Public Health Research & Practice最新文献

Background: Cervical cancer is a major global public health challenge, with an alarmingly high burden in low- and middle-income countries (LMICs), where approximately 88% of deaths occur. The singular, well-established agent that causes invasive cervical cancer is an oncogenic type of human papillomavirus (HPV) infection. Cervical cancer is both highly preventable and highly treatable when detected at early and pre-invasive stages. Nearly all cases of cervical cancer can be avoided through vaccination against the HPV virus.

Aim: In this perspective article, we track India's efforts in the HPV immunization program for primary prevention, supplementing early detection and screening programs. Also, we discuss the roadblocks that may interfere with this mission and highlight the assets that will pave the way for a better understanding of how to eliminate cervical cancer.

Method: This perspective article utilizes the World Health Organization's Building Blocks for Effective Health Systems framework to examine India's current HPV immunization efforts. This framework was contextualized with insights from peer-reviewed research and relevant grey literature to identify key facilitators and obstacles influencing the implementation of the HPV vaccination program.

Results: Globally available and approved HPV vaccines, although successful, are still expensive in LMICs. Therefore, India has been putting efforts into a locally produced HPV vaccine. The affordability of this vaccine makes the impact potentially transformative, but its future success depends on scaling up and utilizing effective strategies for nationwide implementation.

Objectives and importance of study Evaluate the effectiveness of training workshops aiming to improve researchers' consumer and community involvement (CCI) related awareness, attitudes, and behaviours, and capture remaining barriers to CCI. Design Cross-sectional questionnaires. Setting University of Queensland researchers attending a CCI training workshop, facilitated by The Kids Institute between 2017 and 2023. Methods Participants were invited to complete two surveys with multiple choice and open-field items: (i) short term evaluation immediately following workshop attendance capturing reactions (ii) long-term evalution up to 6 years following attendance, including retrospective and current perceptions of confidence, motivation, capability, opportunity and reported behaviours. Survey items mapped to the Kirkpatrick model for training evaluations (reaction, learning, behaviour, and results) and COM-B model of behaviour change (capability, opportunity, and motivation). Multiple-choice responses were summarised with descriptive statistics and Chi-square analysis while open-field responses were mined qualitatively with content analysis. Results 17/183 and 104/240 individuals completed/partially completed Surveys 1 and 2 respectively. Survey 1 comments captured satisfaction with content and facilitation, and improved learning (Kirkpatrick's 'reaction' and 'learning'). Most Survey 2 participants were satisfied/highly satisfied with the workshop (n = 82/101, 81%) and agreed CCI was relevant (n = 88/90, 98%) or valuable (n = 86/89, 97%) to their research (COM-B 'motivation'). When completing Survey 2, a minority (n = 17/90, 19%) felt they were confident/very confident in implementing CCI prior to the workshop, which increased significantly post-workshop (n = 54/89, 61%) (P < 0.05). Participants reported moderate to high levels of capability (n = 78/83, 94%) and capacity (73/83, 88%) implementing CCI. The proportion of researchers implementing CCI in their research increased from 65% (n = 59/91) to 78% (n = 71/91) in the months/years post-workshop (P < 0.05). Researchers reported consistent CCI throughout the research journey and diverse models of involvement. Participants identified financial and administrative institutional barriers to optimal CCI implementation in research. These results align with all elements of the Kirkpatrick and COM-B models. Conclusions CI training improved researchers' CCI-related awareness, confidence and behaviours. However, the remaining barriers to optimal CCI implementation included logistical and institutional barriers, which reflect the opportunity element of COM-B. Thus, while CCI training of researchers is valuable and effective, institutions need to capitalise on these benefits with administrative and financial support.

Objectives: Australia needs to increase linkage to viral hepatitis care and treatment to achieve the 2030 elimination targets. This study assessed the intervention of enhanced local public health (PH) follow-up of hepatitis B and hepatitis C notifications on linkage to care and treatment, compared to standard PH management, in the Barwon South West (BSW) and Gippsland regions in Victoria. Importance of study: Innovative models to increase viral hepatitis testing and linkage to care and treatment are required, especially in regional Australia.

Study type: Retrospective cohort study.

Methods: Study periods were March-August 2022 (standard PH management), and September 2022-February 2023 (enhanced local PH follow-up). Notifications from correctional facilities were excluded. Outcomes by study period compared time to complete hepatitis C diagnosis, hepatitis C treatment initiation, hepatitis B viral load measurement and referral for hepatitis B care. A Kaplan-Meier survival analysis and Cox regression model was performed.

Results: 190 notifications met inclusion criteria and 174 people were included in the analysis - 133 with hepatitis C and 41 with hepatitis B (16 were lost to follow-up). The probability of having an incomplete hepatitis C diagnosis within 180 days from notification was 2.33 (95% CI 1.40, 3.89) times higher among patients receiving standard PH management compared to enhanced local PH follow-up. The probability of not being referred to hepatitis B care within 90 days from notification was 2.78 times (95% CI 1.13, 6.82) higher among patients receiving standard PH management compared to enhanced local PH follow-up.

Conclusions: Enhanced local PH follow-up increased the proportion of hepatitis C notifications with a complete diagnosis and hepatitis B notifications referred to care. Local PH follow-up presents a unique opportunity to accelerate progress towards the 2030 viral hepatitis elimination targets in Victoria.

Objectives and importance of study: In recognition of the contribution that consumers can make to research, the National Health and Medical Research Council has called for the "active involvement of consumers and community members in all aspects of health and medical research". However, there are very few publicly available, easy to understand, co-designed resources that are targeted towards helping diverse consumers learn about specific research methods. The aim of this project was to co-design health literacy informed, plain language guides for qualitative and (quantitative) survey research.

Study type: Multi-phase participatory co-design study.

Methods: This project was underpinned by consumer engagement principles (respect and equity; trust; empowerment) and followed the Agency for Clinical Innovation's four co-design steps (Engage; Gather; Understand; Improve). The co-design team comprised people with experience in qualitative and survey research, including members of the Sydney Health Literacy Lab's community panel (Co-SHeLL). The project involved a series of online workshops to discuss each research method and learn from lived experience. Insights from the workshops informed drafts of the guides, which were iteratively revised with ongoing feedback. Health literacy resources including the Health Literacy Editor (assessing grade reading score, complex language, and passive voice) and the Patient Education Materials Assessment Tool (assessing understandability and actionability) were then applied to assess each guide.

Results: The two guides provide foundational knowledge about each research method, such as what research questions qualitative and survey research can answer, the types of data collected, and the types of analyses undertaken. Content provides clear examples of how consumers can be involved at each stage of the research process and best practice activities. The guides incorporate health literacy strategies where possible (Grade 9 reading level; 84% understandability and 83% actionability).

Discussion and conclusion: Through an iterative co-design process, we have developed research guides that seek to build consumers' capacity to engage more deeply in any given project, throughout the research process. They are positioned to support more equitable consumer engagement that better reflects the diversity of the communities we serve including those with diverse health literacy needs.

Background: Tuberculosis (TB) remains a global public health concern. In Australia, TB incidence is low but remains elevated among overseas-born individuals. This study investigates a TB cluster in a nonclinical hospital setting during the COVID-19 pandemic, highlighting transmission dynamics and the public health response.

Methods: A retrospective observational study was conducted using medical records and epidemiological contact tracing data within a tertiary hospital in New South Wales, Australia. Three screening rounds targeted office contacts in different air-conditioning zones. Whole genome sequencing (WGS) was used to assess Mycobacterium tuberculosis isolates.

Results: Five secondary cases of TB disease were identified following exposure to the index case, a non-clinical hospital employee with cavitating pulmonary TB. Among 233 identified contacts, 117 completed screening. Initially screened high-risk contacts (n=31) had high rates of TB disease (n=4; 12.9%) and newly detected IGRA-positivity (n=14; 45.1%), with lower rates in broader screening. Transmission likely occurred via prolonged office exposure. WGS linked a sixth TB case in a clinical healthcare worker to the cluster, with 26 secondary contacts screened.

Conclusion: This study underscores the potential for highly infectious TB transmission within Australian healthcare settings. Timely contact tracing, genomic surveillance, and pre-employment screening are essential for effective prevention and control.

Objectives and Importance of Study: Given the limited research on anti-racism interventions in health care, this study examined the effectiveness of bystander intervention training in the context of a comprehensive, multi-pronged approach to bystander anti-racism intervention for healthcare staff at one local health district in Sydney, Australia.

Study type: Pre-post-follow up study.

Methods: Data was collected over two years (January 2021 to February 2023), at three time points through an online survey. Supplementary data were also obtained from the public sector's state annual employee experience survey.

Results: The results showed that the training improved staff's understanding of racism and its impacts on health, increased their confidence and likelihood to respond to a racist incident at work, and increased their feelings of being supported by their workplace and/or manager to respond to an act of racism. Most staff were satisfied with the training, felt it was useful, and would recommend the training to colleagues. Supplementary data from the state annual employee experience survey showed that reported racism decreased slightly, and overall satisfaction with how their reported racism experience was handled more than doubled.

Conclusions: The local health district developed and evaluated the effectiveness of their comprehensive, multi-pronged Addressing Racism in Healthcare Strategy. The strategy included the foundational principles and strategies for effective anti-racism interventions in healthcare settings: laying the foundation for the anti-racism intervention, addressing institutional racism, and addressing personally-mediated racism. The Addressing Racism in Healthcare Strategy is a successful model that other health districts can adapt to promote inclusivity and cultural safety across the broader health system.

Objectives The objective was to examine demographic, social, and health trends over 24 years in a disadvantaged Sydney community through sustained household surveillance, demonstrating the feasibility of longitudinal community-level health monitoring for informing policy and service delivery whilst building local capacity. This study addresses a gap in Australian community-level health surveillance data, particularly for disadvantaged areas where health needs often differ from broader population patterns. Methods This repeated cross-sectional study conducted household surveys at six time points (1999, 2002, 2005, 2007, 2010, and 2022-2023) using quantitative measures including SF-12 Physical and Mental Health Component Summary scores, demographic data, and structured questions assessing community perceptions. Randomly selected households completed face-to-face interviews, telephone surveys (CATI), written questionnaires, online surveys, or drop-off/pick-up questionnaires lasting 20-45 minutes. Multilingual delivery accommodated Miller's diverse population. Local residents trained as interviewers in 2010 and 2022-2023 enhanced community engagement and trust. Results Adult participation ranged from 180 to 335 participants, with response rates from 17.1% (2007) to 51.6% (2022-2023). Notable demographic changes occurred: population ageing (31.6% over 65 by 2022-2023), growing overseas-born residents (49.8%), and rising educational achievement (55.5% with secondary qualifications or above). SF-12 Physical Component scores fell from 47.1 (2002) to 41.5 (2022-2023). SF-12 Mental Component scores dropped substantially from 48.8 (2002) to 30.6, nearly 20 points below Australian population norms. Social cohesion indicators varied across survey waves, with lower values in 2010 and higher values by 2022-2023. Health service enhancements between 2006-2010 yielded limited benefits, suggesting structural obstacles persist. Conclusion Community surveys were used to create health baselines, monitor changes during urban renewal, and inform policy and service planning. Sustained community-engaged surveillance through varied approaches to data collection is feasible in disadvantaged Australian contexts, uncovering localised health issues whilst supporting targeted public health interventions. Results reveal serious mental health deterioration warranting immediate attention alongside ongoing monitoring to tackle enduring inequalities and strengthen community capacity.

Objectives and importance of study Chronic hepatitis B and C are leading causes of liver cancer in Australia, and understanding prevalence, diagnosis, and care uptake is a public health priority in the context of a strategic commitment to elimination. This study aims to estimate the degree of movement between jurisdictions among people with hepatitis B and hepatitis C in Australia, to understand the impact on national notifications data and the implications for modelling of prevalence and diagnosis, and consequently uptake measures. Study type Retrospective cohort study using linked health service provision data. Methods Individuals who received Medicare services restricted to those diagnosed with hepatitis B or hepatitis C (nucleic acid testing or treatment) via Medicare during 2011-2023 were analysed. The proportion who changed jurisdictions and the proportion who had a service in multiple jurisdictions were generated, with sub-analysis by jurisdiction and among priority populations (those born overseas and Aboriginal and/or Torres Strait Islander people). Results Among the cohort (n=137,041 hepatitis B; n=252,144 hepatitis C), 9.8% of those with hepatitis B and 15.1% of those with hepatitis C resided in more than one jurisdiction, ranging from 6.7%-33.3% by jurisdiction for hepatitis B and 14.5%-42.8% for hepatitis C. This compared to 10.3% (range 8.0%-28.9%) among the total Australian population. Movement was higher among Aboriginal and Torres Strait Islander people for hepatitis B, with a different pattern by jurisdiction than the total cohort. The proportion who had a hepatitis B or hepatitis C service in multiple jurisdictions was 3.2% and 4.6%, respectively, with similar trends by state and territory. Conclusions Movement among people with hepatitis B and C was highly variable according to jurisdiction. This movement should be accounted for in the use of notifications data according to geographic area, and in assessing national progress towards viral hepatitis elimination goals.

Objectives Timely, accurate reporting of pregnancy vaccination coverage is key to evaluating pregnancy immunisation programs. We compared influenza and pertussis vaccination reporting on the New South Wales (NSW) Perinatal Data Collection (PDC) and the Australian Immunisation Register (AIR), to understand coverage, reporting, timing of vaccination and provider type. Methods This retrospective population-based cohort study in New South Wales, Australia, included people giving birth at ≥20-weeks' gestation (2017-2022) in the NSW PDC (total number of pregnancies 555,553), linked to AIR-reported influenza and pertussis vaccinations. Main outcomes of interest were influenza and pertussis coverage according to 1) the PDC and 2) linked AIR records. We assessed agreement between data sources (i.e. whether an AIR record during the pregnancy existed if vaccine receipt was reported on the PDC, and vice versa) by year (influenza: 2021-2022, pertussis: 2017-2022) and selected characteristics (2022). Provider type and timing for vaccinations reported to the AIR are described (2022). Results PDC-reported influenza and pertussis coverage peaked in 2020 (influenza: 58.8%, pertussis: 79.0%), decreasing thereafter (influenza: 49.1%, pertussis: 77.6% in 2022). AIR-reported influenza and pertussis vaccination coverage increased (influenza: 34.7% in 2021 to 44.8% in 2022; pertussis: 24.4% in 2017 to 51.6% in 2022). Agreement between AIR and PDC improved over time, but remained suboptimal (influenza: 75.5%, pertussis: 56.6% in 2022). AIR and PDC agreement differed most by antenatal care model, particularly for pertussis vaccinations. In 2022, of pregnancy vaccinations reported to the AIR, >75% were provided in general practices. Co-administration occurred infrequently (8.8%). Conclusions Despite mandated reporting to the AIR, there was significant underreporting of pregnancy vaccinations to the AIR as compared with the NSW PDC. National collection of accurate and timely data on pregnancy vaccination coverage is needed to monitor vaccine uptake, and identify and monitor strategies to improve uptake, particularly with the new pregnancy respiratory syncytial virus vaccine program in 2025. We identified co-administration as a potential strategy to improve influenza vaccination coverage during pregnancy.

Involving young people in the development of health interventions can result in interventions that are more fit for purpose. However, few, if any, studies outline how to successfully and meaningfully engage young people in the development process. This report outlines the successes and challenges of three strategies we used to involve young people in designing a health intervention targeting young people. It is hoped that our experience can help inform other researchers how young people can be meaningfully engaged in research.