Public Health Research & Practice最新文献

Objectives: The Australian Government, through the National Obesity Strategy 2022-2032, has set an aspirational goal of reducing the prevalence of childhood and adolescent overweight and obesity by 5% by 2030 (from 25% to 20%). Our objective was to quantify the long-term economic benefits of achieving this goal.

Methods: Using a microsimulation model and a synthetic cohort of Australian children and adolescents aged 4-17 years, we estimated the excess per capita lifetime costs of overweight and obesity. Using these results and population projections for 2030, we estimated the potential lifetime cost savings that could be achieved through attaining the National Obesity Strategy goal.

Results: Compared with their peers of a healthy weight, children and adolescents with overweight and obesity were estimated to incur, per capita, excess lifetime costs (discounted) of approximately $19 700 and $46 700, respectively (in 2030 Australian dollars). Achieving the National Obesity Strategy's goal was estimated to save approximately $7.44 billion, predominantly through reductions in lifetime obesity-related healthcare costs and premature mortality.

Conclusion: Our results demonstrate the considerable economic benefits that could be achieved by reducing the current prevalence of childhood and adolescent overweight and obesity in Australia; they provide justification for investment in prevention and treatment for this demographic.

Objectives: The coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare systems worldwide, causing substantial changes to routine healthcare delivery. National and international modelling studies have predicted adverse impacts of this disruption. This study aimed to assess the real-world impact of the COVID-19 pandemic on quality of care and outcomes for patients with lung cancer in New South Wales (NSW).

Study type: Pre-post observational cohort study using data prospectively collected for the Embedding Research (and Evidence) in Cancer Healthcare (EnRICH) Program.

Methods: The study population comprised 2000 patients with lung cancer from six specialist cancer centres in metropolitan and regional NSW. We split this population into two cohorts: the pre-COVID-19 cohort (1143 patients diagnosed from 8 September 2016 to 10 March 2020) and the post-COVID-19 cohort (857 patients diagnosed from 11 March 2020 to 28 October 2021). The main outcome measures were lung cancer clinical quality indicators, 1-year and 2-year overall survival, and patient-reported health-related quality of life and psychological distress.

Results: Patient and disease characteristics (e.g. age, gender, cancer stage) were similar for the pre-and post-COVID-19 cohorts, except for histology (non-small cell lung cancer (NSCLC) 88% in the pre-COVID-19 cohort and 84% in the post-COVID-19 cohort; p = 0.008) and region of residence (62% and 55%, respectively, lived in metropolitan areas; p = 0.002). Compared to the pre-COVID-19 cohort, fewer patients in the post-COVID-19 cohort received a diagnosis within 28 days of the first investigation of symptoms (clinical diagnosis: 77% compared with 72%; p = 0.017, pathological diagnosis: 60% compared with 53%; p = 0.005). However, the median time from the first investigation of symptoms to treatment initiation did not differ. One- and 2-year overall survival, quality of life and psychological distress did not differ between cohorts.

Conclusions: This analysis found that the COVID-19 pandemic did not significantly adversely affect quality of care and outcomes for patients with lung cancer in NSW. Reassuringly, these results suggest that prioritising urgent health services, such as cancer care and implementing protective mitigation measures were effective in avoiding the predicted adverse outcomes of healthcare service disruption.

Background: An asymptomatic COVID-19 rapid antigen testing (RAT) screening program was implemented in Victorian schools in January 2022, to support keeping schools open throughout the pandemic. This study explored compliance with the program among caregivers from priority populations in Victorian mainstream and specialist schools.

Methods: We conducted semi-structured interviews between 7-31 March 2022 with caregivers of school-aged children participating in the RAT program in Victoria. Participants were asked about awareness, acceptability, compliance, frequency, and barriers to testing. Recordings were transcribed and deductively analysed using a framework approach.

Results: Fifty caregivers participated. They expressed confusion about the 'recommended' program, assuming it was mandatory. Caregivers wanted notification from schools of positive cases to increase motivation for compliance. Culturally and linguistically diverse (CALD) families were compliant; however, in-language resources were limited. Aboriginal or Torres Strait Islander (Koori) families tested less regularly and received information from their community rather than school. Caregivers of children living with disabilities reported behavioural challenges to testing, resulting in distress or non-compliance, and received non-specific information for their children.

Conclusions: To increase engagement with future surveillance programs, caregivers need clarity about optionality, conducting tests, reporting results, and timely notification of cases. Requirements unique to each priority population include: accurate in-language information for CALD caregivers, community-led communication for Koori caregivers, tailored information, less testing, and flexibility for caregivers of children living with a disability. Keeping schools open and having tailored strategies to ensure equitable access for priority populations are essential for future pandemic management.

Objective: The Australian Government Tackling Indigenous Smoking (TIS) program aims to reduce tobacco use among Aboriginal and Torres Strait Islander peoples, delivering locally tailored health promotion messages, including promoting the Quitline. We aimed to analyse data on use of the Quitline by Aboriginal and Torres Strait Islander peoples nationally, specifically in TIS and non-TIS areas.

Methods: We analysed usage of the Quitline in seven jurisdictions across Australia in areas with and without TIS teams (TIS areas and non-TIS areas respectively) between 2016-2020. Demographic and usage characteristics were quantified. Clients and referrals as a proportion of the current smoking population were calculated for each year, 2016-2020.

Results: From 2016-2020, 12 274 Aboriginal and Torres Strait Islander people were clients of the Quitline in included jurisdictions. Most (69%) clients were living in a TIS area. Two-thirds (66.4%) of referrals were from third‑party referrers rather than self-referrals. Overall, between 1.25% and 1.62% of Aboriginal and Torres Strait Islander peoples who currently smoked were clients of Quitline (between 1.15-1.57% in TIS areas and 0.82-0.97% in non-TIS areas).

Conclusions: The Quitline provided smoking cessation support to approximately 2500-3000 Aboriginal and Torres Strait Islander clients annually between 2016-2020. Referrals from third parties including Aboriginal and Torres Strait Islander services are an important pathway connecting community members to an evidenced-based cessation support service.

Objectives and importance of study: Despite an increasing trend in digitally delivered health promotion programs, evidence of their effectiveness compared to face-to-face approaches is limited. Go4Fun is a 10-week, scaled-up healthy lifestyle program in New South Wales (NSW) for children 7-13 years who are above a healthy weight and their families, delivered either face-to-face or digitally. We compared the impact of Standard Go4Fun (face-to-face) and Go4Fun Online (digital) on children's weight and health behaviour outcomes and whether attendance levels influenced outcomes.

Study type: Pre-post study.

Methods: We conducted a secondary analysis of Go4Fun cohort data from 1893 face-to-face and 1283 digital participants (January 2018 to May 2022). Outcomes of interest were body mass index z-score (zBMI), physical activity, sedentary behaviour, and fruit, vegetable, sugary drink and takeaway food consumption.

Results: A higher proportion of Standard Go4Fun children lived in major cities, in areas of greatest disadvantage and spoke a language other than English at home than in Go4Fun Online. Children in both Standard Go4Fun and Go4Fun Online demonstrated improvements in all outcomes; however, children in Go4Fun Online showed significantly larger improvements. On average, digital participants had a reduction in zBMI of 0.11 more than the reduction seen in face-to-face participants (95% Confidence Interval [CI] -0.12, -0.09), increased the days/week of moderate-to-vigorous-physical-activity by 30% more (95% CI 24%, 36%), were more likely to eat ≥ 2 serves of fruit/day (compared to < 2, Odds Ratio [OR] 1.85; 95% CI: 1.36, 2.52) or eat ≥ 3 serves of vegetables/day (compared to < 3, OR 1.96; CI: 1.58, 2.42). Across both modes, with each additional session attended, the odds of eating ≥ 3 serves of vegetables/day increased by 10% (95% CI 1.02, 1.19). There were no significant differences for other health outcomes.

Conclusions: Our evaluation demonstrated that both face-to-face and digital program delivery helped children above a healthy weight to improve their weight and health behaviour outcomes. Go4Fun Online achieved significantly greater improvements in outcomes, which is encouraging for the future of digital interventions. Participation in Standard Go4Fun by more children with obesity from disadvantaged areas and non-English speaking backgrounds suggests that ongoing delivery of both modes of Go4Fun could facilitate program reach among all children above a healthy weight.

A new discipline, implementation science, has emerged in recent years. This has resulted in confusion between what 'implementation science' is and how it differs from real-world scale-up of health interventions. While there is considerable overlap, in this perspective, we seek to highlight some of the differences between these two concepts in relation to their origin, drivers, research methods and implications for population impact and practice. We recognise that implementation science generates new information on optimal methods and strategies to facilitate the uptake of evidence-based practices. This new knowledge can be used as part of any scaling-up endeavour. However, real-world scale-up is influenced to a much greater extent by political and strategic needs and key actors and generally requires the support of governments or large agencies that can fund population-level scale-up. Furthermore, scale-up often occurs in the absence of any evidence of effectiveness. Therefore, while implementation science and scale-up both ultimately aim to facilitate the uptake of interventions to improve population health, their immediate intentions differ, and these distinctions are worth highlighting for policymakers and researchers.

Co-creation is a participatory design approach that leverages the experiential knowledge of non-academic actors. It is increasingly adopted in public health research to enhance the relevance, acceptability, and impact of interventions. This perspective article provides a practical introduction to co-creation, its application, and benefits and considerations for public health researchers. Based on the authors' experiences with co-creation in public health, four key considerations for co-creation are outlined: 1) the selection of collaborators (those participating in the co-creation process) and their power dynamics and interests; 2) frameworks and guidelines for the co-creation process; 3) capacities needed to successfully apply a co-creation approach, such as emotional intelligence and adaptability; and 4) practical matters, such as resources and ethics approval. These insights serve as a practical introduction for public health researchers considering the application of co-creation in their projects to facilitate more effective and impactful, user-centered research designs and interventions.

Objectives and importance of study: Australian children frequently travel overseas, but little is known about their travel-related morbidity. We aimed to describe the spectrum of illness and injury in returned travellers presenting to the largest paediatric referral centre in NSW, the Children's Hospital at Westmead (CHW).

Study type: Observational cohort study.

Methods: In the 18 months immediately before the COVID-19 pandemic (2018-2020), we prospectively collected demographic, travel and clinical data from children with travel-acquired illness or injury identified by active surveillance of CHW Emergency Department attendees and referrals to the infectious diseases service.

Results: We identified 587 returned child travellers with an illness or injury associated with overseas travel. Most were aged younger than 5 (62.8%) and had travelled within the Asia-Pacific region (84.6%). The main reason for travel, where recorded (50.3%), was visiting friends and relatives (VFR)(65.4%). Most travellers (90.1%) had a common childhood infection, illness or injury coincidentally acquired during travel, including respiratory infection (37.5%), acute diarrhoea (15.7%) and nonspecific febrile illness (13.1%). Exotic/nonendemic infections were uncommon (9.9%, including potential rabies exposure) but were associated with much higher admission rates than 'cosmopolitan' (globally distributed) diseases (74.2% vs 21.9%). Most of these occurred in VFR travellers (86.3%); enteric fever, largely acquired in South Asia, predominated (51.7%). One in five admitted patients had a disease for which specific pretravel vaccination is available. Receipt of pretravel vaccines was infrequently recorded.

Conclusions: Returned child travellers in Western Sydney frequently presented with respiratory infections and may be a key population for surveillance of imported respiratory viruses. The burden of exotic disease was small and borne by VFR travellers. Travel-related illness in Western Sydney could be reduced by health education of travellers and targeted pretravel vaccination, especially typhoid vaccination for VFR travellers to South Asia. Universal, systematic screening of emergency department attendees for recent overseas travel would improve surveillance of travel-related illness.

Objectives and importance of study: In the public service context, co-design is novel and ever-expanding. Co-design brings together decision-makers and people impacted by a problem to unpack the problem and design solutions together. Government agencies are increasingly adopting co-design to understand and meet the unique needs of priority populations. While the literature illustrates a progressive uptake of co-design in service delivery, there is little evidence of co-design in policy development. We propose a qualitative study protocol to explore and synthesise the evidence (literary, experiential and theoretical) of co-design in public policy. This can inform a framework to guide policymakers who co-design health policy with Aboriginal and Torres Strait Islander people. Methods: The study design is informed by a critical qualitative approach that comprises five successive stages. The study commences with the set-up of a co-design brains trust (CBT), comprising people with lived experience of being Aboriginal and Torres Strait Islander who have either co-designed with public agencies and/or have health policymaking expertise (stage 1) The brains trust will play a key role in guiding the protocol's methodology, data collection, reporting and co-designing a 'Version 1' framework to guide policymakers in co-designing health policy with Aboriginal and Torres Strait Islander people (the framework). Two realist evaluations will explore co-design in health policy settings to understand how co-design works for whom, under what circumstances, and how (stages 2 and 3) The findings of the realist evaluations will guide the CBT in developing the framework (stage 4). A process evaluation of the CBT setup and framework development will assess the degree to which the CBT achieved its intended objectives (stage 5). Conclusion: The proposed study will produce much-needed evidence to guide policymakers to share decision-making power and privilege the voices of Aboriginal and Torres Strait Islander people when co-designing health policy. Learnings from this translational research will be shared via the CBT, academic papers, conference presentations and policy briefings.