Public Health Research & Practice最新文献

Objectives: To describe patterns of skin checks for potential skin cancers in general practice and subsequent skin-related healthcare, and the associated costs.

Study type: Retrospective longitudinal health record linkage.

Methods: Patient encounters between 2010 and 2017 were extracted from clinical information systems at 73 general practice sites in Victoria, Australia, including Medicare billing information, from the MedicineInsight primary care dataset. The main outcomes were skin checks, skin-related healthcare up to 3 months after the skin check, and health system costs.

Results: There were 59 046 skin check encounters (0.7% of all general practice encounters) identified for 40 014 people with a median age of 52 years (interquartile range 36-67). Of these people, 26% had multiple skin checks. Of the subsequent skin checks, 28% were within 3 months of the initial skin check and 15% were after > 2 years. There was subsequent skin-related healthcare ≤ 3 months after 20% of all skin checks: 8% had a skin biopsy, 11% had a skin excision (of which 2% indicated a melanoma diagnosis, 29% keratinocyte carcinoma and 68% benign or other skin lesion), 2% had skin-related medicine prescribed and 5% had other skin-related treatment such as cryotherapy (not mutually exclusive). Ninety per cent of skin checks were billed as general practitioner (GP) consultations, including 65% as GP consultations of < 20 minutes although the proportion of longer consultations increased over time. The mean 3-month skin-related general practice health system costs for people without and with subsequent skin-related healthcare were A$58 and A$240, respectively, and up to a mean of A$595 for those having a melanoma excised.

Conclusions: Skin checks for potential skin cancers occur frequently in Australian general practice and accumulate substantial health system costs, with one in five skin checks resulting in subsequent treatment. This study adds to scarce real-world skin check and cost data in Australia.

Objectives To describe the changing landscape of congenital syphilis. Type of program We present a case report of congenital syphilis, highlighting some of the challenges in management, and placing it within the broader public health context of rising syphilis rates. Methods This article is a brief case report in the context of a broader narrative review of congenital syphilis, including clinical significance, recent epidemiological trends in Australia and evolving recommendations on screening. Results The rising rates of infectious syphilis across Australia, specifically an increase in incidence amongst non-Indigenous and Indigenous females of 22 and 11% respectively across 2023, is associated with an increase in congenital syphilis diagnoses. Concerningly, more diagnoses are occurring late in pregnancy, with 79% of reported cases since 2016 being either post-delivery or within the 30days prior. The 10 deaths reported in 2023 from congenital syphilis is the highest number of deaths ever recorded in Australia. Our case was diagnosed early in pregnancy but did not receive sufficient antenatal care to prevent vertical transmission, despite intensive public health involvement. Lessons learnt We note that rising rates of congenital syphilis have prompted New South Wales (NSW), Queensland (Qld), Western Australia (WA) and South Australia (SA) to now universally recommend screening for syphilis multiple times in pregnancy and no longer reserve this for high-risk populations; however, our case would not have benefitted from these recommendations, emphasising the need for broader public health interventions to reduce the prevalence of infectious syphilis in Australia.

The increasing prevalence of e-cigarette use (vaping) among adolescents and young adults has ignited debate over its potential role in the initiation of cigarette smoking. Prospective cohort studies at the individual level consistently demonstrate a higher risk of smoking initiation among young people who have previously vaped when compared with those who have never vaped (sometimes called a 'gateway effect'). On the other hand, several studies analysing repeated cross-sectional data argue that vaping might decrease the risk of smoking through a 'displacement effect', as evidenced by an increasing vaping trend coinciding with a decreasing smoking trend. This perspective article examines these conflicting viewpoints in the context of a misinterpretation of these coinciding trends.

Objectives and importance of the study Applications of artificial intelligence (AI) platforms and technologies to healthcare have been widely promoted as offering revolutionary improvements and efficiencies in clinical practice and health services organisation. Practical applications of AI in public health are now emerging and receiving similar attention. This paper provides an overview of the issues and examples of research that help separate the potential from the hype. Methods Selective review and analysis of cross-section of relevant literature. Results Great potential exists for the use of AI in public health practice and research. This includes immediate applications in improving health education and communication directly with the public, as well as great potential for the productive use of generative AI through chatbots and virtual assistants in health communication. AI also has applications in disease surveillance and public health science, for example in improving epidemic and pandemic early warning systems, in synthetic data generation, in sequential decision-making in uncertain conditions (reinforcement learning) and in disease risk prediction. Most published research examining these and other applications is at a fairly early stage, making it difficult to separate the probable benefits from the hype. This research is undoubtedly demonstrating great potential but also identifying challenges, for example in the quality and relevance of health information being produced by generative AI; in access, trust and use of the technology by different populations; and in the practical application of AI to support disease surveillance and public health science. There are real risks that current access and patterns of use may exacerbate existing inequities in health and that the orientation towards the personalisation of health advice may divert attention away from underlying social and economic determinants of health. Conclusions Realising the potential of AI not only requires further research and experimentation but also careful consideration of its ethical implications and thoughtful regulation. This will ensure that advances in these technologies serve the best interests of individuals and communities worldwide and don't exacerbate existing health inequalities.

Objective The public health workforce is central to promoting and protecting the health of individuals, communities, and populations, and to creating environments that support healthy living and wellbeing. This paper describes the history and key outcomes of the NSW Public Health Training Program and examines the program's contribution to building public health capacity in New South Wales (NSW), Australia. Type of program The program is a 3-year workplace training program for public health graduates. Methods The authors used a mixed methods design, including analysis of program data and document review. Results From 1990 to 2023, the program supported the training of 223 public health professionals, including 52 medical graduates undertaking specialist training in public health medicine. Trainees supported critical population health initiatives, provided surge capacity for a range of public health emergencies, and published more than 600 peer-reviewed publications. Most graduates (n =115, 81.0%) and just over half of early exits (n =29, 51.8%) remained with NSW Health after training. The most common graduate occupations were epidemiologist (32.4%), policy analyst (15.5%), and public health or program manager (12.0%). Lessons learnt Building public health workforce capacity takes time and a sustained commitment. Employment outcomes are important indicators of success for workplace training programs. The program has made a substantial contribution to building public health capacity in NSW.

In Australia, consistent with the global picture, the development of a multidisciplinary public health workforce and its education have evolved, mainly because of government reforms driven by comprehensive social initiatives. Recent polycrises - natural and man-made disasters and crises - shed light on the strengths and weaknesses of the Australian public health effort and its workforce education. Internationally accepted and recently redeveloped multidisciplinary competencies are available, however Australian public health education is not routinely accredited, and much of the public health workforce lacks appropriate education and training. Public health qualifications are not routinely required for the public health workforce so, for graduates, appropriate work is hard to find. Academic public health staff are driven by metrics, that do not measure education quality or appropriateness of the content. In the current era of polycrises as well as rapidly evolving scientific knowledge, public health education providers must work in tandem with governments to prepare a workforce ready to deliver essential public health functions with the flexibility to adapt to emerging health challenges, pointing to how education must be developed to ensure an appropriately educated, trained, future-proofed workforce in both the art and science of public health.

The modern field of 'planetary health' was instigated in 2015 by the Rockefeller Foundation-Lancet Commission, which defined it as 'the health of human civilisation and the state of the natural systems on which it depends'. However, this view of human health in relation to natural systems is not really new at all. Rather, it is (re)emerging as the environmental impacts of human activities and their effects on the health of all life on Earth, now and in the future, become increasingly clear. A planetary health approach requires us to rethink dominant perspectives about how we feed, move, house, power and care for the world, as well as the implications for wellbeing and equity across generations and locations. This shift in understanding of our place as humans in relation to the planet is fundamental to addressing the polycrises of the 21st century. Planetary health approaches are increasingly embraced but not yet fully realised or embedded. More organisations and collaborations, in the health sector and beyond, are incorporating these ideas into their methods, plans and training, including concepts that are part of, but not synonymous with planetary health, such as one health, global health, environmental health, climate health and sustainable healthcare. Yet, we are still far from the collective cultural transformation needed to achieve the promise of planetary health as a movement that puts the health of people and the planet at the centre of all policy and action. Education and training in the Western tradition encourage 'human-centred' or 'colonial' thinking. There is much to (re)learn from First Nations peoples, and other non-Western worldviews, about the interdependence of all species and what that means for sustainable health and wellbeing. We offer proposals for how public health policymakers, researchers and practitioners, might support the transformation needed and address the conceptual, knowledge and governance challenges identified by the Rockefeller Foundation-Lancet Commission.

Australia's National Lung Cancer Screening Program will commence in July 2025, targeted at individuals aged 50-70 years with a 30 pack-year smoking history (equivalent to 20 cigarettes per day for 30 years), who either currently smoke or have quit within the past 10 years. We forecasted the number of screening-eligible individuals over the first 5 years of the program using data from the 2019 National Drug Strategy Household Survey and the 2022 Australian Bureau of Statistics population projections. Multiple imputation integrated with predictive modelling of future or unmeasured smoking characteristics was used to address missing data and, simultaneously, to project individuals' smoking histories to 2030. In 2025, 930 500 (95% prediction interval 852 200-1 019 000) individuals were estimated to be eligible, with the number meeting the criteria declining slightly during the years 2025-2030 in all Australian jurisdictions. Overall, 26-30% of those eligible will have quit smoking, and 70-74% will currently smoke. These estimates can be used in resource planning and as an indicative denominator to track participation rates for the program over time.