernos de Informações de Saúde dos 853 municípios do estado de Minas Gerais referentes a 2009, disponíveis no Sistema de Informações em Saúde brasileiro, o DATASUS. Foram pesquisados os indicadores: população municipal, número total de fonoaudiólogos da rede SUS e da rede privada e número médio de fonoaudiólogos (SUS e rede privada) por mil habitantes. RESULTADOS: a análise dos dados revelou a presença de 1.733 fonoaudiólogos atuando no estado em 2009. Destes, 67,8% atendiam à rede SUS. Dos 853 municípios, 505 (59%) não possuíam o profissional fonoaudiólogo no período investigado. Observou-se que entre as 13 macrorregiões estaduais as regiões Centro-Sul e Sul apresentaram a melhor média de fonoaudiólogos por 10.000 habitantes (1/10.000) e as regiões Norte de Minas e Nordeste, as piores: 0,16 e 0,05/10.000, respectivamente. Observou-se a presença de 0,58 fonoaudiólogos/10.000 habitantes disponíveis na rede SUS e 0,86 fonoaudiólogos/10.000 atendendo à rede privada e ao SUS no estado. CONCLUSÃO: a inclusão de fonoaudiólogos na assistência à saúde estadual ainda é deficitária, sendo observada grande disparidade na distribuição dos profissionais. É notório o estrangulamento da assistência fonoaudiológica no SUS em Minas Gerais, visto que para cada 17.000 mineiros existia somente um fonoaudiólogo no SUS estadual em 2009. Ressalta-se a necessidade de uma mobilização dos profissionais e dos gestores de saúde para garantir a integralidade da atenção à saúde no estado.

PURPOSE: to investigate the distribution of speech therapists in the state of Minas Gerais, their inclusion in SUS (Unique Health System) and analyze the geographical variations of this distribution and its inequalities. METHOD: analyzing Reports in Health Information of 853 municipalities in Minas Gerais, in the year of 2009, which are available at the Health Information System in Brazil, called DATASUS. The indicators: municipal population, total number of speech therapists in SUS and in the private network and the average number of speech therapists (SUS and private network) per thousand inhabitants were examined. RESULTS: data analysis revealed the presence of 1733 speech therapists acting in the state in 2009. Of these, 67.8% attended the SUS system. Of the 853 municipalities, 505 (59%) lacked the professional speech therapist in the investigated period. It was observed that among the 13 state geographical regions, the Centre-South and South regions had the best average of speech therapists per 10,000 inhabitants (1/10.000) and the North of Minas Gerais and Northeast regions, the worst, 0.16 and 0.05 / 10,000, respectively. IWe observed the presence of 0.58 speech therapists/10.000 inhabitants available in SUS and 0.86 speech pathologist/10.000 in the private network and health care system in Brazil. CONCLUSION: the inclusion of speech therapists in the state health care is poor, being observed a great disparity in the distribution of professionals. The bottleneck in the speech therapy care in SUS in Minas Gerais is notorious, since that for every 17 000 Minas residents there was only one speech therapist in SUS in the state in 2009. It is important to highlight the need for mobilization of professionals and health managers to ensure health care integrity in the state.