No abstract

Background: Estimating the cost of postoperative respiratory complications is crucial in developing appropriate strategies to mitigate the global and national economic burden. However, systematic analysis of the economic burden in low-and middle-income countries is lacking. Methods:We used the nationwide database of the Vietnam Social Insurance agency and extracted data from January 2017 to September 2018. The data contain 1 241 893 surgical patients undergoing one of seven types of surgery. Propensity score matching method was used to match cases with and without complications. We used generalized gamma regressions to estimate the direct medical costs; logistic regressions to evaluate the impact of postoperative respiratory complications on re-hospitalization and outpatient visits.Findings: Postoperative respiratory complications increased the odds of re-hospitalization and outpatient visits by 3 •49 times (95% CI: 3 •35-3 •64) and 1 •39 times (95% CI: 1 •34-1 •45) among surgical patients, respectively. The mean incremental cost associated with postoperative respiratory complications occurring within 30 days of the index admission was 1053 •3 USD (95% CI: 940 •7-1165 •8) per procedure, which was equivalent to 41% of the GDP per capita of Vietnam in 2018. We estimated the national annual incremental cost due to respiratory complications occurring within 30 days after surgery was 13 •87 million USD. Pneumonia contributed the greatest part of the annual cost burden of postoperative respiratory complications. Interpretation:The economic burden of postoperative respiratory complications is substantial at both individual and national levels. Postoperative respiratory complications also increase the odds of rehospitalization and outpatient visits and increase the length of hospital stay among surgical patients.

Youth suicide is a leading cause of death among adolescents, but evidence about the influences of parental involvement on adolescent suicidal behaviors is inconsistent and have not been well studied. We used nationally representative data from the Vietnam Global School-based Student Health Survey (GSHS) 2019 (n = 7796 students aged 13-18 years). Using the 2-level random intercept logistic regressions, we evaluated the relationship between parental involvement (high expectation, monitoring, and understanding) and suicidal ideation and identified related factors of suicidal ideation. The overall prevalence of suicidal ideation was 15.6%. While high level of parental monitoring and understanding were associated with lower odds of suicidal ideation among adolescents (OR: 0.63; 95% CI: 0.52-0.77 and OR: 0.60; 95% CI: 0.49-0.73, respectively), high parental expectation was linked to higher odds of suicidal ideation (OR: 1.42; 95% CI: 1.24-1.63). Other risk factors at the individual- and school-level for suicidal ideation included being girls, living in urban areas, having mental health problems, involving in risk behaviors, suffering from bullying and violence, and poor school quality. Targeted suicide prevention initiatives should take into account comprehensive aspects of parent-child bonding, student, and school factors to mitigate the burden of suicidal behaviors among adolescents.

Background: Adolescence is a vulnerable period for many lifestyle risk behaviors. In this study, we aimed to 1) examine a clustering pattern of lifestyle risk behaviors; 2) investigate roles of the school health promotion programs on this pattern among adolescents in Vietnam. Methods: We analyzed data of 7,541 adolescents aged 13-17 years from the 2019 nationally representative Global School-based Student Health Survey, conducted in 20 provinces and cities in Vietnam. We applied the latent class analysis to identify groups of clustering and used Bayesian 2-level logistic regressions to evaluate the correlation of school health promotion programs on these clusters. We reassessed the school effect size by incorporating different informative priors to the Bayesian models. Findings: The most frequent lifestyle risk behavior among Vietnamese adolescents was physical inactivity, followed by unhealthy diet, and sedentary behavior. Most of students had a cluster of at least two risk factors and nearly a half with at least three risk factors. Latent class analysis detected 23% males and 18% females being at higher risk of lifestyle behaviors. Consistent through different priors, high quality of health promotion programs associated with lower the odds of lifestyle risk behaviors (highest quality schools vs. lowest quality schools; males: Odds ratio (OR) = 0 •67, 95% Highest Density Interval (HDI): 0 •46 -0 •93; females: OR = 0 •69, 95% HDI: 0 •47 -0 •98). Interpretation: Our findings demonstrated the clustering of specific lifestyle risk behaviors among Vietnamese in-school adolescents. School-based interventions separated for males and females might reduce multiple health risk behaviors in adolescence.