Rural and remote health最新文献

Introduction: This study aimed to explore type 2 diabetes mellitus patients' perspectives on diabetic foot complications and challenges of footcare management in Sigatoka, Fiji.

Methods: This study applied a qualitative approach among persons with diabetes who attended diabetic foot clinics from August to September 2021. Participants were selected through purposive sampling and included any self-identified Fijian aged 18 years and over who had type 2 diabetes with a minimum diagnosis duration of 6 months and no experience of an amputation. Data were collected using semi-structured in-depth interviews, and the content of interviews was transcribed and analysed using thematic analysis to generate themes and subthemes outlined in the study.

Results: The study included 30 participants. Three major themes were identified. The first was patient perceptions of diabetic foot complications, which showed that there was very limited patient knowledge of how diabetes caused foot complications. The second was practising foot care, which reflected that commonly practised recommendations were associated with daily activities like washing the feet. Third was patient perceptions of footcare services, whereby the majority were generally happy with the footcare services available to them.

Conclusion: The study results indicated that patients lacked sufficient knowledge about the symptoms and prevention of type 2 diabetes mellitus, and healthy practices related to food complications. More effort needs to be invested into diabetes and footcare knowledge and practices for patients at the Sigatoka Hospital. This will help guide patients to make life-altering decisions that can help reduce the rate of diabetes related lower limb amputations, which are easily preventable.

Introduction: Aging in rural areas is challenging and has very specific characteristics in the way these elderly people live their old age, from the perspectives of cognition, functionality and life purpose. There is a lack of information and data in the literature on how people age in rural areas around the world. The aim of this study was to identify and describe how people age in rural areas, focusing on the following domains: cognition, physical function/functionality and life purpose.

Methods: We included cross-sectional studies published up to April 2023 found in six databases: PubMed, LILACS, PsycINFO, Scopus, SciELO and Web of Science. The Rayyan software was used for the first selection of studies and the Observational Study Quality Evaluation was used to assess methodological quality and risk of bias. For the primary analysis, the titles and abstracts available in the search engine were analyzed using the following MeSH descriptors: "physical functioning"; "cognition"; "cognitive function"; "life purpose"; 'personal satisfaction'; 'subjective well-being'; "aged"; "elderly"; "old"; "rural aging"; "rural population"; "communities, rural"; "distribution, rural spatial"; "medium communities"; "rural settlement"; "small community". In the secondary selection, the selected articles were fully read by two independent reviewers and confirmed by a third reviewer when necessary.

Results: From 22 studies methodologically evaluated it was seen that rural aging in the world is female and mostly in elderly women farmers; mental evaluation together with activities of daily living and instrumental activities were the most evaluated; the studies did not mention the evaluation of life purpose.

Conclusion: The world ages very differently in rural areas, and the way we age is directly linked to where this process takes place. Cognition, followed by functionality, are the most researched outcomes in cross-sectional studies with this population and the assessment of life purpose has not been investigated to date.

Human parechovirus (HPeV) infections in neonates and infants have been linked to outbreaks in regions including Australia, Northern Europe, and the US, resulting in long-term neurological complications. HPeV symptoms range from mild gastroenteritis and respiratory issues to severe systemic illness, including seizures and neurological damage. Human parechovirus type 3 (HPeV3) has emerged as a significant cause of sepsis-like illness in infants aged less than 3 months. We describe the case of a neonate aged 11 days with an acute abdomen and meningitis, treated at a rural hospital in Queensland, Australia. Early diagnosis of HPeV3 in this case facilitated supportive management of the neonate, and avoided unnecessary transfer to a tertiary centre.

Introduction: The long-term outcomes of different telerehabilitation gains for discharged COVID-19 patients are largely uncertain, and this point needs to be explored. This study aimed to research the effectiveness of telerehabilitation and compare the long-term results of videoconferencing-guided synchronous telerehabilitation and mobile application-guided asynchronous telerehabilitation programs, as well as determine the correlation between clinical and hemodynamic parameters.

Methods: Exercise programs including aerobic exercises, strengthening exercises, and pulmonary exercises were given to COVID-19 patients discharged from the Kartal Dr. Lütfi Kirdar City Hospital in Istanbul, Türkiye between August 2021 and January 2022, by videoconferencing or mobile application telerehabilitation. All patients underwent programs three times per week for 8 weeks. Lower extremity strength and functional status were assessed using a 30-second sit-to-stand test (30 s STS); physical activity level was assessed using the International Physical Activity Questionnaire short form (IPAQ); pulse oximetry was used to determine oxygen saturation and heart rate; and dyspnea and fatigue were assessed using a modified Borg Rating of Perceived Exertion Scale. Baseline, post-treatment, and long-term data were analyzed.

Results: A total of 27 patients completed the study. Significant improvement was seen in all parameters in long-term results with telerehabilitation programs (p<0.05). Especially in the between-group effect at rest (p=0.031) and post-exertion oxygen saturation (p=0.004), there were significant differences in favor of videoconferencing. Oxygen saturation was negatively correlated with dyspnea and fatigue (p<0.05). Post-exercise, dyspnea showed a moderate positive correlation with fatigue (r=0.582, p=0.001) and heart rate (r=0.412, p=0.033), while it exhibited a moderate negative correlation with 30 s STS (r=-0.424, p=0.027) and IPAQ (r=-0.401, p=0.038).

Conclusion: Both methods generally provide positive gains in clinical and hemodynamic parameters, but the videoconferencing results were slightly better. Saturation at rest and dyspnea after exertion can provide a brief prediction about the cardiopulmonary system. Our findings are important for individuals who have access problems to the clinic and city center, and can be used for follow-up and treatment approaches.

Context: Ireland has one of the most rural populations in Europe. Rurality presents challenges when accessing health services but should not be perceived as problematic and in need of a structural fix. Structural urbanism where health care is viewed as a commodity for individuals, rather than an infrastructure for populations, innately favours larger urban populations and has detrimental outcomes for rural health. In this article we present a brief account of advocacy led by rural GPs, their communities, and the political and policy implications of their efforts.

Issues: In the period 2010-2016, Irish rural general practices were struggling for viability. Two key financial supports, distance coding and the Rural Practice Allowance, were withdrawn. This directly contributed to the founding of the 'No Doctor No Village' public campaign, following which the Rural Practice Allowance took shape as the Rural Support Practice Framework and was expanded to cover a larger number of rural practices. The World Rural Health Conference in June 2022 at the University of Limerick invited over 600 expert delegates who contributed to the authorship of the Limerick Declaration, a blueprint for advancing rural health in Ireland and internationally. This created a new momentum in advocacy for Irish rural general practice, which has drawn financial investments, sparked research interest building capacity for a pipeline to train rural general practitioners.

Lessons learned: Local voices have driven monumental change in the Irish healthcare context. For these communities, the policy and politics of rural health are mere tools to maintaining or restoring their way of life. The biggest lesson to be learned is that unrelenting community commitment, when supported by the capacity to advocate, can influence politics and policy to generate sustainable outcomes and thriving communities.