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The experiences and perceptions of rural and remote nurses who provide care to pregnant women in the absence of midwives. 在没有助产士的情况下为孕妇提供护理服务的农村和偏远地区护士的经验和看法。
IF 2 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-06-01 Epub Date: 2024-06-21 DOI: 10.22605/RRH8721
Michelle McElroy, Kristin Wicking, Nichole Harvey, Karen Yates
<p><strong>Introduction: </strong>Maternity unit closures in rural and remote settings of Australia have left a substantial gap in services for pregnant women. In the absence of midwives, and when women are unable to attend a maternity facility, registered nurses (RNs) are required to fill the void. While maternity education can attempt to prepare RNs for such encounters, there is little documented to suggest it meets all their physical and psychological needs. The existing challenges for health professionals, practising a vast generalist scope of practice while living and working in a rural and remote location, have been well researched and documented. How nurses feel about the expectation that they work outside their scope of practice to provide maternity care in a rural and remote setting in Australia has not been asked until now. This study explores the perceptions and experiences of RNs who find themselves in this situation.</p><p><strong>Methods: </strong>The study utilised a hermeneutic phenomenological methodology to examine the experiences and perceptions of rural and remote nurses providing care for pregnant women. RNs working in rural and remote health facilities that had no maternity services were recruited by a purposive sampling method. Semistructured conversational interviews were recorded and transcribed verbatim. Data analysis was guided by van Manen's analytical approach.</p><p><strong>Results: </strong>Eight nurses participated, and from the data three themes, each with several subthemes, emerged: 'being-in-the-world of the rural and remote nurse' - described how participants viewed rural and remote nursing as an entity with unchangeable aspects that could not be considered in isolation; 'scope of practice - unprepared or underprepared' described how, despite their existing and extensive nursing skills, participants felt ill-equipped theoretically, practically and mentally to care for pregnant women; 'moral distress' - participants expanded their feelings of unpreparedness to include inadequacy, fear, and appropriateness of care delivery.</p><p><strong>Discussion: </strong>The realism of rural and remote nursing practice demonstrates that at some point in their career, rural and remote nurses will care for a labouring and/or pregnant woman at high risk for complications. Participants in this study appeared open and honest in their interviews, displaying pride at their extensive nursing skills and job satisfaction. However, they were unanimous in their discussions of what being a nurse and providing maternity care in a rural and remote setting meant to themselves and to pregnant women. They suggested care was fragmented and inadequate from a workforce that is inadequately prepared and stressed.</p><p><strong>Conclusion: </strong>This study has highlighted another concerning aspect of rural and remote midwifery care - the experiences and perceptions of eight nurses delivering care that has previously been overlooked. The united v
导言:澳大利亚农村和偏远地区产科机构的关闭给孕妇服务留下了巨大缺口。在没有助产士的情况下,当孕妇无法前往产科机构时,就需要注册护士来填补空缺。虽然产科教育可以帮助注册护士为这种情况做好准备,但很少有文献表明这种教育能满足她们所有的生理和心理需求。在农村和偏远地区生活和工作的医疗专业人员,既要从事广泛的全科工作,又要应对现有的挑战,这一点已经得到了充分的研究和记录。在澳大利亚的农村和偏远地区,人们期望护士在其执业范围之外工作,以提供孕产妇护理服务,护士们对此有何感受,直到现在还没有人问过她们。本研究探讨了处于这种情况下的注册护士的看法和经验:本研究采用诠释学现象学方法,探讨农村和偏远地区护士为孕妇提供护理的经验和看法。通过有目的的抽样方法,招募了在没有产科服务的农村和偏远地区医疗机构工作的护士。对半结构式对话访谈进行了录音和逐字记录。数据分析以 van Manen 分析法为指导:八名护士参加了访谈,从访谈数据中发现了三个主题,每个主题下又有几个次主题:农村和偏远地区护士的世界"--描述了参与者如何将农村和偏远地区护理视为一个实体,其不可改变的方面不能孤立地考虑;"实践范围--无准备或准备不足"--描述了尽管参与者已有丰富的护理技能,但他们如何感到在理论上、实践上和心理上都不具备为孕妇提供护理的能力;"道德困扰"--参与者将其无准备的感觉扩大到包括护理服务的不足、恐惧和适当性。讨论:农村和偏远地区护理实践的现实性表明,农村和偏远地区的护士在其职业生涯的某个阶段会护理面临并发症高风险的产妇和/或孕妇。本研究的参与者在访谈中开诚布公,对自己丰富的护理技能和工作满意度感到自豪。然而,她们在讨论作为一名护士以及在农村和偏远地区提供孕产妇护理对她们自己和孕妇的意义时,意见却很一致。她们认为,由于护理人员准备不足、压力过大,导致护理工作支离破碎、不尽如人意:本研究强调了农村和偏远地区助产护理的另一个令人担忧的方面--8 名护士在提供护理时的经验和看法,而这一点以前一直被忽视。在这项研究中,护士们的共同心声需要一个发言平台,也值得政府和助产政策推动者的认可和关注。这些护士以及接受她们护理的妇女应该得到更多。
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引用次数: 0
The link between pesticide exposure and suicide in agricultural workers: a systematic review. 农业工人接触杀虫剂与自杀之间的联系:系统综述。
IF 2 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-06-01 Epub Date: 2024-06-26 DOI: 10.22605/RRH8190
Moisés Barbosa Junior, Diego Alexis Ramos Huarachi, Antonio Carlos de Francisco

Introduction: The aim of this study was to conduct a systematic literature review to find the association between pesticide exposure and the incidence of suicide in agricultural workers, focusing on analyzing the profile of agricultural workers, the countries with the highest number of publications and, especially, the link between occupational exposure to pesticides, the degradation of mental health and suicide among agricultural workers.

Methods: A systematic literature review was conducted following the PRISMA protocol using Scopus, Web of Science, and PubMed databases, where 33 articles were screened to compose the final portfolio.

Results: There is a strong link between pesticide exposure and suicide in agricultural workers. Smoking, alcohol consumption, exposure time, and marital status influence the decision to die by suicide. Brazil and the US lead the ranking in publications, demonstrating that it is not a problem only for developing countries. Organophosphates are the main pesticides used, and they degrade an enzyme crucial for the nervous system, which can result in mental disorders and consequent suicide in agricultural workers.

Conclusion: There is a need for stricter norms for the commercialization and use of pesticides. There is also a need for providing training to agricultural workers on the application and storage of pesticides, and to communicate about the compounds and the consequences of pesticides to mental health.

引言:本研究旨在进行系统性文献综述,以发现农药暴露与农业工人自杀发生率之间的关联,重点分析农业工人的概况、发表论文数量最多的国家,尤其是农业工人职业暴露于农药、心理健康退化和自杀之间的关联:方法:按照 PRISMA 协议,使用 Scopus、Web of Science 和 PubMed 数据库进行了系统性文献综述,筛选出 33 篇文章,组成了最终的文献组合:结果:农业工人接触杀虫剂与自杀之间存在密切联系。吸烟、饮酒、接触时间和婚姻状况都会影响自杀的决定。巴西和美国的出版物数量位居前列,这表明农药问题并不只是发展中国家的问题。有机磷是主要的杀虫剂,它们会降解一种对神经系统至关重要的酶,从而导致农业工人精神失常,进而自杀:结论:有必要对农药的商业化和使用制定更严格的规范。结论:有必要对杀虫剂的商业化和使用制定更严格的规范,也有必要对农业工人进行杀虫剂施用 和储存方面的培训,并就杀虫剂的化合物和对精神健康的影响进行宣传。
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引用次数: 0
Rural generalist medicine: a developing approach to health care in rural and island Japan. 农村全科医学:日本农村和岛屿医疗保健的发展方向。
IF 2.1 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-06-01 Epub Date: 2024-06-04 DOI: 10.22605/RRH8641
Nicholas S Schubert, Takara Tsuzaki, Rebecca Evans, Tarun Sen Gupta, Sarah Larkins, Kristine M Battye
<p><strong>Introduction: </strong>Despite universal health coverage and high life expectancy, Japan faces challenges in health care that include providing care for the world's oldest population, increasing healthcare costs, physician maldistribution and an entrenched medical workforce and training system. Primary health care has typically been practised by specialists in other fields, and general medicine has only been certified as an accredited specialty since 2018. There are continued challenges to develop an awareness and acceptance of the primary health medical workforce in Japan. The impact of these challenges is highest in rural and island areas of Japan, with nearly 50% of rural and remote populations considered 'elderly'. Concurrently, these areas are experiencing physician shortages as medical graduates gravitate to urban areas and choose medical specialties more commonly practised in cities. This study aimed to understand the views on the role of rural generalist medicine (RGM) in contributing to solutions for rural and island health care in Japan.</p><p><strong>Methods: </strong>This was a descriptive qualitative study. Data were collected via semi-structured interviews with 16 participants, including Rural Generalist Program Japan (RGPJ) registrars and supervisors, the RGPJ director, government officials, rural health experts and academics. Interviews were of 35-50 minutes duration and conducted between May and July 2019. Some interviews were conducted in person at the WONCA Asia-Pacific Conference in Kyoto, some onsite in hospital settings and some were videoconferenced. Interviews were recorded and transcribed. All transcripts were analysed through an inductive thematic process based on the grouping of codes.</p><p><strong>Results: </strong>From the interview analysis, six main themes were identified: (1) key issues facing rural and island health in Japan; (2) participant background; (3) local demography and population; (4) identity, perception and role of RGM; (5) RGPJ experience; and (6) suggested reforms and recommendations.</p><p><strong>Discussion: </strong>The RGPJ was generally considered to be a positive step toward reshaping the medical workforce to address the geographic inequities in Japan. While improvements to the program were suggested by participants, it was also generally agreed that a more systematic, national approach to RGM was needed in Japan. Key findings from this study are relevant to this goal. This includes considering the drivers to participating in the RGPJ for future recruitment strategies and the need for an idiosyncratic Japanese model of RGM, with agreed advanced skills and supervision models. Also important are the issues raised by participants on the need to improve community acceptance and branding of rural generalist doctors to support primary care in rural and island areas.</p><p><strong>Conclusion: </strong>The RGPJ represents an effort to bolster the national rural medical workforce in Japan. Di
导言:尽管日本拥有全民医保和高预期寿命,但在医疗保健方面却面临着诸多挑战,包括为世界上最年长的人口提供医疗保健服务、医疗保健成本不断增加、医生分布不均以及根深蒂固的医疗队伍和培训体系。初级医疗保健通常由其他领域的专家开展,全科医学自 2018 年起才被认证为认可的专科。在日本,培养对初级卫生医疗队伍的认识和接受程度仍面临挑战。这些挑战对日本农村和岛屿地区的影响最大,近 50%的农村和偏远地区人口被视为 "老年人"。与此同时,由于医学毕业生倾向于选择城市中更常见的医学专业,这些地区正面临着医生短缺的问题。本研究旨在了解人们对农村全科医学(RGM)在解决日本农村和海岛医疗保健问题中的作用的看法:这是一项描述性定性研究。通过对 16 名参与者进行半结构化访谈收集数据,其中包括日本农村全科计划(RGPJ)注册人员和主管、RGPJ 主任、政府官员、农村医疗专家和学者。访谈时间为 35-50 分钟,在 2019 年 5 月至 7 月期间进行。有些访谈是在京都举行的 WONCA 亚太地区会议上当面进行的,有些是在医院现场进行的,还有一些是通过视频会议进行的。访谈进行了录音和誊写。所有记录誊本均通过基于代码分组的归纳式主题过程进行分析:通过访谈分析,确定了六大主题:(1) 日本农村和岛屿卫生面临的主要问题;(2) 参与者背景;(3) 当地人口和居民;(4) 农村保健管理的身份、认知和作用;(5) 农村保健项目的经验;(6) 提议的改革和建议:人们普遍认为,RGPJ 是重塑医疗队伍以解决日本地域不平等问题的一个积极步骤。与会者对该计划提出了改进建议,但也普遍认为日本需要一种更系统的、全国性的 RGM 方法。本研究的主要发现与这一目标相关。这包括考虑参与 RGPJ 的驱动因素,以制定未来的招聘战略,以及日本需要一种独特的 RGM 模式,并商定先进的技能和监督模式。同样重要的是,与会者提出了需要提高社区对乡村全科医生的接受度和品牌效应,以支持乡村和岛屿地区的初级医疗服务:RGPJ 代表了日本为加强全国农村医疗队伍所做的努力。本研究参与者的讨论表明,他们强烈支持继续研究、探索和推广适合日本国情的全国农村全科医生模式,并对其进行品牌宣传和推广,以建立社区对农村全科医生作用的支持。
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引用次数: 0
History repeats itself: consumption of a local traditional roast pork meat recipe leads to Salmonella ser. Give cases in Greece. 历史重演:食用当地传统烤猪肉导致沙门氏菌感染。希腊出现沙门氏菌感染病例。
IF 2 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-06-01 Epub Date: 2024-06-30 DOI: 10.22605/RRH8391
Georgia Mandilara, Anthi Chrysostomou, Michalis Polemis, Daiana Duro, Grigorios Karaj, Eleni Mathioudaki, Kleon Karadimas, Kyriaki Tryfinopoulou, Kassiani Mellou, Theologia Sideroglou

Introduction: An outbreak of gastroenteritis due to Salmonella Give, a very rarely identified serotype in human isolates in Greece, occurred in participants of a religious festival in a rural area of southern Greece, in September 2022. The objectives of this study were to describe the outbreak in terms of epidemiology, identify the vehicle of transmission of the foodborne pathogen and recommend prevention measures.

Methods: The outbreak was linked to the consumption of a local traditional recipe of roasted pork meat served by a street food vendor. In 2018, the same food item, served in a restaurant in the same region, was implicated in another S. Give outbreak.

Results: Outbreak investigations revealed that outbreak-associated isolates, of food and human origin, belonged to the same S. Give strain. Significant deficiencies regarding food safety practices were identified.

Conclusion: Technical knowledge about pathogen transmission paths is important in order for both food handlers and consumers to follow hygiene and sanitary measures, mainly in cases of mass gatherings, where large quantities of food are prepared, handled, cooked and served. Efficient official supervision, mainly during summer festivals, is required in order to avoid recurrence of foodborne infections by different combinations of pathogens/food commodities.

导言:2022 年 9 月,希腊南部农村地区的一个宗教节日的参与者中爆发了由给力沙门氏菌引起的肠胃炎疫情。本研究旨在从流行病学角度描述疫情,确定食源性病原体的传播途径,并提出预防措施建议:疫情与食用街头小贩提供的当地传统食谱烤猪肉有关。2018年,同一地区一家餐馆供应的同一种食品牵涉到另一起S. Give疫情:疫情调查显示,与疫情相关的食品和人源分离物属于同一S. Give菌株。结果:疫情调查显示,与疫情相关的食品和人类分离物属于同一种 S. Give 菌株:关于病原体传播途径的技术知识对于食品处理人员和消费者遵守卫生和健康措施非常重要,主要是在大规模聚会的情况下,因为在聚会中会准备、处理、烹饪和供应大量食品。主要在夏季节日期间,需要有效的官方监督,以避免再次发生由不同病原体/食品组合引起的食源性感染。
{"title":"History repeats itself: consumption of a local traditional roast pork meat recipe leads to Salmonella ser. Give cases in Greece.","authors":"Georgia Mandilara, Anthi Chrysostomou, Michalis Polemis, Daiana Duro, Grigorios Karaj, Eleni Mathioudaki, Kleon Karadimas, Kyriaki Tryfinopoulou, Kassiani Mellou, Theologia Sideroglou","doi":"10.22605/RRH8391","DOIUrl":"https://doi.org/10.22605/RRH8391","url":null,"abstract":"<p><strong>Introduction: </strong>An outbreak of gastroenteritis due to Salmonella Give, a very rarely identified serotype in human isolates in Greece, occurred in participants of a religious festival in a rural area of southern Greece, in September 2022. The objectives of this study were to describe the outbreak in terms of epidemiology, identify the vehicle of transmission of the foodborne pathogen and recommend prevention measures.</p><p><strong>Methods: </strong>The outbreak was linked to the consumption of a local traditional recipe of roasted pork meat served by a street food vendor. In 2018, the same food item, served in a restaurant in the same region, was implicated in another S. Give outbreak.</p><p><strong>Results: </strong>Outbreak investigations revealed that outbreak-associated isolates, of food and human origin, belonged to the same S. Give strain. Significant deficiencies regarding food safety practices were identified.</p><p><strong>Conclusion: </strong>Technical knowledge about pathogen transmission paths is important in order for both food handlers and consumers to follow hygiene and sanitary measures, mainly in cases of mass gatherings, where large quantities of food are prepared, handled, cooked and served. Efficient official supervision, mainly during summer festivals, is required in order to avoid recurrence of foodborne infections by different combinations of pathogens/food commodities.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"24 2","pages":"8391"},"PeriodicalIF":2.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Exploring arts-health ecologies in the very remote Barkly Region of Australia. 在澳大利亚非常偏远的巴克利地区探索艺术-健康生态。
IF 2.1 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-01 Epub Date: 2024-05-08 DOI: 10.22605/RRH7832
Naomi Sunderland, Brydie-Leigh Bartleet, Sarah Woodland, Sandy O'Sullivan, Kristy L Apps, Robin Gregory
<p><strong>Introduction: </strong>This article explores links between arts, health, and wellbeing for diverse First Nations and non-Indigenous peoples living in the very remote Barkly Region of the Northern Territory in Australia. The article stems from a major 3-year study of the Barkly arts sector conducted in partnership with Barkly Regional Arts and Regional Development Australia Northern Territory. Key findings relate to an arts-health ecology evident in the region, the interdependence between artists' own health and their arts activity, the value of arts spaces as places of safety and refuge, and the potential of the arts to promote cultural and intercultural healing and development. We discuss these findings in the context of relevant literature and make suggestions for future arts-health and wellbeing related research, policy and practice in rural and remote contexts.</p><p><strong>Methods: </strong>This study employed an ecological mixed-methods research design, including quantitative and qualitative survey and interview data collection as well as collaborative, data-driven thematic analysis. The ecological approach was used to map a variety of creative practices through a broad range of art forms. Commercial, amateur and subsidised art and creative practices were included in this study and represented the multicultural population of the Barkly Region (both First Nations and non-Indigenous peoples). Arts and creativity in the region were recognized as a complex ecology that saw individuals, businesses, organisations and government working in different ways to sustain culture and contribute to social and economic development.</p><p><strong>Results: </strong>Research participants from diverse cultural backgrounds recognised health and wellbeing benefits of arts and creative activity. Arts participation and engagement were reported to have intrinsic individual health and wellbeing effects such as mental health and mindfulness, emotional regulation, enjoyment, and relief of physical and emotional pain and stress alongside promoting spiritual connection to self, culture and community. The study indicates that the arts can also shape powerful determinants of health and wellbeing such as employment, poverty, racism, social inclusion, and natural and built environments. Barkly arts-health ecology featured extensive involvement from health and human service and arts organisations, which provided a strong foundation for inclusive, healing and holistic regional development.</p><p><strong>Conclusion: </strong>This study has outlined how arts and creative activity contribute to holistic regional development in the Barkly desert region, an area with a high percentage of First Nations peoples. Arts and creative activity were reported to have intrinsic health and wellbeing effects for individuals, which included mental health and mindfulness, emotional regulation, enjoyment, and relief of physical and emotional pain and stress as well as promoting spiri
导言:本文探讨了生活在澳大利亚北部边远地区巴克利的原住民和非原住民在艺术、健康和福祉之间的联系。文章源于与巴克利地区艺术和澳大利亚北领地地区发展部合作开展的一项为期 3 年的巴克利艺术部门大型研究。主要研究结果涉及该地区明显的艺术-健康生态、艺术家自身健康与艺术活动之间的相互依存关系、艺术空间作为安全和避难场所的价值,以及艺术促进文化和跨文化愈合与发展的潜力。我们结合相关文献对这些研究结果进行了讨论,并对未来在农村和偏远地区开展的艺术-健康和幸福相关研究、政策和实践提出了建议:本研究采用了生态学混合方法研究设计,包括定量和定性调查及访谈数据收集,以及合作式数据驱动主题分析。生态学方法被用于通过广泛的艺术形式来描绘各种创造性实践。商业、业余和受资助的艺术和创意实践都被纳入了这项研究,并代表了巴克利地区的多元文化人口(包括原住民和非原住民)。该地区的艺术和创造力被认为是一种复杂的生态,个人、企业、组织和政府以不同的方式努力维持文化并促进社会和经济发展:来自不同文化背景的研究参与者认识到艺术和创意活动对健康和幸福的益处。据报告,艺术的参与和投入对个人的健康和幸福有内在的影响,如心理健康和正念、情绪调节、享受、缓解身体和情绪上的痛苦和压力,同时促进与自我、文化和社区的精神联系。研究表明,艺术还能塑造健康和幸福的强大决定因素,如就业、贫困、种族主义、社会包容以及自然和建筑环境。巴克利艺术-健康生态的特点是健康和人类服务以及艺术组织的广泛参与,这为包容性、治疗性和整体性的区域发展奠定了坚实的基础:本研究概述了在原住民比例较高的巴克利沙漠地区,艺术和创意活动是如何促进地区整体发展的。据报告,艺术和创意活动对个人的健康和福祉具有内在的影响,其中包括心理健康和正念、情绪调节、享受、缓解身体和情感上的痛苦和压力,以及促进与自我、他人和环境的精神联系。艺术活动还被视为影响健康和福祉的强大决定因素,如就业、贫困、种族主义、社会包容以及自然和人造环境。
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引用次数: 0
Access to maternal health services for Indigenous women in low- and middle-income countries: an updated integrative review of the literature from 2018 to 2023. 低收入和中等收入国家土著妇女获得孕产妇保健服务的机会:2018 年至 2023 年最新文献综述。
IF 2.1 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-01 Epub Date: 2024-05-25 DOI: 10.22605/RRH8520
Julia Morgan, Genevieve M Breau
<p><strong>Introduction: </strong>Ninety-seven per cent of Indigenous Peoples live in low-and middle-income countries (LMICs). A previous systematic integrative review of articles published between 2000 and 2017 identified numerous barriers for Indigenous women in LMICs in accessing maternal healthcare services. It is timely given the aim of achieving Universal Health Coverage in six years' time, by 2030, to undertake another review. This article updates the previous review exploring the recent available literature on Indigenous women's access to maternal health services in LMICs identifying barriers to services.</p><p><strong>Methods: </strong>An integrative review of literature published between 2018 and 2023 was undertaken. This review followed a systematic process using Whittemore and Knafl's five-step framework for integrative reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 944 articles were identified from six databases: Academic Search Premier, MEDLINE, Psychology and Behavioral Sciences Collection, APA PsycInfo, CINAHL Plus with Full Text and APA PsycArticles (through EBSCOhost). The search was undertaken on 16 January 2023. After screening of the title/abstract and the full text using inclusion and exclusion criteria 26 articles were identified. Critical appraisal resulted in 24 articles being included in the review. Data were extracted using a matrix informed by Penchansky and Thomas's taxonomy, extended by Saurman, which focused on six dimensions of access to health care: affordability, accessibility, availability, accommodation, acceptability and awareness. Ten studies took place in Asia, 10 studies were from the Americas and four studies took place in the African region. Seventeen articles were qualitative, two were quantitative and five were mixed methods. The methods for the integrative review were prespecified in a protocol, registered at Open Science Framework.</p><p><strong>Results: </strong>Barriers identified included affordability; community awareness of services including poor communication between providers and women; the availability of services, with staff often missing from the facilities; poor quality services, which did not consider the cultural and spiritual needs of Indigenous Peoples; an overreliance on the biomedical model; a lack of facilities to enable appropriate maternal care; services that did not accommodate the everyday needs of women, including work and family responsibilities; lack of understanding of Indigenous cultures from health professionals; and evidence of obstetric violence and mistreatment of Indigenous women.</p><p><strong>Conclusion: </strong>Barriers to Indigenous women's access to maternal health services are underpinned by the social exclusion and marginalisation of Indigenous Peoples. Empowerment of Indigenous women and communities in LMICs is required as well as initiatives to challenge the stigmatisation and marginalisation tha
导言:97%的土著居民生活在中低收入国家(LMICs)。之前对 2000 年至 2017 年间发表的文章进行的系统性综合审查发现,中低收入国家的土著妇女在获得孕产妇医疗保健服务方面存在诸多障碍。鉴于在六年后的 2030 年之前实现全民医保的目标,再次进行综述是非常及时的。本文对之前的综述进行了更新,探讨了关于低收入国家土著妇女获得孕产妇保健服务的最新文献,确定了获得服务的障碍:方法:对 2018 年至 2023 年间发表的文献进行了综合回顾。该综述采用了Whittemore和Knafl的综合综述五步框架以及系统综述和Meta分析首选报告项目(PRISMA)指南,遵循了系统化流程。从六个数据库中共鉴定出 944 篇文章:从以下六个数据库中共检索到 944 篇文章:Academic Search Premier、MEDLINE、Psychology and Behavioral Sciences Collection、APA PsycInfo、CINAHL Plus with Full Text 和 APA PsycArticles(通过 EBSCOhost)。检索于 2023 年 1 月 16 日进行。使用纳入和排除标准对标题/摘要和全文进行筛选后,确定了 26 篇文章。经过严格评审,24 篇文章被纳入综述。数据提取采用的矩阵参考了经 Saurman 扩展的 Penchansky 和 Thomas 的分类法,该分类法侧重于获得医疗服务的六个方面:可负担性、可获得性、可利用性、便利性、可接受性和认知度。10 项研究发生在亚洲,10 项研究来自美洲,4 项研究发生在非洲地区。17 篇文章采用定性方法,2 篇采用定量方法,5 篇采用混合方法。综合综述的方法在一份协议中进行了预先规定,并在开放科学框架中进行了注册:结果:发现的障碍包括:负担能力;社区对服务的认识,包括服务提供者与妇女之间沟通不畅;服务的提供情况,设施中经常缺少工作人员;服务质量差,没有考虑到土著居民的文化和精神需求;过度依赖生物医学模式;缺乏能够提供适当孕产妇护理的设施;服务不能满足妇女的日常需求,包括工作和家庭责任;卫生专业人员缺乏对土著文化的了解;有证据表明土著妇女遭受产科暴力和虐待:结论:土著妇女在获得孕产妇保健服务方面遇到的障碍是土著人民被社会排斥和边缘化造成的。需要增强低收入和中等收入国家土著妇女和社区的能力,并采取主动行动挑战她们所面临的污名化和边缘化。必须让社区参与到支持土著人民政治和人权的设计和干预措施中来。本综述的局限性包括可能存在遗漏文章的情况,因为有时文章中并不清楚某一特定群体是否来自土著社区。仍需对产后获得服务的情况进行更多研究,并开展高质量的定量研究。此外,还缺乏对北非和撒哈拉以南非洲土著群体--尤其是狩猎采集群体--的研究,以及 COVID-19 对获得服务的影响的研究。
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引用次数: 0
Ability to pay and catastrophic health expenditure of urban and rural deceased households over the past decade (2009-2018). 过去十年(2009-2018 年)城市和农村死亡家庭的支付能力和灾难性医疗支出。
IF 2.1 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-01 Epub Date: 2024-05-21 DOI: 10.22605/RRH8566
Sun Mi Shin
<p><strong>Introduction: </strong>Examining the equity of health care and financial burden in households of deceased individuals in urban and rural areas is crucial for understanding the risks to both national and individual household finances. However, there is a lack of research on catastrophic health expenditure (CHE) in these households, specifically in urban and rural contexts. This study aims to identify the ability to pay and equity of CHE for both households of deceased individuals in urban and in rural areas.</p><p><strong>Methods: </strong>This study analysed data from the Korea Health Panel for 10 years (2009-2018) and targeted 869 deceased individuals and their households in the Republic of Korea (South Korea). Annual household income and living costs were adjusted based on equivalent household size, and the difference between these values represented the household's ability to pay. Out-of-pocket (OOP) expenditure included copayments and uninsured healthcare expenses for emergency room visits, inpatient care, outpatient treatments and prescription medications. CHE was defined as OOP expenditure reaching or exceeding 40% of the household's ability to pay. ANCOVA was performed to control for confounding variables, and the equity of CHE prevalence between urban and rural area was assessed using χ2 analysis.</p><p><strong>Results: </strong>Compared to urban households, the rural households of deceased individuals had, respectively, fewer members (2.7 v 2.4, p=0.03), a higher rate of presence of a spouse (63.8% v 70.7%, p=0.04) and a higher economic activity rate (12.7% v 20.5%, p=0.002). The mean number of comordities before death was 3.7 in both urban and rural areas, and there was no difference in the experience of using over-the-counter medicines for more than 3 months, emergency room, hospitalisation, and outpatient treatment. In addition, annual household OOP expenditures in urban and rural areas were US$3020.20 and US$2812.20, respectively, showing no statistical difference (p=0.341). This can be evaluated as a positive effect of various policies and practices aimed at alleviating urban-rural health equity. However, the financial characteristics of the household of the deceased in the year of death differed decisively between urban and rural areas. Compared to urban households, the annual income of rural households (US$15,673.80 v US$12,794.80, respectively, p≤0.002) and the annual ability to pay of rural households (US$14,734.10 v US$12,069.30, respectively, p=0.03) were lower. As a result, the prevalence of CHE was higher in rural areas than in urban areas (68.3% v 77.6%, p=0.003).</p><p><strong>Conclusion: </strong>The findings of this study highlight the higher risk of CHE in rural areas due to the lower income level and ability to pay of the household of the deceased. It is evident that addressing the issue of CHE requires broader social development and policy efforts rather than individual-level interventions focused solely
导言:研究城市和农村地区已故人员家庭的医疗保健公平性和经济负担对于了解国家和个人家庭财政所面临的风险至关重要。然而,目前缺乏对这些家庭灾难性医疗支出(CHE)的研究,特别是在城市和农村地区。本研究旨在确定城市和农村地区已故个人家庭的支付能力和灾难性医疗支出的公平性:本研究分析了韩国健康面板 10 年(2009-2018 年)的数据,对象是大韩民国(南韩)869 个已故个人及其家庭。家庭年收入和生活费用根据同等家庭规模进行调整,两者之间的差值代表家庭的支付能力。自付(OOP)支出包括急诊室就诊、住院治疗、门诊治疗和处方药的共付额和未投保的医疗费用。自付费用达到或超过家庭支付能力的 40% 即为 "CHE"。采用方差分析控制混杂变量,并使用χ2分析评估城市和农村地区CHE患病率的公平性:与城市家庭相比,农村死者家庭的成员人数较少(2.7 对 2.4,P=0.03),有配偶的比例较高(63.8% 对 70.7%,P=0.04),经济活动率较高(12.7% 对 20.5%,P=0.002)。城市和农村地区死亡前的平均并发症次数均为 3.7 次,使用非处方药超过 3 个月、急诊、住院和门诊治疗的经历没有差异。此外,城市和农村地区家庭每年的自费项目支出分别为 3020.20 美元和 2812.20 美元,无统计学差异(P=0.341)。这可以被评价为旨在缓解城乡卫生公平的各种政策和做法所产生的积极影响。然而,死者家庭在死亡当年的经济特征在城市和农村地区之间存在决定性差异。与城市家庭相比,农村家庭的年收入(分别为 15,673.80 美元对 12,794.80 美元,p≤0.002)和年支付能力(分别为 14,734.10 美元对 12,069.30 美元,p=0.03)较低。因此,农村地区的 CHE 患病率高于城市地区(68.3% 对 77.6%,P=0.003):这项研究的结果突出表明,由于死者家庭的收入水平和支付能力较低,农村地区发生 CHE 的风险较高。显然,要解决 CHE 问题,需要更广泛的社会发展和政策努力,而不是仅侧重于改善医疗途径和控制医疗费用的个人层面的干预措施。越来越多的证据表明,收入在农村健康结果中起着至关重要的作用。
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引用次数: 0
Recruitment and retention of rural allied health professionals: a scoping review. 农村专职医疗人员的招聘和留用:范围界定审查。
IF 2.1 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-01 Epub Date: 2024-05-30 DOI: 10.22605/RRH8374
McKenzie Peterson, Sarah Nielsen, Devon Olson

Introduction: The purpose of this study was to understand what literature exists to comprehend demographics and predicted trends of rural allied health professionals (AHPs), person factors of rural AHPs, and recruitment and retention of rural AHPs.

Methods: A scoping review was completed and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Articles were analyzed using three a priori categories of recruitment and retention, person factors, and demographics and trends.

Results: Eighty articles met inclusion criteria for the review. Most of the literature came from Australia. Most research studies were qualitative or descriptive. A priori coding of the articles revealed overlap of the a priori codes across articles; however, the majority of articles related to recruitment and retention followed by demographics and trends and person factors. Recruitment and retention articles focused on strategies prior to education, during education, and recruitment and retention, with the highest number of articles focused on retention. Overall, there were no specific best strategies. Demographic data most commonly gathered were age, practice location, profession, sex, gender, previous rural placement and number of years in practice. While person factors were not as commonly written about, psychosocial factors of rural AHPs were most commonly discussed, including desire to care for others, appreciation of feeling needed, connectedness to team and community and enjoyment of the rural lifestyle.

Conclusion: The evidence available provides an understanding of what research exists to understand recruitment and retention of AHPs from a recruitment and retention approach, person factor approach, and demographics and trends approach. Based on this scoping review, there is not a clear road map for predicting or maintaining AHPs in a rural workforce. Further research is needed to support increased recruitment and retention of AHPs in rural areas.

导言:本研究的目的是了解现有哪些文献可用于理解农村专职医疗人员(AHPs)的人口统计学和预测趋势、农村专职医疗人员的个人因素以及农村专职医疗人员的招聘和留用:方法:采用《系统综述和元分析首选报告项目》(Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews)完成并报告了范围综述。文章按照招聘与留任、人员因素、人口统计与趋势三个先验类别进行分析:有 80 篇文章符合审查的纳入标准。大部分文献来自澳大利亚。大多数研究都是定性或描述性的。对文章进行的先验编码显示,不同文章的先验编码存在重叠;不过,大多数文章都与招聘和留用有关,其次是人口统计和趋势以及个人因素。关于招聘和留用的文章主要集中在教育前的策略、教育过程中的策略以及招聘和留用方面,其中以留用方面的文章数量最多。总体而言,没有具体的最佳策略。最常收集的人口统计学数据是年龄、执业地点、职业、性别、性别、以前的农村工作经历和执业年限。虽然对个人因素的论述并不常见,但最常讨论的是农村助理护士的社会心理因素,包括关爱他人的愿望、对被需要感的感激、与团队和社区的联系以及对农村生活方式的喜爱:通过现有证据,我们可以从招聘和留用方法、个人因素方法以及人口统计和趋势方法等方面了解现有的研究对招聘和留用助理水文工程师的意义。根据此次范围界定审查,在预测或保留农村劳动力中的助理水文工程师方面没有明确的路线图。需要进一步开展研究,以支持农村地区增加招聘和留住助理水文工程师。
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引用次数: 0
Drivers of access to cardiovascular health care for rural Indigenous Peoples: a scoping review. 农村原住民获得心血管保健服务的驱动因素:范围界定审查。
IF 2 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-01 Epub Date: 2024-05-03 DOI: 10.22605/RRH8674
Tāria Tane, Vanessa Selak, Kyle Eggleton, Matire Harwood
<p><strong>Introduction: </strong>Māori (the Indigenous Peoples of Aotearoa New Zealand) are disproportionately represented in cardiovascular disease (CVD) prevalence, morbidity and mortality rates, and are less likely to receive evidence-based CVD health care. Rural Māori experience additional barriers to treatment access, poorer health outcomes and a greater burden of CVD risk factors compared to Non-Māori and Māori living in urban areas. Importantly, these inequities are similarly experienced by Indigenous Peoples in other nations impacted by colonisation. Given the scarcity of available literature, a systematic scoping review was conducted on literature exploring barriers and facilitators in accessing CVD health care for rural Māori and other Indigenous Peoples in nations impacted by colonisation.</p><p><strong>Methods: </strong>The review was underpinned by Kaupapa Māori Research methodology and was conducted utilising Arksey and O'Malley's (2005) methodological framework. A database search of MEDLINE (OVID), PubMed, Embase, SCOPUS, CINAHL Plus, Australia/New Zealand Reference Centre and NZResearch.org was used to explore empirical research literature. A grey literature search was also conducted. Literature based in any healthcare setting providing care to adults for CVD was included. Rural or remote Indigenous Peoples from New Zealand, Australia, Canada, and the US were included. Literature was included if it addressed cardiovascular conditions and reported barriers and facilitators to healthcare access in any care setting.</p><p><strong>Results: </strong>A total of 363 articles were identified from the database search. An additional 19 reports were identified in the grey literature search. Following screening, 16 articles were included from the database search and 5 articles from the grey literature search. The literature was summarised using the Te Tiriti o Waitangi (Treaty of Waitangi) Framework principles: tino rangatiratanga (self-determination), partnership, active protection, equity and options. Themes elucidated from the literature were described as key drivers of CVD healthcare access for rural Indigenous Peoples. Key driver themes included input from rural Indigenous Peoples on healthcare service design and delivery, adequate resourcing and support of indigenous and rural healthcare services, addressing systemic racism and historical trauma, providing culturally appropriate health care, rural Indigenous Peoples' access to family and wellbeing support, rural Indigenous Peoples' differential access to the wider social determinants of health, effective interservice linkages and communication, and equity-driven and congruent data systems.</p><p><strong>Conclusion: </strong>The findings are consistent with other literature exploring access to health care for rural Indigenous Peoples. This review offers a novel approach to summarising literature by situating the themes within the context of equity and right
导言:Māori(新西兰奥特亚罗瓦的土著居民)在心血管疾病(CVD)患病率、发病率和死亡率中的比例过高,而且不太可能获得循证的心血管疾病医疗保健服务。与生活在城市地区的非毛利人和毛利人相比,农村毛利人在获得治疗方面面临更多障碍,健康状况更差,心血管疾病风险因素的负担也更重。重要的是,受殖民化影响的其他国家的土著居民也同样经历着这些不平等。鉴于现有文献稀缺,我们对农村地区的 Māori 和其他受殖民化影响国家的原住民在获得心血管疾病医疗保健方面的障碍和促进因素的文献进行了系统性的范围界定综述:该研究以 Kaupapa Māori 研究方法为基础,采用 Arksey 和 O'Malley(2005 年)的方法框架进行。数据库搜索包括 MEDLINE (OVID)、PubMed、Embase、SCOPUS、CINAHL Plus、澳大利亚/新西兰参考资料中心和 NZResearch.org,以探索实证研究文献。此外,还进行了灰色文献检索。所有为成年人提供心血管疾病治疗的医疗机构中的文献均被包括在内。新西兰、澳大利亚、加拿大和美国的农村或偏远地区的原住民也包括在内。如果文献涉及心血管疾病,并报告了在任何医疗机构中获得医疗服务的障碍和促进因素,则也包括在内:通过数据库搜索,共发现了 363 篇文章。在灰色文献检索中还发现了另外 19 篇报告。经过筛选,16 篇文章被数据库检索收录,5 篇文章被灰色文献检索收录。文献总结采用了 Te Tiriti o Waitangi(《威坦哲条约》)框架原则:tino rangatiratanga(自决)、伙伴关系、积极保护、公平和选择。文献中阐明的主题被描述为农村原住民获得心血管疾病医疗保健的关键驱动因素。关键驱动因素主题包括:农村原住民对医疗保健服务设计和提供的投入、为土著和农村医疗保健服务提供充足的资源和支持、解决系统性种族主义和历史创伤问题、提供文化上适当的医疗保健、农村原住民获得家庭和福利支持、农村原住民获得更广泛的健康社会决定因素的机会不同、有效的服务间联系和沟通,以及公平驱动和一致的数据系统:结论:研究结果与其他探讨农村原住民获得医疗保健的文献一致。本综述提供了一种新颖的方法,通过将主题置于土著人民的公平和权利的背景下来总结文献。本综述还强调,有必要在新西兰奥特亚罗瓦(Aotearoa New Zealand)的背景下进一步开展该领域的研究。
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引用次数: 0
Virtual communities of practice for novice occupational therapists: a vehicle for learning, support and professional identity strengthening? 职业治疗师新手的虚拟实践社区:学习、支持和强化专业身份的工具?
IF 2.1 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-01 Epub Date: 2024-05-22 DOI: 10.22605/RRH8555
Kirsty van Stormbroek, Lisa O'Brien, Tania Rauch van der Merwe, Hellen Myezwa

Introduction: Healthcare practitioners delivering services in rural and underserved areas need timely access to appropriate knowledge to optimise the care they deliver. Novice generalist occupational therapists in South Africa experience this need as they respond to a high demand for hand therapy. Embedded within a study aimed at identifying their support and development needs, this article describes participants' experience of a virtual community of practice.

Methods: A qualitative case study design was employed. Nine occupational therapists participated in a virtual community of practice that met fortnightly for meetings and interacted on WhatsApp. Data were collected through photo elicitation, facilitated reflection, and case discussions. An online survey questionnaire was used to evaluate participants' experience of this virtual community. Thematic analysis was applied to the anonymous responses submitted by participants (n=7). A number of strategies were employed to ensure the trustworthiness of results including prolonged engagement, member checking, peer examination, reflexive reading and writing, triangulation, and a dense description of participants to enable readers to evaluate the transferability of results.

Results: Three themes were generated from analysis. The first theme, versatile support, describes participants' experience of being helped and supported, appreciating the immediacy of support, and being able to share resources. A vehicle for learning captures participants' experience of mutual learning, opportunity to reflect, to acquire knowledge and skills, and develop their clinical reasoning. Finally, the community of practice was grounding: learning opportunities were contextually relevant and participants were able to consolidate their professional values and identity. Participants raised the importance of using online platforms that were accessible, recommended a group size of 5-10 members, and proposed 60-90-minute meetings held weekly or fortnightly.

Conclusion: A virtual community of practice provided both support and professional development opportunities for therapists delivering hand therapy. Careful planning and implementation to upscale this intervention are recommended for rehabilitation personnel delivering care to underserved communities in South Africa. The logistics of virtual communities need to mitigate for connectivity difficulties, and online platforms should enable real-time support. Participant satisfaction and the evaluation of implementation outcomes should be considered in the design of virtual communities of practice.

导言:在农村和服务欠缺地区提供服务的医疗从业人员需要及时获取适当的知识,以优化他们提供的医疗服务。南非的全科职业治疗师新手在应对手部治疗的高需求时就遇到了这种需求。本文在一项旨在确定他们的支持和发展需求的研究中,描述了参与者在虚拟实践社区中的体验:方法:采用定性案例研究设计。九名职业治疗师参加了一个虚拟实践社区,他们每两周举行一次会议,并通过 WhatsApp 进行互动。通过照片诱导、协助反思和案例讨论收集数据。在线调查问卷用于评估参与者对该虚拟社区的体验。对参与者(7 人)提交的匿名回复进行了主题分析。为确保分析结果的可信度,研究人员采用了一系列策略,包括长期参与、成员核查、同行审查、反思性阅读和写作、三角测量以及对参与者的详细描述,以便读者评估分析结果的可转移性:分析产生了三个主题。第一个主题 "多功能支持 "描述了参与者获得帮助和支持的经历,赞赏支持的即时性,以及能够共享资源。学习的载体反映了参与者相互学习、反思、获取知识和技能以及发展临床推理能力的经历。最后,实践社区具有基础性:学习机会与背景相关,参与者能够巩固其专业价值观和身份。参与者提出了使用可访问的在线平台的重要性,建议小组人数为 5-10 人,并建议每周或每两周举行一次 60-90 分钟的会议:虚拟实践社区为手部治疗师提供了支持和专业发展机会。建议南非为服务不足社区提供护理服务的康复人员认真规划和实施这一干预措施。虚拟社区的后勤工作需要缓解连接困难,在线平台应能提供实时支持。在设计虚拟实践社区时,应考虑参与者的满意度和对实施结果的评估。
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Rural and remote health
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