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SOCIAL ASPECTS OF SUICIDES COMMITTED BY HANGING IN THE REGION OF PLOVDIV, REPUBLIC OF BULGARIA, IN THE PERIOD 2000-2009
Marin Kostadinov Baltov
PhD, Chief Assistant Professor at the Department of General and Clinical Pathology and Forensic Medicine, Medical
University; St. George University Multi-Profile Hospital for Active Treatment EAD,
Department of Forensic Medicine, Plovdiv, Bulgaria Ekaterina Lyubenova Raykova
Assistant Professor at the Department of Healthcare Management, Faculty of Public Health, Medical University,
Plovdiv, Bulgaria Vanina Krasteva Mihaylova
PhD, Assoc. proff Doctor's educational and scientific decree on scientific specialty 03.01.53 Social Medicine and
Healthcare and Pharmacy at the Department of Preventive Medicine, Faculty of Public Health, Sofia; Chief Assistant Department of Healthcare Management, Faculty of Public Health, Medical University, Plovdiv, Bulgaria
ABSTRACT
Death by hanging is one of the most common suicide methods. This research studies some social aspects of suicidal hangings committed in the region of Plovdiv, Republic of Bulgaria, during the period 2000-2009.
Throughout that period, 944 suicides were committed in the region, of which 480 (51.56±1.66%) by hanging. Men committed 365 (76.04±1.95%) of the hangings, whereas women - 115 (23.96±1.95%). People living in the cities of the region committed 54.58±2.27% of the suicides, whereas rural residents - 45.42±2.27%. The smaller part of the population of the region of Plovdiv lives in the country, so suicide index with rural residents is 2.2 times higher than the suicide index of urban population. The average age of suicides who committed hanging is 56.13±0.82 years, and the relative share ofpersons in mature age (4564) is the largest.
Key words: suicides, hanging, suicide index.
Suicide is a phenomenon which accompanies the historic development of mankind. In modern society, it is a social problem due to the growing number of people choosing to end their own lives. On a global scale, suicide is the fifth most frequent cause of death among people aged between 30 and 49, as well the second among young people in the age group from 15 to 29 [12, 13, 14].
One of the most common suicidal methods is death by hanging [1, 3, 7, 8]. In Europe, the highest rates of suicidal hangings are reported in the former socialist countries -Lithuania, Poland, Latvia, Estonia [13]. Varying information is reported about the Balkan peninsula regarding the number of suicidal hangings committed, the largest number being reported for the region of Mures, Republic of Romania [8].
In the Republic of Bulgaria, the relative share of committed suicidal hangings has increased over the years. In the period 1929-1941, they make up 30.12% of all suicides and increase to 68.9% in the period 1989-2001 [11, 4].
The AIM of this study is to examine the main tendencies in the dynamics of the level of suicides by hanging committed in the region of Plovdiv over the period 2000-2009.
Material and methods: The object of study are the committed suicidal hangings which are registered at the Departments of Forensic Medicine of St. George University Multi-Profile Hospital for Active Treatment EAD and Plovdiv Multi-Profile Hospital for Active Treatment AD, Plovdiv, over the period 2000-2009. The information about the population in the region used is courtesy of the National Statistical Institute (NSI) [15]. For the collection of input information has been used a historical method of choice. Alternative, variation, non-parametric and graphical analysis has been used in the statistical processing of the information [5, 6].
Results: Over the period 2000-2009, 944 cases of suicide were registered in the region of Plovdiv, of which 480 (51.56±1.64%) were suicidal hangings (Diagram 1).
Diagram 1. Change of the relative share of suicidal hangings in the region of Plovdiv over the period 2000-2009
Based on the information available about the population in the region, the hanging suicide index has been calculated and
compared to the total suicide index of the region (Diagram 2).
%000
17,13 ■ *" 16,69 J5.â2_
14,55s ^4,49s
12,32 12.25 12,86 13,18
9,3 8,51 7.89
6,8 6,7 6.14 5 6"1 6,23 6,42
5,09 "
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 • hangings Yt=6,87=0.15x —•—total number of suicides Yt=13,90=0,32x
Diagram 2. Dynamics of the suicide index of suicidal hangings and of the total suicide index in the region of Plovdiv
over the period 2000-2009
During the period 2000-2009, 365 men (76.04±1.95%) and 115 women (23.96±1.95%) committed suicide by hanging. The relative share of hangings committed by men and women changes over the years (Diagram 3).
Diagram 3. Gender differentiation of suicidal hangings for the period 2000-2009
The results of the study on suicides in the region of Plovdiv over the period show that hangings are more frequent among rural residents than among urban residents. Out of the 480 registered cases of suicidal hanging, 262 (54.58±2.27%)
were committed by urban residents, whereas 218 cases (45.42±2.27%) were committed by rural residents. A clearer idea of the different suicidal behavior of urban and rural residents is given by the suicide index (Diagram 4).
—#—urban residents Yt=5,l7±0,12x —■—rural residents Yt=ll,22±0,14x
Diagram 4. Suicide index of urban and rural residents who committed suicidal hanging during the period 2000-2009
The average age of suicides for the entire period is 56.13±0.82 (Sx=16.49). The distribution of suicidal hanging deaths by age groups for the period 2000-2009 is shown in diagram 5.
0-19
20-44
45-64
over 65
Diagram 5. Age structure of suicidal hangings in the region of Plovdiv in the period 2000-2009
The results presented in Diagram 5 show that suicidal hangings are most common among the active population. Maximum suicide rates are reported for the age group 45-64.
Discussion: The analysis of the data shows that death by hanging is the most common suicidal method used in the region of Plovdiv. The relative share of committed suicidal hangings in reference to the total number of suicides varies over the years, so their dynamics is unstable, with a peak in 2005 and a dip in 2006. The data from the last year of the research is close to the mean rate for the period.
The suicidal hanging rates established are close to the rates reported for the region of the Balkan peninsula -Montenegro - 51.88%, Republic of Serbia - 57.00%, the region of Trakya in the Republic of Turkey - 41.8% [1, 2, 9, 10].
The suicide index (%000), reflecting the quantitative side of hangings also varies, but since 2006 its values have been decreasing and its lowest rate was reported in 2008.
The prevalence of male suicidal behavior reflects the same tendency in other countries too, however, the inter-gender ratio is variable. For the region of Plovdiv, the proportion between male and female suicides is 3.2: 1.0, identical to the proportion in Montenegro, but lower than the rate reported for the Republic of Romania and the Republic of Turkey [1, 2, 7].
The dynamics of suicidal hangings by gender over the entire period under examination shows that relative share of male suicides reaches its peak in 2007, and its lowest rate in 2008. In that same year, the relative rates of male and female suicides by hanging come close, with the difference being smaller than 10%. For the entire period under investigation, male suicidal hangings were 76.04±1.95%, and female -23.96±1.95%. Non-parametric analysis confirms the existence of statistically significant difference at a level of 95.00%, P<0.05 (X2=17.05).
The place of residence is one of the risk factors for suicidal behavior. Throughout the entire period under observation, residents of cities in the region of Plovdiv committed 54.58±2.27% of all cases of hanging, whereas rural residents committed 45.42±2.27%. Defining the suicide index by place of residence of the persons committing suicide has reveled much higher rates for people living in the country than for people living in the city. One of the reasons for this is the population decline of villages on the one hand, and on the other, their deteriorating economic situation. All this, in combination with the easy access to the means for committing
suicide, makes it the most common method of suicide in the country.
Comparative analysis of suicidal hangings by age groups shows that their largest share is within the age group 45-64. This group is most seriously affected by the economic crisis. The oldest people who committed suicide were a man and a woman at the age of 89.
Conclusions:
1. In the region of Plovdiv 51.56±1.64% of all suicides are committed by suicidal hanging.
2. Suicidal hanging dynamics over the period 2000-2009 is fluctuating with a tendency for a decrease.
3. Men commit 3.2 times more suicides by hanging than women.
4. The suicide index of hangings committed by rural residents is e 2.2 higher than the suicide index of hangings committed by urban residents.
5. Hanging is the most common method of suicide among people in mature age (45-64).
Literature:
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6. Dimitrov I. Medical statistics. "Pygmalion", Plovdiv, 1996.
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demographic, social-psychological and meteotropic factors, Receptor, Ill, 2006, No. 4, p 54-62.
12. Suicide Statistics URL: www.suicide.org/suicide-statistics.html
13. WHO- Suicide Statistics, Geneve 2010; URL: www.who.int/en/
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15. www.nsi.bg
СРАВНИТЕЛЬНАЯ ИММУНОГИСТОХИМИЧЕСКАЯ ХАРАКТЕРИСТИКА И ОСОБЕННОСТИ КОННЕКСИНОВ ГЛИАЛЬНЫХ ОПУХОЛЕЙ ГОЛОВНОГО МОЗГА ПРИ СТУПЕНЧАТОМ ПОДХОДЕ К ХИМИОТЕРАПИИ В ИХ КОМПЛЕКСНОМ ЛЕЧЕНИИ
И.В. Балязин-Парфенов, С.С. Тодоров.
ФГБУ «Ростовский научно-исследовательский онкологический институт» МЗ России. г. Ростов-на-Дону.
АННОТАЦИЯ
Проведено сравнительное морфологическое и иммуногистохимическое исследование доброкачественных и злокачественных глиальных опухолей головного мозга при использовании ступенчатого подхода к химиотерапии в их комплексном лечении. В исследование включены наблюдавшиеся с 2013 по 2015 год. 95 больных с астроцитомами: GrI -19чел., GrII- 21чел., GrIII -28чел., GrIV(глиобластомы)- 27чел.. Иммуногистохимическое (ИГХ) исследование опухолей головного мозга было выполнено с использование следующих моно- и поликлональных антител: р53, Ю-67, СБ31, СБ34, ЕОЕК, Ьс1-6. Показано наличие морфологических особенностей глиом, которые определяют выбор тактики их комплексного лечения, что является основой для прогноза лечения таких больных. В то же время по мере нарастания степени злокачественности в глиомах нарушаются взаимоотношения коннексинов Сх36, Сх43, вплоть до полного их отсутствия в глиобластомах. Такая дезинтеграция коннексинов с преобладанием коннексина-36 в астроцитомахразной степени злокачественности может указывать на нарушение синхронизации межклеточных взаимодействий,ухуд-шение передачи межнейрональных импульсов, а негативная реакция коннексинов в глиобластомах обоих типов может свидетельствовать о полном закрытии или повреждении щелевых контактов, что, несомненно, может определять чувствительность к химиотерапии и продолжительность жизни.
Злокачественные глиомы составляют около 60% от всех первичных опухолей центральной нервной системы и в последние десятилетия во всем мире и России наблюдается рост заболеваемости опухолями головного мозга (ОГМ). Современная тактика лечения больных глиаль-ными опухолями головного мозга включает в себя их микрохирургическое удаление, лучевую и химиотерапию. Химиотерапия, биотерапия (интерфероны, интерлейкины, вакцины), гормонотерапия, а также молекулярно-нацелен-ная и генная терапия в последние годы играет существенную роль в лечении злокачественных глиом помимо лучевой терапии [1]. Однако, чувствительность к цитоста-тикам злокачественных опухолей головного мозга различных гистологических типов различна [2,3]. Тактика лечения нейроонкологических больных определяется на основании гистологического диагноза, который далеко не всегда в точности характеризует гистобиологическую агрессивность опухолей [4]. Кроме того, также известно, что все глиальные опухоли являются потенциально злокачественными, могут содержать «островки» анапластиче-ской астроцитомы, глиобластомы, что затрудняет их радикальное удаление, и послеоперационное применение адъювантной лучевой терапии или химиотерапии. С появлением методов иммуногистохимии расширились диагностические возможности для углубленной оценки гисто-биологических свойств глиальных опухолей.
В настоящее время известны некоторые гистологические маркеры глиальных опухолей, определяющие прогноз лечения и химиочувствительность [5]. Несмотря на имеющиеся достижения, эффективность методов лечения глиальных опухолей недостаточна, что является причиной
продолжения изучения морфологических и иммуногисто-химических характеристик данных новообразований.
Целью нашего исследования явилось изучение сравнительных морфоиммуногистохимических показателей и коннексинов в астроцитомах головного мозга различной степени злокачественности с целью обосновать их комплексное лечение и улучшение его результатов.
Материалы и методы. Под наблюдением с 2013 по 2015 г.г. находились 95 больных. Из них - 19 больных, оперированы по поводу GrI астроцитомы (11 женщин, 8 мужчин), 21 человек - по поводу - астроцитомы GrII (12 женщин и 9 мужчин), 28 человек - астроцитомы GrlII (16 женщин и 12 мужчин), 27 чел. - GrIV-глиобластомы (14 женщин и 13 мужчин). Возраст больных был от 32 до 74 лет (средний возраст 53±14 лет). Для всех больных комплексное лечение заключалось в оперативном вмешательстве с микрохирургическим удалением опухоли в пределах здоровых тканей, адъювантной дистанционной гамма-терапей (ДГТ) и последующими курсами химиотерапии. Во время удаления опухоли с разрешения этического комитета института и согласия больных для гистологического и иммуногистохимического исследования забирался фрагмент опухоли объемом 1 см3.
Больные с астроцитомами GrI и GrII получили курс адъювантной дистанционной гамматерапии (ДГТ) до СОД 60 Гр и последующие курсы химиотерапии ломусти-ном в дозе 100 мг/м2. Больные с астроцитомой GrIII и аст-роцитомой GrIV (глиобластомой) получали курс адъ-ювантной дистанционной гамматерапии до СОД 60 Гр на фоне курса монохимиотерапии карбоплатином в дозе 50
