Suicide mortality among older adults in Brazil between 2000 and 2019 - estimates from the Global Burden of Disease Study 2019

Abstract INTRODUCTION: Older adults present a higher risk of suicide, and Brazil is experiencing a fast population aging. To understand the impact of demographic transition, we compared Brazilian suicide mortality rates (MR) among adults (50+ years) with global rates, those from one high-income country, and those from one middle-income country. Looking for regional disparities, the MR was analyzed among older adults (60+ years) by Brazilian states. METHODS: This was an ecological study based on estimates from the Global Burden of Disease Study, from 2000 to 2019. Age-standardized MR and age-specific MR per 100,000 inhabitants were described, with 95% uncertainty intervals (UI). RESULTS: During the period, the annual estimates and the declining trend in mortality were higher in the world than in the studied countries. In 2019, global age-standardized MR was 9.39 (95% UI 8.48-10.29), compared to 5.68 (95% UI 5.40-6.19), 6.01 (95% UI 5.10-7.04), and 6.63 (95% UI 6.43-6.95) in Brazil, Mexico, and England, respectively. In Brazil, despite a significant decline in national rates, stability was observed in 15 states. An increase in aging was only found for men, who presented 3-4 times higher MR than women. The states' rates presented large differences: in 2019, the rates among men aged 60-64 years varied from 7.24 (95% UI 5.31; 9.85) to 26.32 (95% UI 20.21; 34.50). CONCLUSIONS: The smaller decline in suicide mortality among older Brazilian adults, the increasing risk with aging, and the higher mortality among men indicate the need for specific prevention policies. The variation within states suggests differences in the data quality or in socio-cultural and historical aspects, which requires further investigation.

Violência contra a mulher e a criança: condutas médicas à paciente agredida sexualmente / Violence against the woman and the child: medical management of the sexually assaulted patient

A assistência a pacientes vítimas de abuso sexual deve ser intersetorial e interdisciplinar, incluindo interface com questões policiais e judiciais. Nesse contexto, o médico tem dever ético e legal de prestar atendimento prioritário a essas pacientes. É necessário que o serviço de saúde realize exame físico, exame ginecológico, coleta de amostras para diagnóstico de infecções genitais e coleta de material para identificação do agressor. As evidências mostram que a violência contra a mulher tem impacto sobre a saúde física e mental desta. A equipe médica, portanto, deve estar preparada para oferecer apoio psicossocial. Outra preocupação médica é diminuir ao máximo as consequências do ato de violência, seja protegendo a mulher de doenças sexualmente transmissíveis ou de gravidez traumática. A paciente vítima de violência sexual, ocasional e sem uso de preservativo, deve receber no serviço de urgência profilaxia contra HIV, hepatite B, sífilis, gonorreia, clamidiose, cancro mole, tricomoníase e tétano. Além de ter direito a receber anticoncepção de emergência, o aborto nessas pacientes pode ser feito legalmente. Para isso, basta a autorização da paciente e/ou do responsável, dependendo da idade da paciente, sendo incorreta e ilegal a exigência de Boletim de Ocorrência Policial ou laudo do Instituto Médico Legal.

The assistance to patients who are victims of sexual abuse should be intersectoral and interdisciplinary, including interface with police and justice affairs. In this context the physician has an ethical and legal obligation to give priority attention to these patients. It is necessary for the health service to perform physical examination, gynecological examination, collection of samples for diagnosis of genital infections and collection of material for the aggressor’s identification. Evidences shows that violence against women has an impact on both their mental and physical health. The medical team, therefore, must be prepared to offer psychosocial support. Another medical concern is to minimize as much as possible the consequences of the act of violence, either by protecting the woman from Sexually transmitted Diseases or from traumatic pregnancy. The patient who was suffered occasional sexual violence without the use of a condom must receive in the emergency service prophylaxis against HIV, type B hepatitis, syphilis, gonorrhea, chlamydia, chancroid, trichomoniasis and tetanus. Besides having the right to receive emergency contraception, abortion in these patients can be legally done. It is only required the written consent of the patient and/or the person legally responsible for her, depending on the patient’s age, and the requirement of the Police or Forensic Medicine reports is considered both incorrect and illegal.

Abuso sexual em serviços de emergência: relato de caso / Sexual abuse in emergency centers: case report

Este artigo trata de paciente com 54 anos, atendida no Hospital Júlia Kubitschek, com relato de ter sido vítima de violência sexual. O agressor armado invadiu sua casa e a obrigou, mediante ameaça de morte, a manter com ele sexo vaginal, anal e oral, sem uso de preservativo. Apresentava-se ansiosa e chorosa. Havia lesão contusa em região escapular esquerda e leve hiperemia de grande lábio direito. O exame especular e a inspeção da região anal não apresentavam alterações. Foram realizadas avaliação laboratorial e profilaxia para doenças sexualmente transmissíveis (DSTs), incluindo administração de antirretrovirais. Foi encaminhada ao ambulatório de vítimas de violência sexual.

This article is about a 54-year-old female patient, assisted at Júlia Kubitschek Hospital, who reported having been victim of sexual violence. According to her, the armed aggressor broke into her house and forced her by threat of death to have vaginal, anal and oral sex with him without using condom. The patient was anxious and tearful. There were blunt injury in the left scapular region (shoulder blade area) and mild hyperemia of the right labium. Speculum examination and inspection of the anal region showed no alterations. The treatment included laboratory tests and prophylaxis for Sexually Transmitted Diseases (STDs), including administration of antiretroviral medication. The patient was referred to an outpatient center for victims of sexual violence.