Prevention versus Clinical Management of Suicide Attempts in Adolescents: What are the Costs? / Prevención versus atención clínica del intento de suicidio en adolescentes: ¿cuáles son los costos? / Prevenção versus atenção clínica da tentativa de suicídio em adolescentes: quais são os custos?

Abstract Introduction: Suicide is a worldwide public health problem, and being the youth are among one of the most affected population groups. In Colombia there is no evidence available about the cost of suicide care or prevention. Or attention to those who make suicide attempts assistance or prevention of suicide. This type of analysis is necessary to guide decisions about resource distribution in mental health and to reduce suicideal rates amongst youths in our country. Thus, the purpose of this study is to estimate and compare the mean cost of in-patient care cost treatment cost of youth suicidal youth suicide attempts, with the mean cost of participation in a school-based suicide preventive prevention program in for adolescents. Materials and methods: Medical charts of adolescents hospitalized for suicideal attempts were reviewed, along with as well as registries from adolescent participants in a suicide prevention program in Bogotá in 2010. Resources used were identified and tariff costs were quantified. Results: The average in-patients cost of a teenage suicideal attempt was $1814000 Colombian pesos (COP) (n = 39) Colombian pesos, and of $10307000 COP (n = 5) Colombian pesos when intensive care was required. The average cost of participation in a prevention ve program was $113000 COP (n = 24) Colombian pesos per high-risk teenager and of $47000 COP (n = 101) Colombian pesos for teenagers without suicide such risk. Conclusion: With For the average in-patient cost of one suicidal suicide attempt, 16 high-risk teenagers could be enrolled in a suicide preventive prevention program.

Resumen Introducción: El suicidio es un problema de salud pública mundial, siendo los jóvenes uno de los grupos poblacionales más afectados. En Colombia no hay evidencia disponible sobre el costo de la atención o de la prevención del suicidio. Este tipo de análisis es necesario para guiar las decisiones sobre la distribución de recursos en salud mental y reducir las tasas de suicidio juvenil en el país. Por lo tanto, el objetivo de este estudio es el de estimar y comparar el costo promedio de la atención médica del intento de suicidio de jóvenes, con el costo promedio de un programa escolar de prevención del suicidio, en adolescentes. Materiales y métodos: Se revisaron las historias clínicas de los adolescentes atendidos en un hospital por intento suicida, y los registros de los adolescentes participantes en un programa de prevención del suicidio en 2010, en Bogotá. Se identificaron los servicios recibidos, cuantificándose su valor tarifario. Resultados: El costo promedio de la atención por paciente con intento de suicidio fue de $1814000 (n = 39), y de $10 307 000 (n = 5) cuando la atención requirió cuidado especializado. El costo promedio de la participación en el programa de prevención de suicidio fue de $113000 (n = 24) por adolescente de alto riesgo y de $47 000 (n = 101) por adolescente sin riesgo. Conclusión: Con el costo promedio de la atención de un intento suicida, se puede realizar un programa de prevención del suicidio con 16 adolescentes de alto riesgo.

Resumo Introdução: o suicídio é um problema de saúde pública mundial, sendo os jovens um dos grupos populacionais mais afetados. Na Colômbia não há evidência disponível sobre o custo da atenção ou da prevenção do suicídio. Este tipo de análise é necessário para guiar as decisões sobre a distribuição de recursos em saúde mental e reduzir as taxas de suicídios juvenil no país. Portanto, o objetivo deste estudo é estimar e comparar o custo da atenção médica da tentativa de suicídio de jovens, com o custo médio de um programa escolar de prevenção do suicídio em adolescentes. Materiais e métodos: revisaram-se as histórias clínicas dos adolescentes atendidos em um hospital por tentativa de suicídio, e os registros dos adolescentes participantes em um programa de prevenção do suicídio em 2010, em Bogotá. Identificaram-se os serviços recebidos, quantificando-se o valor tarifário dos mesmos. Resultados: o custo médio da atenção por paciente com tentativa de suicídio foi de $1814000 (n = 39), e de $10307000 (n = 5) quando a atenção requereu cuidado especializado. O custo médio da participação no programa de prevenção de suicídio foi de $113000 (n = 24) por adolescente de alto risco e de $47000 (n = 101) por adolescente sem risco. Conclusão: com o custo médio da atenção de uma tentativa suicida, se pode realizar um programa de prevenção do suicídio com 16 adolescentes de alto risco.

A mixed methods study to assess the effectiveness of food-based interventions to prevent stunting among children under-five years in Districts Thatta and Sujawal, Sindh Province, Pakistan: study protocol.

BACKGROUND: Maternal and child malnutrition is widely prevalent in low and middle income countries. In Pakistan, widespread food insecurity and malnutrition are the main contributors to poor health, low survival rates and the loss of human capital development. The nutritional status trends among children exhibit a continuous deteriorating with rates of malnutrition exceeding the WHO critical threshold. With the high prevalence of maternal and child malnutrition, it is important to identify effective preventative approaches, especially for reducing stunting in children under-five years of age. The primary aim of this study is to assess the effectiveness of food-based interventions to prevent stunting in children under-five years. METHODS: A mixed methods study design will be conducted to evaluate the effectiveness of food-based interventions to prevent stunting among children under-five years in districts Thatta and Sujawal, Sindh Province, Pakistan. The study will include cross sectional surveys, a community-based cluster randomized controlled trial and a process evaluation. The study participants will be pregnant women, lactating mothers and children under-five years. The cross-sectional surveys will be conducted with 7360 study participants at baseline and endline. For the randomized control trial, 5000 participants will be recruited and followed monthly for compliance of food-based supplements, dietary diversity, pregnancy outcomes, and maternal and child morbidity and mortality. Anthropometric measurements and hemoglobin levels will be measured at baseline, quarterly and at endline. The interventions will consist of locally produced lipid-based nutrient supplement (Wawamum) for children 6-23 months, micronutrient powders for children 24-59 months, and wheat soya blends for pregnant and lactating mothers. Government lady health workers will deliver interventions to participants. The effectiveness of the project will be measured in terms of the impact of the proposed interventions on stunting, nutritional status, micronutrient deficiencies, and other key indicators of the participants. The process evaluation will assess the acceptability, feasibility and potential barriers of project implementation through focus group discussions, key informant interviews and household surveys. Data analysis will be conducted using STATA version 12. DISCUSSION: There is considerable evidence on the effectiveness of food-based interventions in managing stunting in developing countries. However, these studies do not account for the local environmental factors and widespread nutrient deficiencies in Pakistan. These studies are often conducted in controlled environments, where the results cannot be generalized to programs operating under field conditions. The findings of this study will provide sufficient evidence to develop policies and programs aimed to prevent stunting in children 6-59 months and to improve maternal and child health and growth outcomes in poor resource settings. TRIAL REGISTRATION: NCT02422953 . Registered on April 15, 2015.

Social protection networks in Central America and the Dominican Republic: Do they have a nutritional dimension?

BACKGROUND: It is not known whether the social protection networks in the Central American subregion and the Dominican Republic have a nutritional dimension. OBJECTIVE: To explore whether the social protection networks in Central America and the Dominican Republic have a nutritional dimension. METHODS: A survey was conducted during 2009 of 110 social protection programs and 10 national plans in Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama, and the Dominican Republic. RESULTS: Most of the social protection programs did not have a nutritional dimension. CONCLUSIONS: With few exceptions, the social protection programs were not prepared to prevent undernutrition. There may be a similar situation in other regions. It is recommended to incorporate the nutritional dimension into all social protection programs and social safety nets in Central America and the Dominican Republic as well as in all other countries with low-income populations, worldwide.