Rural and remote health最新文献

Introduction: We aimed to investigate the correlation between spinal sarcopenia, spinal sagittal balance (SSB), and spinal function in older women living in rural areas versus those of the older urban women in our previous study.

Methods: Twenty-five older rural-dwelling women aged more than 70 years were compared with 24 older urban-dwelling women from our previous study. Demographic variables, conventional and spinal sarcopenic indices, variable functional outcome parameters, occupational state, and exercise participation rate were evaluated. We also measured the isometric back extensor strength, radiological parameters for SSB on whole-spine radiography, and volumetric parameters of the lumbar extensor muscle on computed tomography.

Results: There were no significant intergroup differences in demographic variables or the prevalence of sarcopenia. Older women in rural areas had greater handgrip strength than those in urban areas (22.7±3.7 kg v 20.0±3.4 kg, p=0.010). However, their mean lumbar lordosis angle was lower (31.7±15.3° v 42.3±11.2°, p=0.012). Isometric back extensor strength was lower in rural women than in urban women. The vocational activity participation rate of rural women was significantly higher (84% v 12.5%, p<0.001), whereas their exercise participation rate was significantly lower (60% v 92%, p<0.001).

Conclusion: Older women in rural areas had greater handgrip strength and vocational participation rates but lower back extensor strength and exercise participation rates. Therefore, more attention is needed for healthcare services to support their spinal health and exercise habits.

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Introduction: Acute appendicitis is the most common general surgical emergency worldwide; however, its diagnosis remains challenging, particularly in rural or remote areas such as Tibet. This study aimed to investigate the clinical characteristics and applicability of the routine risk prediction models of acute appendicitis for rural Tibetan populations.

Methods: Data of patients who underwent appendectomy at the Chaya People's Hospital between 1 April 2018 and 30 September 2021 were retrospectively collected. Multivariate logistic regression analysis was performed to identify risk factors associated with complicated appendicitis. The appendicitis risk prediction model scores for each patient were calculated by the binary logistic regression model based on the data. The index of union method was applied to identify the optimal cut-off value for the critical values of risk prediction models.

Results: We included 127 patients with suspected acute appendicitis in the study, consisting of 96 surgically and 31 non-surgically treated. The diagnoses of 93 patients who underwent appendectomy included 55 (59.1%) cases of uncomplicated appendicitis. Patients with complicated appendicitis had a significantly longer postoperative hospital stay (11.0 (interquartile range 8.8-13.3) days v 8.0 (interquartile range 6.0-11.0) days; p<0.001) and higher hospital costs (US$2147.2 (interquartile range US$1625.1-2516.6) v US$1487.9 (interquartile range US$1202.6-1809.2); p24 hours, age >30 years, and male sex were independent risk factors associated with complicated appendicitis. The appendicitis inflammatory response score showed the best performance among the prediction models. Incorporating imaging features in the prediction models may provide better diagnostic value for appendicitis.

Conclusion: Acute appendicitis in the rural Tibetan population has unique clinical features. To reduce the incidence of complicated appendicitis, local health workers must balance religious beliefs and professional services for residents.

Introduction: Most Australian jurisdictions have passed voluntary assisted dying (VAD) laws, with some regimes already in operation. Inequitable access to assisted dying in regional communities has been described internationally. Although regional access to VAD has been identified as a concern in Australia, to date it has been understudied empirically. Western Australia (WA) was the second Australian jurisdiction to pass and implement VAD laws. Due to the vast geography of WA (and the potential for such geography to exacerbate regional access inequities) several initiatives were introduced to try to mitigate such inequities. This article aims to explore the effectiveness of these initiatives, and report on regional provision of VAD in WA more generally, by drawing on the early experiences and reflections of key stakeholders.

Methods: A total of 27 semi-structured interviews were conducted with 29 participants belonging to four main stakeholder groups: patients and families, health practitioners, regulators and VAD system personnel, and health and professional organisation representatives. Interviews were transcribed verbatim and analysed using inductive thematic analysis.

Results: Data analysis led to the description of four main themes: the importance of the Regional Access Support Scheme, the need for local providers, the role of telehealth in VAD provision and the impact of distance.

Conclusion: Early experiences and reflections of key stakeholders suggest that while many of the regional initiatives implemented by WA are largely effective in addressing regional access inequities, challenges for regional VAD provision and access remain.