Journal of Public Health

Background: Workplace discrimination and violence against health workers including sexual harassment is a societal problem worldwide. We aimed to assess the frequency, predictive factors, and effects of sexual harassment using a nationwide survey of physicians working in Switzerland. Materials and Methods: We conducted a self-administered questionnaire survey of physicians working in Swiss healthcare institutions. The questionnaire assessed experiences of sexual harassment at work, including frequency, types, and sources of harassment. It also asked about the impact of sexual harassment, whether incidents were reported, and what actions were taken following a report. Results: Among the 1837 physicians that participated in the survey, 575 (31.3%) had experienced sexual harassment at least once during their career. Among those reporting sexual harassment, 39.1% of women and 13.2% of men had experienced harassment at least once in their job. Women reported more verbal harassment, while men reported more physical harassment. Women were also more likely to face both forms combined. The main sources of harassment were colleagues of the same profession (46.7%), patients (42.3%), and superiors (41.0%). The most frequently reported impacts included stress (60.1%), emotional exhaustion (34.7%), reduced motivation at work (30%), and considering leaving the job (7.5%). Gender-men was associated with a lower likelihood of experiencing harassment 0.24 (0.18 to 0.31), whereas working in the German-speaking region was associated with a slightly higher likelihood of having experienced sexual harassment at least once (OR 1.35, 95% CI:1.02-1.81). Conclusions: Sexual harassment is common among physicians in Swiss healthcare institutions. It adversely affects the mental health and career trajectories of both men and women yet remains widely underreported due to fears of reprisals and inaction. Institutions should effectively intervene to ensure that reported incidents result in appropriate actions, and that those who report them receive adequate protection from reprisals.

Objectives To investigate the association between time spent in NHS Type 1 emergency departments (EDs, consultant led 24 hour services with full resuscitation facilities) and risk of leaving employment and hospitalisation after leaving the department alive up to two years after attendance. Methods We conducted a retrospective cohort study using linked administrative data from the NHS Emergency Care Dataset, Hospital Episode Statistics, Census 2021, and mortality records. ED length of stay was categorised from under 2 hours to 12 hours or more. Cox proportional hazards models were fitted to estimate the association between ED length of stay and subsequently leaving employment or being hospitalised over a two year follow-up period, adjusting for demographic, socioeconomic, and clinical characteristics. Results Our study population comprised 3,347,008 individuals aged 25 to 64 who attended a Type 1 ED in England between April 2021 and March 2023. For leaving employment, adjusted hazard ratios (aHRs) increased from 1.04 (95% CI 1.03 to 1.06) for stays of 2 to <4 hours to 1.21 (1.17 to 1.24) for 12 hours or more, compared with stays under 2 hours. A similar but more pronounced gradient was observed for post-discharge hospitalisation, with aHRs rising from 1.06 (1.04 to 1.07) at 2 to <4 hours to 1.95 (1.91 to 1.99) for stays of 12 hours or more. Conclusions Prolonged time spent in the ED is associated with poorer outcomes among working-age employees, including reduced labour market participation and increased hospital use. These findings suggest that long ED stays may have wider and longer-term implications beyond immediate clinical outcomes, including potentially for national labour markets and economic growth.

This paper examines the impact of Cancer Care Ontario's regionalization of lung cancer surgery on blood transfusion use for thoracic surgery at The Ottawa Hospital. Using aggregate data scraped from the paper ''Changing trends in blood transfusion: an analysis of 244,013 hospitalizations'' by Shehata et al. (2014) we estimated the effect regionalization on the log mean number of blood transfusions among thoracic surgeons (who treat lung cancer), utilizing other surgical specialties as controls. We found that the average number of blood transfusions increased significantly among thoracic surgeons following the opening of a new cancer care centre at the hospital in December 2009, while control specialties showed no parallel change. Contextualizing these results in a modified ''population level'' treatment threshold model, it is argued that the main driver of this increase in blood transfusions among thoracic surgeons was due to the influx of less skilled thoracic surgeons to The Ottawa Hospital, and the closing of thoracic surgery units at smaller hospitals which was part of the broader regionalization process.

Background: Rising rates of young people Not in Education, Employment, or Training (NEET) in the UK have recently coincided with declining youth physical and mental health but no study has asked whether this reflects a growing proportion of young people with health problems (prevalence) or those with health problems becoming more likely to be NEET (penalty). Methods: Using 15 years of Understanding Society data (2009-23), we analysed 15,242 respondents aged 16-24 (66,160 observations). We employed three complementary approaches: descriptive trends, Blinder-Oaxaca-Kitagawa (BO) probit decomposition comparing 2009-2013 and 2019-2023 against a 2014-2018 reference period, and fixed-effects (FE) Poisson models with lagged health status. Exposures included self-reported health conditions or disability (SRHD), psychological distress , diagnosed conditions and socio-demographic factors. Findings: NEET rates were lowest in 2014-18 (10.5-11.5%) and higher in 2009-13 (12-15%) and 2019-23 (15-16%). Higher prevalence of SRHD, psychological distress, diagnosed depression and multimorbidity explained changes in NEET prevalence across both the 2009-13 to 2014-2018 and 2014-18 to 2019-23 periods. No change in penalty was observed for any health variable across periods, except for an increase in the penalty for SRHD between the 2009-13 to 2014-18 periods. Interpretation: Rising NEET rates among UK youth are driven largely by more young people having physical and psychological ill health. Whilst labour market and education accommodations remain important, reducing NEET rates will require reversing the decline in youth health, not just accommodating it.

Objective: In 2021, a large-scale survey highlighted that in a subset of biomedical journals, a few authors -often serving on the editorial board- published disproportionately and experienced shorter acceptance times. Our study aims to specifically quantify editors research articles within the journals in which they operate. Methods: We selected journals indexed in Open Editors, a dataset that collects publicly available information on journal editorial boards through web scraping. Journals not indexed in PubMed, mega-journals, and those with very low publication volume were excluded. For the remaining journals, we linked the 2022 editorial boards from Open Editors to authors of research articles (i.e., original articles, case reports, and reviews) published between 2020 and 2023. For each journal, we then computed indicators describing publication patterns: the percentage of research articles (i) by the most prolific editor, (ii) with at least one editor, and (iii) by the most prolific author, as well as publication lags for each article. Results: Across the 1,623 journals studied, the median and 95th percentile of research articles are 1.78% and 6.7% for those co-authored with the most prolific editor, 12.1% and 41.1% for those with at least one editor, and 2.5% and 7.9% for those with the most prolific author. An editor was among the most prolific author(s) in 45.0% of the journals. For authors, the median and 5th percentile publications lags are 99 and 35 days; for editors, it is 95 and 33 days; and for editors-in-chief, it amounts to only 84 and 12 days. An in-depth examination of journals where the most prolific editor co-authored more than 6.7% (95th percentile) found a median impact factor of 3, and a median h-index of 42 for their most prolific editor(s). Conclusion: In 5% of cases, an editor contributes to approximately >7% of the articles published in their own journal. In nearly half of the journals, the most prolific author is an editor. These results need to be complemented by a qualitative approach to examine whether research articles authored by editors appropriately address potential conflicts of interest, as required by COPE recommendations, and to better understand the motivations underlying this practice.

Background: Disaster medicine has been a formal curricular recommendation in German health professions education since 2006, and comparable recommendations exist internationally. Evidence on implementation is confined almost entirely to human medicine, rests on faculty self-reports or small student samples, and measures delivery rather than retention. Whether curricular exposure is associated with willingness to serve has not been adequately examined in interprofessional samples. Objective: We aimed to characterize disaster medicine education across 7 health professions in Germany, distinguishing delivery from retention, to identify profession-specific gaps and training priorities, and to examine how educational and experiential factors relate to willingness to serve. Methods: We conducted an anonymous nationwide online cross-sectional survey of students and trainees across 7 health professions in Germany between July 9 and August 25, 2026, recruited through institutional distribution lists. The interprofessionally developed instrument comprised 48 items. We assessed delivery and retention of 12 disaster medicine topics (4-point scale), self-rated confidence in 22 clinical and nursing skills (6-point scale), desired content, formats, motivators and barriers, and formal and spontaneous willingness. For all rating scales, higher values denote the more favorable level. We derived a delivery-retention gap and a want-deficit index, examined the dimensional structure of the competence battery, tested for differential item functioning by prior civil protection engagement, and modeled willingness with a cumulative link model. Results: Of 8133 respondents (completion rate 87.5%), 33.1% had never been taught disaster medicine and 25.0% only in passing; 22.1% had comprehensive teaching including practical exercises. Across the 12 topics, the proportion able to retrieve content confidently never exceeded 23.9%; the delivery-retention gap reached 47.3 percentage points. More than half (54.6%) had never taken part in a practical exercise. Competence formed more than 1 dimension: 18 acute-technical items loaded 0.54-0.86 on the first factor, 4 relational and nursing items 0.14-0.28. Prior civil protection engagement was associated with higher confidence on every acute-technical item (Cliff delta 0.26-0.55) and lower confidence on all 4 relational items (-0.22 to -0.09). Willingness was high and homogeneous across groups (78.7% formal, 84.1% spontaneous), whereas competence varied by about 2 scale points. Adjusted, active civil protection engagement (odds ratio 2.49, 95% CI 2.12-2.94) and practical exercise experience (odds ratio 1.78, 95% CI 1.54-2.05) were the strongest predictors; curricular exposure contributed weakly (odds ratio 1.06 per SD, 95% CI 0.99-1.14). Conclusions: Two decades after the curricular recommendation, disaster medicine is largely absent from health professions education in Germany, and what is delivered is not retained. Willingness is nevertheless high and largely decoupled from competence, so qualification and recruitment require separate instruments. Curricula should be prioritized by the coincidence of demand and deficit rather than by coverage, built for retention, and should treat relational and nursing competence as a distinct learning objective.

Background: Social vulnerability is associated with adverse health outcomes, but existing social vulnerability indices often rely on cohort-based and self-reported data, potentially limiting their population-level applicability. Therefore, this study aimed to develop an SVI from routinely collected electronic health records (EHRs) using natural language processing (NLP) and examine its association with mortality and healthcare utilization. Method: EHR data from 193,629 individuals aged 35 to102 from the Wellbeing Services County of Central Finland between years 2010 and 2023 were used in this study. A 6 item SVI (total score 0 to 6) was developed from free-text clinical notes using deep-learning-based NLP. SVI scores were calculated at baseline and annually for individuals. Associations between baseline SVI and all cause mortality and healthcare utilization were assessed over 12-year follow-up using Cox and count models. Results: The mean baseline SVI among all participants was 0.35 (range 0 to 6). Women had higher SVI (0.39) than men (0.32, p<0.001). SVI increased with age. One unit increase in SVI was associated with a higher risk of mortality (Hazard Ratio (HR) 1.23; 95% Confidence Interval (CI) (1.21 to 1.24), a higher odds of using healthcare services (Odds Ratio (OR) = 1.20; 95% CI): 1.19 to 1.21) and a greater healthcare service use (Incidence Rate Ratio (IRR) = 1.07; 95% CI: 1.06 to 1.07). Discussion: An index capturing multiple domains of social vulnerability can be derived from EHRs using NLP. Higher SVI was associated with increased mortality and healthcare utilization. These findings support the potential of EHR data for assessing social vulnerability and related health risks.

Introduction Hearing loss (HL) affects over 1{middle dot}5 billion people globally and India shares a disproportionately high burden including Disabling Hearing Loss (DHL). HL affects an Individual socio-economically, but there are limited studies on the broader societal economic consequences of HL in India.Methods Using Cost-of-Illness (COI) approach, we studied the societal economic burden of HL in India. This study uses epidemiological and macroeconomic data and modelling to estimate the loss of Gross National Income (GNI) due to HL and DHL across three economic pathways. Uncertainty is evaluated using deterministic and Probabilistic Sensitivity Analyses (PSA).Results The model estimates that there are in India, 289 million and 85{middle dot}9 million people with HL and DHL respectively. Direct Loss of GNI and Indirect Loss of GNI (Caregiver burden) are estimated as INR 4,648{middle dot}4 billion (USD 55{middle dot}6 billion) and INR 3,268 billion (USD 39 billion) respectively. The Loss of GNI due to Low Education amongst those with HL is estimated as INR 1,041{middle dot}9 billion (USD 12{middle dot}45 billion).Discussion Economic burden of HL is presented across three pathways with Direct Loss of GNI due to DHL being the greatest. It also presents age stratified caregiver economic burden. The findings of the study help in estimating similar cost pathways, advocacy, and policy decisions towards reducing HL prevalence in India and LMICs. This study also highlights the need for India specific estimations related to the HL attributable low education, state-wise disaggregates, and prevalence studies. Funding This study has not received any funding.

Introduction In July 2025, WHO launched the 3 by 35 Initiative calling on countries to increase real prices of tobacco, alcohol, and sugary drinks by at least 50% by 2035 to secure an additional $ 1 trillion in public revenue. While the effectiveness of excise taxes and prices in reducing tobacco use is well-documented, the feasibility of this call to action has not been evaluated empirically across the world. Methods Trend changes in countries nominal and inflation-adjusted retail prices were investigated using the most-sold brand of cigarettes over windows ranging from 2 to 16 years over the period 2008-2024, derived from nine editions of the World Health Organization Report on the Global Tobacco Epidemic. Statistical models of the association of cigarette excise taxes and prices from the panel of 195 countries were estimated. The frequencies of cigarette prices rising by at least 20% and 50% over preceding periods was estimated, and the length of time countries would need to reach these targets based on past trends were predicted. Results Over one- fifth of nominal cigarettes prices (and up to 40% in WHOs African region) were sticky across successive periods, even in countries with high overall consumer price inflation. Between 2008 and 2024, inflation-adjusted international dollar cigarette prices rose at a least squares annual trend growth rate of 2.9% (95% UI 2.8-3.0%) Excise tax increases strongly predict price increases. One-third of countries saw real prices at least 50% higher than 10 years prior. Conclusion Many of the instances of real price increases of 50% or more over 10-year periods occurred without countries implementing a conscious strategy to raise taxes. It is feasible to achieve and even surpass WHOs 3 by 35 call to action for tobacco if countries strategize and accelerate tobacco tax increases.

Background: High rates of young people who are not in education, employment or training (NEET) are a major societal concern in the UK. Whilst other studies have highlighted that adolescent health can predict NEET status in young adulthood, robust and recent longitudinal evidence remains limited. Methods: This study used data from the Millennium Cohort Study, a longitudinal study of people born in the UK in the early 2000s, to estimate the extent to which mental health conditions, physical health conditions and health behaviours during adolescence predict NEET status in early adulthood (median age: 23). Co-occurrence of exposures was also considered and population attributable fractions were calculated to account for differences in exposure prevalence. Results: Among 8,374 young people, 12.5% were NEET at age 23; approximately two thirds were seeking work and one third were economically inactive. Estimates adjusted for demographic factors indicated that multiple health exposures increased risk of being NEET at age 23, with mental health conditions predicting greater risk than physical health conditions and health behaviours. For instance, a longstanding mental health condition more than doubled the risk of being NEET (adjusted relative risk [aRR] = 2.39, 95% CIs = 1.85, 3.09), while autism (aRR = 3.60, 95% CIs = 2.69, 4.83) and ADHD (aRR = 3.25, 95% CIs = 2.38, 4.44) more than tripled the risk. A greater number of reported adolescent mental health conditions was associated with greater risk of being NEET in young adulthood. Obesity predicted being NEET at age 23 (aRR = 1.54, 95% CIs = 1.18, 2.01) and obesity accompanied by a mental health condition further increased risk (aRR = 2.01, 95% CIs = 1.38, 2.93). Follow-up analyses indicated that associations between adolescent mental health and young adult NEET status were more pronounced for females than males and for the economically inactive than those seeking work. Conclusions: Findings indicate that adolescent health, especially mental health, strongly predicts being NEET in early adulthood. Early, integrated health and education interventions may help reduce later educational and labour market disengagement.

Background: Internationally, workforce planning models are focussed on balancing supply and demand, rarely addressing factors such as demographic shifts and evolving health needs. There is a clear imperative for improved workforce planning to ensure adequate staff numbers to deliver audiology safely and effectively but there is still no consensus on safe minimum staffing levels or the optimal skill mix for high-quality audiology services. Methods: This research aimed to establish markers of quality in audiology service provision and estimate the audiology workforce requirements to meet current and projected demand for services, based on population changes and anticipated changes in demand. Following stakeholder engagement, a needs-based model was developed by (1) analysing NHS England's national Audiology stocktake dataset to determine current workforce, (2) creating an epidemiological model to predict changes in service population over next 5 and 10 yrs (3) use of BAA endorsed estimates delivered in East of England on staff grade required per activity. [SR1.1] Results: The estimates for 10-year adult and paediatric audiology whole time equivalent (WTE) safe minimum staffing levels for England (bands 2-7, current waiting times maintained) based on a population change model (Model 1), and two further models for paediatrics specifically (Model 2 and Model 3) were as follows: for adult audiology Model 1 estimates a 7.40% increase by 2035 (to 1125.18 WTE). For paediatric audiology Model 1 estimates a -6.3% (to 593.47 WTE) decrease due to underlying paediatric population decline in England, whereas the case complexities considered in Model 2 (1072.33 WTE) and Model 3 estimate a 10-year increase of 71.23% ( to 1072.33 WTE) and 59.17% (to 996.82 WTE) respectively. Conclusions: This is the first study to conduct a needs-based assessment of workforce requirements for audiology services. Given the substantial need for audiology staff, investment in workforce recruitment and training is essential to ensure that future activity levels meet population needs. Consideration of changing demographics is required for planning future workforce specialisation. Further analysis to address workforce equity, the impact of changes in skill mix and service delivery models and local area demographics/prevalence variation is required alongside potential efficiencies.

Preventive health is a crucial health systems component for managing disease burden and achieving health promotion policy goals. However, effective prevention relies on the modification of relevant risks, often requiring systemic health behaviour change. Australia's National Preventive Health Strategy (NPHS) prioritises seven focus areas: tobacco and nicotine, healthy diet, physical activity, cancer screening, immunisation, alcohol and other drugs, and mental health. The readiness of community members in Australia to address health behaviours relating to these areas has not been fully examined. In response, six focus groups were conducted with 27 adults from the Australian general population to explore their perspectives and experiences of preventive health information and behaviours relating to the seven NPHS focus areas. Themes and sub-themes were identified using an applied descriptive framework. Participants described motivations, barriers and experiences surrounding preventive health through the themes of 'Making informed health choices', 'Facilitating behaviour change and the role of support systems' and 'Spreading the preventive health word'. Sub-themes detailed processes of prioritisation, risk-benefit assessment, critical appraisal, sociocultural influence and support-seeking to understand and personalise preventive health information, implement behavioural change, and share information with others. The focus areas participants engaged with most strongly were healthy eating and physical activity, while cancer screening was discussed less often. These findings indicate high preventive health engagement in the Australian community, alongside challenges navigating and adapting relevant information to personal needs. These insights can support policymakers, healthcare providers and others to effectively enact the NPHS through more targeted preventive health information and care delivery.

Background: Suicide rates are highest among older adults. Yet, little is known regarding differences in suicide risk of older adults in Austria. This nationwide, retrospective cohort study aimed to characterize suicides among older adults in Austria during 2014-2023 and examine differences those who were young-old (65-74), middle-old (75-84), and oldest-old (85 +). Methods: We applied a cohort design to individual-level linkage data on all residents in Austria aged 65 years and older during 2014-2022 (N = 2,442,939). We compared characteristics of individuals who died by suicide and other causes of death, as well as by age group (i.e., young-old, middle-old, oldest-old) using trend tests and odds ratios. We calculated crude incidence rates of suicide per age group and sex. Results: During 2014-2023, 4,724 older adults died by suicide in Austria. The overall suicide rate was 23.4 per 100,000 person-years, while males had higher rates than females. Suicide rates increased with age and peaked among the oldest-old (33.2/100,000). Hanging, firearms, and jumping were the predominant methods, and the prevalence of hanging increased relative with increasing age. With increasing age, also widowhood and cardiovascular and genitourinary disorders were more prevalent among those who died by suicide. Conclusions: In Austria, oldest-old adults have the highest suicide rates, especially for males. whereas rates were considerably lower and did not change throughout old age for females. Distinct differences in suicide rates with respect to marital status, health conditions, and suicide methods. This emphasizes the need for preventive strategies to target older adults at different stages of life.

Background Access to exercise facilities is particularly important for the health, wellbeing, and social participation of people with disability. However, many facilities remain difficult for them to access. Methods This research used a mixed-method case study of twenty-three gyms in New Zealand. Quantitative accessibility audits based on the requirements of NZS4121:2001 were used to assess the compliance of accessible parking, entrances, interiors and bathrooms. Interviews with staff or managers at each gym provided qualitative data on operational practice and awareness of inclusivity. Results The most accessible aspects include parking spaces, footpaths, entrance doors and bathrooms with features such as clear signage, well-designed ramps, and evacuation protocols demonstrating best practice inclusivity. Improvements in service counters, lifts, tactile and auditory communication are needed. Community gyms and university gyms are the most inclusive and their staff have the most comprehensive experience in interacting with people with different disabilities. Small private gym owners know little about accessibility barriers and financial constraints limit their ability to improve access features. Conclusion The main recommendations for improving gym accessibility for people of all abilities include strategies to facilitate their joining gyms and strategies to support them as long-term gym members. The involvement of healthcare professionals in prescribing regular exercise and monitoring the health effects, coupled with subsidised gym membership will make it easier for people with disability to join gyms. More extensive staff training, targeted exercise programs, inclusive signage and communication and regular maintenance of the facility will improve the ongoing experience. Participating in regular exercise and social environments will help improve the physical and psychological health of people with disability.

Background Child marriage/cohabitation before 18 years of age disproportionately affects girls worldwide, but its impacts on mental health are poorly understood. Existing research is mostly cross-sectional, hence unable to estimate causal impacts or longer-term outcomes of child marriage. Methods We analysed longitudinal cohort data across Ethiopia, India, Peru, and Vietnam from Young Lives to investigate the relationship between child marriage/cohabitation and life satisfaction and emotional symptoms. We used linear regression, difference-in-differences estimation (DiD), and propensity score matching (PSM) to examine short and longer-term impacts from age 19 to 29. Findings Across countries 5% (Peru) to 20% (India) of girls were child brides. Child marriage/cohabitation predicted lower life satisfaction -- pooled estimates at age 19 (-0.25 [95%CI=0.40,-0.10]), across 19-29 (-0.22 [95%CI=-0.32,-0.13]), and heterogeneity estimates suggest consistently negative impacts across countries. However, child brides have lower life satisfaction at age 8 even before marriage occurs, likely due to pre-existing disadvantages such as poverty that increase child marriage likelihood. DiD and PSM analyses confirm that most of the differences are due to pre-existing vulnerability and there is a small additional impact of child marriage on worse life satisfaction at age 19 (pooled matched estimate -0.09 [95%CI=-0.19, 0.00]). No differences in emotional symptoms were observed, nor any differences by age of marriage within the child-married sample. Interpretation Child brides have lower life satisfaction from childhood through to early adulthood, which is mostly explained by prior disadvantages and risk factors, with a small additional impact of child marriage itself.

Background Introducing a reimbursement restriction on lidocaine plaster prescribing in Ireland may have had unintended effects on prescribing of other analgesics with misuse potential. This study evaluates the impact of this policy on use, treatment intensification and initiation of opioids, gabapentinoids, and other analgesics. Methods This cohort study included adults eligible for Ireland's public health cover (approximately 33% of the population), using primary care dispensing data. The policy was fully implemented in December 2017, requiring individual patient approval for coverage of lidocaine plasters. In interrupted time series analysis, we examined change in level and trend of prescribing of other analgesics. In cohort analysis we compared lidocaine users to users of any other analgesic pre-policy and assessed outcomes of treatment intensification and initiation of opioids, gabapentinoids, and other analgesics in the three months post-policy. Results Among 1.65 million individuals, up to 1.4% were dispensed lidocaine plasters monthly pre-policy. Population-level use of other analgesics remained largely unchanged (except for topical agents). Compared to other analgesic users, lidocaine plasters users were significantly more likely to experience treatment intensification (adjusted risk ratio 1.47, 95%CI 1.38-1.57) of opioids after the policy, and initiation of strong (2.07, 1.85-2.30) and weak opioids (1.38, 1.21-1.59), controlling for baseline differences. Similar results were identified for gabapentinoid treatment intensification (1.26, 1.16-1.38) and initiation (1.34, 1.11-1.61), as well as for other analgesics. Conclusions This policy aimed at reducing low-value care was associated with greater opioid and gabapentinoid consumption, exposing patients to greater risk of drug-related harm from analgesic use and misuse.

Background: Limited evidence motivated us to examine risk of suicide after partner loss among older adults in Austria. Methods: All married older adults aged [&ge;]65 years and living in Austria (N=1,293,557) were followed during 2014-2023. Risk ratios (aRRs) for partner loss were calculated based on adjusted cumulative incidence functions. Results: A total of 357 suicides occurred among widowed older adults. Incidence rates among widowed and not widowed were 56.9 and 29.4 per 100,000 person-years, respectively. High rates were found among widowed males (170.8/100,000) and widowers aged [&ge;]85 (94.1/100,000). Suicide risk was highest in the first month (aRR, 13.6; 95%-CI: 8.7,22.4) but remained elevated up to five years after partner loss (aRR, 2.5; 95%-CI: 2.1, 2.8). Conclusion: Recently bereaved older adults had elevated risks of suicide suggesting monitoring and psychosocial support may be beneficial when bereaved.

Objective This study evaluated how well subjective life expectancy (SLE) predicts mortality and actual life expectancy (ALE), along with factors associated with inaccurate expectations. Methods Using panel data on approximately 2,000 individuals with up to 28 years of follow-up from a nationally representative sample of older Japanese adults, we examined relationships among SLE, actual mortality, and ALE by survival analysis. We also evaluated health and socioeconomic disparities using concentration indices and investigated factors influencing SLE and ALE discrepancies and focal-point (i.e. rounded or anchored estimates) and do-not-know responses. SLE was measured as a self-reported point estimate, whereas ALE mainly came from official records and family reports. Results SLE was significantly associated with both actual mortality and ALE, even after accounting for demographic and socioeconomic variables. Nonetheless, significant inaccuracies remain: approximately 59% of individuals surpassed their expected lifespan. SLE was positively associated with ALE; however, the association was inelastic. Women and those with higher education levels were more likely to outlive their SLE, whereas those in poorer health were less likely to do so. Higher education correlated with fewer focal point responses to the SLE question. Discussion SLE effectively predicts ALE; however, gaps are non-negligible and differ across gender and socioeconomic groups. Offering more precise data, such as sex- and age-specific remaining life expectancy, can enhance SLE formation and lead to more informed economic choices.

Adolescent suicidal ideation is a critical public health issue, yet empirical evidence on its prevalence and associated factors among adolescents in northern Bangladesh remains limited. This study estimated the 12-month prevalence of suicidal ideation and examined its associated factors among school-going adolescents in Nilphamari District, Bangladesh. A cross-sectional survey was conducted between May and June 2026 among 365 adolescents aged 13-19 years across eight secondary schools and colleges. Self-administered questionnaires assessed suicidal ideation alongside validated tools for depression (PHQ-9), anxiety (GAD-7), and perceived social support (MSPSS). Factors associated with suicidal ideation were examined using multivariable logistic regression. The 12-month prevalence of suicidal ideation was 30.7% (112/365; 95% CI 26.0%-35.7%). In the primary multivariable model, moderate depression (AOR = 6.05, 95% CI 1.03-35.38; p = 0.046) and moderately severe depression (AOR = 6.86, 95% CI 1.05-44.62; p = 0.044) were associated with higher odds of suicidal ideation compared to minimal depression. However, this association was not statistically significant in a sensitivity analysis using the PHQ-8 score after excluding Item 9 (AOR = 1.06, 95% CI: 0.96-1.17; p = 0.228). Loneliness "often" showed the strongest association with suicidal ideation (AOR = 10.59, 95% CI: 2.53-44.35; p = 0.001). Suicidal ideation was also associated with truancy of 6-9 days (AOR 4.44, 95% CI 1.24-15.90; p = 0.022), truancy of [&ge;]10 days (AOR 3.77, 95% CI 1.34-10.59; p = 0.012), intentional self-harm (AOR = 2.51, 95% CI: 1.17-5.41; p = 0.018), and physical harm exposure (AOR = 2.63, 95% CI: 1.24-5.57; p = 0.012). Maternal secondary education was associated with lower odds of suicidal ideation (AOR = 0.34, 95% CI: 0.12-0.99; p = 0.048). Suicidal ideation was common among school-going adolescents in northern Bangladesh, affecting nearly one in three participants. Early school-based identification and support for adolescents experiencing mental-health and psychosocial difficulties, together with family engagement and strengthened suicide-prevention services, are warranted.

Background: Long-term mortality data among Brazilian police officers and firefighters are scarce. This study investigated the leading causes of death in Brazilian male military police officers and firefighters over three decades, comparing their mortality and mean age at death with those of the male population. Methods: We retrospectively analyzed death records of male military police officers and firefighters from Espirito Santo (ES), Brazil, from 1988 to 2019. Mortality was analyzed across three decades and the standardized mortality ratios (SMRs) for the three leading causes were calculated using the male populations of ES and Brazil as references. Results: Overall, 2,198 deaths were identified, with a mean age at death of 59 {+/-} 18.5 years, compared with 60.5 {+/-} 23.9 years among men in ES and 63.4 {+/-} 23.7 years among Brazilian men. Mean age at death was 36 {+/-} 9 years among active-duty and 68 {+/-} 13 years among inactive personnel. Across the study population, the leading causes of death were circulatory system diseases (32%), external causes (26%) and neoplasms (15%). Circulatory disease mortality was higher in the second and third decades compared with both reference populations, whereas external-cause mortality shifted from higher, in the first two decades, to lower than expected in the last decade. Neoplasm mortality was higher relative to Brazil only in the last decade. Conclusion: Mortality patterns differed by cause and over time. The younger mean age at death among active-duty personnel, together with cause-specific excess mortality, highlights the importance of long-term occupational health surveillance and preventive strategies.