Public Health Research & Practice最新文献

Objective: This manuscript describes the novel approach to developing a toolkit to support meaningful consumer involvement in clinical trials in Australia to help guide others in considering the development of similar resources.The toolkit aims to support greater consumer involvement in shaping how clinical research is prioritised, designed and conducted. Type of program or service: A working group of researchers, research organisations and consumers was established to co-develop the Consumer Involvement and Engagement Toolkit (the 'Toolkit'), a digital resource to guide researchers and organisations regarding consumer involvement in clinical trials.

Findings: A literature review and international scan of best practice revealed numerous resources outlining best practice for consumer involvement in clinical research and clear evidence of its impact and value. Through a novel content-sharing process, we were able to utilise these resources to develop a comprehensive Toolkit for researchers and research organisations that provides world-class guidance.

Lessons learnt: There is a growing movement to ensure consumer involvement in healthcare, including in clinical research. We discovered its proponents were willing to share their tools and resources to promote international consumer involvement. Although these international tools and resources needed adaptation to suit the Australian research environment, this was achievable with far less effort than developing them from scratch.

Objectives and importance of study: Colorectal cancer (CRC) is Australia's fourth most commonly diagnosed cancer. CRC screening is an effective intervention to reduce this burden. The National Bowel Cancer Screening Program (NBCSP) provides 2-yearly immunochemical faecal occult blood tests (iFOBTs) to Australians aged 50-74 years; a diagnostic colonoscopy is conducted after a positive iFOBT. Clinical guidelines inform colonoscopy usage, and appropriate use of these guidelines is vital to investigate gastrointestinal symptoms, detect bowel abnormalities and CRC, and remove precancerous polyps. Colonoscopy services are under strain, with limited formal strategies to prioritise patients. There are concerns among practitioners and patient advocates that the NBCSP generates additional colonoscopy requests and increases wait times, worsening patient outcomes and prolonging distress. In this research study, we estimate and project colonoscopy use in Australia from 2001 to 2030 and determine the impact of the NBCSP by examining model-estimated NBCSP colonoscopy demand.

Methods: Colonoscopy use in Australia was compiled using Medicare Benefits Schedule (MBS) claims for colonoscopies from 2001 to 2019. From these data, projections were made from 2020 to 2030. Policy1-Bowel, a microsimulation model, was used to estimate NBCSP-related colonoscopy demand from screening follow-up and colonoscopic surveillance from 2006 to 2030.

Results: MBS-funded colonoscopy use increased from 284 676 in 2001 to 663 213 in 2019. Annual use is projected to be more than 780 000 by 2030. Of these, 10-14% are projected to be generated by the NBCSP. Per-capita MBS-funded colonoscopy utilisation increased 0.2% annually over 2015-2019, a slowing of growth compared to previous trends.

Conclusion: The NBCSP accounts for a modest fraction of colonoscopy use in Australia, and a better understanding of colonoscopy use not associated with the NBCSP is needed. Promoting adherence to guideline-recommended iFOBT and colonoscopy use could ease pressure on services and improve outcomes.

Objectives: Low-alcohol beverages (LABs) are becoming increasingly popular and more accepted in Australia. However, the extent to which these products are accessible in licensed venues remains unknown. This investigation aimed to explore the availability, visibility, advertising, and promotion of LAB products at licensed venues.

Study type: A cross-sectional environmental audit of licensed venues in four entertainment locations on the Gold Coast, Queensland.

Methods: An audit tool was developed. Licensed venues selected for auditing included bars, pubs, clubs, and nightclubs. Consent for conducting the audits was obtained from selected venues. Audits involved a walk-through of each venue's public areas and a review of their beverage menu to observe availability, visibility, advertising, and promotion of LAB products.

Results: A total of 58 venues were identified, with 32 (55%) providing written consent to audit. Overall, 18 venues (56%) offered patrons the opportunity to purchase LAB products. At bar service areas, LAB products were 'not visible' in 20 (63%) venues, and 'somewhat visible' in 12 (38%) venues. No bar service areas displayed LAB products with 'high visibility'. Of 29 beverage menus audited, 10 (34%) displayed LAB products, with varying levels of visibility. LAB-related advertising and/or promotion was not identified in any of the venues.

Conclusions: LABs were available in approximately half the licensed venues audited; however, the visibility and promotion of these products were poor. There is capacity to improve access to and promote lower alcohol alternatives within licensed venues.

Australia's National Bowel Cancer Screening Program (NBCSP) has the potential to prevent almost 84 000 bowel cancer deaths if 60% program participation rates could be reached and maintained over the next two decades. Immunochemical faecal occult blood test (iFOBT) is used as an initial screening tool. Participants who test positive are referred for colonoscopy for diagnostic assessment. Concerns about colonoscopy capacity and lengthy wait times between positive iFOBT and colonoscopy have hampered efforts to promote the program. However, a separate research paper published in this issue of PHRP shows that only an estimated 10-14% of Medicare-funded colonoscopies (almost 75% of all colonoscopies) in Australia are generated by the NBCSP. Inappropriate use of colonoscopy as a primary screening tool and failure to prioritise NBCSP participants may be the main reasons for long colonoscopy wait times associated with the program. Promoting clinical practice guidelines, and the Direct Access Colonoscopy initiative for priority patients, are key to reducing colonoscopy wait times and proactive promotion of the NBCSP.

In the modern era, evidence-based medicine (EBM) has been embraced as the best approach to practising medicine, providing clinicians with 'objective' evidence from clinical research. However, for presentations with complex pathophysiology or from complex social environments, sometimes there remains no evidence, and no amount of research will obtain it. Yet, health researchers continue to undertake randomised controlled trials (RCT) in complex environments, ignoring the risk that participants' health may be compromised throughout the trial process. This paper examines the role of research that seeks to obtain evidence to support EBM. We provide examples of RCTs on ear disease in Aboriginal populations as a case-in-point. Decades of ear research have failed to yield statistically significant findings, demonstrating that when multiple factors are at play, study designs struggle to balance the known disease process drivers, let alone unknown drivers. This paper asks the reader to consider if the pursuit of research is likely to produce evidence in complex situations; or if perhaps RCTs should not be undertaken in these situations. Instead, clinicians could apply empirical evidence, tailoring treatments to individuals while taking into account the complexities of their life circumstances.

Aim: To explore perspectives of leaders in pharmacoepidemiology on building workforce capacity in the routinely collected data arena to enable researchers to generate evidence to support clinical and policy decision-making.

Methods: Semi-structured interviews were conducted between May and August 2018 with 13 leaders in pharmacoepidemiology in Australia. Discussion topics included training needs, workforce enablers, barriers and priorities for building capacity. The data was analysed using a content analysis approach.

Results: Leaders identified a range of knowledge and skills that are needed to work with routinely collected data and generate evidence to support clinical and policy decision making. Enablers identified included collaborations and promoting awareness to attract new people to work with this data type. Barriers included difficulty accessing data, lack of critical mass of human capital to build skill levels and funding issues.

Conclusions: Building workforce capacity involves addressing identified enablers and barriers. Central to building workforce capacity is the harmonisation of Australia's data infrastructure, which can improve the way people work, learn, collaborate, share ideas and expand their professional network.

Australia has long been heralded as a leader in tobacco control, but more than 10 years have passed since the country implemented the world's first tobacco plain packaging reforms. In late 2022, the Australian Federal Government announced it would be "reigniting the fight against tobacco addiction". The forthcoming reforms package will help modernise and re-energise Australian tobacco control. The Government has signalled that preliminary reforms will include updating graphic health warnings, standardising tobacco pack sizes and filters, and banning menthol and flavours. The recently endorsed National Tobacco Strategy 2023-2030 also opens the door to further supply-side reforms. Ten years ago, when Australia fought multiple legal challenges from the tobacco industry and established plain packaging as a best practice standard, e-cigarette or vaping products were a fringe issue with little presence in Australia. Today, vaping product use by young Australians has dramatically and rapidly increased. Easy access and marketing of cheap, flavoured, disposable, nicotine-containing vaping products are driving use. Recognising that the current approach to e-cigarette regulation is not achieving its aim of preventing children and adolescents from accessing vaping products, the Australian Therapeutic Goods Administration (TGA) launched a consultation on possible reforms in late 2022. Currently, vaping importers and retailers are exploiting an exemption for non-nicotine products in regulations, and nicotine-containing products are masquerading as non-nicotine products. The ideal public health solution would see the elimination of all vaping product sales, nicotine and non-nicotine alike, that fall outside of the TGA prescription-only access pathway. After 10 years of minimal action, it is invigorating to have three key initiatives in play to fully "reignite" tobacco control - the tobacco legislation renewal and update, the imminent national strategy release, and the TGA consultation on vaping products. Re-establishing Australia as a tobacco control leader is welcome news for public health.

In recent years, there has been a large increase in cosmetic applications using non-ionising radiation (NIR). These applications use various types of NIR such as lasers and ultrasound for numerous cosmetic outcomes such as epilation, skin rejuvenation and tattoo removal. Cosmetic NIR procedures are marketed as a low-cost and low-risk alternative to more invasive procedures. However, treatments with these devices always result in high NIR exposure to targeted tissue in order to ensure efficacy of treatment. Consequently, there is always a risk of adverse health effects from these procedures, which may be temporary or longer lasting. Research on the health risks of cosmetic NIR applications is lacking, particularly on the extent of poor treatment application or misuse. In Australia, except for the banning of solaria, there is no national regulation for the use of NIR devices for cosmetic purposes and only three states have established regulatory controls for certain optical cosmetic applications. To mitigate the impacts of this gap in oversight, the Australian Radiation Protection and Nuclear Safety Agency has published national advice for consumers and service providers that give information on cosmetic NIR treatments and the potential risks involved.

Since 2020, hundreds of thousands of more deaths than expected have been observed across the globe. Amid the coronavirus 2019 (COVID-19) pandemic, current research priorities are to control the spread of infection and minimise loss of life. However, there may be future opportunities to learn from the pandemic to build a better healthcare system that delivers maximum health benefits with minimum harm. So far, much research has focused on foregone benefits of healthcare services such as cancer screening during the pandemic. A more balanced approach is to recognise that all healthcare services have potential harms as well as benefits. In this way, we may be able to use pandemic 'natural experiments' to identify cases where a reduction in a healthcare service has not been harmful to the population and some instances where this may have even been beneficial.