Public Health

Direct healthcare costs of spinal disorders in Brazil Abstract Objectives To estimate the direct healthcare costs of spinal disorders in Brazil over 2016. Methods This is a prevalence-based cost-of-illness study with a top-down approach from the perspective of the public healthcare system. All international Classification of Diseases codes related to spinal disorders were included. The following costs were obtained: (1) hospitalization; medical professional service costs; intensive care unit costs; companion daily stay; (2) outpatient (services/procedures). Data were analyzed descriptively and costs presented in US$. Results The healthcare system spent US$ 71.4 million, and inpatient care represented 58%. The number of inpatient days was 250,426, and there were 36,654 hospital admissions (dorsalgia and disk disorders representing 70% of the costs). More than 114,000 magnetic resonance scans and 107,000 computerized tomography scans were adopted. Men had more inpatient days (138,215) than women (112,211). Overall, the inpatient/outpatient cost ratio was twice as high for men. Conclusions We demonstrated that the direct costs of spinal disorders in Brazil in 2016 were considerable. We also found a substantial amount of financial resources spent on diagnostic imaging. This is relevant as the routine use of diagnostic imaging for back pain is discouraged in international guidelines.

Roma health: Do we know enough?

Reducing socioeconomic inequalities in life expectancy among municipalities: the Brazilian experience Abstract Objectives This study analyzed the evolution of regional and socioeconomic inequality in life expectancy (LE) at birth and the probability of living up to 40 (LU40) and up to 60 years of age (LU60) in Brazilian municipalities between 1991 and 2010. Methods We analyzed data from the last three national census (1991, 2000 and 2010) computed for the 5565 Brazilian municipalities. They were divided into centiles according to the average per capita income. Poisson regression was performed to calculate the ratios between the poorest and the richest centiles. Results The average LE (+ 8.8 years), LU40 [6.7 percentage points (pp)] and LU60 increased (12.2 pp) between 1991 and 2010. The ratio of LE between the 1% of richest counties and the 1% of poorest counties decreased from 1.20 in 1991 to 1.09 in 2010. While in the poorest municipalities there was a gain of around 12 years of life, among the richest this increase was around 7 years. Conclusions There was a remarkable decrease in regional and socioeconomic inequality in LE, LU40 and LU60 in Brazil between 1991 and 2010.

Clusters of risk behaviors for noncommunicable diseases in the Brazilian adult population Abstract Objectives To identify clusters of risk behaviors among Brazilian adults, by sex, and to associate clusters with sociodemographic factors and self-perception of health. Methods We assessed 46,785 adults from the Brazilian National Health Survey. The risk behaviors were low consumption of fruits and vegetables—LFV (< 5 times/week), physical inactivity—PI (< 150 min/week), smoking (yes/no) and excessive consumption of alcohol—EA (5 doses for male, 4 doses for female). We used Venn diagram, cluster analysis and multinomial regression models. Results We found 9 clusters. The cluster of four risk behaviors was more common in males (3.2% vs. 0.83%). Despite a greater potential for aggregation of behaviors in females (O/E = 2.48) than in males (O/E = 1.62), the women were less likely to have all risk behaviors jointly (OR 0.24, 95% CI 0.19; 0.31), and this was found for the other clusters. In general, Brazilian black/brown, younger, with low education level and who had a self-perception of bad health, were more likely to engage in clusters of risk behaviors. Conclusions The prevalence of Brazilian adults engaging in clusters of risk behaviors is high, mainly among males, those who reported a bad health and with low socioeconomic status.

Palliative care in universal health coverage: What about humanitarian emergency assistance?

Migrant mental health, Hickam's dictum, and the dangers of oversimplification

Road map towards a harmonized pan-European surveillance of obesity-related lifestyle behaviours and their determinants in children and adolescents Abstract Objectives To develop a road map towards a harmonized pan-European surveillance system for children and adolescents. Methods Representatives of five European surveillance systems and the German Health Interview and Examination Survey for Children and Adolescents contributed to the road map through a structured workshop in 2016. Results A conceptual framework for this road map was developed with seven action points (APs) guiding the successive cross-country harmonization. First, key indicators of health behaviour and their determinants in children and adolescents will be identified (AP1, 2); short screening instruments will be developed and implemented to assess and monitor key indicators (AP3, 4). In parallel, optional supplementary modules could be implemented to provide objective data (AP5). This would allow mutual calibration and improvement of existing instruments before their progressive replacement by more comparable measurement tools (AP6). The establishment of a competence platform is envisaged for guiding the harmonization process (AP7). Conclusions This approach builds on existing systems, provides comparable key health indicators across European regions, helps to assess temporal trends and—once in place—will facilitate health reporting and monitoring of national and international health targets.

Association of objectively measured and perceived environment with accelerometer-based physical activity and cycling: a Swiss population-based cross-sectional study of children Abstract Objectives We tested whether objectively assessed neighbourhood characteristics are associated with moderate-to vigorous physical activity (MVPA) and cycling in Swiss children and adolescents and assessed the mediating role of the perception of the environment. Methods The cross-sectional analyses were based on data of 1306 participants aged 6–16 years of the population-based SOPHYA study. MVPA was measured by accelerometry, time spent cycling and the perceived environment by questionnaire. Objective environmental parameters at the residential address were GIS derived. In all analyses, personal, social and environmental factors were considered. Results MVPA showed significant positive associations with perceived personal safety and perceived access to green spaces but not with respective objective parameters. Objectively assessed main street density and shorter distance to the next public transport were associated with less cycling in adolescents. Parents' perceptions did not mediate the observed associations of the objectively assessed environment with MVPA and cycling. Conclusions Associations between the environment and physical activity differ by domain. In spatial planning efforts to improve objective environments should be complemented with efforts to increase parental sense of security.

Obesity risk in women of childbearing age in New Zealand: a nationally representative cross-sectional study Abstract Objectives To investigate risk factors for women with obesity of childbearing age. Methods A cross-sectional survey of New Zealand women (15–49 years) with measured height and weight was used [unweighted (n = 3625) and weighted analytical sample (n = 1,098,372)] alongside sociodemographic-, behavioural- and environmental-level predictors. Multilevel logistic regression weighted for non-response of height and weight data was used. Results Meeting physical activity guidelines (AOR (adjusted odds ratio) 0.66, 95% CI 0.54–0.80), Asian (AOR 0.15, 95% CI 0.10–0.23) and European/other ethnicity (AOR 0.46, 95% CI 0.36–0.58) and an increased availability of public greenspace (Q4 AOR 0.55, 95% CI 0.41–0.75) were related to decreased obesity risk. Older age (45–49 years AOR 3.01, 95% CI 2.17–4.16), Pacific ethnicity (AOR 2.81, 95% CI 1.87–4.22), residing in deprived areas (AOR 1.65, 95% CI 1.16–2.35) or secondary urban areas (AOR 1.49, 95% CI 1.03–2.18) were related to increased obesity risk. When examined by rural/urban classification, private greenspace was only related to increased obesity risk in main urban areas. Conclusions This study highlights factors including but not limited to public greenspace, which inform obesity interventions for women of childbearing age in New Zealand.

Source-country individualism, cultural shock, and depression among immigrants Abstract Objectives To determine whether there is a relationship between source-country individualism and depression among different immigrant groups. Methods Pooled data from the 2009–2014 waves of the Canadian Community Health Survey (CCHS) were used. The CCHS is a cross-sectional, nationally representative household survey. A sample of 4347 immigrants in Canada were studied, representing 101 source countries. Results Multi-level logistic regression analysis showed a curvilinear relationship between source-country individualism and depression. A positive relationship was found among immigrants from countries with mid- to high levels of individualism. However, an inverse relationship was observed among immigrants from countries with low to mid-levels of individualism. Depression was significantly associated with the linear form of the source-country individualism measure [odds ratio (OR) 0.950; 95% confidence interval (CI) 0.915–0.987] and its squared term (OR 1.063; 95% CI 1.026–1.102). Conclusions A high level of source-country individualism tends to increase the prevalence of depression among immigrants. There is also a cultural shock effect: the prevalence of depression was stronger in the initial years after immigration for those who migrated from countries with low levels of individualism.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com