Rural and remote health最新文献

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.

Introduction: Rural physician engagement in continuous quality improvement (CQI) activities is vital to improving quality of care, patient safety, and healthcare delivery efficiencies. However, there is a lack of evidence surrounding the barriers and facilitators to CQI uptake across rural medical practices. This study aimed to explore enablers and barriers to CQI implementation and identify ways to foster greater engagement of rural physicians.

Methods: A mixed-methods triangulation study design was undertaken encompassing a survey and focus group interviews with physicians practising in rural communities of British Columbia, Canada.

Results: The survey was distributed to 1584 rural physicians, and 299 responses were received (response rate of 19%). Seven focus groups were conducted with 33 participants. Survey respondents indicated strong support towards CQI and the benefits of improved patient outcomes and practice quality. Less than half (47%) of respondents had participated in a CQI initiative within the previous 2 years. Key barriers to CQI engagement included time constraints, limited knowledge of CQI principles, and a lack of understanding of accessing and using relevant data. Key motivators for CQI engagement were opportunities for peer collaboration and receiving practice improvement feedback. Key enablers included more usable and accessible data and appropriate staffing resources to assist with undertaking CQI activities.

Conclusion: Given rural physicians' time demands, better support systems are required to enhance rural physician engagement in systematic CQI activities. Specific support areas include dedicated CQI staff resources and better practice data systems and processes to support CQI initiatives.

Introduction: Rural populations in Australia rely upon local primary health care for medication abortion access. Yet little is known about how individual primary healthcare providers themselves negotiate the unique complexities of the rural health system to provide local abortion services.

Methods: To address this gap, we conducted qualitative, semi-structured interviews with primary healthcare providers in rural New South Wales (NSW). Recruitment strategies included sending invitations to all GP clinics in Western NSW, distribution of flyers via professional networks and social media posts as well as snowballing. The Framework Method was used to conduct an inductive thematic analysis.

Results: We interviewed 16 rural GPs, nurses, midwives and women's health clinic operational staff. Four themes were identified: (1) scarce abortion services place overreliance on availability and goodwill of local prescribers; (2) lack of back-up support, financial incentives and training deters providers; (3) there is interprofessional stigma, secrecy and obstruction; and (4) local abortion access requires workarounds through informal rural networks. Participants described abortion exceptionalism within Australia's health system and chronic rural workforce shortages in rural settings as unique and compounding challenges to local provision. Conversely, strong rural community networks were identified as important enablers of informal pathways to abortion within or around systemic barriers.

Conclusion: Improving rural abortion access in Australia requires attention to the numerous intersecting barriers that local primary care providers themselves face when providing services at the periphery of an unaccommodating health system.