Rural and remote health最新文献

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.

Introduction: Rural Canadians have poorer health indices than their urban counterparts and struggle with worse access to care due to an undersupply of physicians. Research has identified personal factors, such as being raised in a rural environment, and traits, such as lower harm avoidance, among those drawn to rural practice. As well, the impact of aspects of medical training, such as rural rotations, have been recognized in creating rural practice intentions, but the role of specific clinical competencies here has yet to be determined. Emergency medicine is often one of the most challenging components of rural practice and thought by some to have its competencies poorly developed in family practice training. We hypothesized a model for rural practice affinity in which a strong sense of general self-efficacy would be independently mediated by the development of emergency medicine competence and rural practice self-efficacy, leading to stronger intentions to embark on a rural practice career.

Methods: This model was tested using the data from a survey of all family medicine residents nearing graduation from 14 of the 17 Canadian medical schools. Demographics and data on factors known to influence a rural career choice were collected and accounted for when determining the strength of the hypothesized relationships. Both existing and specifically designed survey tools were used to assess model components. A partial correlation matrix between the variables of interest (general self-efficacy, emergency medicine competency, rural practice self-efficacy, and rural practice intentions) - controlling for the effects of relationships, financial aspects, personal aspects, and social desirability - was created and subjected to a structural equation model.

Results: Our initial rural practice affinity model resulted in a poor fit of the model to the data. However, the addition of a pathway from emergency medicine competence to rural practice self-efficacy improved the model to one showing significant paths as hypothesized as well as excellent measures of fit.

Discussion: The importance of general self-efficacy is recognized and is itself mediated by the more specific rural practice self-efficacy to rural practice intentions, consistent with the literature. Emergency medicine competency has a central role in both mediating general self-efficacy to rural practice intentions, while also being mediated itself by rural practice self-efficacy to rural practice intentions. This provides new understanding in the development of rural practice self-efficacy. The link of emergency medicine competency to both rural practice self-efficacy and rural practice intentions suggests that this is a curricular area that deserves greater focus and consideration of how to ensure that residents are meeting emergency medicine requirements and receiving robust training in this area. This is especi

Context: Necrotising fasciitis is a rapidly progressing, life-threatening soft tissue infection that carries a high morbidity and mortality, especially in susceptible populations.

Issue: During the La Niña spring-summer-autumn of 2021-2022, five male patients aged between 59 and 86 were admitted into the Hervey Bay Hospital (Queensland, Australia) intensive care unit (ICU) with necrotising fasciitis and multi-organ failure. All five patients had been in saltwater rivers within the local Fraser Coast area and either hunting for Scylla serrata (commonly known as green mud crabs), or descaling barnacles from their vessels. Following rapid and extensive surgical intervention and aggressive antibiotic and supportive treatment, all five patients were either discharged home or are currently in rehabilitation.

Lessons learned: With a strong possibility of future floods due to climate change and the cyclic return of the La Niña in the future, this article highlights a potential public health issue. This case series demonstrates the importance of increased vigilance for necrotising fasciitis by frontline healthcare staff after flooding events. Identification and escalation of a potential public health warning about the need for vigilance by people experiencing even the smallest of injury by green mud crabs or barnacles post-flood event may need to be considered.