Rural and remote health最新文献

Introduction: Oral and maxillofacial (OMF) injuries encompass all forms of trauma to the tissues of the oro-facial complex, the face, jaws and mouth. In rural areas, where healthcare access is often limited, OMF injuries pose unique challenges. These challenges are compounded by environmental factors, occupational hazards and socioeconomic disparities, making rural populations particularly vulnerable to such injuries. This study explores the epidemiology and geographical variation of OMF injuries in Queensland, Australia.

Methods: Data for injury from several Queensland hospital emergency departments were obtained from state register Queensland Injury Surveillance Unit for the years 2015-2021. Data parameters included patient demographics, mechanism, intent and location of injury.

Results: The data (n=9095) revealed that OMF injuries are more prevalent in rural areas and increasing in incidence. Those in inner and outer regional areas sustained injuries 1.8-2.2 times more than the metropolitan population and the incidence was 8.7-11.7 times higher in remote and very remote locations (p<0.05). Approximately 70% of injuries occurred among males in all populations, with peak age of injuries noted as 15-24 years. Assault-related injuries were the predominant cause of injury, notably more common in regional (35.6%) and remote (45.7%) areas compared to metropolitan regions (19.8%) (p<0.05).

Conclusion: The high proportion of OMF injuries experienced in rural areas signifies a considerable health concern. This may be attributable to engagement in risk-taking behaviours, contributing as aetiology or exacerbators. These findings underscore the need for targeted interventions aimed at addressing the mental health and risky behaviour patterns in rural communities. Further research should consider wider aetiological and exacerbating factors including social determinants of health, ethnicity and cultural factors that underlie interpersonal violence in these communities.

Introduction: Attracting and retaining physicians in rural and medically underserved areas is a global challenge. In France, undergraduate medical students must do their professional training in the region where they attend school. Many students from rural underserved areas register at distant schools, thereby precluding training in their region of origin. We hypothesised that the relocation of potential future physicians to regions outside the rural and underserved Centre-Val de Loire (CVDL) region exacerbates the lack of physicians in that region.

Methods: This mixed-methods study with simultaneous quantitative and qualitative analyses focused on medical students from the rural county of Indre (in CVDL). The quantitative analysis assessed the number of Indre students at three medical faculties (one in CVDL, and two in a nearby region) during the academic years 2014-2017, and compared their passing rates with those of their peers. The qualitative analysis investigated factors that may hinder or facilitate choice of faculty, using in-person and telephone student interviews from academic year 2017-2018.

Results: From academic years 2014-2017, 296 students from Indre registered for the first-year examination, with significantly fewer enrolled at the medical faculty of Tours (in CVDL) than at the other two faculties combined (2.0% v 6.8%; p<0.01). First-year pass rates for all faculties combined were similar for Indre students compared to all students (15.5% v 16.1%; p=0.84). Most of the 22 students interviewed knew that they would have to relocate for school. Key determining factors in their choice of faculty included a nearby support network of family and friends, prior impressions of the city, and school reputation as shared with them by others.

Conclusion: Students from the rural county of Indre were as successful as their peers in their first year of medical school, yet were convinced of the opposite. For the confidence to apply and the community assistance to succeed, students need both reliable information, preferably from undergraduates to whom they feel close, and logistical and moral support. Medical schools can work to build community, in order to attract students and help them succeed in their studies.

Introduction: Rural Longitudinal Integrated Clerkships (LICs) have been shown to produce graduate doctors who are more likely to work rurally than those from other clinical training pathways. The student selection and admission process to rural LICs is a relatively unexplored area. To address this knowledge gap, rural LIC graduates' perceptions on participating in the program and the medical students most suited to an LIC were explored. Enhanced understanding of selection and admission processes could provide procedures to optimise student success and wellbeing in rural training environments. Additionally, it could ensure student selection aligns with the program goal and help build targeted strategies to select and train medical students for rural practice.

Methods: An exploratory qualitative study was undertaken. Participants were graduates of the Doctor of Medicine at Deakin University, Australia, who participated in the rural LIC and graduated between 2011 and 2020. Semi-structured qualitative interviews were undertaken, and reflexive thematic analysis was employed.

Results: A sample of 39 graduates participated. Two main themes were identified: selecting and selection. The 'why' (selecting) referred to perceptions on clinical school preferencing decisions, with associated subthemes of being at the centre, aspiration, size matters and being disrupted. The 'who' (selection) referred to the type of student most suited to thrive in the clerkship, with associated subthemes of adaptive learner, relationship builders, harnessing life experiences and familiarity with rurality.

Conclusion: The linking of the 'why' and 'who' has the capacity to ensure that the most suitable students are selecting and selected to undertake a rural LIC. This has benefits for students' personal learning, but also for medical schools with an interest in building effective training models that integrate selection policies with intended outcomes of the program, which often include to graduate doctors who work rurally.

Introduction: Limited data exist on allergic rhinitis and asthma control in rural primary care. Therefore, the aim of our study was to assess asthma and comorbid allergic rhinitis control in patients attending primary care in both urban and rural settings in Greece. Additionally, we aimed to identify potential factors associated with the control of asthma and comorbid allergic rhinitis.

Methods: In this cross-sectional study, patients with asthma and comorbid allergic rhinitis completed questionnaires assessing demographic, co-morbidities and treatment status. Symptom control was evaluated by the Asthma Control Test (ACT), Asthma Control Questionnaire (ACQ) and Control of Allergic Rhinitis/Asthma Test (CARAT). Multivariate logistic regression analysis was applied to identify associated factors of asthma and comorbid allergic rhinitis control after adjusting for age, gender, smoking status and comorbidities.

Results: Out of 121 subjects with asthma and comorbid allergic rhinitis 75 (62%) resided in rural areas. A significant percentage of participants reported suboptimal asthma control using the ACT (54%) and ACQ (67%). Moreover, 88% of participants had not-well-controlled asthma and comorbid allergic rhinitis based on CARAT. Females (odds ratio (OR)=4.1, 95% confidence interval (CI) 0.8-19.9, p=0.043) and patients living in rural areas (OR=3.8, 95%CI 1.34-10.5, p=0.010) were more likely to report well-controlled asthma and allergic rhinitis based on CARAT score (>24). Patients reporting intranasal steroid use (OR=3.6, 95%CI 1.1-121, p=0.035) were more likely to have well-controlled asthma based on ACT score. Analysis also indicated a trend towards significance for the association between short-acting beta-agonist use and not-well-controlled asthma based on the ACT (score≤19) (OR=5, 95%CI 0.9-10, p=0.066) and partially and not-well-controlled asthma based on the ACQ (score>0.75) (OR=5, 95%CI 0.9-10, p=0.066).

Conclusion: Our results suggest that asthma and allergic rhinitis control remain suboptimal in a large proportion of patients in primary care. Area of residence, female gender and medications emerged as significant associated factors that must be taken into account in order to effectively improve asthma and comorbid allergic rhinitis outcomes.

Introduction: Agriculture is Indonesia's largest sector and largest employer, with 10.5% (40.9 million) of the population working in agriculture, forestry or fishing. However, little is known about agricultural workers' health status; risk factors for non-communicable diseases such as heart disease, stroke, cancer, respiratory diseases, diabetes; and wellbeing. This study aimed to undertake a pilot to assess health status, behavioural risk factors, wellbeing and safety among farmers in Indonesia.

Methods: Data were collected from 51 participants in a small rural area of East Java, Indonesia. Trained medical students, supervised by doctors, conducted assessments including anthropometric measurements, overall health status, lifestyle factors and wellbeing using the translated Kessler Psychological Distress Scale (K10). Data analyses were performed using SPSS statistical software and presented descriptively.

Results: The mean age of farmers was 39.5 years with the majority having normal BMI (64.7%). Most farmers reported good health status (62.7%), good hearing (98%), and good vision (88.2%). Overall health is not interfered with their farm activities (76.5%). A total of 76% were active smokers, and 96.1% had low diabetes risk based on the Finnish Diabetes Risk Score - Bahasa Indonesia as well as low psychological distress (76.5%) using the K10-Indonesian adapted scale. All participants used agrichemicals and use of appropriate personal protective equipment was lacking.

Conclusion: Farmers in this pilot study generally reported good health status, although smoking and use of and exposure to agricultural chemicals were highly prevalent. Although a pilot study, the findings highlight the need for further studies on the health, wellbeing and safety of farmers to engage the agricultural community and foster collaboration between local health services, farmers' groups and students.

Introduction: Deterioration of chronic conditions and serious acute illnesses are major factors preventing older individuals from remaining within their local communities, which may be significant burdens for islanders. The specific reasons and risk factors associated with non-returned off-island referrals remain insufficiently investigated. This study aims to describe cases of non-return after off-island referrals and to examine the relationship between polypharmacy and non-returned off-island referral among older residents regularly attending remote island clinics.

Methods: We conducted a retrospective cohort study across 14 solo-practice outpatient clinics on the remote islands of Okinawa Prefecture, Japan. The study participants were island residents aged 65 years or older who were regularly visiting clinics between 1 April 2015 and 31 March 2020. Exposure was defined as polypharmacy, specified as the use of five or more chronic medications at baseline. The outcome was defined as non-returned off-island referrals, encompassing emergent transfer or scheduled referrals from island clinics to off-island core institutions or specialists, which resulted in relocation outside the islands or death off-island, as confirmed by medical records or referral letter responses. The analysis for the association between polypharmacy and non-returned off-island referral was adjusted for age, sex, activities of daily living, dementia, multimorbidity, and the presence of specific medical conditions, including coronary artery disease, stroke and malignancy at baseline.

Results: A total of 1566 patients regularly visiting clinics were included in the analysis. At baseline, 41.9% of all participants classified as having polypharmacy. During a median follow-up of 5 years, 181 of 1566 (11.6%) participants resulted in non-returned off-island referrals. The most frequent health events resulting in them were bone fracture, pneumonia/bronchitis and acute heart failure. Among the 656 polypharmacy participants, 112 experienced non-returned off-island referrals with an adjusted odds ratio of 1.98 (95% confidence interval: 1.38-2.85).

Conclusion: A significant association was observed between polypharmacy and non-returned off-island referrals on the remote islands of Okinawa Prefecture, Japan. Older island residents with polypharmacy are at a higher risk of non-returned off-island referrals than those with non-polypharmacy, and physicians managing these patients in remote primary care settings should be aware of this risk. This awareness may promote physician responses to other modifiable risk factors and potentially mitigate the consequences.

Introduction: Ensuring access to health services, including maternity services, is challenging for island regions. Local governments in Indonesia are trying to minimize this situation by providing maternity waiting homes. This study aimed to examine the utilization of maternity waiting homes and its effect on institutional delivery in Indonesia's island areas.

Methods: The secondary analysis used the 2023 Indonesian Health Survey data in the Maluku Province, one of Indonesia's island areas. It included 1372 participants who gave birth within the previous 5 years. We looked at nine control variables and factors related to institutional delivery and maternity waiting homes: type of residence, age, marital status, education, work, wealth, insurance, antenatal care, and parity (number of previous births). In the last part of the study, binary logistic regression was used Results: The results showed that only 6.8% of women in Indonesia's Maluku Province used maternity waiting homes; 46.1% gave birth in an institution. Women who utilize maternity waiting homes were 2.756 times more likely than those who didn't to deliver in an institutional setting (adjusted odds ratio 2.756; 95% confidence interval 2.625-2.894). Moreover, the study found seven control factors were related to institutional delivery: type of residence, age group, education level, employment status, wealth status, health insurance ownership, and parity.

Conclusion: The study concluded that maternity waiting home utilization was related to institutional delivery in Indonesia's Maluku Province. The utilization of maternity waiting homes could increase the possibility of institutional delivery.

Introduction: Self-esteem plays a crucial role in adolescent development, influencing psychological wellbeing, academic performance, and social interactions. However, there is limited research examining self-esteem differences between urban and rural adolescents in Nigeria. This study investigates the self-esteem levels of secondary school students in urban and rural settings in Oyo State, Nigeria, and identifies key predictors of low self-esteem.

Methods: A cross-sectional comparative study was conducted among 1638 secondary school adolescents (1181 urban; 457 rural). Participants were recruited from randomly selected schools in Ibadan (urban) and Igbo-Ora (rural). Self-esteem was assessed using the Rosenberg Self-Esteem Scale, which was analyzed as both a continuous and categorical variable. Hierarchical linear modelling and logistic regression were used to account for clustering effects and identify factors associated with low self-esteem.

Results: Urban adolescents had significantly higher self-esteem scores than their rural counterparts (mean 14.2 v 12.1, p<0.001). The prevalence of low self-esteem was higher among rural adolescents (11.2% males, 8.2% females) compared to urban adolescents (7.8% males, 4.7% females). In the urban setting, attending a public school (odds ratio (OR)=2.24, 95% confidence interval (CI): 1.52-3.31) and identifying as Muslim (OR=2.10, 95%CI: 1.41-3.12) were significant predictors of low self-esteem. No single predictor was statistically significant for rural adolescents, suggesting self-esteem variability may be influenced by multiple interacting factors.

Conclusion: This study highlights significant disparities in self-esteem levels between urban and rural adolescents, emphasizing the role of educational and sociocultural factors. Findings underscore the need for targeted interventions to enhance self-esteem, particularly among rural adolescents and public school students. Gender-sensitive strategies and improved access to psychological support services should be integrated into adolescent development programs.