Public Health

Health asset profiles and health indicators among 13- and 15-year-old adolescents Abstract Objectives We examined the associations between adolescents’ health assets and various health indicators (smoking, alcohol use, sleep length, physical activity, healthy eating, oral health, self-reported health, multiple health complaints). Methods A nationally representative sample was drawn from Finnish-speaking schools, comprising 13- and 15-year-old adolescents (n = 3833). The measures taken covered the adolescents’ health assets, which were labelled Family-financial, Psychological, Family-social, Friends-social, School-social, and Human. Our analysis applied two-step cluster analysis and multilevel mixed-effects binary logistic regression. Results Six asset profiles were identified: ‘Limited in most assets, despite medium affluence’, ‘Mostly average assets, but low affluence’, ‘Mostly average assets, though high affluence’, ‘Mostly above average assets’, ‘Rich in most assets’, and ‘Rich in all assets’. There were significant differences between the profiles in terms of risk level and desirable level health outcomes. Conclusions Adolescents differ in their asset profiles. Having multiple health assets appears to protect adolescents from risky behaviour or poor health, and to promote positive health. There is a need for health initiatives to develop a range of health-protecting and health-promoting assets, rather than focus on only one.

Commonalities and differences in legal euthanasia and physician-assisted suicide in three countries: a population-level comparison Abstract Objectives To describe and compare euthanasia and physician-assisted suicide (EAS) practice in Flanders, Belgium (BE), the Netherlands (NL) and Switzerland (CH). Methods Mortality follow-back surveys among attending physicians of a random sample of death certificates. Results We studied 349 EAS deaths in BE (4.6% of all deaths), 851 in NL (4.6% of all deaths) and 65 in CH (1.4% of all deaths). People who died by EAS were mostly aged 65 or older (BE: 81%, NL: 77% and CH: 71%) and were mostly diagnosed with cancer (BE: 57% and NL: 66%). Home was the most common place of death in NL (79%), while in BE and CH, more variation was found regarding to place of death. The decision to perform EAS was more frequently discussed with a colleague physician in BE (93%) and NL (90%) than in CH (60%). Conclusions EAS practice characteristics vary considerably in the studied countries with legal EAS. In addition to the legal context, cultural factors as well as the manner in which legislation is implemented play a role in how EAS legislation translates into practice.

Belgian Poison Centre impact on healthcare expenses of unintentional poisonings: a cost–benefit analysis Abstract Objectives This study evaluates the impact of the Belgian Poison Centre (BPC) on national healthcare expenses for calls from the public for unintentional poisonings. Methods The probability of either calling the BPC, consulting a general practitioner (GP) or consulting an emergency department (ED) was examined in a telephone survey (February–March 2016). Callers were asked what they would have done in case of unavailability of the BPC. The proportion and cost for ED-ambulatory care, ED 24-h observation or hospitalisation were calculated from individual invoices. A cost–benefit analysis was performed. Results Unintentional cases (n = 485) from 1045 calls to the BPC were included. After having called the BPC, 92.1% did not seek further medical help, 4.2% consulted a GP and 3.7% went to an ED. In the absence of the BPC, 13.8% would not have sought any further help, 49.3% would have consulted a GP and 36.9% would have gone to the hospital. The cost–benefit ratio of the availability of the BPC as versus its absence was estimated at 5.70. Conclusions Financial savings can be made if people first call the BPC for unintentional poisonings.

Understanding the etiology and impact of hatred globally in a public health context

Sitting time among adolescents across 26 Asia–Pacific countries: a population-based study Abstract Objectives To assess the prevalence of sitting time (ST) and examine sex and age disparities in the prevalence among adolescents from Asia–Pacific countries. Methods We used the Global School-based Student Health Survey data (n = 101,785) from 26 Asia–Pacific countries and computed the pooled prevalence of high ST (≥ 3 h/day) using random effect meta-analysis. We used logistic regression to examine sex and age disparities in the prevalence, and meta-regression to assess whether the prevalence was associated with common global indices. Results The overall prevalence of ST was 29.9% (95% CI 24.1–35.8) with 29.8% (24.4–35.2) among male and 29.9% (23.4–36.3) female adolescents. Males had higher odds of high ST than females in seven countries, while females had higher odds in six countries. Older adolescents had higher prevalence than their younger counterparts. High ST was more common in high-income countries and was positively associated with country Human Development Index (β = 1.28, 95% CI 0.88–1.68). Conclusion Continued monitoring of adolescents’ ST is warranted in this region to generate consistent and comparable surveillance data that can inform policies and actions for the health and well-being of the regional adolescents.

Vigorous physical activity in relation to family affluence: time trends in Europe and North America Abstract Objectives The aim of the study was to determine secular trends in vigorous physical activity (VPA) among adolescents in relation to family affluence across 34 countries. Methods This study used data from the Health Behaviour in School-aged Children (HBSC) study from 34 countries in Europe and North America. Adolescents (N = 501,647) aged 11, 13 and 15 years across three survey cycles (2006, 2010, 2014) self-reported data on VPA and a family affluence scale (FAS) using standardized questionnaires. Results A significant increase in VPA was found in low-FAS boys (girls) in four (10) countries and a decrease in four (three) countries. In high-FAS boys (girls), a significant increase was observed in nine (11) countries and a decrease in two(three) countries. An overall significant increase in meeting the VPA recommendations was found in high-FAS boys (OR 1.11; 95% CI 1.06–1.16) and in all FAS groups in girls, with the largest effect being found among high-FAS girls (OR 1.24; 95% CI 1.18–1.30). Conclusions A country-specific increase in VPA was observed primarily in the medium- and high-FAS categories. This study suggests a need to focus on increasing VPA efforts, especially in low- and medium-FAS boys.

The integration of primary care and public health to improve population health: tackling the complex issue of multimorbidity

Divergent trends in life expectancy across the rural–urban gradient and association with specific racial proportions in the contiguous USA 2000–2005 Abstract Objectives To estimate county-level adult life expectancy for Whites, Black/African Americans (Black), American Indian/Alaska Native (AIAN) and Asian/Pacific Islander (Asian) populations and assess the difference across racial groups in the relationship among life expectancy, rurality and specific race proportion. Methods We used individual-level death data to estimate county-level life expectancy at age 25 (e25) for Whites, Black, AIAN and Asian in the contiguous USA for 2000–2005. Race–sex-stratified models were used to examine the associations among e25, rurality and specific race proportion, adjusted for socioeconomic variables. Results Lower e25 was found in the central USA for AIANs and in the west coast for Asians. We found higher e25 in the most rural areas for Whites but in the most urban areas for AIAN and Asians. The associations between specific race proportion and e25 were positive or null for Whites but were negative for Blacks, AIAN, and Asians. The relationship between specific race proportion and e25 varied across rurality. Conclusions Identifying differences in adult life expectancy, both across and within racial groups, provides new insights into the geographic determinants of life expectancy disparities.

Correction to: Attendance to cervical cancer screening among Roma and non-Roma women living in North-Western region of Romania Romania has Europe’s highest incidence and mortality rates of cervical cancer. Participation in the national cervical cancer-screening programme is low, especially among minority Roma women.

RETRACTED ARTICLE: Direct healthcare costs of spinal disorders in Brazil