Archives of Public Health最新文献

Background: Addiction has an impact not only on the individual but also on family members. Stress and strain are high especially in parents of individuals with an addiction. Aim of the study is to focus on the experiences of parents and to integrate their view in a model for a better understanding of psychosocial burdens of addiction-affected families.

Methods: The multi-modal study included qualitative in-depth semi-structured interviews following a guideline based on the Stress-Strain-Information-Coping-Support Model and additional quantitative assessment. Participants were recruited via self-help groups for parents (nationwide and regional). Data of 21 mothers and 9 fathers were analysed in terms of gender differences.

Results: While mothers were more affected by emotional and cognitive stress factors, fathers suffered more from violent conflicts. Mothers tended more towards stressful coping strategies such as taking responsibility and tabooing the addiction, whereas fathers were more able to distance themselves from the addiction problem. For mothers, feelings of guilt and shame were a major barrier to seeking help; for fathers, the lack of admission of their own helplessness played a significant role. Both groups expressed the wish for extended support, better access to the help system, intensified media awareness, and advertisement of easy-to-access emergency help.

Conclusions: Feelings of guilt, shame, and fear of stigmatisation were identified as key barriers to seeking professional help. The Stress-Strain-Information-Coping-Support Model of how family members are affected by addiction was enlarged to include 'barriers to' and 'needs for' support.

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.