Rural and remote health最新文献

Almost universally, people living in rural and remote places die younger, poorer, and sicker than urban-dwelling citizens of the same country. Despite clear need, health services are commonly less available, and more costly and challenging to access, for rural and remote people. Rural geography is commonly cited as a reason for these disparities, that is, rural people are said to live in places too distant, too underpopulated, and too difficult to access. However, all these descriptions tacitly compare rural places with urban spaces. That is, rural places are perceived as too distant from cities, less populated than cities, and too difficult to access from cities. This relative framing situates urban geography as normal, and non-urban geography as abnormal and blames people who live outside of normalised urban spaces for their own disadvantage. It suggests rural people should expect less service, higher costs, and increased awkwardness in using healthcare services due to the 'abnormality' of living in rural spaces. The concept of spatial justice provides an alternative way of considering geography that we propose could effectively reframe understanding of and approaches to rural and remote health care to improve health outcomes. Spatial justice refers to the experience of justice relative to location and requires opportunities, including access to health care, to be distributed equally across geographic spaces as well as among people. To critical geographers, places are not static; humans both respond to geography and shape it based on decisions influenced by contemporary social ideologies. As a society we decide where we build housing, roads, and healthcare facilities, based on what and who we value. Rural health outcomes could therefore be conceived as resulting from social ideology regarding locational investment, social worth, and urbanormativity, rather than challenges of topography. In this critical narrative review, we apply geographical concepts to suggest how rural and remote geography may have been shaped by ideologies of capitalism and neoliberalism to result in spatial injustice. Our analysis suggests that, rather than rural geography being a neutral issue, society shaped geographies to limit health opportunities for people who live in rural and remote places. We suggest reframing to allow rural and remote geography to be conceived as a social factor able to be shaped, rather than as an insurmountable barrier to equity. We consider how application of French philosopher and geographer Lefebvre's tripartite model of conceived, perceived, and lived space could be used to examine and guide social policy to reshape rural and remote geography to increase health opportunities. This application of spatial justice to rural and remote health care suggests opportunities to reframe assumptions that rural and remote people should necessarily experience greater cost, inconvenience, and difficulty accessing health care due to geography. If soc

Introduction: Little is known about the differences between rural and urban gamblers and potential vulnerabilities that may be unique to either population. This exploratory study aimed to evaluate differences between rural and urban Pennsylvanians' gambling behaviors and beliefs.

Methods: A dual-frame random digit dial survey was conducted in the US state of Pennsylvania. The analyses included a final sample of 1934 Pennsylvanian adults, with nearly three-quarters of the sample residing in rural counties. The survey was designed to assess online and offline gambling prevalence, engagement in different gambling formats, risk for problem gambling, motivations to gamble online, beliefs about gambling, and demographic characteristics.

Results: Prevalence rates were higher in urban populations for both online and offline gambling. However, those living in rural areas tended to gamble on more gambling formats. Motivations were largely the same in both regions, and there were no differences in risk for problem gambling. Beliefs about gambling harms and benefits were similar in urban and rural populations, but those in rural areas were less likely to believe all forms of gambling should be legal. In addition, there were several demographic differences, which largely reflected existing differences between those living in rural and urban areas.

Conclusion: Findings suggest a need for provision of policies, treatment, and prevention targeting those living in rural areas, where individuals may be at a greater risk of developing a gambling problem due to less access to relevant service.

Human parechovirus (HPeV) infections in neonates and infants have been linked to outbreaks in regions including Australia, Northern Europe, and the US, resulting in long-term neurological complications. HPeV symptoms range from mild gastroenteritis and respiratory issues to severe systemic illness, including seizures and neurological damage. Human parechovirus type 3 (HPeV3) has emerged as a significant cause of sepsis-like illness in infants aged less than 3 months. We describe the case of a neonate aged 11 days with an acute abdomen and meningitis, treated at a rural hospital in Queensland, Australia. Early diagnosis of HPeV3 in this case facilitated supportive management of the neonate, and avoided unnecessary transfer to a tertiary centre.

Introduction: The long-term outcomes of different telerehabilitation gains for discharged COVID-19 patients are largely uncertain, and this point needs to be explored. This study aimed to research the effectiveness of telerehabilitation and compare the long-term results of videoconferencing-guided synchronous telerehabilitation and mobile application-guided asynchronous telerehabilitation programs, as well as determine the correlation between clinical and hemodynamic parameters.

Methods: Exercise programs including aerobic exercises, strengthening exercises, and pulmonary exercises were given to COVID-19 patients discharged from the Kartal Dr. Lütfi Kirdar City Hospital in Istanbul, Türkiye between August 2021 and January 2022, by videoconferencing or mobile application telerehabilitation. All patients underwent programs three times per week for 8 weeks. Lower extremity strength and functional status were assessed using a 30-second sit-to-stand test (30 s STS); physical activity level was assessed using the International Physical Activity Questionnaire short form (IPAQ); pulse oximetry was used to determine oxygen saturation and heart rate; and dyspnea and fatigue were assessed using a modified Borg Rating of Perceived Exertion Scale. Baseline, post-treatment, and long-term data were analyzed.

Results: A total of 27 patients completed the study. Significant improvement was seen in all parameters in long-term results with telerehabilitation programs (p<0.05). Especially in the between-group effect at rest (p=0.031) and post-exertion oxygen saturation (p=0.004), there were significant differences in favor of videoconferencing. Oxygen saturation was negatively correlated with dyspnea and fatigue (p<0.05). Post-exercise, dyspnea showed a moderate positive correlation with fatigue (r=0.582, p=0.001) and heart rate (r=0.412, p=0.033), while it exhibited a moderate negative correlation with 30 s STS (r=-0.424, p=0.027) and IPAQ (r=-0.401, p=0.038).

Conclusion: Both methods generally provide positive gains in clinical and hemodynamic parameters, but the videoconferencing results were slightly better. Saturation at rest and dyspnea after exertion can provide a brief prediction about the cardiopulmonary system. Our findings are important for individuals who have access problems to the clinic and city center, and can be used for follow-up and treatment approaches.

Context: Ireland has one of the most rural populations in Europe. Rurality presents challenges when accessing health services but should not be perceived as problematic and in need of a structural fix. Structural urbanism where health care is viewed as a commodity for individuals, rather than an infrastructure for populations, innately favours larger urban populations and has detrimental outcomes for rural health. In this article we present a brief account of advocacy led by rural GPs, their communities, and the political and policy implications of their efforts.

Issues: In the period 2010-2016, Irish rural general practices were struggling for viability. Two key financial supports, distance coding and the Rural Practice Allowance, were withdrawn. This directly contributed to the founding of the 'No Doctor No Village' public campaign, following which the Rural Practice Allowance took shape as the Rural Support Practice Framework and was expanded to cover a larger number of rural practices. The World Rural Health Conference in June 2022 at the University of Limerick invited over 600 expert delegates who contributed to the authorship of the Limerick Declaration, a blueprint for advancing rural health in Ireland and internationally. This created a new momentum in advocacy for Irish rural general practice, which has drawn financial investments, sparked research interest building capacity for a pipeline to train rural general practitioners.

Lessons learned: Local voices have driven monumental change in the Irish healthcare context. For these communities, the policy and politics of rural health are mere tools to maintaining or restoring their way of life. The biggest lesson to be learned is that unrelenting community commitment, when supported by the capacity to advocate, can influence politics and policy to generate sustainable outcomes and thriving communities.

Introduction: Relationships are the core of Indigenous Peoples' spiritual and cultural identities, and therapeutic relationships are an integral part of the physical rehabilitation process, directly influencing health outcomes. However, participating in therapeutic relationships can be difficult for First Nations Peoples, particularly in the virtual landscape. There is limited understanding of First Nations Peoples' perspectives on this issue, and this understanding is crucial to developing culturally safe and effective telehealth physiotherapy programs. Therefore, the purpose of this study is to explore the perspectives of First Nations Peoples from British Columbia, Canada, on telehealth physiotherapy, with an emphasis on the virtual therapeutic relationship.

Methods: A narrative qualitative study that utilized one-on-one, semistructured interviews was conducted with 19 First Nations adults from remote and rural First Nations communities in north-central British Columbia, Canada. Interviews were recorded, transcribed verbatim, and analyzed using an inductive approach to reflexive thematic analysis.

Results: Three themes emerged from data analysis. 'Therapist's attitude and rapport' captures participants' perceptions of what matters the most in how physiotherapists relate to First Nations Peoples and carry out their work. 'Remote nature of virtual care' encompasses the main challenges of virtual care visits, particularly how these were perceived to impact establishing and maintaining solid therapeutic relationships. 'Fostering culturally appropriate and safe telehealth physiotherapy' focuses on what is needed to advance telehealth physiotherapy in a manner that respects and reflects First Nations cultures, equipping all involved parties to provide comprehensive and sensitive services. Our findings advocate a hybrid model that combines in-person and telehealth visits to address communication barriers and the absence of physical interaction. Bridging the digital health literacy gap through training and collaboration with local support staff is crucial (as it is to bridge the possible cultural literary gap of therapists), and the incorporation of cultural elements holds promise for enhancing the engagement and effectiveness of telehealth services in these communities.

Conclusion: The pursuit of equitable health care for First Nations communities demands not only increased access but also a thoughtful, culturally safe, trauma-informed, and holistic approach. This approach must be tailored to the unique needs of First Nations Peoples, emphasizing the integration of cultural elements and community support. A hybrid model combining in-person and telehealth visits is recommended to address logistical challenges and enhance the therapeutic relationship, ensuring that care is both effective and respectful of cultural values and practices.

Introduction: Adherence to iron-folic acid supplementation (IFAS) has been linked with maternal anaemia. While findings about determinants of IFAS adherence have been mixed across different research, there is inadequate evidence in relation to socioeconomic inequalities. This study aims to examine social determinants and socioeconomic inequalities of adherence to IFAS in urban and rural Indonesia.

Methods: We conducted a secondary analysis of the 2017 Indonesia Demographic and Health Survey by including a total of 12 455 women aged 15-49 years. The outcome was adherence to IFAS for at least 90 days. We used multiple logistic regression analysis adjusted for the survey design to analyse factors associated with IFAS adherence. We estimated socioeconomic inequalities using the Wagstaff normalized concentration index and plotted them using the concentration curve.

Results: About half of women consumed IFAS for at least 90 days, with a higher proportion in urban areas (59.0%) than in rural areas (47.8%). Social determinants of adherence to IFAS were similar for urban and rural women. Overall, being an older woman, having weekly internet access, antenatal care for at least four visits, and residing in Java and Bali were significantly linked to IFAS adherence. Higher maternal education was significantly linked to IFAS adherence in urban settings, but not in rural settings. There were interactions between place of residence and woman's education (p<0.001) and household wealth (p<0.001). Concentration indices by woman's education and household wealth were 0.102 (p<0.001) and 0.133 (p<0.001), respectively, indicating pro-educated and pro-rich inequalities. However, no significant education-related disparity was found among rural women (p=0.126).

Conclusion: Women (age, education, occupation, birth number, internet access, involvement in decision-making), household (husband's education, household wealth), health care (antenatal care visit) and community (place of residence, geographic region) factors are associated with overall adherence to IFAS. These factors influence the adherence to IFAS in a complex web of deep-seated socioeconomic inequalities. Thus, programs and interventions to improve adherence to IFAS should target women of reproductive age and their families, particularly those from socioeconomically disadvantaged groups residing in rural areas.