Rural and remote health最新文献

Introduction: Community water fluoridation (CWF) is a cost-effective intervention to reduce dental caries at population level. This Australian study used a difference-in-difference (DiD) analysis to measure dental caries in children exposed to CWF in the Northern Territory (NT), Australia.

Methods: Oral health data obtained from the NT Department of Health contained 64 399 person-year observations from 2008 to 2020, totalling 24 546 children aged 1-17 years. Drinking water quality data for fluoride levels, held by the Power and Water Corporation, were obtained for 50 remote communities and linked to the oral health dataset. The DiD analysis used a treatment group and two control groups to compare the effects of CWF on dental caries outcomes in children, measured using the decayed, missing and filled teeth (dmft/DMFT) index. The treatment group consisted of records from children residing in five remote NT communities that implemented CWF in 2014.The control 1 group included records of children residing in communities with naturally occurring fluoride in drinking water supplies at levels at or above the Department of Health policy threshold of 0.5 mg/L. The control 2 group included records of children residing in communities with naturally occurring fluoride in drinking water supplies below the level recommended by the Department of Health policy (<0.5 mg/L). The data were grouped into time periods prior to the inception of CWF in five remote communities in 2014 (pre-intervention) and after 2014 (post-intervention).

Results: Our results demonstrated that dental caries was significantly decreased for children in the treatment group following the implementation of CWF at a greater magnitude than both control groups for the same time period. Overall, children assigned to the treatment group exhibited a decline in the number of teeth affected by caries by an average of 0.28 (p=0.001). Notably, children of ages 7-10 years and 11-17 years experienced significantly greater post-intervention declines in average dmft/DMFT, by 0.32 (p=0.051) and 0.40 (p=0.012) fewer affected teeth respectively.

Conclusion: While dental caries disproportionately impacts Aboriginal children in remote and very remote NT, it is clear that CWF produces population-level reductions in overall dental caries for these populations. Additionally, our study demonstrates the application of the DiD method in a public health policy evaluation. Our findings suggest that the longstanding policy position of the NT Department of Health on CWF has supported improvements in oral health among child populations that experience high levels of dental caries in remote NT communities.

Introduction: Patient perception of quality of care is an essential component in evaluating healthcare delivery. This article reports data from primary health care (PHC) centers before Greece's most recent PHC reform. The study was undertaken to offer some baseline information about patient experience, support the decision-making processes taking place, and provide valuable input for future policy-making comparisons in Greece.

Methods: The research was conducted across the 16 PHC centers of Epirus, a region of north-western Greece, from June to September 2017, with 532 patients rating the importance of different aspects of three main healthcare domains (clinical behavior, support and services, and organization of care) of PHC provision. The Greek version of the European Task Force on Patient Evaluations of General Practice (EUROPEP) questionnaire was implemented for research purposes. Univariate comparisons were performed for patients with and without chronic disease, using Pearson's χ2 test for categorical data.

Results: Study findings support that the organization of care domain is of highest importance and priority, with clinical behavior and support and services following closely. Among recruited patients, on average, only 2.1% of patients with a chronic disease were satisfied (rated 4 or 5 on the Likert scale) with the organization of care aspects under consideration, compared to 18.4% of patients without a chronic disease. Furthermore, only 4% of patients with a chronic disease were satisfied with the aspects examined in the clinical behavior domain, compared to 27% of patients without a chronic disease. Finally, 18% of sampled patients with a chronic disease reported being satisfied with the quality of support and services provided, compared to 38% of patients without a chronic disease.

Conclusion: It is necessary to back up available past information to afterwards estimate reform imprinting on expectations and perceptions. The items and aspects of EUROPEP, in line with the new tasks of the personal doctor within the PHC system that patients perceive as most essential, can be used to prioritize quality improvement activities to strengthen PHC delivery in Greece. Communication skills, practices, and behavioral change skills seem to need more attention for an efficient PHC model.

Introduction: Nurses play a vital role in the provision of health care in rural, remote and isolated locations. Consequently, the current global nursing workforce shortage has significant and far-ranging implications for these communities where there are enduring issues with workforce maldistribution and shortage, instability, high staff turnover and health disparities. This article provides an analysis of existing literature on what rural, remote and isolated practising nurses view as important for the attraction and retention of this workforce in the Australian context.

Methods: A structured scoping review informed by Arksey and O'Malley's framework for conducting scoping studies was undertaken. Six electronic databases were searched in August 2022. Cosgrave's person-centred retention improvement framework (which includes attraction) for addressing health workforce challenges in rural contexts was used to guide the synthesis and interpretation of information from the included studies. Key themes were identified inductively, conceptualised within Cosgrave's framework and mapped to the overarching lifecycle stages of attraction, retention and resignation, also referred to as turnover or decision to leave.

Results: Twelve articles met the inclusion criteria for this review. Six themes related to attraction, retention and resignation were identified: (1) demanding role and scope of practice; (2) values divergence and professional opportunities; (3) continuing professional development and mentoring; (4) social, lifestyle and personal or family; (5) management and organisation; and (6) pay and incentives. The issues articulated within each of these themes overlapped, highlighting the complexities involved.

Conclusion: Limited empirical research that combines a person-centred and whole-of-lifecycle approach to understanding the rural and remote nursing workforce was found. However, our analysis of existing evidence suggests that such approaches are required to appropriately plan for and target solutions that centre nurses' specific needs and experiences for the future nursing workforce. Relatedly, limited translational research on the nursing workforce that explicitly includes and engages with nurses was found. Such research is fundamentally needed to improve retention outcomes.

Introduction: Iodine is an essential mineral for fetal growth and brain development. The aim of this research was to evaluate goiter, iodine deficiency and intrauterine growth restriction in pregnant women of minority ethnic groups in Colombia.

Methods: A cross-sectional study was performed in six non-metropolitan areas of Colombia.

Results: A total of 318 Indigenous and Afro-descendant pregnant women were invited to participate: 248 (83.2%) Indigenous and 50 (16.8%) Afro-descendants were studied. The mean age was 24 years (range 13-44 years). Of the women, 130 (43.5%) were from the department of Cauca, 72 (24.1%) were from Córdoba, 28 (9.4%) were from Guajira, 26 (8.8%) were from Sierra Nevada de Santa Marta, 22 (7.4%) were from Amazonas, 16 (5.4%) were from Meta and 4 (1.3%) were from the department of Cesar. A total of 244 (81.8%) were illiterate and 291 (97.7%) were of very low socioeconomic level. Goiter was observed in 69 (23.3%) pregnant women (38 (41.7%) from the department of Cauca, 10 (35.7%) from Guajira, 5 (31.2%) from Meta, 6 (27.2%) from Amazonas and 10 (13.8%) from Córdoba). Iodine deficiency (<100 µg/L) was observed in 42 (14.9%) pregnant women (16 (11.6%) mild (50-99 µg/L), 19 (13.8%) moderate (20-49 µg/L) and 7 (5.1%) severe (<20 µg/L)). Being literate was a protective factor for iodine deficiency (odds ratio (OR)=0.19, 95% confidence interval (CI) 0.04-0.84, p=0.016). Being illiterate and iodine deficient was only a risk factor for goiter (OR=6.72, 95%CI 3.9-9.5, p=0.038) in the department of Cauca.

Conclusion: A high prevalence of goiter, iodine deficiency and intrauterine growth restriction was observed in minority ethnic groups of Colombia. The highest prevalence and risk was observed in the department of Cauca.

Introduction: Geese harvesting is a longstanding cultural tradition deeply ingrained among the Omushkego Cree in Fort Albany First Nation, embodying a holistic approach to health that integrates Indigenous knowledge, community wellbeing, and resilience. Despite historical disruptions stemming from colonization and assimilation policies, women have played a pivotal role in preserving and passing down traditional practices. The significance of goose harvesting extends beyond providing a nutrient-rich and cost-effective food source; it serves as a vehicle for cultural preservation and education, particularly fostering language acquisition among children. Nevertheless, concerns persist regarding the potential decline in the transmission of Indigenous knowledge. The interruption of intergenerational knowledge transfer not only poses implications for overall wellbeing but also worsens historical trauma within the community. In response to these challenges, the Niska (goose) harvesting program was developed with an aim to revitalize community harvesting practices, with a specific focus on incorporating the perspectives of women, especially in the preparatory and smoking phases of the geese.

Methods: Omushkego Cree women were approached to participate. The study was conducted during the spring of 2018, and employed photovoice and semi-structured interviews that explored the impact of geese preparatory activities on the health and wellbeing of Indigenous women.

Results: Major themes from the qualitative data included the importance of knowledge sharing, cultural continuity, healing, and the profound connection to the land. Women emphasized the value of sharing acquired knowledge, passing on traditions, and maintaining a connection to their cultural identity. Cultural continuity, depicted through intergenerational teachings and experiences, emerged as crucial for overall wellbeing. Participants spoke of the healing dynamics derived from engaging in traditional activities, highlighting the positive impact on physical, mental, emotional, and spiritual wellbeing. The land was identified as a central element in this healing process, representing more than just a physical space but an extension of home, contributing to a sense of peace and tranquility. The land became a medium for transmitting cultural teachings, shaping identity, and sustaining a subsistence lifestyle.

Conclusion: The study emphasizes the importance of future research including more female youth participants to uncover specific challenges and strengths within this demographic. Overall, the Niska program demonstrates a comprehensive approach that intertwines cultural revitalization, community engagement, and holistic wellbeing, emphasizing the need for interventions that go beyond immediate challenges to create enduring positive impacts on Indigenous communities.

Introduction: There are few studies on probable sarcopenia in rural areas. This study aims to assess prevalence of probable sarcopenia and its associated factors in older adults living in the rural area of a municipality in southern Brazil.

Methods: This cross-sectional study assessed data from the second wave of the EpiRural Cohort Study. Structured questionnaires, handgrip strength, gait speed, and anthropometric measurements were collected from 651 older adults. The criteria from the European Working Group on Sarcopenia in Older People 2 were used in this study. Chi-square test and logistic regression with robust variance were performed.

Results: Prevalence of probable sarcopenia was 19.2% (95% confidence interval (CI): 16.3-25.2%). Male sex (prevalence ratio (PR) 1.61; 95%CI 1.17-2.21), age ≥80 years (PR 4.15; 95%CI 2.65-6.50), underweight (PR 1.90; 95%CI 1.23-2.93), diabetes mellitus (PR 1.80; 95%CI 1.20-2.73), and hospitalization in the past year (PR 2.00; 95%CI 1.36-2.91) were significantly associated with probable sarcopenia.

Conclusion: One in five rural older adults have probable sarcopenia. Older adults living in rural areas need frequent measurements of muscle strength, and greater investments should be made to minimize the physical disability caused by sarcopenia among this population.

Introduction: The aim of the study was to explore, in one remote hospital, emergency department healthcare providers' experience and perceptions of the factors surrounding a patient's decision to discharge against medical advice (DAMA). The secondary objective was to gain insight into staff experiences of the current protocols for managing DAMA cases and explore their recommendations for reducing DAMA incidence.

Methods: This was a cross-sectional study involving a survey and semi-structured interviews exploring healthcare providers' (n=19) perceptions of factors perceived to be influencing DAMA, current practice for managing DAMA and recommendations for practice improvements. Health professionals (doctors, nurses, Aboriginal Health Workers) all worked in the emergency department of a remote community hospital, Queensland, Australia. Responses relating to influencing factors for DAMA were provided on a three-point rating scale from 'no influence/little influence' to 'very strong influence'. DAMA management protocol responses were a three-point rating scale from 'rarely/never' to 'always'. Semi-structured interviews were conducted after the survey and explored participants' perceptions in greater detail and current DAMA management protocol.

Results: Feedback from the total of 19 participants across the professions presented four prominent yet interconnected themes: patient, culture, health service and health provider, and health literacy and education-related factors. Factors that were perceived to have a strong influence on DAMA events included alcohol and drug abuse (100%), a lack of culturally sensitive healthcare services (94.7%), and family commitments or obligations (89.5%). Healthcare provider recommendations for preventing DAMA presented themes of right communication, culturally safe care (right place, right time) and the right staff to support DAMA prevention. The healthcare providers described the pivotal role the Indigenous Liaison Officer (ILO) plays and the importance of this position being filled.

Conclusion: DAMA is a multifaceted issue, influenced by both personal and hospital system-related factors. Participants agreed that the presence of ILO and/or Aboriginal Health Workers in the emergency department may reduce DAMA occurrences for Indigenous Australians who are disproportionately represented in DAMA rates, particularly in rural and remote regions of Australia.