Rural and remote health最新文献

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.

Introduction: Stroke is a leading cause of disability globally, significantly impacting patients' quality of life and self-efficacy. Research from various countries indicates that rural stroke patients face challenges such as reduced access to healthcare services and lower quality of life than their urban counterparts. The aim of the study was to examine how the residential location in Türkiye affects the quality of life and self-efficacy levels of stroke patients.

Methods: A cross-sectional study was carried out among stroke patients in Türkiye, examining the differences between individuals living in rural and urban areas. Information regarding population characteristics, use of healthcare services, and self-reported evaluations, including the stroke-specific quality-of-life scale (SSQoL) and stroke self-efficacy questionnaire (SSEQ), was collected.

Results: There was no difference in demographic and disease-related characteristics between the two groups. Patients from urban areas had notably fewer emergency department visits (p<0.001) as well as fewer appointments at physical medicine and rehabilitation clinics (p<0.001) and family practitioner clinics (p<0.001) in the previous year. Additionally, rural patients demonstrated lower SSEQ scores (p=0.036) and poorer SSQoL scores (p<0.001) than urban patients, while also having significantly greater access to rehabilitation services (p=0.027).

Conclusion: The results of this study show that people living in rural areas experience reduced quality of life and confidence in managing their stroke compared to those residing in urban areas. Rural individuals with strokes often depend more on family physicians, urgent care facilities, and rehabilitation services for medical support. To improve the wellbeing and outcomes of stroke patients in rural regions, it is essential to address the limited access to rehabilitation services, healthcare infrastructure, resources, and medical professionals through policy changes and innovative strategies such as telerehabilitation.

Introduction: Mental health in rural areas can be affected by a lack of available services, which highlights the need for alternative support. Social relationships are known to bolster mental health, yet discussions of mental health in rural areas may be hindered by concerns over stigma and anonymity. This study applies a novel social network design to identify characteristics of mental health discussion networks among rural residents in Scotland.

Methods: Data were collected on 505 social contacts of residents living in the Scottish Highlands. Study participants (n=20) completed a personal network interview, which captured information about their social relationships, including whether they would discuss their mental health with each individual. Multilevel models were used to parse characteristics of individuals (study participants and social contacts), aspects of relationships and social network structure associated with the discussion of mental health.

Results: The results show that 23% of social contacts were rated as someone with whom rural residents would speak about their mental health. Social contacts who were women (odds ratio (OR) 4.06, 95% confidence interval (CI) 1.77-9.32) and younger (OR 0.71, 95%CI 0.54-0.94) were more likely to be engaged for mental health discussion. Occupying a more central position in the network increased the likelihood that a social contact would be a mental health discussion partner (ie betweenness; OR 1.03, 95%CI 1.01-1.05), but other aspects of network structure were not associated. Longer relationships (OR 2.33, 95%CI 1.40-3.87) and more frequent interactions (OR 5.05, 95%CI 3.12-8.17) increased the likelihood of mental health discussion, while higher mental health stigma (OR 0.38, 95%CI 0.17-0.85) of study participants lowered the likelihood of mental health discussion.

Conclusion: Findings demonstrate that personal attributes, relational characteristics and network properties can all affect the likelihood of mental health discussions. The study uncovers multiple processes through which social networks can support rural residents, including the promotion of frequent contact, and mixed age/gender relationships, as well as reductions in mental health stigma.

Introduction: Complex challenges exist in the recruitment, retention and turnover of allied health professionals (AHPs) in rural and remote areas, which negatively impacts the provision of services. The aim of this review was to synthesise evidence from studies with a quantitative component to examine the length of employment of allied health professionals, and significant factors and costs associated with the recruitment, retention and turnover of the rural and remote allied health workforce.

Methods: Six databases were searched, along with grey literature, to identify studies using a quantitative approach or a mixed-methods approach with a quantitative component. The review focused on quantitative approaches due to the gap in the literature in relation to quantitative data on rural and remote AHP recruitment and retention. Included studies had to report on either recruitment, retention, turnover, length of employment or associated costs such as vacancy and recruitment costs of allied health professionals in rural or remote settings. Data for each study - including costs, employment duration and any factors affecting recruitment, retention and turnover - were extracted. The factors were identified directly from the articles and then assigned into two overarching categories of 'personal' and 'organisational'. The data were then further examined to identify if there were any significant relationships between the identified factors and recruitment, retention and turnover.

Results: Twenty-four articles were included in the review. A variety of methods were used to measure length of employment. Overall, findings indicated that length of employment for rural and remote allied health professionals was often short with survival rates dropping substantially after 2 years of employment. Only two studies measured costs, and both indicated a relatively high cost associated with workforce turnover. A range of personal and organisational factors were identified that significantly impacted the recruitment, retention and turnover of allied health professionals in rural and remote areas.

Conclusion: This review highlighted length of employment, personal and organisational factors influencing recruitment, retention and turnover and the associated costs. Having a rural background or undertaking a rural placement, being older, being integrated into the community, good working conditions and financial incentives positively impacted upon recruitment, retention and turnover. However, there was limited evidence available on costs, which indicates a need for more research to be undertaken in this area. A variety of methods were used to measure length of employment, recruitment, retention and turnover, and currently a standardised framework does not exist to collectively synthesise data. Therefore, future research should focus on developing and then using a rigorous framework to bett

Introduction: Carer roles in palliative care are complex and have many location-based issues, including for people in rural areas. Meaningful support for carers in rural areas needs to be informed by carers' actual experiences rather than relying on routine data collection. To embrace the complexity of carer experiences, we framed caregiving in palliative care as a journey that involves actions and needs to be navigated. We deliberately chose to use the verb 'navigate' as an action-based metaphor. Thus, we positioned ourselves to view carers' involvement in palliative care in rural areas as being non-linear, active and involving undetermined paths. Locating our research in the interpretive paradigm, we sought to develop a conceptual framework to inform reflections and discussions to provide meaningful support for carers involved in palliative care in rural areas.

Methods: Our qualitative research, undertaken in the interpretive paradigm, was informed by philosophical hermeneutics. Participants were carers who had previously cared for patients requiring palliative care. Local clinicians approached potential participants known to them, inviting them to participate if interested. Our sample size of eight reflects the outcome of a deliberate balance between the sensitivity of the topic, scope for deep engagement through semi-structured interviews, recruitment requiring established carer-clinician relationships, our location with low population density and workforce shortages, and considerations for research informed by philosophical hermeneutics. Interpretations were iterative, involving cyclical phases of analysis, moving between individual and collective engagement with data, participant quotes and whole transcripts (hermeneutic circle). Through ongoing returns to the data, we moved to conceptually higher understandings (question-and-answer dialogue) that were portrayed through three dimensions (fusion of horizons).

Results: The experiences of carers as they navigated palliative care were interpreted as three interrelated dimensions: 'realm of shifting sands', 'staying afloat' and 'doing for and with'. 'Realm of shifting sands' highlights the diversity and potential fragility of terrains carers are navigating: that is foundational sense of duty, constellations of relationships and inevitability of decline. 'Staying afloat' highlights the dynamic responses required to navigate these terrains, that is revisiting foundational sense of duty, engaging with constellations of relationships and responding to the inevitability of decline. Doing for and with highlights the multiple actions as carers hold their course and participate in palliative care, that is advocating, preparing and collaborating.

Conclusion: Complexities faced by caregivers can be framed in relation to individual reference points, personal capabilities, particular circumstances and locational factors

Introduction: A severe shortage and inequitable distribution of doctors between rural and urban populations leave the rural population in Papua New Guinea deprived of medical care. Our medical school adopted strategies proven in other countries to motivate medical students to undertake rural practice effectively. This study aims to explore medical students' perceptions of rural clinical placement in Papua New Guinea.

Methods: We adopted a mixed-methods parallel design. We included 41 students who undertook the rural clinical placement. For the data collection instruments, we employed the semi-structured questionnaire for the quantitative strand and focus group discussion for the qualitative strand.

Results: Most students reported positive experiences of rural placement evaluating highly rural supervisors. Among the benefits of rural placement are enhanced confidence and competence level in clinical skills, an opportunity to practise several procedures, hands-on diagnosing and managing patients, a wide variety of cases and taking more responsibility for patients' care. For the students with rural upbringings, rural placement influenced them to consider future work in rural areas. For the urban students, it increased their understanding of health issues in the rural population.

Conclusion: This study enhances our understanding of factors affecting medical students' opinions on rural clinical placement and how this experience will likely influence their future career choices. Further study is required to assess the association between rural placement and choosing a rural career path.