Rural and remote health最新文献

Introduction: The third objective of the UN Sustainable Development Goals (SDGs), 'ensure healthy lives and promote well-being for all at all ages', is manifest in Indonesia's commitment to health. One of the SDG3 targets is to reduce under-five mortality and infant mortality. In rural areas of Indonesia, there is a lack of access to medical facilities (healthcare services, anthropometry tools) and health workers, so low birth weight (LBW, <2500 g) in rural areas remains high. This study aimed to determine the profile of and test the factors that cause LBW in Indonesia.

Methods: This study used secondary data from the National Socio-Economic Survey/Survei Sosial Ekonomi Nasional (SUSENAS) 2021 with a national sample of 4 711 455 women (weighted), which is analyzed descriptively and inferentially. The analysis was conducted descriptively to determine the profile and distribution of LBW at the national and provincial levels, while inferential analysis was performed using logistic regression to determine the variables that most influence LBW.

Results: The prevalence of LBW in Indonesia was found to be 11.7%. North Maluku was the province with the highest LBW rate (20.1%), and West Java had the highest number of LBW infants in Indonesia, with 104 585 infants. This study found that smoking, rural areas, poor nutrition, age of childbirth, age and birth spacing significantly affected the incidence of LBW in Indonesia. In rural Indonesia, women tend to give birth to LBW babies (adjusted odds ratio: 1.249; 95%CI: 1.241-1.256). The incidence of LBW babies in rural areas was higher than in urban areas (12.9% v 10.8%) in Indonesia.

Conclusion: This study concluded that smoking behavior is the main variable that influences the incidence of LBW in Indonesia. Therefore, there should be assistance to families by prioritizing significant factors for LBW (living in a village/rural area, low education, smoking behavior, not or rarely consuming nutritious food, maternal age at first birth 35 years and birth spacing <33 months). Especially for rural areas, governments need to improve access to healthcare facilities including availability of anthropometry tools, health workers, and healthcare services.

Introduction: UN Sustainable Development Goal 3 and the nurturing care framework highlight the importance of healthcare services and preventive measures to ensure optimal health outcomes for children, including those with disabilities. However, the contributions of male caregivers in the general care of children with disabilities in Sub-Saharan African contexts are often overlooked. This article therefore aims to understand how male caregivers navigate and negotiate healthcare options for their children with disabilities in rural Kenya.

Methods: A qualitative approach was adopted, following the phenomenological tradition, to collect data from 22 male caregivers of children with neurodevelopmental disabilities in rural Kenya using four focus group discussions. The data were analyzed using inductive thematic analysis. The interpretation of the findings was guided by the theoretical approach of critical disability studies.

Results: The article contributes new knowledge to the understanding of the roles and experiences of male caregivers in the healthcare of children with disabilities in rural Sub-Saharan African contexts. Four emergent themes are presented: '... hospitals around cannot offer a solution to their problems ...', '... regarding finances, I have to struggle alone ...', '... the only place one can pity you is the traditional herbalist ...' and 'I pray to God to heal him'.

Conclusion: Faced with significant challenges in accessing conventional healthcare services, male caregivers employ the local cultural resources available to them to address the healthcare needs of their children with disabilities. This emphasizes the need to complement their efforts by mobilizing the healthcare system to offer quality, equitable, culturally sensitive and inclusive healthcare solutions.

Introduction: Factors influencing mortality in patients with COVID-19 treated in a community hospital in a rural region in south-eastern Poland during the first and the second wave of the pandemic were analyzed.

Methods: A retrospective observational study based on a hospital-based registry of Holy Spirit Specialist Hospital in Sandomierz was conducted. The study population consisted of patients treated between 1 March 2020 and 31 May 2021.

Results: We analyzed data of 24 057 Caucasian patients including 798 patients with COVID-19. During both waves of the COVID-19 pandemic 22.4% of patients hospitalized in the community hospital in Sandomierz died due to COVID-19. The multivariate logistic regression model showed that older age (p<0.001), fever (p<0.001), diagnosis of sepsis (p<0.001) and high levels of C-reactive protein (p=0.041) were factors related to mortality. In the group of patients in whom oxygen therapy (p<0.001) and invasive mechanical ventilation (p<0.001) were used more frequently, mortality was higher, whereas treatment with convalescent plasma increased the chance of survival (p<0.001).

Conclusion: Fever and high laboratory values of inflammation, in particular coexisting sepsis, worsened the prognosis in patients with COVID-19. Most traditional methods of treating the infection did not affect the course of the disease.

Introduction: As the numbers of, and interest for, decentralized medical curricula increase, the need for knowledge about enrolled students' experiences becomes increasingly urgent. Concerns have been raised that the learning environment may be impaired when educational programs are moved from urban to less central locations. Previous research investigating this issue has revealed discrepant findings, and no such studies have been conducted in Scandinavia.

Methods: In this cross-sectional study, the 50-item Dundee Ready Education Environment Measure (DREEM) was used to compare learning environment perceptions of students in a decentralized medical program in Norway to that of their urban peers. DREEM includes statements about different aspects of a learning environment. Three student cohorts were included, and students responded to the questionnaire during the final 2 months of year 4. The original English DREEM was translated to Norwegian as a part of the study. Independent t-test was used for comparison of DREEM overall scores and subscale scores.

Results: Both student groups perceived the learning environment as good, and the educational atmosphere was seen as particularly positive. The decentralized group obtained a significantly higher overall DREEM score, as well as significantly higher scores for all subscales. The largest intersite difference was found for students' perception of learning, while students' academic and social self-perceptions were subject to less score differences.

Conclusion: Despite concerns about suboptimal learning environment conditions in decentralized curricula, this study indicated the opposite. Plausible explanations include integration of students in a clinical community, development of continuous longitudinal relations between students and teachers, and the use of flipped classroom activities in small student groups. Considering the learning environment's importance for student learning and wellbeing, these findings are valuable in the further establishment and development of decentralized medical education.

Context: Promoting rural development can pose numerous policy and governance challenges. However, rural proofing offers a vital solution. It helps policymakers create strategies that cater to rural needs, which is particularly relevant to health care. It involves making policy decisions based on evidence on rural dynamics available in a timely fashion to enable changes and adjustments.

Issues: Governments should consider rural proofing health sector policies and strategies because making health policies rural-friendly encourages innovation and ensures access to services in rural and remote communities.

Lessons learned: Effective rural proofing mechanisms give policymakers the necessary information and data to assess how policies affect rural areas, allowing for timely adjustments early in the policy design phase. The key to this process is timing, evidence and flexibility - one size does not fit all. The rural proofing requires experimentation to find the best solutions and modalities that fit a country's context.

Introduction: This study aimed to explore type 2 diabetes mellitus patients' perspectives on diabetic foot complications and challenges of footcare management in Sigatoka, Fiji.

Methods: This study applied a qualitative approach among persons with diabetes who attended diabetic foot clinics from August to September 2021. Participants were selected through purposive sampling and included any self-identified Fijian aged 18 years and over who had type 2 diabetes with a minimum diagnosis duration of 6 months and no experience of an amputation. Data were collected using semi-structured in-depth interviews, and the content of interviews was transcribed and analysed using thematic analysis to generate themes and subthemes outlined in the study.

Results: The study included 30 participants. Three major themes were identified. The first was patient perceptions of diabetic foot complications, which showed that there was very limited patient knowledge of how diabetes caused foot complications. The second was practising foot care, which reflected that commonly practised recommendations were associated with daily activities like washing the feet. Third was patient perceptions of footcare services, whereby the majority were generally happy with the footcare services available to them.

Conclusion: The study results indicated that patients lacked sufficient knowledge about the symptoms and prevention of type 2 diabetes mellitus, and healthy practices related to food complications. More effort needs to be invested into diabetes and footcare knowledge and practices for patients at the Sigatoka Hospital. This will help guide patients to make life-altering decisions that can help reduce the rate of diabetes related lower limb amputations, which are easily preventable.

Introduction: Aging in rural areas is challenging and has very specific characteristics in the way these elderly people live their old age, from the perspectives of cognition, functionality and life purpose. There is a lack of information and data in the literature on how people age in rural areas around the world. The aim of this study was to identify and describe how people age in rural areas, focusing on the following domains: cognition, physical function/functionality and life purpose.

Methods: We included cross-sectional studies published up to April 2023 found in six databases: PubMed, LILACS, PsycINFO, Scopus, SciELO and Web of Science. The Rayyan software was used for the first selection of studies and the Observational Study Quality Evaluation was used to assess methodological quality and risk of bias. For the primary analysis, the titles and abstracts available in the search engine were analyzed using the following MeSH descriptors: "physical functioning"; "cognition"; "cognitive function"; "life purpose"; 'personal satisfaction'; 'subjective well-being'; "aged"; "elderly"; "old"; "rural aging"; "rural population"; "communities, rural"; "distribution, rural spatial"; "medium communities"; "rural settlement"; "small community". In the secondary selection, the selected articles were fully read by two independent reviewers and confirmed by a third reviewer when necessary.

Results: From 22 studies methodologically evaluated it was seen that rural aging in the world is female and mostly in elderly women farmers; mental evaluation together with activities of daily living and instrumental activities were the most evaluated; the studies did not mention the evaluation of life purpose.

Conclusion: The world ages very differently in rural areas, and the way we age is directly linked to where this process takes place. Cognition, followed by functionality, are the most researched outcomes in cross-sectional studies with this population and the assessment of life purpose has not been investigated to date.

Introduction: The geographic, cultural, social and economic milieu that impacts mental health in rural communities globally has been well documented. However, few studies have addressed how rural ecosystems impact specifically upon the mental health and wellbeing of young people. Furthermore, the limited explorations of factors contributing to poorer mental health outcomes in rural youth have primarily included adult voices. The study aimed to give a youth voice to the vexed problem of high rates of youth mental illness and suicide in rural and remote areas, exploring young people's experiences in a deeply contextual manner.

Methods: This study followed a phenomenological qualitative design underpinned by the principles of participatory action research. A youth-led reference group provided guidance on the study design and recruitment. A total of 29 young people aged 12-19 years were recruited from a small rural community in southern Western Australia. Individual and focus group semi-structured interviews were conducted. The interviews were transcribed and subjected to thematic analysis informed by ecological systems theory.

Results: The findings demonstrate the impact of a rural address on youth mental health through the influence of three overarching spheres of influence, as described by ecological systems theory: 'everyone knows everyone', 'small school and beyond' and 'the place'. Most themes included both positive and negative components, as well as ambivalence, demonstrating a double-edged sword.

Conclusion: The study findings support the view that mental health in rural young people is best viewed through an ecosystem lens, acknowledging the complex and dynamic interplay between interpersonal, community and environmental factors on young people. The paradoxes and contradictions present in almost every interview are informative, instructive and of great value in considering the needs and desires of rural young people. Rural communities should be supported to build upon their intrinsic strengths to ameliorate the impact of rurality on mental health risk factors for young people. Building on the assets inherent in rural communities, could rural young people have better outcomes than urban youth?