Australian Journal of Rural Health最新文献_第10页

Tranexamic acid versus oxytocin for primary postpartum Haemorrhage in the out-of-hospital setting: A systematic review with implications for rural practice 氨甲环酸与催产素治疗院外环境下的原发性产后出血：系统性综述对农村实践的影响。

IF 1.8 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2024-03-15 DOI: 10.1111/ajr.13103

Megan De Silva BHlthSc (Paramedicine), Gabrielle Mizzi BHlthSc (Paramedicine), Emily Potts BHlthSc (Paramedicine), Jayden Webb BHlthSc (Paramedicine), Elizabeth Thyer PhD, Navindhra Naidoo PhD

Introduction

Primary postpartum haemorrhage causes approximately 25% of global maternal deaths and accounts for significant maternal morbidity. While high certainty evidence demonstrates that tranexamic acid reduces comparative blood loss in postpartum haemorrhage in hospital settings, limited data exist on the specific pharmacological management of this condition in out-of-hospital settings, and the implications for rural communities.

Objective

To determine the efficacy of oxytocin compared to tranexamic acid in women suffering postpartum haemorrhage in the out-of-hospital environment.

Design

A systematic review comparing evidence containing patients with postpartum haemorrhage in the out-of-hospital and/or rural setting, in which oxytocin/tranexamic acid were used. Outcome measures were comparative blood loss/haemorrhagic shock, the need for further interventions and maternal/neonatal morbidity/mortality.

Findings

No randomised control trials have been conducted in an out-of-hospital environment in relation to oxytocin/tranexamic acid. In this setting, there is no difference in outcome measures when using oxytocin compared to no intervention, or oxytocin compared to standard care. Data are lacking on the effect of tranexamic acid on the same outcome measures.

Discussion

Rural and out-of-hospital management of postpartum haemorrhage is limited by resource availability and practitioner availability, capacity and experience. In-hospital evidence may lack transferability, therefore direct evidence on the efficacy of pharmacological management in these contexts is scant and requires redress.

Conclusion

There is no difference in blood loss, neonatal or maternal mortality or morbidity, or need for further interventions, when using oxytocin or TXA compared to no intervention, or compared to standard care, for PPH. Further studies are needed on the efficacy of these drugs, and alternate or co-drug therapies, for PPH in the out-of-hospital environment and rural clinical practice.

导言：原发性产后出血约占全球孕产妇死亡人数的 25%，也是孕产妇发病率的重要原因。尽管确凿证据表明，氨甲环酸可减少医院环境中产后出血的失血量，但有关院外环境中这种情况的具体药物治疗以及对农村社区的影响的数据却很有限：目的：确定催产素与氨甲环酸对医院外产后出血妇女的疗效比较：设计：一项系统性综述，比较医院外和/或农村地区产后出血患者使用催产素/氨甲环酸的证据。结果测量指标为比较失血量/失血性休克、是否需要进一步干预以及孕产妇/新生儿发病率/死亡率：没有在院外环境中进行过与催产素/氨甲环酸有关的随机对照试验。在这种情况下，使用催产素与不使用干预措施相比，或使用催产素与标准护理相比，在结果测量方面没有差异。关于氨甲环酸对相同结果指标的影响，目前还缺乏相关数据：讨论：农村和院外产后出血管理受到资源可用性、从业人员可用性、能力和经验的限制。院内证据可能缺乏可移植性，因此在这些情况下药物治疗疗效的直接证据很少，需要加以纠正：结论：在 PPH 的治疗中，使用催产素或 TXA 与不使用干预措施相比，或与标准护理相比，在失血量、新生儿或产妇死亡率或发病率或进一步干预的需求方面没有差异。在院外环境和农村临床实践中，还需要进一步研究这些药物以及替代或联合药物疗法对 PPH 的疗效。

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引用次数: 0

Scapular fractures: A regional and rural perspective 肩胛骨骨折：地区和农村视角。

IF 1.8 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2024-03-13 DOI: 10.1111/ajr.13100

Nordan Flaaten MD, Huissan Moslim MD, Eric Tang MBBS, Ruth Varrall MBBS

Introduction

Scapular fractures (SFs) have historically been associated with severe trauma and multiple injuries. Recent studies have demonstrated improved outcomes. However, SFs have never been studied from a strictly rural or Australian perspective.

Objective

The study's objective was to assess whether associations still exist between a fractured scapula and trauma scores, mortality rates, and other commonly associated injuries in a regional Australian trauma centre.

Design

The study design examined prospectively collected data from a regional hospital between the years 2012 to 2021 presenting to the emergency department with traumatic SFs. Primary outcomes of interest were mortality rate, method of injury, ISS scores, and associated injuries.

Findings

One hundred and five patients had a SF. The median age was 49 with 93 (89%) being male. Most fractures were located in the body of the scapula (80%). The primary mechanism of injury was motorbike accidents (36%), falls (24%), and motor vehicle accidents (22%). Two patients died from their injuries (1.9%). Thirty-four percent demonstrated mild trauma scores, with 36% moderate, 28% severe, and 1.9% critical. Commonly observed associated injuries included chest wall fractures, vertebral fractures, thoracic injuries, brain injury, and abdominal trauma.

Discussion

A minority of SFs were associated with severe or critical trauma, and overall, patients who sustained a SF had a low mortality rate. These findings suggest that patients from regional areas have similar outcomes to those from more urban centres in other parts of the world.

Conclusion

Given these results, a re-examination of whether SFs are a reliable marker of severe trauma should be considered.

介绍：肩胛骨骨折（SFs）历来与严重创伤和多发性损伤有关。最近的研究表明，肩胛骨骨折的治疗效果有所改善。然而，人们从未从严格意义上的农村或澳大利亚角度对肩胛骨骨折进行过研究：该研究的目的是评估在澳大利亚一个地区性创伤中心，肩胛骨骨折与创伤评分、死亡率和其他常见相关损伤之间是否仍然存在关联：研究设计对一家地区医院在2012年至2021年期间收集到的急诊科创伤性肩胛骨骨折患者的前瞻性数据进行了检查。主要研究结果包括死亡率、受伤方式、ISS评分和相关损伤：105 名患者患有 SF。中位年龄为 49 岁，其中 93 人（89%）为男性。大多数骨折位于肩胛骨体（80%）。受伤的主要原因是摩托车事故（36%）、跌倒（24%）和机动车事故（22%）。两名患者因伤死亡（1.9%）。34%的患者为轻度创伤，36%为中度创伤，28%为重度创伤，1.9%为危重创伤。常见的相关损伤包括胸壁骨折、脊椎骨折、胸部损伤、脑损伤和腹部创伤：讨论：少数 SF 与严重或危重创伤相关，总体而言，SF 患者的死亡率较低。这些研究结果表明，来自地区的患者与来自世界其他地区城市中心的患者结果相似：鉴于这些结果，应考虑重新审查 SF 是否是严重创伤的可靠标志。

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引用次数: 0

Positive change in intent to practice rurally is strongly associated with nursing and allied health students of metropolitan origin after rural clinical placement 来自大都市的护理和专职医疗学生在农村临床实习后，其农村实习意向发生了积极变化。

IF 1.8 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2024-03-08 DOI: 10.1111/ajr.13099

Kristen M. Glenister PhD, Robyn McNeil MPH, Trish Thorpe MCB, Lisa Bourke PhD

Objective

To: (1) assess whether rural clinical placements influence change in intention to practice rurally for nursing and allied health students, (2) to assess whether residential origin (metropolitan or rural) or university location (metropolitan or non-metropolitan) influence this change, and (3) assess residential origin of health professionals practicing rurally after graduation.

Design

Cross-sectional survey (2014-2022) conducted in Northern/Northeastern Victoria and Grampians region by nursing and allied health students completing rural clinical placements. Survey explored student placement satisfaction, intention to practice rurally and demographic information, with a follow-up two years’ post-placement.

Findings

Experience of a rural placement increased students’ intention of practicing rurally. Importantly, 57% of metropolitan origin students studying at metropolitan campuses exhibited positive change. Logistic regression analysis suggested that after controlling for age, gender and satisfaction with placement and supervision, students of metropolitan origin at metropolitan campuses were 6.4 times more likely to report positive change in intent to practice rurally after placement than students of rural origin studying at non-metropolitan campuses.Follow-up data suggested that a substantial proportion of health professionals providing services in rural areas were of metropolitan origin.

Results

These findings concur that rural origin and rural training are important predictors of working rurally. Additionally, metropolitan students can change their intention to practice rurally after a rural placement.

Conclusions

This study supports strategies to enhance intention to practice rurally that are not restricted to rural origin students to build rural workforce.

目的目的：(1) 评估农村临床实习是否会影响护理和专职医疗学生的农村实习意向的变化，(2) 评估居住地（大都市或农村）或大学所在地（大都市或非大都市）是否会影响这种变化，(3) 评估毕业后在农村实习的医疗专业人员的居住地：设计：在维多利亚州北部/东北部和格兰皮恩斯地区对完成农村临床实习的护理和专职医疗学生进行横断面调查（2014-2022 年）。调查内容包括学生对实习的满意度、在农村实习的意向以及人口统计学信息，并在实习两年后进行跟踪调查：调查结果：农村实习经历增加了学生的农村实习意向。重要的是，57%在大都市校园学习的大都市出身的学生表现出了积极的变化。逻辑回归分析表明，在控制了年龄、性别以及对实习和监督的满意度后，在大都市校园学习的大都市籍学生在实习后报告在农村实习的意愿发生积极变化的可能性是在非大都市校园学习的农村籍学生的 6.4 倍：这些研究结果表明，农村出身和农村培训是在农村工作的重要预测因素。此外，大都市学生在农村实习后也会改变他们在农村实习的意向：本研究支持提高农村实习意向的策略，这些策略并不局限于农村出身的学生，而是要建立农村劳动力队伍。

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引用次数: 0

Perioperative knowledge, self-efficacy and clinical practices related to postoperative delirium care in older people across geographical regions in Australia 与澳大利亚不同地区老年人术后谵妄护理相关的围手术期知识、自我效能和临床实践。

IF 1.8 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2024-03-08 DOI: 10.1111/ajr.13097

Ezinne O. Igwe PhD, Jessica Nealon PhD, Pauline O'Shaughnessy PhD, Callum Ormonde MBBS, Victoria Traynor PhD

Introduction

In older people undergoing surgery, there is a lower tolerance for complications. This highlights the need for documented clinical practices on proper prevention, pre-screening and management of complications such as postoperative delirium (POD). Evidence-based clinical practice guidelines exist for delirium management; however, the management of delirium in clinical settings differs widely.

Objective

This study aims to develop an understanding of the knowledge, components of self-efficacy (confidence/competence), and clinical practice related to POD care among preoperative and recovery nurses across different types of geographical locations in Australia.

Design

A 27-item online survey was sent out to professional associations focused on perioperative care across Australia. The participants included practicing registered nurses specialising in perioperative care. The main outcome measures were Knowledge, confidence/competence and clinical practice relating to POD care in older patients.

Findings

Respondents were categorised into two groups—major cities and rural and remote. Mean age was 46.3 years for respondents in Australian major cities and 49.5 for the comparison group. There was a statistically significant difference between Australian major cities and ‘rural and remote’ in confidence in detecting hyperactive delirium, 25.2% versus 11.7% respectively as well as managing hyperactive delirium, 13.8% versus 1.7%, respectively. Similar results were also observed on hypoactive delirium. Respondents from both groups did not mirror the ideal situation in managing a hyperactive delirium.

Discussion

Results from this study are inconclusive and there is no clear-cut observation in clinical practice or knowledge between the two geographical categories in this study.

Conclusion

The absence of a distinct strategy with POD prevention highlights the need for a uniform approach and consensus on POD prevention and management in older people. This can be achieved by creating more awareness and education through professional development related to POD.

导言接受手术的老年人对并发症的耐受力较低。这凸显了对术后谵妄（POD）等并发症的正确预防、预检和管理的临床实践记录的必要性。目前已有基于证据的谵妄管理临床实践指南，但临床环境中对谵妄的管理却大相径庭：本研究旨在了解澳大利亚不同地理位置的术前和恢复期护士对 POD 护理的相关知识、自我效能（信心/能力）和临床实践：设计：向澳大利亚各地专注于围术期护理的专业协会发送了一份包含 27 个项目的在线调查。参与者包括专门从事围手术期护理的执业注册护士。主要结果指标为老年患者 POD 护理的相关知识、信心/能力和临床实践：受访者分为两组--大城市和农村及偏远地区。澳大利亚大城市受访者的平均年龄为 46.3 岁，对比组为 49.5 岁。澳大利亚大城市与 "农村和偏远地区 "的受访者在发现多动谵妄的信心方面存在显著差异（分别为 25.2% 对 11.7%），在处理多动谵妄的信心方面也存在显著差异（分别为 13.8% 对 1.7%）。在低能谵妄方面也观察到了类似的结果。两组受访者在处理多动谵妄时都没有反映出理想的情况：讨论：本研究的结果尚无定论，在临床实践或知识方面，本研究中的两个地域类别之间没有明显的差异：结论：缺乏预防 POD 的独特策略凸显了在老年人 POD 预防和管理方面采取统一方法和达成共识的必要性。要做到这一点，就必须通过与 POD 相关的专业发展，提高人们对 POD 的认识并加强教育。

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引用次数: 0

Young people's experiences of the Northern Rivers 2017 flood and its effects on their mental health 年轻人在 2017 年北部河流洪灾中的经历及其对心理健康的影响。

IF 1.8 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2024-03-08 DOI: 10.1111/ajr.13095

Michelle Luk, Jo Longman PhD

Objective

To explore young people's (YP) experiences of catastrophic flooding in the Northern Rivers area of northern NSW in 2017 and its effect on their mental health.

Design

Content analysis of free-text survey responses (written responses to open questions, rather than selecting a response option).

Setting

Northern Rivers NSW.

Participants

YP aged 16–25 years who were Northern Rivers residents at the time of the 2017 flood.

Results

YP found their flood experience to be novel and challenging. They expressed worry, distress, anxiety, and worsened pre-existing mental health issues as a result of the flood. YP reported a number of primary stressors (inadequate preparedness, warning and support during the flood) and secondary stressors (loss/damage of property and possessions, financial strain and disruptions to daily life) which potentially contributed to poor mental health. Some YP reported positive outcomes from their flood experience, notably increased community connectedness and personal resilience. However, they also expressed concern for the future, particularly potential reoccurrence of extreme floods as well as climate change. YP conveyed a desire for better community involvement to improve preparedness for future floods and a clear motivation to take action on climate change.

Conclusion

The flood was a challenging experience for YP which was commonly described as negatively affecting their mental health. Understanding what YP view as significant events or issues arising from their personal flood experience may help target support mechanisms and services to maintain their mental. More focus on community-based initiatives to improve disaster preparedness can support mental health in YP.

目的：探讨年轻人（YP）在 2017 年新南威尔士州北部北河地区灾难性洪灾中的经历及其对心理健康的影响：探讨年轻人（YP）在 2017 年新南威尔士州北部北河地区灾难性洪灾中的经历及其对心理健康的影响：对自由文本调查回复（对开放式问题的书面回复，而非选择一个回复选项）进行内容分析：新南威尔士州北部河流地区：参与者：2017 年洪灾发生时身为北部河流居民的 16-25 岁青年：结果：青年认为他们的洪灾经历既新奇又具有挑战性。他们对洪灾表示担忧、苦恼、焦虑，原有的心理健康问题也因洪灾而恶化。青年报告了一些主要压力源（洪灾期间准备不足、预警不足和支持不足）和次要压力源（财产和物品的损失/损坏、经济压力和对日常生活的干扰），这些都有可能导致心理健康状况不佳。一些青年报告说，他们从洪灾经历中获得了积极的结果，尤其是增强了社区联系和个人复原力。然而，他们也对未来表示担忧，特别是可能再次发生的特大洪灾以及气候变化。青年党表达了更好地参与社区活动的愿望，以提高对未来洪灾的防备能力，并表达了采取行动应对气候变化的明确动机：洪水对青少年来说是一次具有挑战性的经历，他们普遍认为洪水对他们的心理健康造成了负面影响。了解青年在个人洪灾经历中认为重要的事件或问题，有助于有针对性地提供支持机制和服务，以保持他们的精神健康。更多关注以社区为基础的措施，以改善备灾工作，可以为青少年的心理健康提供支持。

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引用次数: 0

Perioperative and anaesthetic considerations in rural patients on GLP-1 receptor agonists: An update 使用 GLP-1 受体激动剂的农村患者的围手术期和麻醉注意事项：更新。

IF 1.8 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2024-02-29 DOI: 10.1111/ajr.13096

Luke K. M. Chan MD

引用次数: 0

The changing psychiatry workforce in Australia: Still lacking in rural and remote regions 澳大利亚不断变化的精神病学人才队伍：农村和偏远地区仍然缺乏。

IF 1.8 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2024-02-28 DOI: 10.1111/ajr.13092

Catherine Mary Hayter MChD, Stephen Allison FRANZCP, Tarun Bastiampillai FRANZCP, Steve Kisely DMedRes, Jeffrey C. L. Looi DMedSc

<div> <section> <h3> Introduction</h3> <p>There is a long standing and worsening shortage of psychiatrists in Australia particularly in rural areas. The majority of psychiatrists work in major cities.</p> </section> <section> <h3> Objective</h3> <p>To identify recent trends in the Australian rural psychiatrist workforce compared with the metropolitan workforce.</p> </section> <section> <h3> Design</h3> <p>We descriptively analysed population-level data from the National Health Workforce Data Set (NHWDS), the Australian Institute of Health and Welfare (AIHW) and the Australian Bureau of Statistics (ABS).</p> <p>A descriptive analysis of the numbers (count) and gender of psychiatrists from 1995 to 2022 working in Australia was conducted. For the period 2013 to 2022, we analysed for rurality, gender, years' experience, hours worked, Medicare-subsidised services provided and proportions of Specialist International Medical Graduates (SIMG) by sex, with a focus on the rural workforce. For international comparison, psychiatrist numbers were obtained for other OECD countries. The number of psychiatrists working in Australia, as per NHWDS and AIHW, was quantified. We analysed trends in demographics, hours worked and rurality of psychiatrists working in Australia in a serial cross-sectional design.</p> </section> <section> <h3> Findings</h3> <p>Most psychiatrists are maldistributed to major cities, while outer regional and remote areas have few resident psychiatrists. Outer regional New South Wales (NSW) and South Australia (SA) have the lowest numbers of psychiatrists per capita. The full-time equivalent (FTE) of psychiatrists per 100 000 has increased from 12.6 in 2000 to 15.2 in 2022. However, the average hours worked by psychiatrists has declined. In total, available psychiatrist hours worked per 100 000 population has increased by 6.1% since the beginning of the millennium.</p> </section> <section> <h3> Discussion</h3> <p>Rural areas in NSW and SA have the greatest shortage of psychiatrists. Specialist International Medical Graduates and females (43% of the overall workforce) are the predominant workforce in rural areas. Although Medicare-subsidised services per 1000 people have increased in rural areas, they remain lower than for those living in major cities.</p> </section> <section> <h3> Conclusion</h3> <p>There remains

导言：在澳大利亚，精神科医生短缺的问题由来已久，而且日益严重，尤其是在农村地区。大多数精神科医生都在大城市工作：目的：与大城市的精神科医生队伍相比，确定澳大利亚农村地区精神科医生队伍的最新趋势：设计：我们对来自国家卫生劳动力数据集（NHWDS）、澳大利亚卫生福利研究院（AIHW）和澳大利亚统计局（ABS）的人口级数据进行了描述性分析。我们对 1995 年至 2022 年在澳大利亚工作的精神科医生的人数（计数）和性别进行了描述性分析。在2013年至2022年期间，我们分析了乡村地区、性别、工作年限、工作时间、提供的医疗保险补贴服务以及按性别分列的国际医学专业毕业生（SIMG）比例，重点关注乡村地区的劳动力。为了进行国际比较，我们还获得了其他经合组织国家的精神科医生人数。根据国家卫生与健康数据系统（NHWDS）和澳大利亚卫生与健康研究院（AIHW）的数据，我们对在澳大利亚工作的精神科医生人数进行了量化。我们采用序列横截面设计，分析了在澳大利亚工作的精神科医生在人口统计学、工作时间和乡村化方面的趋势：大多数精神科医生分布在大城市，而外围地区和偏远地区的常驻精神科医生很少。新南威尔士州（NSW）和南澳大利亚州（SA）外围地区的人均精神科医生人数最少。每 10 万名精神科医生中的全职等效人数（FTE）已从 2000 年的 12.6 人增至 2022 年的 15.2 人。然而，精神科医生的平均工作时数却有所下降。总体而言，自本世纪初以来，每 10 万人中精神科医生的可用工作时数增加了 6.1%：讨论：新南威尔士州和南澳大利亚州的农村地区最缺乏精神科医生。专科国际医学毕业生和女性（占总劳动力的 43%）是农村地区的主要劳动力。虽然农村地区每千人的医疗保险补贴服务有所增加，但仍低于大城市：结论：在未来需求增加的背景下，澳大利亚许多地区和偏远地区仍然严重缺乏精神科医生，而在这些地区工作的 SIMGs 和女性比例也在不断增加。

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引用次数: 0

The impact of extreme heat on older regional and rural Australians: A systematic review 极端高温对澳大利亚地区和农村老年人的影响：系统回顾。

IF 1.8 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2024-02-28 DOI: 10.1111/ajr.13094

Grace Harvey BHLTH, Suzanne Bain-Donohue VCHAM, Sari Puspa Dewi MD, MHPE

Introduction

Extreme heat causes a major health burden, especially for older Australians.

Objective

To assess the impact of extreme heat on older regional and rural Australians, including clinical presentations, social implications, and health-seeking behaviours and adaptations.

Design

A systematic review and narrative synthesis.

Findings

Ten articles were included in the review with research on this topic limited. Extreme heat causes an increase in mortality and ambulance dispatches for older rural Australians. Social connectedness is negatively affected by extreme heat due to cancellation of events and individuals becoming housebound. Air conditioning is the main cooling mechanism used, although cost is a major concern. Despite this, older rural populations display a depth of knowledge regarding practical behavioural responses to adapt to extreme heat. Studies show older rural Australians do not consider extreme heat to be a threat to health.

Discussion

Further research needs to examine the role extreme heat may play in contributing to experiences of loneliness. Air conditioning cannot be the ultimate solution in responding to extreme heat due to cost and increased carbon emissions. The low-risk perception of extreme heat for older rural people may inform effective heat health warnings and effective use of primary health care in heat-health education. Listening to First Nations knowledge in dealing with heat may provide a powerful mechanism in which to protect health.

Conclusion

The extensive health effects of extreme heat highlights the necessity of further research and strengthening of services in preparation for an ageing rural population enduring climate change.

简介：极端高温对健康造成重大负担，尤其是对澳大利亚老年人而言：酷热会造成严重的健康负担，尤其是对澳大利亚老年人而言：评估酷热对澳大利亚地区和农村老年人的影响，包括临床表现、社会影响以及寻求健康的行为和适应：设计：系统性综述和叙述性综合：综述共收录了 10 篇文章，但对该主题的研究有限。酷热导致澳大利亚农村老年人的死亡率和救护车出动次数增加。极热天气会取消各种活动，并导致个人无法出门，从而对社会联系产生负面影响。空调是主要的降温机制，但成本是一个主要问题。尽管如此，农村老年人对适应极端高温的实际行为应对措施仍有很深的了解。研究表明，澳大利亚农村老年人并不认为酷热会威胁健康：讨论：需要进一步研究酷热对孤独感的影响。由于成本和碳排放量的增加，空调不可能成为应对酷热的最终解决方案。农村老年人对极端高温的低风险认知可能会为有效的高温健康警告和在高温健康教育中有效利用初级卫生保健提供依据。倾听原住民应对酷热的知识可能会为保护健康提供一个强有力的机制：极端高温对健康的广泛影响凸显了进一步研究和加强服务的必要性，以便为经受气候变化的农村老龄人口做好准备。

{"title":"The impact of extreme heat on older regional and rural Australians: A systematic review","authors":"Grace Harvey BHLTH, Suzanne Bain-Donohue VCHAM, Sari Puspa Dewi MD, MHPE","doi":"10.1111/ajr.13094","DOIUrl":"10.1111/ajr.13094","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Extreme heat causes a major health burden, especially for older Australians.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the impact of extreme heat on older regional and rural Australians, including clinical presentations, social implications, and health-seeking behaviours and adaptations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A systematic review and narrative synthesis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Ten articles were included in the review with research on this topic limited. Extreme heat causes an increase in mortality and ambulance dispatches for older rural Australians. Social connectedness is negatively affected by extreme heat due to cancellation of events and individuals becoming housebound. Air conditioning is the main cooling mechanism used, although cost is a major concern. Despite this, older rural populations display a depth of knowledge regarding practical behavioural responses to adapt to extreme heat. Studies show older rural Australians do not consider extreme heat to be a threat to health.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Further research needs to examine the role extreme heat may play in contributing to experiences of loneliness. Air conditioning cannot be the ultimate solution in responding to extreme heat due to cost and increased carbon emissions. The low-risk perception of extreme heat for older rural people may inform effective heat health warnings and effective use of primary health care in heat-health education. Listening to First Nations knowledge in dealing with heat may provide a powerful mechanism in which to protect health.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The extensive health effects of extreme heat highlights the necessity of further research and strengthening of services in preparation for an ageing rural population enduring climate change.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 2","pages":"216-226"},"PeriodicalIF":1.8,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13094","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139991893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Barriers and enablers of dementia training in healthcare workers in rural and remote Australia: A scoping review to inform future approaches to training 澳大利亚农村和偏远地区医护人员痴呆症培训的障碍和促进因素：为未来培训方法提供参考的范围审查。

IF 1.8 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2024-02-26 DOI: 10.1111/ajr.13090

Sandra Thompson PhD, Heidi Shukralla MPH&TM, Katrina Fyfe MSN, Ellie Newman MSc, Kathryn Fitzgerald MHPE

Introduction

Dementia is now responsible for the greatest burden of disease of any chronic illness in older Australians. Rural and remote communities bear the impacts of this disproportionately. Additional training and education for healthcare staff to support people living with dementia is needed.

Objective

The objective of this scoping review was to map and synthesise the evidence related to barriers and enablers of accessing dementia training for Australian healthcare workers located in rural and remote areas.

Design

This scoping review systematically searched multiple databases in January 2023 for peer-reviewed literature on the topic. Reviewers used Covidence to screen titles and abstracts of located sources, and to screen full-text articles.

Findings

From 187 articles screened, seven peer-reviewed journal articles were included in the final data analysis; all were from Australia or Canada. The most common barrier described was low staffing, precluding release of staff for dementia training. Enablers to participation in dementia training were availability of online training programs, as well as training providers collaborating with end users to ensure the training met their learning needs.

Discussion

This review provides evidence of barriers and enablers specific to rural and remote healthcare workers accessing dementia training. It also explores other approaches to training that have been trialled successfully in different settings.

Conclusion

Addressing the identified barriers and enablers may assist in developing training approaches appropriate for existing staff, and in meeting training needs for the future workforce.

导言：在所有慢性疾病中，痴呆症是目前给澳大利亚老年人造成最大疾病负担的疾病。农村和偏远社区受到的影响尤为严重。需要对医护人员进行更多的培训和教育，以支持痴呆症患者：本范围界定综述旨在对与澳大利亚农村和偏远地区医护人员获得痴呆症培训的障碍和促进因素有关的证据进行摸底和综合：本范围界定综述于 2023 年 1 月在多个数据库中系统检索了与该主题相关的同行评审文献。审稿人使用 Covidence 筛选所查找来源的标题和摘要，并筛选全文文章：从筛选出的 187 篇文章中，有 7 篇经同行评审的期刊文章被纳入最终数据分析；所有文章均来自澳大利亚或加拿大。最常见的障碍是人员配备不足，无法安排员工参加痴呆症培训。参加痴呆症培训的有利因素是在线培训项目的可用性，以及培训提供者与最终用户的合作，以确保培训满足他们的学习需求：本综述提供了有关农村和偏远地区医护人员参加痴呆症培训的障碍和促进因素的证据。讨论：本综述提供了农村和偏远地区医护人员在接受痴呆症培训时所面临的障碍和有利因素，同时还探讨了在不同环境下成功试行的其他培训方法：结论：解决已发现的障碍和有利因素可能有助于制定适合现有员工的培训方法，并满足未来员工队伍的培训需求。

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引用次数: 0

‘It sort of broke me’: A thematic analysis of the psychological experiences and coping strategies employed by Australian fire-affected farmers 它有点让我崩溃"：对澳大利亚受火灾影响的农民的心理经历和应对策略的专题分析。

IF 1.8 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2024-02-26 DOI: 10.1111/ajr.13086

Shannen R van der Kruk MSc, Kate M Gunn PhD

Introduction

People exposed to bushfires are known to be at heightened risk of experiencing mental health challenges. When farms are impacted, farmers often risk losing not only their homes but also their businesses, containing their livestock, infrastructure and identities.

Objective

To understand the psychological experiences of farmers who have been exposed to fires on their farms and identify the coping strategies they already employ to recover and prepare psychologically for future bushfires.

Design

In-depth, semi-structured interviews were conducted face-to-face or via Zoom. Thematic analysis was used to analyse the data, using a descriptive, essentialist approach. Sixteen farmers and/or their spouses (50% female; median age of 50.8 years), who owned and/or played an active role in the operation of a farming or pastoral enterprise and had been affected by a farm fire within the last 20 years, participated. Participants resided in inner regional, outer regional and remote South Australia and New South Wales.

Findings

Seven overarching themes and 22 subthemes resulted: (1) intense emotions in the aftermath, (2) long-term psychological challenges, (3) deliberate focus on organising, prioritising and completing recovery-focused tasks, (4) importance of seeking and/or accessing support to rebuild, (5) adopting a positive attitude and outlook, (6) (dis)engaging from/with community and social connection and (7) various strategies employed to self-regulate emotions.

Discussion/Conclusion

This study demonstrates the unique set of psychological challenges Australian farmers experience in the wake of a farm fire and the coping strategies they report using to help them manage. Findings will inform the development of contextually and culturally appropriate bushfire recovery and preparedness initiatives that are tailored to meet the unique needs of farmers and build upon their existing strengths.

导言：众所周知，遭受丛林火灾的人面临心理健康挑战的风险更高。当农场受到影响时，农民往往不仅面临失去家园的风险，还可能失去生意、牲畜、基础设施和身份：了解农场遭受火灾的农民的心理经历，并确定他们已经采取的应对策略，以便为今后的丛林火灾做好恢复和心理准备：面对面或通过 Zoom 进行了深入的半结构化访谈。采用描述性的本质主义方法对数据进行了主题分析。16 名农民和/或其配偶（50% 为女性；年龄中位数为 50.8 岁）参加了访谈，他们拥有农牧企业和/或在农牧企业的经营中发挥着积极作用，并在过去 20 年中受到过农场火灾的影响。参与者居住在南澳大利亚州和新南威尔士州的内地区、外地区和偏远地区：研究结果显示了 7 个总体主题和 22 个次主题：(1) 善后工作中的强烈情绪；(2) 长期的心理挑战；(3) 有意识地专注于组织、优先考虑和完成以恢复为重点的任务；(4) 寻求和/或获得重建支持的重要性；(5) 采取积极的态度和前景；(6) (不)参与社区和社会联系；(7) 采用各种策略来自我调节情绪：本研究展示了澳大利亚农民在农场火灾后所经历的一系列独特的心理挑战，以及他们所报告的帮助他们应对这些挑战的应对策略。研究结果将为制定符合实际情况和文化背景的丛林火灾恢复和防备措施提供信息，这些措施将满足农民的独特需求，并利用他们现有的优势。

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引用次数: 0