Archives of Public Health最新文献

Background: Cutaneous melanoma (CM) is a lethal skin malignancy with increasing global incidence and a growing economic burden. This study aimed to assess the epidemiological trends and healthcare expenditures associated with CM in Kazakhstan from 2019 to 2023.

Methods: We conducted a retrospective population-based study using data from the national oncology registry and the Healthcare Insurance Fund of Kazakhstan. Incident CM cases (ICD-10 C43-C43.9) diagnosed between 2019 and 2023 were analyzed. Demographic, clinical, and survival data were examined alongside healthcare expenditures for outpatient diagnostics, pharmaceutical treatment, and inpatient care. Multivariable Cox regression was used to assess factors associated with all-cause mortality.

Results: A total of 1,760 patients were included; 61% were female, and 46% were aged 51-70 years. Male patients had significantly higher rates of metastatic disease, nodal involvement, and mortality. From 2019 to 2023, CM prevalence increased from 24.7 to 62.7 per million, while mortality rose from 2.2 to 6.3 per million. Pharmaceutical spending surged nearly tenfold, from USD 4.1 million to USD 38.0 million, while outpatient diagnostic and inpatient treatment costs more than doubled. Whole-body PET scans and BRAF testing accounted for a growing share of outpatient costs. Significant mortality predictors included male sex (HR = 1.59), age ≥ 71 years (HR = 1.87), ECOG score, metastases, and lymph node involvement (p < 0.05).

Conclusion: CM imposes an increasing clinical and financial burden on Kazakhstan's healthcare system. Rising prevalence and escalating treatment costs highlight the need for early detection, improved disease management, and cost-effective interventions to reduce the long-term impact of melanoma.

Background: Child obesity is a major global public health challenge. One way to reduce risk is through effective health promotion programs in schools that include parental involvement. However, programs often fail to be scaled up and sustained under real-world conditions. Therefore, it is necessary to study their implementation and study the perspective of decision-makers and school principals. The universal Healthy School Start (HSS) program, designed to promote healthy dietary and physical activity habits in children aged 5-7 years, was implemented in three municipalities in Sweden. This study aimed to identify and understand the success factors and barriers for scale-up and sustainment of the HSS program.

Methods: This study used a qualitative explorative design. Individual semi-structured interviews were conducted with eight municipality leaders responsible for the school sector and eight school principals during 2023 and 2024. Data were analyzed using reflexive thematic analysis.

Results: For a municipality to adopt and sustain the HSS program, dedicated leaders, in terms of health promotion, are crucial. Integrating the program into school routines and into the yearly quality assessment could support its sustainment. Barriers included challenges in prioritization of the HSS at the municipal level, perceived workload for school nurses, and staff and leadership turnover which could potentially reduce commitment to long-term program implementation. Facilitators and champions alleviated organizational challenges such as staff turnover. The feeling of support among staff was a key factor for successful implementation. To effectively promote health and prevent obesity, a multilevel and life-course approach involving several community actors was seen as necessary.

Conclusion: Success factors for scale-up and sustainment included the appointment of dedicated leaders in the municipality serving as program facilitators by providing consistent support and follow-up during the first year, while barriers such as lack of program prioritization, high workload and staff turnover posed a challenge to the implementation. Program integration into the yearly quality assessment might be the missing piece of the puzzle needed to achieve sustained implementation at scale. These findings are likely applicable in settings with a decentralized school system similar to Sweden's.

Background: The risk of post-acute sequelae of COVID-19 (PASC) is estimated at 3-6% per infection in 2024. We hypothesized that widespread SARS-CoV-2 infections could lead to population-level consequences. Our previous study identified substantial increases in Norwegian primary healthcare consultations in 2023-compared to pre-pandemic levels-for conditions associated with acute COVID-19 and PASC. This study extended that analysis to 2024. We then assessed whether observed patterns were compatible with our hypothesis.

Methods: We used data from the Norwegian Syndromic Surveillance System, which captures nationwide primary healthcare consultations for 102 ICPC-2 codes (out of a possible 710) that are relevant for infectious disease surveillance and some post-acute infection syndromes. Bayesian linear regression models were fitted to 2010-2019 trends, adjusting for population changes, to estimate expected values for 2024. Excess consultations were calculated by age and sex. A COVID-19 community spread was proxied by vaccination-adjusted weekly hospitalization rates.

Results: In 2024, there were 17,800,365 consultations, corresponding to an absolute excess of 1,185,231 consultations, or a 7.1% relative excess, compared to the modelled baseline. The 10 code combinations with largest absolute excess in 2024 were respiratory infections (325,726 excess consultations; 20% relative excess), fatigue (205,381; 70%), psychological symptom/complaint other (188,978; 87%), acute stress reaction (182,079; 76%), feeling depressed (126,783; 133%), hyperkinetic disorder (112,763; 116%), abdominal pain/cramps general (84,544; 29%), memory disturbance (39,177; 63%), conjunctivitis (34,643; 59%), and infectious disease other/NOS (33,556; 81%). COVID-19 community spread showed the strongest correlations with conjunctivitis, strep throat, respiratory infections as a group (R**), fatigue, infectious disease other, memory disturbances, and pneumonia. Deviations from pre-pandemic trends varied: respiratory and psychological disorders worsened from 2020 onward and several conditions showed dramatic excess from 2022-2024. Females 15-29, children, adolescents, and young adults had disproportionately large relative excesses for consultations for memory disturbances.

Conclusions: Primary healthcare consultations in 2024 significantly exceeded pre-pandemic expectations, especially for conditions linked to acute COVID-19 and PASC, though the two cannot be differentiated in these data. While other factors undoubtedly also play a role, findings are compatible with ongoing population-level health impacts associated with repeated SARS-CoV-2 infections, particularly among women, children, adolescents, and young adults. These results emerged under a national COVID-19 strategy that does not account for post-acute consequences of SARS-CoV-2 infection.

Background: Health shocks were a major cause of poverty in low and middle income countries, including China. China has implemented a series of Health Poverty Alleviation Policy (HPAP) policies aimed at reducing poverty driven by health related factors. This study aims to systematically evaluate the short term and long term effects of China's HPAP on preventing health induced poverty.

Methods: Four waves of data from the China Health and Retirement Longitudinal Study (CHARLS), involving 11,380 respondents, were used in this study. We employed two indicators to estimate both current and future health-related poverty risks at the household level: the Catastrophic Health Expenditure (CHE) index and the Health Poverty Vulnerability index, calculated using a three-stage feasible generalized least squares (FGLS) method. In the research design, households that answered "yes" to the survey question "Is your household registered as a poor household?" were classified as the treatment group, while those that answered "no" were classified as the control group. A difference-in-differences (DID) model was applied to assess the impact of the Health Poverty Alleviation Policy (HPAP) on the incidence of CHE. Given that households with different levels of risk may respond differently to the policy, we further employed a quantile difference-in-differences (QDID) model to evaluate the heterogeneous effects of HPAP on health poverty vulnerability.

Results: The average household health poverty vulnerability index was 0.48 ± 0.02. Longitudinal analyses indicated a declining trend over time in both the treatment and control groups. However, the treatment group consistently exhibited higher vulnerability levels than the control group across all survey waves. Furthermore, the incidence of CHE in the treatment group showed a sustained downward trajectory. difference-in-differences (DID) analysis demonstrated that the HPAP significantly reduced the incidence of CHE. However, its impact on overall health poverty vulnerability was limited, with only modest improvements observed among high-risk subpopulations.

Conclusions: The HPAP policy achieved notable effects in alleviating the direct economic burden caused by illness, but its impact on the long-term health poverty vulnerability of uncompensated low-to-medium-risk households remains limited. This disparity in effects primarily stems from the policy's focus on medical cost control, which, while helpful in reducing CHE, lacks systematic investment in health capacity building. Future policy design should strengthen risk identification and dynamic monitoring mechanisms, expand the scope of coverage for preventive care to achieve sustainable mitigation of health poverty vulnerability.

Background: Understanding the predictors of birth size is essential for designing effective interventions to reduce neonatal morbidity and mortality in Somaliland.

Methods: A comprehensive cross-sectional study was conducted using the 2020 Somali Health and Demographic Survey (SHDS). An ordinal logistic regression model, a robust statistical method, was applied to identify determinants of birth size (Low, Normal, High) among 2,137 mother-infant pairs, ensuring a thorough and reliable analysis.

Results: The prevalence of reported small, average, and large birth sizes was 9.0%, 75.0%, and 16.0%, respectively. Our study identified significant predictors of birth size, including household wealth, maternal age, and birth order. The adjusted odds of having a larger baby were significantly higher for infants from the wealthiest households compared to the poorest (AOR = 1.45; 95% CI: 1.12-1.87), for second-order births compared to first-borns (AOR = 1.38; 95% CI: 1.10-1.74), and for infants of mothers aged 30-34 compared to adolescent mothers (AOR = 2.09; 95% CI: 1.25-3.48). These findings provide valuable insights for designing targeted interventions to improve maternal and child health in Somaliland.

Conclusion: Our findings underscore the importance of socioeconomic status and maternal reproductive patterns in determining birth size. We recommend tailored interventions that target the identified risk factors, with a focus on nutritional support for poor households and reproductive health education for young women. Implementing these recommendations has the potential to significantly improve maternal and child health outcomes in Somaliland, offering hope for a healthier future and a brighter outlook for the region's health. However, our findings also suggest that while factors such as antenatal care attendance are important, their impact may be limited without concurrent improvements in service quality and the empowerment of women, underscoring the need for a multifaceted public health strategy.

Background: Managing modifiable risk factors in early life is associated with reduced risk of cognitive decline, stroke, and dementia later in life. This is especially important in the US Deep South, which has the highest rates of stroke and dementia nationally. While prevention efforts for brain health are gaining attention, they remain limited within primary care settings.

Objective: To describe the methods and baseline characteristics of the Brain Health Advocacy Mission (BHAM) Registry, an initiative aimed at implementing brain health education and intervention in central Alabama primary care clinics and building a participant registry for longitudinal brain health assessment.

Design: Prospective, longitudinal, single-group study evaluating changes in the McCance Brain Care Score (BCS) and adherence to brain health strategies over time.

Participants: Adults recruited from four primary care clinics across two locations.

Interventions: Participants review individual BCS results and select personalized brain health targets to guide lifestyle change.

Main measures: BCS (range 0-21; higher scores indicate better brain health) summarizes biologic, lifestyle, and emotional factors associated with long-term brain health.

Key results: Among the initial 150 participants (72% female; 67% Black; median age 48 [IQR 39-56]; mean BCS 14.3), 61% had treated hypertension and 67% had a BMI >30 kg/m². The most frequent suboptimal BCS domains were elevated blood pressure, obesity, and physical inactivity. Top participant-selected brain health targets were body weight (20.7%), exercise (20.0%), and diet (18.7%).

Conclusions: The BHAM Registry highlights the urgent need for early brain health intervention in the Deep South, where disparities in modifiable stroke and dementia risk factors are extreme. Its integration into primary care demonstrates patient willingness to engage in prevention and offers a scalable model for improving brain health through lifestyle modification across the life span.