Bronchiectasis among Indigenous adults in the Top End of the Northern Territory, 2011-2020: a retrospective cohort study.

OBJECTIVES: To assess the prevalence of bronchiectasis among Aboriginal and Torres Strait Islander (Indigenous) adults in the Top End of the Northern Territory, and mortality among Indigenous adults with bronchiectasis. STUDY DESIGN: Retrospective cohort study. SETTING, PARTICIPANTS: Aboriginal and Torres Strait Islander adults (18 years or older) living in the Top End Health Service region of the NT in whom bronchiectasis was confirmed by chest computed tomography (CT) during 1 January 2011 - 31 December 2020. MAIN OUTCOME MEASURES: Prevalence of bronchiectasis, and all-cause mortality among Indigenous adults with CT-confirmed bronchiectasis - overall, by sex, and by health district - based on 2011 population numbers (census data). RESULTS: A total of 23 722 Indigenous adults lived in the Top End Health Service region in 2011; during 2011-2020, 459 people received chest CT-confirmed diagnoses of bronchiectasis. Their median age was 47.5 years (interquartile range [IQR], 39.9-56.8 years), 254 were women (55.3%), and 425 lived in areas classified as remote (93.0%). The estimated prevalence of bronchiectasis was 19.4 per 1000 residents (20.6 per 1000 women; 18.0 per 1000 men). The age-adjusted prevalence of bronchiectasis was 5.0 (95% CI, 1.4-8.5) cases per 1000 people in the Darwin Urban health area, and 18-36 cases per 1000 people in the three non-urban health areas. By 30 April 2023, 195 people with bronchiectasis had died (42.5%), at a median age of 60.3 years (IQR, 50.3-68.9 years). CONCLUSION: The prevalence of bronchiectasis burden among Indigenous adults in the Top End of the NT is high, but differed by health district, as is all-cause mortality among adults with bronchiectasis. The socio-demographic and other factors that contribute to the high prevalence of bronchiectasis among Indigenous Australians should be investigated so that interventions for reducing its burden can be developed.

Development of a University-Government Partnership for Public Health Response and Workforce Development in the State of Oregon.

The COVID-19 pandemic exposed and exacerbated a public health workforce shortage and national strategies have called for the development of clear occupational pathways for students to enter the public health workforce and meaningful public health careers. In response to the immediate need for public health workers during the pandemic, several universities and academic hospitals rapidly mobilized students and employees and partnered with local or state health departments. However, many of those partnerships were based on short-term volunteer effort to support critical COVID-19 public health efforts. In this article, we document the development of Oregon's Public Health Practice Team, a student, staff, and faculty workforce developed at the Oregon Health & Science University-Portland State University (OHSU-PSU) School of Public Health in close collaboration with the Oregon Health Authority (OHA). This project contributed significant effort to several phases of Oregon's statewide public health response to COVID-19, and over time developed into a lasting, multi-purpose, inter-agency collaborative public health practice program. Health equity has been centered at every stage of this work. We describe the phases of the partnership development, the current team structure and operations, and highlight key challenges and lessons learned. This provides a case-study of how an innovative and flexible university-government partnership can contribute to immediate pandemic response needs, and also support ongoing public health responses to emerging needs, while contributing to the development of a skilled and diverse public health workforce.

[Mapping public health training in Latin America: perspectives for training institutionsMapeamento da formação em saúde pública na América Latina: perspectivas para as instituições formadoras]. / Mapeo de la formación en salud pública en América Latina: perspectivas para las instituciones formadoras.

Objective: Map the public health training courses and programs offered in Latin America, and identify regional training strategies and competencies developed in health workers. Methods: An internet search was conducted to identify public health training courses and programs offered by Latin American institutions. The following data were collected: name, country, and province/state of the training institution; course name; type of institution; educational level; modality; accreditation; year first offered; periodicity; and contact information. The programs and curricula on offer were analyzed by training level using descriptive content analysis, and the main competencies developed were identified. Results: The mapping identified 2 296 public health training opportunities in all Latin American subregions, distributed across 29 of the Region's 33 countries; these were fairly heterogeneous, both conceptually and programmatically, with uneven geographical distribution within and between countries. In the analysis of curricula and programmatic contents, a need for greater linkage with essential public health functions was detected. Conclusion: It is necessary to adapt the competencies and skills developed by the courses and programs to the demands of users of the regional health services, programs, and systems in order to achieve programs aimed at tackling the socio-environmental determinants of health and the production and reproduction of inequalities.

Objetivo: Mapear os cursos e programas de formação em saúde pública oferecidos na América Latina e identificar estratégias de formação e competências desenvolvidas na formação regional de profissionais de saúde pública. Métodos: Foi realizada uma busca na internet para identificar cursos e programas de formação em saúde pública oferecidos por instituições latino-americanas. Foram coletados os seguintes dados: nome, país e estado ou província da instituição formadora; nome do curso; característica da instituição; nível de formação; modalidade; acreditação; ano da primeira turma; regularidade e detalhes de contato. Em seguida, os programas e currículos oferecidos foram analisados por nível de formação, por meio da técnica descritiva de análise de conteúdo, e foram identificadas as principais competências desenvolvidas. Resultados: O mapeamento permitiu identificar 2 296 ofertas de formação em saúde pública em todas as sub-regiões da América Latina, distribuídas em 29 dos 33 países da Região. As ofertas identificadas foram bastante heterogêneas, tanto do ponto de vista conceitual como programático, e com uma distribuição geográfica desproporcional nos países e entre as sub-regiões. A análise dos currículos e conteúdos programáticos detectou a necessidade de um maior vínculo com as funções essenciais da saúde pública. Conclusão: Observou-se a necessidade de adequar as competências e habilidades desenvolvidas pelos cursos e programas às demandas dos usuários dos serviços, programas e sistemas regionais de saúde, a fim de concretizar programas voltados para o enfrentamento dos processos de determinação socioambiental da saúde e de produção e reprodução de desigualdades.

Meals and movies: making our microbiota merry.

OBJECTIVE: To investigate the impact of festive cinematic diets on the gut microbiota. DESIGN: Observational (watching films) and creative review. Sadly, we couldn't incorporate any snowball sampling. SETTING: In front of a television, by a blazing log fire. PARTICIPANTS: Everyone: you don't need to be on the nice list! MAIN OUTCOME MEASURES: Microbiota INdex of Comparative Evaluation for Pictorial Infographic Evidence (MINCE PIE) scores (difference between the numbers of microbiota-enhancing and microbiota-detrimental food groups) for foods depicted in twelve festive films. RESULTS: Most festive films featured meals or foods from a typical Western diet, with high sugar and fat content, with overall negative effects on the microbiota. However, some films promoted options containing fibre, beneficial proteins, or polyphenols. These are gifts under the Christmas tree for our microbiota. CONCLUSION: Good balance is needed for our microbiota, and consequently our mental health. Many festive films portray a Western diet that can lead to dysbiosis. Through their action on the gut-brain axis and the influence of media on dietary choices, the festive foods consumed in these films (maybe an extra chocolate biscuit during Love Actually) can be stressful for our microbiota.

Offering mailed nicotine replacement therapy and Quitline support before elective surgery: a randomised controlled trial.

OBJECTIVE: To assess whether offering free mailed nicotine replacement therapy (NRT) and telephone counselling to smokers on elective surgery waiting lists increases quitting before surgery. DESIGN, SETTING: Randomised, controlled trial at Frankston Hospital, a public tertiary referral hospital in Melbourne. PARTICIPANTS: Adult smokers added to elective surgery waiting lists for operations at least ten days in the future, 1 April 2019 - 3 April 2020. INTERVENTION: In addition to normal care, intervention participants received a brochure on the risks of low frequency smoking, an offer of Quitline call-back registration, and an offer of mailed NRT according to reported daily smoking: 1-9 cigarettes/day, 2 mg lozenges; 10-15/day, 7-14 mg patches [three weeks] and 2 mg lozenges; > 15/day, 7-21 mg patches [five weeks] and 2 mg lozenges. MAIN OUTCOME MEASURES: Primary outcome: quitting at least 24 hours before surgery, verified by exhaled carbon monoxide testing. SECONDARY OUTCOMES: quitting at least four weeks before surgery, adverse events, and (for those who had quit before surgery) abstinence three months after surgery. RESULTS: Of 748 eligible participants (control, 363; intervention, 385), 516 (69%) had undergone elective surgery when the trial was terminated early (for COVID-19-related reasons) (intervention group, 274; control group, 242). 122 of the 385 intervention participants (32%) had accepted the offer of cessation support. The proportions of intervention participants who quit at least 24 hours before surgery (18% v 9%; odds ratio [OR], 1.97; 95% CI, 1.22-3.15) or at least four weeks before surgery (9% v 4%; OR, 2.20; 95% CI, 1.08-4.50) were larger than for the control group. Three months after surgery, 27 of 58 intervention (47%) and 12 of 25 control participants (48%) who quit before surgery reported not smoking in the preceding seven days. No major adverse events were reported. CONCLUSION: Uptake of free mailed NRT and Quitline support by smokers on elective surgery waiting lists was good, and offering additional support was associated with higher proportions of smokers quitting before surgery. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12619000032156 (prospective).

Activating people to partner in health and self-care: use of the Patient Activation Measure.

Patient activation is a behavioural concept and is at the heart of personalised care. It is defined as an individual's knowledge, skill and confidence for managing their health and health care. Evidence indicates that patient activation scores can predict health behaviour and are closely linked to various clinical outcomes: reduced unnecessary emergency department visits, hospital admissions and re-admissions. Patients with lower activation levels (25-40% of the population) are less likely to adopt healthy behaviour, and more likely to have poorer clinical outcomes and higher rates of hospitalisation. Effective interventions can improve a patient's activation level, and positive change in activation equates to positive change in self-care behaviour. But to improve patient activation, we must first measure it using a robust evidence-based tool such as the Patient Activation Measure (PAM) survey. Armed with the patient's PAM score, providers can tailor their care and help patients achieve better self-care, which can improve outcomes of care and reduce unnecessary health care utilisation. The PAM is also useful for population segmentation and risk stratification - to target interventions and health strategies to meet the needs of patients who are at different points along the activation continuum, to measure the performance of health care systems, and to evaluate the effectiveness of health care interventions. The role of patient activation requires further serious consideration if we are to improve the long-term health and wellbeing of all Australians. The PAM tool is a feasible and cost-effective solution for achieving the Quadruple Aim - improving population health, the cost-efficiency of the health system, and patient and provider experience.

[Permanent professional development in health through the Virtual Campus for Public Health in Colombia (2012-2019)Desenvolvimento profissional permanente em saúde por meio do Campus Virtual de Saúde Pública na Colômbia (2012-2019)]. / Desarrollo profesional permanente en salud por intermedio del Campus Virtual de Salud Pública en Colombia (2012-2019).

Objective: Reconstruct the experience of the Virtual Campus for Public Health (VCPH) from 2012 to 2019 in Colombia. Methods: The experience of public health training through the VCPH in Colombia in the period 2012-2019 was systematized. The information is presented in cross-section time series to show the evolution of the VCPH in Colombia over time. Results: A total of 2 627 health professionals took tutored courses and 34 012 followed self-learning courses on relevant, up-to-date, priority public health issues. An important aspect was the opportunity to access remote regions through VCPH training processes that were cost-free for end users. The experience highlights the relevance of the VCPH in reducing the gap in updated human talent in the health field through virtual education with diversity in its modalities and content. Conclusions: Reconstruction of the experience in Colombia showed how the VCPH evolved and strengthened to offer quality training processes that respond to the country's problems and needs. Collaborative work between universities and the Pan American Health Organization resulted in consolidation of the VCPH.

Objetivo: Reconstruir a experiência do Campus Virtual de Saúde Pública (CVSP) de 2012 a 2019 na Colômbia. Métodos: Realizou-se a sistematização da experiência do processo de formação em saúde pública na Colômbia por meio do Campus, referente ao período de 2012 a 2019. As informações são apresentadas em séries transversais de períodos de tempo para mostrar a evolução histórica do CVSP na Colômbia. Resultados: Foram capacitados 2.627 profissionais de saúde em cursos com instrutor e 34.012 em cursos de autoaprendizagem sobre temas relevantes, atuais e prioritários de saúde pública. Destacam-se a oportunidade e o acesso a regiões remotas que o Campus obteve, por meio de processos de formação sem custo para o usuário final. A experiência destaca a relevância do Campus na redução da lacuna de atualização do talento humano da área da saúde, mediante processos de educação virtual com diversidade nas modalidades e ofertas de formação. Conclusões: A reconstrução da experiência da Colômbia mostrou a evolução e o fortalecimento do CVSP para oferecer processos de formação com qualidade, a fim de responder aos problemas e necessidades do país. A consolidação do Campus deve-se ao trabalho colaborativo entre as universidades e a Organização Pan-Americana da Saúde.

Future directions of Doctor of Public Health education in the United States: a qualitative study.

BACKGROUND: The Doctor of Public Health (DrPH) degree is an advanced and terminal professional degree that prepares the future workforce to engage in public health research, teaching, practice, and leadership. The purpose of the present research was to discuss the desirable future direction and optimal education strategies for the DrPH degree in the United States. METHODS: A total of 28 Council on Education for Public Health (CEPH)-accredited DrPH programs in the United States was identified through the Association of Schools and Programs of Public Health (ASPPH) Academic Program Finder. Then, a qualitative analysis was conducted to obtain perspectives from a total of 20 DrPH program directors through in-depth interviews. RESULTS: A DrPH program should be recognized as equal but different from an MPH or a PhD program and strengthen the curriculum of methodology and leadership education. It is important that a DrPH program establishes specific partnerships with other entities and provide funding for students. In addition, rather than being standardized nationwide, there is value in each DrPH program maintaining its unique character and enabling students to be open to all career pathways. CONCLUSIONS: The future of DrPH programs in the twenty-first century should aim at effective interdisciplinary public health approaches that draw from the best of both academic and applied sectors. A DrPH program is expected to provide academic, applied public health, and leadership training for students to pursue careers in either academia or the public/private sector, because public health is an applied social science that bridges the gap between research and practice.

Italian physiotherapists' knowledge of and adherence to osteoarthritis clinical practice guidelines: a cross-sectional study.

INTRODUCTION: Implementation of clinical practice guidelines (CPGs) to manage musculoskeletal conditions among physiotherapists appears suboptimal. Osteoarthritis is one of the most disabling conditions worldwide and several studies showed a lack of knowledge of and adherence to osteoarthritis CPGs in physiotherapists' clinical practice. However, those studies are not conclusive, as they examine the knowledge of and adherence to CPGs only in isolation, or only by focussing on a single treatment. Thus, analysis of the knowledge of and adherence to CPGs in the same sample would allow for a better understanding of the evidence-to-practice gap, which, if unaddressed, can lead to suboptimal care for these patients. This study aims at assessing Italian physiotherapists' evidence-to-practice gap in osteoarthritis CPGs. METHODS: An online survey divided into two sections investigating knowledge of and adherence to CPGs was developed based on three high-quality, recent and relevant CPGs. In the first section, participants had to express their agreement with 24 CPG statements through a 1 (completely disagree) to 5 (completely agree) scale. We defined a ≥ 70% agreement with a statement as consensus. In the second section, participants were shown a clinical case, with different interventions to choose from. Participants were classified as 'Delivering' (all recommended interventions selected), 'Partially Delivering' (some recommended interventions missing) and 'Non-Delivering' (at least one non-recommended interventions selected) the recommended intervention, depending on chosen interventions. RESULTS: 822 physiotherapists (mean age (SD): 35.8 (13.3); female 47%) completed the survey between June and July 2020. In the first section, consensus was achieved for 13/24 statements. In the second section, 25% of the participants were classified as 'Delivering', 22% as 'Partially Delivering' and 53% as 'Non-Delivering'. CONCLUSIONS: Our findings revealed an adequate level of knowledge of osteoarthritis CPGs regarding the importance of exercise and education. However, an adequate level of adherence has yet to be reached, since many physiotherapists did not advise weight reduction, but rest from physical activity, and often included secondary treatments (e.g. manual therapy) supported by low-level evidence. These results identify an evidence-to-practice gap, which may lead to non-evidence based practice behaviours for the management of patients with osteoarthritis.

The United Kingdom Field Epidemiology Training Programme: meeting programme objectives.

IntroductionMost evaluations of field epidemiology training programmes (FETP) are limited to process measures, but stakeholders may need evidence of impact.ObjectiveTo ascertain if the United Kingdom (UK) FETP met its objectives to: (i) strengthen capacity and provision of national epidemiology services, (ii) develop a network of highly skilled field epidemiologists with a shared sense of purpose working to common standards and (iii) raise the profile of field epidemiology through embedding it into everyday health protection practice.MethodsThe evaluation consisted of: (i) focus groups with training site staff, (ii) individual interviews with stakeholders and (iii) an online survey of FETP fellows and graduates. Findings were synthesised and triangulated across the three evaluation components to identify cross-cutting themes and subthemes.FindingsEight focus groups were undertaken with 38 staff, ten stakeholders were interviewed and 28 (76%) graduates and fellows responded to the survey. Three themes emerged: confidence, application and rigour. FETP was perceived to have contributed to the development, directly and indirectly, of a skilled workforce in field epidemiology, increasing stakeholders' confidence in the service. Graduates applied their learning in practice, collaborating with a wide range of disciplines. Fellows and graduates demonstrated rigour by introducing innovations, supporting service improvements and helping supervisors maintain their skills and share good practice.ConclusionThe UK FETP appears to have met its three key objectives, and also had wider organisational impact. FETPs should systematically and prospectively collect information on how they have influenced changes to field epidemiology practice.

Psychological distress in remote mining and construction workers in Australia.

OBJECTIVES: To assess the prevalence and correlates of psychological distress in a sample of remote mining and construction workers in Australia. Design, setting: A cross-sectional, anonymous Wellbeing and Lifestyle Survey at ten mining sites in South Australia and Western Australia, administered at meetings held during 2013-2015. PARTICIPANTS: 1124 employees at remote construction, and open cut and underground mining sites completed the survey. MAIN OUTCOME MEASURES: General psychological distress (Kessler Psychological Distress Scale, K10) and self-reported overall mental health status; work, lifestyle and family factors correlated with level of psychological distress. RESULTS: The final sample comprised 1124 workers; 93.5% were men, 63% were aged 25-44 years. 311 respondents (28%) had K10 scores indicating high/very high psychological distress, compared with 10.8% for Australia overall. The most frequently reported stressors were missing special events (86%), relationship problems with partners (68%), financial stress (62%), shift rosters (62%), and social isolation (60%). High psychological distress was significantly more likely in workers aged 25-34 years (v ≥ 55 years: odds ratio [OR], 3.2; P = 0.001) and workers on a 2 weeks on/1 week off roster (v 4 weeks on/1 week off: OR, 2.4; P < 0.001). Workers who were very or extremely stressed by their assigned tasks or job (OR, 6.2; P = 0.004), their current relationship (OR, 8.2; P < 0.001), or their financial situation (OR, 6.0; P < 0.001) were significantly more likely to have high/very high K10 scores than those not stressed by these factors. Workers who reported stress related to stigmatisation of mental health problems were at the greatest risk of high/very high psychological distress (v not stressed: OR, 23.5; P < 0.001). CONCLUSIONS: Psychological distress is significantly more prevalent in the remote mining and construction workforce than in the overall Australian population. The factors that contribute to mental ill health in these workers need to be addressed, and the stigma associated with mental health problems reduced.

Patterns of poisoning exposure at different ages: the 2015 annual report of the Australian Poisons Information Centres.

OBJECTIVES: To characterise the types of calls received by Australian Poisons Information Centres (PICs) in Australia, and to analyse poisoning exposures by age group, circumstances of exposure, and the types of substances involved. Design, setting: Retrospective analysis of call records from all four Australian PICs (national coverage). MAIN OUTCOME MEASURES: Basic demographic information; exposure circumstances, substance types involved in each age group; recommendations for management (eg, stay at home, go to hospital). RESULTS: There were 204 906 calls to Australian PICs in 2015, 69.0% from the general public, 27.9% from health professionals; 16.2% of calls originated from hospitals. 170 469 calls (including re-calls about an exposure) related to 164 363 poison exposure events; 64.4% were unintentional, 18.1% were the consequences of medication error, and 10.7% involved deliberate self-poisoning. Most exposures were of 20-74-year-old adults (40.1%) or 1-4-year-old toddlers (36.0%). The PICs advised callers to stay at home for 67.4% of exposures, and to present to hospital for 10.9%. The most common substances involved in exposures overall were household cleaners (10.2%) and paracetamol-containing analgesics (7.3%). Exposures of infants and toddlers were most frequently to household cleaning substances (17.8%, 15.3% respectively) and personal care items (6.6%, 7.3%); callers were usually advised to stay at home (88.5%, 86.4%). Deliberate self-poisoning (49.1%) and hospital referral (23.9%) were most frequent for adolescents. Exposures of adults (20-74 years) frequently involved psychotropic pharmaceuticals (17.8%) or painkillers (15.1%). Exposures in adults over 74 were typically medication errors involving cardiovascular (23.6%), anticoagulant (4.6%), or antidiabetic (4.1%) medications. CONCLUSIONS: Poisoning is a significant public health problem throughout life, but the nature of the hazards differs markedly between age groups. PIC data could inform strategic public health interventions that target age-specific poisoning hazards.

Active surveillance of men with low risk prostate cancer: evidence from the Prostate Cancer Outcomes Registry-Victoria.

OBJECTIVE: To characterise the practice of active surveillance (AS) for men with low risk prostate cancer by examining the characteristics of those who commence AS, the rate of adherence to accepted AS follow-up protocols over 2 years, and factors associated with good adherence. Design, setting: Retrospective cohort study; analysis of data collected from 38 sites participating in the Prostate Cancer Outcomes Registry-Victoria. PARTICIPANTS: Men diagnosed with prostate cancer between August 2008 and December 2014 aged 75 years or less at diagnosis, managed by AS for at least 2 years, and with an ISUP grade group of 3 or less (Gleason score no worse than 4 + 3 = 7). MAIN OUTCOME MEASURES: Adherence to an AS schedule consisting of at least three PSA measurements and at least one biopsy in the 2 years following diagnosis. RESULTS: Of 1635 men eligible for inclusion in the analysis, 433 (26.5%) adhered to the AS protocol. The significant predictor of adherence in the multivariate model was being diagnosed in a private hospital (v public hospital: adjusted odds ratio [aOR], 1.83; 95% CI, 1.42-2.37; P < 0.001). Significant predictors of non-adherence included being diagnosed by transurethral resection of the prostate (v transrectal ultrasound biopsy [TRUS]: OR, 0.54; 95% CI, 0.39-0.77; P < 0.001) or transperineal biopsy (v TRUS: OR, 0.32; 95% CI, 0.19-0.52; P < 0.001), and being 66 years of age or more at diagnosis (v < 55 years: OR, 0.65; 95% CI, 0.45-0.92; P = 0.015). CONCLUSION: Almost three-quarters of men who had prostate cancer with low risk of disease progression did not have follow-up investigations consistent with standard AS protocols. The clinical consequences of this shortcoming are unknown.