Jamie Cransberg, Judith Katzenellenbogen, Bo Remenyi, Carl Francia, Kevin Murray, Ingrid Stacey
Objective
To describe the clinical and demographic profile of Australian children first diagnosed with acute rheumatic fever (ARF) or rheumatic heart disease (RHD) before the age of 5 years, with comparison to children aged 5–14 years.
Methods
Linked emergency department, hospitalisation, RHD register and death records from the End RHD in Australia: Study of Epidemiology were used to identify first ARF/RHD diagnosis occurring in < 15-year-olds. Demographic/clinical profiles and pre-diagnosis healthcare interactions were analysed with stratification into 5-year age groups.
Design
Retrospective cross-sectional linked administrative data analysis.
Setting
Northern Territory, South Australia, Queensland and Western Australia.
Participants
Children aged < 15 years at first hospitalisation or notification for ARF or RHD, 2001–2017.
Main Outcome Measures
Disease stage and severity at diagnosis, register notification status, clinical history prior to ARF or RHD diagnosis.
Results
Of 2382 children diagnosed with ARF/RHD aged < 15 years, 180 (7.6%) were aged under 5 years. Among under 5-year-olds with ARF or RHD, 30.6% had not been notified to RHD registers. A total 49 under 5-year-olds were diagnosed with RHD; with 22 (44.9%) classified as having mild disease, 16 (32.7%) moderate and 6 (12.2%) severe. High hospitalisation rates for injury in the first year of life were observed for the < 5-year-old cohort with ARF/RHD.
Conclusions
We present the first comprehensive Australian evidence that ARF and RHD diagnoses are occurring in Australian children aged under 5 years. Greater awareness among clinicians is needed regarding ARF/RHD as a potential diagnosis in this young, high risk age group.
{"title":"A Retrospective Linked Data Analysis of Acute Rheumatic Fever and Rheumatic Heart Disease Diagnoses in Children Aged Under Five Years in Australia, 2001–2017","authors":"Jamie Cransberg, Judith Katzenellenbogen, Bo Remenyi, Carl Francia, Kevin Murray, Ingrid Stacey","doi":"10.1111/ajr.70135","DOIUrl":"10.1111/ajr.70135","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To describe the clinical and demographic profile of Australian children first diagnosed with acute rheumatic fever (ARF) or rheumatic heart disease (RHD) before the age of 5 years, with comparison to children aged 5–14 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Linked emergency department, hospitalisation, RHD register and death records from the End RHD in Australia: Study of Epidemiology were used to identify first ARF/RHD diagnosis occurring in < 15-year-olds. Demographic/clinical profiles and pre-diagnosis healthcare interactions were analysed with stratification into 5-year age groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective cross-sectional linked administrative data analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Northern Territory, South Australia, Queensland and Western Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Children aged < 15 years at first hospitalisation or notification for ARF or RHD, 2001–2017.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Disease stage and severity at diagnosis, register notification status, clinical history prior to ARF or RHD diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 2382 children diagnosed with ARF/RHD aged < 15 years, 180 (7.6%) were aged under 5 years. Among under 5-year-olds with ARF or RHD, 30.6% had not been notified to RHD registers. A total 49 under 5-year-olds were diagnosed with RHD; with 22 (44.9%) classified as having mild disease, 16 (32.7%) moderate and 6 (12.2%) severe. High hospitalisation rates for injury in the first year of life were observed for the < 5-year-old cohort with ARF/RHD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We present the first comprehensive Australian evidence that ARF and RHD diagnoses are occurring in Australian children aged under 5 years. Greater awareness among clinicians is needed regarding ARF/RHD as a potential diagnosis in this young, high risk age group.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"34 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12800885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967911","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}
Clara Walker, Gordon Mander, Roma Forbes, Anthony Bruce Fallon, Jessica Elliott, Marina Paine, Geoff Argus
Objective
To understand student and supervisor perceptions of the benefits and challenges of undertaking longer-term rural placements.
Participants and Setting
Nursing, midwifery and allied health students who completed a clinical placement of at least 8-week duration in the Darling Downs and South West Queensland regions in 2022 and placement supervisors.
Design
Qualitative inductive design using semi-structured interviews.
Results
Nineteen student and 14 supervisor interviews were conducted. Four key themes were identified—(1) Rural community connection and engagement, (2) Students developing confidence and integrating into healthcare teams, (3) Investing in student supervision and (4) Social, practical and logistical considerations.
Conclusion
Results suggest that longer-term placements facilitate valuable rural community connections and foster trust between students and supervisors, leading to increased independent practice and, in some cases, reduced supervision workload. Both community connections and integration into healthcare teams are likely to foster place-based connections over the longer duration of placements, thereby positively contributing to rural workforce outcomes. Social, practical and financial challenges were noted, and as such, adequate supports are critical to positive longer-term placement experiences. Rural workforce policy should continue to promote longer-term health placement opportunities, including sufficient support for placement provider organisations and supervisors, to support rural workforce recruitment and retention.
{"title":"Student and Supervisor Qualitative Perspectives of the Benefits and Challenges of Longer-Term Rural Nursing, Midwifery and Allied Health Placements","authors":"Clara Walker, Gordon Mander, Roma Forbes, Anthony Bruce Fallon, Jessica Elliott, Marina Paine, Geoff Argus","doi":"10.1111/ajr.70139","DOIUrl":"10.1111/ajr.70139","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To understand student and supervisor perceptions of the benefits and challenges of undertaking longer-term rural placements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants and Setting</h3>\u0000 \u0000 <p>Nursing, midwifery and allied health students who completed a clinical placement of at least 8-week duration in the Darling Downs and South West Queensland regions in 2022 and placement supervisors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Qualitative inductive design using semi-structured interviews.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Nineteen student and 14 supervisor interviews were conducted. Four key themes were identified—(1) Rural community connection and engagement, (2) Students developing confidence and integrating into healthcare teams, (3) Investing in student supervision and (4) Social, practical and logistical considerations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Results suggest that longer-term placements facilitate valuable rural community connections and foster trust between students and supervisors, leading to increased independent practice and, in some cases, reduced supervision workload. Both community connections and integration into healthcare teams are likely to foster place-based connections over the longer duration of placements, thereby positively contributing to rural workforce outcomes. Social, practical and financial challenges were noted, and as such, adequate supports are critical to positive longer-term placement experiences. Rural workforce policy should continue to promote longer-term health placement opportunities, including sufficient support for placement provider organisations and supervisors, to support rural workforce recruitment and retention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"34 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145960872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sisira Dharmaratne, Wasana Jayarathne, Asela Olupeliyawa, Kam Cheong Wong, Stephen Tobin, Damien Limberger, Uchechukwu Levi Osuagwu
Introduction
Understanding the unique affordances of place-based medical education (PBME) is essential to train highly skilled physicians for a particular place. Clinical reasoning (CR)—a context-specific core physician competency—is well suited to achieve this goal.
Objective
To map existing evidence and conceptualise how ‘place’ impacts CR development in medical students and trainees.
Design
Using PRISMA ScR guidelines, empirical, peer-reviewed, full-text, English-language journal articles on PBME in Medline, CINAHL, Scopus, and ERIC databases published between 1975 and 2024 were reviewed. Place and CR development were defined as participants' sense of authentic clinical training environment and learning of relevant to cognitive and sociocultural processes of patient diagnosis and management, respectively. A theory informed constructivist content analysis of data was undertaken.
Results
Of 2874 records, 27 met the inclusion criteria. CR development was an indirect finding in 26/27 reports. Evidence was available only for rural medically underserved places which afforded ‘HARD’, detailed as follows: longitudinal integrated clerkships, routine parallel consultations, closely knit teams, and workforce constraints enabled Hands-on patient engagements (H), Abundant patient exposures (A), and supported taking responsibility in patient care (R). Exposure to diverse practice niches and resource constraints sensitised students to Diversity in clinical practices (D).
Discussion
‘HARD’ characterises place dependence and place attachment in CR development and fosters an identity aligning with expert clinicians situating reasoning in context. These underpin dynamic patterns of context signifying the distinctiveness of place.
Conclusions
Exploring distinctiveness of place using ‘HARD’ framework can transform PBME scholarship to prepare more physicians ready to serve intended places, including the medically underserved.
{"title":"‘HARD’ Training Environments Foster a Distinct Sense of Place: A Scoping Review and a Conceptual Framework on ‘Place’ and Clinical Reasoning Development","authors":"Sisira Dharmaratne, Wasana Jayarathne, Asela Olupeliyawa, Kam Cheong Wong, Stephen Tobin, Damien Limberger, Uchechukwu Levi Osuagwu","doi":"10.1111/ajr.70145","DOIUrl":"10.1111/ajr.70145","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Understanding the unique affordances of place-based medical education (PBME) is essential to train highly skilled physicians for a particular place. Clinical reasoning (CR)—a context-specific core physician competency—is well suited to achieve this goal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To map existing evidence and conceptualise how ‘place’ impacts CR development in medical students and trainees.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Using PRISMA ScR guidelines, empirical, peer-reviewed, full-text, English-language journal articles on PBME in Medline, CINAHL, Scopus, and ERIC databases published between 1975 and 2024 were reviewed. Place and CR development were defined as participants' sense of authentic clinical training environment and learning of relevant to cognitive and sociocultural processes of patient diagnosis and management, respectively. A theory informed constructivist content analysis of data was undertaken.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 2874 records, 27 met the inclusion criteria. CR development was an indirect finding in 26/27 reports. Evidence was available only for rural medically underserved places which afforded ‘HARD’, detailed as follows: longitudinal integrated clerkships, routine parallel consultations, closely knit teams, and workforce constraints enabled Hands-on patient engagements (H), Abundant patient exposures (A), and supported taking responsibility in patient care (R). Exposure to diverse practice niches and resource constraints sensitised students to Diversity in clinical practices (D).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>‘HARD’ characterises place dependence and place attachment in CR development and fosters an identity aligning with expert clinicians situating reasoning in context. These underpin dynamic patterns of context signifying the distinctiveness of place.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Exploring distinctiveness of place using ‘HARD’ framework can transform PBME scholarship to prepare more physicians ready to serve intended places, including the medically underserved.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"34 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145960727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To identify the barriers and facilitators for timely detection and optimal management of otitis media (OM) in Aboriginal children in a primary care setting from the perspective of Health Care Providers (HCPs).
Setting
A large regional town in the Kimberley region of Western Australia.
Participants
Thirty HCPs to Aboriginal children.
Design
A qualitative, aboriginal co-designed, participatory action research study with semi-structured interviews and focus groups.
Results
Barriers were identified throughout the child's presentation and management and included challenges with paediatric ear examinations, earwax obstructing the view of the tympanic membrane, unfamiliarity with diagnostic tools, multiple guidelines with varying recommendations, and confusion with accessing ENT specialists. Multiple facilitators were identified and included training HCPs in paediatric examination techniques and wax removal, a single best practice guideline, and system changes to facilitate access to ENT specialist support if required. Importantly, an expanded clinical role of Aboriginal Health Practitioners (AHPs) was identified to augment efficient and effective clinical OM assessment and management in children presenting to clinic.
Conclusions
All barriers could potentially be overcome through a programme that enhances theoretical knowledge and practical skills in paediatric ear examination, otoscopy, and safe, timely removal of earwax, improved communication with ENT specialists, and an expanded clinical role for AHPs. Our findings carry important implications for managing OM in primary care services across Australia.
{"title":"The Determinants to Effective Diagnosis and Management of Otitis Media in Aboriginal Children in Primary Care From the Perspective of Health Care Practitioners","authors":"Gloria Lau, Roz Walker, Pamela Laird, Philomena Lewis, Jafri Kuthubutheen, André Schultz","doi":"10.1111/ajr.70144","DOIUrl":"10.1111/ajr.70144","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To identify the barriers and facilitators for timely detection and optimal management of otitis media (OM) in Aboriginal children in a primary care setting from the perspective of Health Care Providers (HCPs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>A large regional town in the Kimberley region of Western Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Thirty HCPs to Aboriginal children.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A qualitative, aboriginal co-designed, participatory action research study with semi-structured interviews and focus groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Barriers were identified throughout the child's presentation and management and included challenges with paediatric ear examinations, earwax obstructing the view of the tympanic membrane, unfamiliarity with diagnostic tools, multiple guidelines with varying recommendations, and confusion with accessing ENT specialists. Multiple facilitators were identified and included training HCPs in paediatric examination techniques and wax removal, a single best practice guideline, and system changes to facilitate access to ENT specialist support if required. Importantly, an expanded clinical role of Aboriginal Health Practitioners (AHPs) was identified to augment efficient and effective clinical OM assessment and management in children presenting to clinic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>All barriers could potentially be overcome through a programme that enhances theoretical knowledge and practical skills in paediatric ear examination, otoscopy, and safe, timely removal of earwax, improved communication with ENT specialists, and an expanded clinical role for AHPs. Our findings carry important implications for managing OM in primary care services across Australia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"34 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145946996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Catherine Sanford, Debra Jones, Melissa Welsh, Robert Dyson, Xiang-Yu Hou
Objective
This case study describes the contributions made by the Broken Hill University Department of Rural Health (BHUDRH) to improving child health care access and health outcomes over almost three decades.
Background
Compared to their metropolitan counterparts, rural and remote children experience persistent inequities in health, development, and education, exacerbated by environmental and service access challenges.
Methods
A retrospective synthesis of program documentation, evaluation reports, and peer-reviewed literature relating to four major BHUDRH-supported initiatives: lead management programs, the Allied Health in Outback Schools Program, School Health Hubs, and the School-Based Primary Health Care Registered Nurse initiative was undertaken.
Findings
The BHUDRH contributed to the development and delivery of child health services through investments in program development; research and evaluation; workforce development; and service delivery. The BHUDRH used its intellectual capital to help guide these developments through leadership and cross sector collaboration; governance and oversight; and securing funding for infrastructure development. Outcomes included a 75% reduction in average blood lead levels; access to allied health services for approximately 150 school children annually; establishment of $4.7M School Health Hub infrastructure across seven primary schools; and creation of a new workforce of school-embedded primary health care nurses.
Conclusion
This case study demonstrates how UDRHs act as catalysts for sustained, system-level change in response to community-identified health priorities. Lessons from Broken Hill highlight the value of university-community partnerships, research translation, and cross-sector governance in addressing complex rural health inequities. These contributions highlight the significant contributions made by UDRHs in rural contexts beyond health workforce parameters.
{"title":"Building Better Futures: A Case Study of the Broken Hill University Department of Rural Health's Contributions to Child Health and Development","authors":"Catherine Sanford, Debra Jones, Melissa Welsh, Robert Dyson, Xiang-Yu Hou","doi":"10.1111/ajr.70143","DOIUrl":"10.1111/ajr.70143","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This case study describes the contributions made by the Broken Hill University Department of Rural Health (BHUDRH) to improving child health care access and health outcomes over almost three decades.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Compared to their metropolitan counterparts, rural and remote children experience persistent inequities in health, development, and education, exacerbated by environmental and service access challenges.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective synthesis of program documentation, evaluation reports, and peer-reviewed literature relating to four major BHUDRH-supported initiatives: lead management programs, the Allied Health in Outback Schools Program, School Health Hubs, and the School-Based Primary Health Care Registered Nurse initiative was undertaken.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>The BHUDRH contributed to the development and delivery of child health services through investments in program development; research and evaluation; workforce development; and service delivery. The BHUDRH used its intellectual capital to help guide these developments through leadership and cross sector collaboration; governance and oversight; and securing funding for infrastructure development. Outcomes included a 75% reduction in average blood lead levels; access to allied health services for approximately 150 school children annually; establishment of $4.7M School Health Hub infrastructure across seven primary schools; and creation of a new workforce of school-embedded primary health care nurses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This case study demonstrates how UDRHs act as catalysts for sustained, system-level change in response to community-identified health priorities. Lessons from Broken Hill highlight the value of university-community partnerships, research translation, and cross-sector governance in addressing complex rural health inequities. These contributions highlight the significant contributions made by UDRHs in rural contexts beyond health workforce parameters.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"34 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145936463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ellen Payne, Susan Heaney, Clare E. Collins, Megan Rollo, Leanne Brown
Objective
The aim of this study was to describe the antenatal healthcare service delivery experienced by Australians with previous diabetes in pregnancy and to compare across regional, rural and metropolitan areas.
Methods
An email invitation with an online survey was sent to potentially eligible individuals on the National Diabetes Services Scheme email list. Individuals over the age of 18 who had experienced diabetes in pregnancy in the previous 2 years, who received their care in Australia and were not currently pregnant were eligible.
Design
Cross-sectional survey.
Setting
Australia-wide.
Participants
People with experience of diabetes in pregnancy in Australia within 2 years at the time of survey completion.
Main Outcome Measures
Demographic, pregnancy and diabetes-related data, frequency and location of contact with key health professionals, distance travelled for care and satisfaction with care delivery.
Results
A total of 668 respondents completed the survey (n = 489 metropolitan, n = 74 regional, n = 101 rural). Those in rural Australia were less likely to see an endocrinologist during their pregnancy compared to metropolitan (34.8% rural, 53.2% metropolitan). There was a statistically significant difference in overall care satisfaction between metropolitan and rural respondents, with rural respondents less likely to be ‘very satisfied’ with their care compared to metropolitan (p = 0.011).
Conclusion
Understanding the differences in antenatal care delivery from the perspectives of those with diabetes in pregnancy can assist in the planning and delivery of optimal antenatal healthcare in rural areas. Further research is required to explore the specific elements of care that rural women would like changed to improve their overall experience.
{"title":"Healthcare Service Delivery Experiences of Australians With Previous Diabetes in Pregnancy: Results From a Cross-Sectional Survey With a Rural and Metropolitan Comparison","authors":"Ellen Payne, Susan Heaney, Clare E. Collins, Megan Rollo, Leanne Brown","doi":"10.1111/ajr.70141","DOIUrl":"https://doi.org/10.1111/ajr.70141","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The aim of this study was to describe the antenatal healthcare service delivery experienced by Australians with previous diabetes in pregnancy and to compare across regional, rural and metropolitan areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An email invitation with an online survey was sent to potentially eligible individuals on the National Diabetes Services Scheme email list. Individuals over the age of 18 who had experienced diabetes in pregnancy in the previous 2 years, who received their care in Australia and were not currently pregnant were eligible.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Cross-sectional survey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Australia-wide.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>People with experience of diabetes in pregnancy in Australia within 2 years at the time of survey completion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Demographic, pregnancy and diabetes-related data, frequency and location of contact with key health professionals, distance travelled for care and satisfaction with care delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 668 respondents completed the survey (<i>n</i> = 489 metropolitan, <i>n</i> = 74 regional, <i>n</i> = 101 rural). Those in rural Australia were less likely to see an endocrinologist during their pregnancy compared to metropolitan (34.8% rural, 53.2% metropolitan). There was a statistically significant difference in overall care satisfaction between metropolitan and rural respondents, with rural respondents less likely to be ‘very satisfied’ with their care compared to metropolitan (<i>p</i> = 0.011).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Understanding the differences in antenatal care delivery from the perspectives of those with diabetes in pregnancy can assist in the planning and delivery of optimal antenatal healthcare in rural areas. Further research is required to explore the specific elements of care that rural women would like changed to improve their overall experience.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"34 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicky Stanley-Clarke, Jorie Knook, Amanda Hay, Robbie Maris, Christopher Andrews, Louise Winder
Objective
The good farmer typology is embedded in New Zealand (NZ) farmer culture as a resilient farmer persevering through tough times without needing help or support from others. This article explores how NZ's good farmer typology influences the mental health help-seeking behaviours of agricultural university students.
Setting
This research took place at the two primary land-based universities in New Zealand.
Participants
Fifteen university students who had recently completed a young farmer mental health education programme participated in this study.
Design
This is a qualitative exploratory study utilising semi-structured interviews and thematic analysis.
Results
This study finds that the NZ good farmer identity dominates agricultural students' attitudes towards help-seeking activities. Despite students saying that the stoic attitude of older farmers was not as prevalent amongst their generation, this was not evident in their attitudes.
Conclusion
Students believed it was important to talk about mental health issues, but did not prioritise this for themselves and were reluctant to engage in help-seeking. The research has implications for those delivering mental health and wellbeing messages and support to young people studying agriculture. It suggests that there is still work to do to address unhelpful attitudes amongst all generations of farmers to break down barriers to mental health education and help-seeking.
{"title":"The Impact of New Zealand's Good Farmer Identity on Agricultural Student's Mental Health Help-Seeking Behaviours","authors":"Nicky Stanley-Clarke, Jorie Knook, Amanda Hay, Robbie Maris, Christopher Andrews, Louise Winder","doi":"10.1111/ajr.70137","DOIUrl":"https://doi.org/10.1111/ajr.70137","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The good farmer typology is embedded in New Zealand (NZ) farmer culture as a resilient farmer persevering through tough times without needing help or support from others. This article explores how NZ's good farmer typology influences the mental health help-seeking behaviours of agricultural university students.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>This research took place at the two primary land-based universities in New Zealand.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Fifteen university students who had recently completed a young farmer mental health education programme participated in this study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>This is a qualitative exploratory study utilising semi-structured interviews and thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This study finds that the NZ good farmer identity dominates agricultural students' attitudes towards help-seeking activities. Despite students saying that the stoic attitude of older farmers was not as prevalent amongst their generation, this was not evident in their attitudes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Students believed it was important to talk about mental health issues, but did not prioritise this for themselves and were reluctant to engage in help-seeking. The research has implications for those delivering mental health and wellbeing messages and support to young people studying agriculture. It suggests that there is still work to do to address unhelpful attitudes amongst all generations of farmers to break down barriers to mental health education and help-seeking.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"34 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Metacarpal fractures are common injuries which can result in significant loss of function. While many metacarpal fractures can be treated nonoperatively, surgical management options include the use of Kirschner wires, plates and screws (1, 2). In Australia, metacarpal fractures are usually managed by specialised Plastic or Orthopaedic surgeons. Provision of plastic and orthopaedic surgery in rural and remote Australia is often limited. Management of metacarpal fractures by general surgeons, who are more widespread throughout rural Australia, is not described in the literature. This study describes the demographics, surgical techniques and outcomes of metacarpal fractures managed by a rural general surgeon in rural Western Australia.
Methods
Retrospective cohort study.
Design
Observational.
Setting
Single-centre public hospital in rural Western Australia.
Participants
All patients who underwent surgical management of metacarpal fractures from 2018 to 2023 at the study hospital.
Main Outcome Measures
Demographics, mechanism of injury, surgical techniques and outcomes of surgically managed metacarpal fractures.
Results
In total, 68 cases of surgically managed metacarpal fractures are described, including 42 open and 25 percutaneous fixations. Mean time to surgery from injury was 7.3 days (median 4 days). Documented nonunion or malunion occurred in 3% of cases. In total, seven cases required unplanned return to theatre, and four cases experienced postoperative infection within 30 days.
Conclusions
Metacarpal fractures can be safely managed by an appropriately trained general surgeon in rural Australia, ensuring patient-centred, timely and effective treatment with excellent clinical outcomes.
{"title":"Surgical Management of Metacarpal Fractures by a General Surgeon in Rural Australia: A Single-Centre Experience","authors":"Jamie Cransberg, Edward Yeboah","doi":"10.1111/ajr.70136","DOIUrl":"10.1111/ajr.70136","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Metacarpal fractures are common injuries which can result in significant loss of function. While many metacarpal fractures can be treated nonoperatively, surgical management options include the use of Kirschner wires, plates and screws (1, 2). In Australia, metacarpal fractures are usually managed by specialised Plastic or Orthopaedic surgeons. Provision of plastic and orthopaedic surgery in rural and remote Australia is often limited. Management of metacarpal fractures by general surgeons, who are more widespread throughout rural Australia, is not described in the literature. This study describes the demographics, surgical techniques and outcomes of metacarpal fractures managed by a rural general surgeon in rural Western Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Observational.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Single-centre public hospital in rural Western Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>All patients who underwent surgical management of metacarpal fractures from 2018 to 2023 at the study hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Demographics, mechanism of injury, surgical techniques and outcomes of surgically managed metacarpal fractures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 68 cases of surgically managed metacarpal fractures are described, including 42 open and 25 percutaneous fixations. Mean time to surgery from injury was 7.3 days (median 4 days). Documented nonunion or malunion occurred in 3% of cases. In total, seven cases required unplanned return to theatre, and four cases experienced postoperative infection within 30 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Metacarpal fractures can be safely managed by an appropriately trained general surgeon in rural Australia, ensuring patient-centred, timely and effective treatment with excellent clinical outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145851283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Karen Lansdown, Heuiwon Han, Daniel Fernandez, Tanya Cleland, Melody Martin, Helen Paris Hamer, Rohini Khareedi
Aim
This article introduces an innovative educational model, ‘flipping the chair,’ a dynamic approach to delivering rural and remote education. Drawing on 4 years of satellite teaching experiences at Auckland University of Technology (AUT), we share key insights and lessons learnt to inform future initiatives in other university and educational settings.
Context
Delivering comprehensive oral health education to rural and remote communities can be a complex challenge due to geographic isolation, limited resources, and workforce shortages. To address these inequities, a strategic partnership was formed in 2022 with Health New Zealand—Te Whatu Ora in Northland. This collaborative initiative prioritises the recruitment of Māori (Indigenous population of Aotearoa New Zealand) students who may experience significant barriers to accessing higher education in urban regions, with the benefit of academic study in familiar surroundings.
Approach
Our satellite model of dental education was introduced in 2022 with an initial cohort of six first-year students, five students in 2023, nine in 2024, and five in 2025. Across all years, 56% of students identified as Māori. The first graduating cohort of five students completed the programme in 2024. This article discusses how AUT developed and implemented dental education within rural and remote communities.
Conclusion
By adapting and ‘flipping’ the traditional university model, we have developed a sustainable approach to rural and remote dental education with promising educational outcomes.
{"title":"‘Flipping the Chair’: A Satellite Model for Dental Education in Rural and Remote Communities in Aotearoa New Zealand","authors":"Karen Lansdown, Heuiwon Han, Daniel Fernandez, Tanya Cleland, Melody Martin, Helen Paris Hamer, Rohini Khareedi","doi":"10.1111/ajr.70138","DOIUrl":"10.1111/ajr.70138","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This article introduces an innovative educational model, ‘flipping the chair,’ a dynamic approach to delivering rural and remote education. Drawing on 4 years of satellite teaching experiences at Auckland University of Technology (AUT), we share key insights and lessons learnt to inform future initiatives in other university and educational settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Context</h3>\u0000 \u0000 <p>Delivering comprehensive oral health education to rural and remote communities can be a complex challenge due to geographic isolation, limited resources, and workforce shortages. To address these inequities, a strategic partnership was formed in 2022 with Health New Zealand—Te Whatu Ora in Northland. This collaborative initiative prioritises the recruitment of Māori (Indigenous population of Aotearoa New Zealand) students who may experience significant barriers to accessing higher education in urban regions, with the benefit of academic study in familiar surroundings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Approach</h3>\u0000 \u0000 <p>Our satellite model of dental education was introduced in 2022 with an initial cohort of six first-year students, five students in 2023, nine in 2024, and five in 2025. Across all years, 56% of students identified as Māori. The first graduating cohort of five students completed the programme in 2024. This article discusses how AUT developed and implemented dental education within rural and remote communities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>By adapting and ‘flipping’ the traditional university model, we have developed a sustainable approach to rural and remote dental education with promising educational outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145851260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cardiometabolic disease contributes to increased morbidity and mortality in rural and remote Australia. Digital health technologies offer a promising solution to enhance healthcare access and support self-management.
Objective
This systematic review examined the effectiveness, feasibility and acceptability of implementing digital health interventions to improve cardiometabolic health outcomes in rural and remote Australia.
Design
PubMed, MEDLINE, Embase, Scopus and CINAHL were searched from inception to end of July 2025. Eligible studies included interventional, observational and qualitative studies focused on digital interventions for cardiometabolic conditions. Due to heterogeneity among studies, a meta-analysis was not conducted; instead, a narrative synthesis was used to summarise outcomes.
Findings
Seventeen studies (7 RCTs, 1 quasi-experimental, 7 observational and 2 qualitative) evaluated digital health interventions including video consultations, telephone coaching, apps, wearables and web platforms. Telemonitoring significantly reduced HbA1c (MD = −5.5%), with modest reduction via telephone support (RR = 0.96). Telestroke programs were associated with lower stroke mortality at 6 months (HR = 0.53) and 12 months (HR = 0.58). The review also demonstrated the feasibility and acceptability of digital health interventions, particularly when culturally tailored and delivered by local providers, with successful remote adaptation and high initial engagement. Interventions such as tele-endocrinology and the “Healthy Weight” program were cost-effective, contributing to improved HbA1c and quality of life. However, challenges included limited physical assessments, technical barriers and declining patient engagement over time.
Conclusions
Digital health technologies, ranging from telehealth to mobile and web-based tools, can enhance cardiometabolic outcomes in rural and remote settings, though barriers such as technology access and sustained engagement remain.
{"title":"Digital Health Interventions for Cardiometabolic Health Outcomes in Rural and Remote Australia: A Systematic Review","authors":"Cheru Tesema Leshargie, Meless Gebrie Bore, Hazel Dalton, Subash Thapa, Fentaw Tadese Berhe, Zemenu Yohannes Kassa, Zekariyas Sahile Nezenega, Setognal B. Aychiluhm, Feleke Hailemichael Astawesegn, Birhanu Wondimeneh Demissie, Tebikew Yeneabat Mengist, Kedir Y. Ahmed","doi":"10.1111/ajr.70130","DOIUrl":"10.1111/ajr.70130","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Cardiometabolic disease contributes to increased morbidity and mortality in rural and remote Australia. Digital health technologies offer a promising solution to enhance healthcare access and support self-management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This systematic review examined the effectiveness, feasibility and acceptability of implementing digital health interventions to improve cardiometabolic health outcomes in rural and remote Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>PubMed, MEDLINE, Embase, Scopus and CINAHL were searched from inception to end of July 2025. Eligible studies included interventional, observational and qualitative studies focused on digital interventions for cardiometabolic conditions. Due to heterogeneity among studies, a meta-analysis was not conducted; instead, a narrative synthesis was used to summarise outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Seventeen studies (7 RCTs, 1 quasi-experimental, 7 observational and 2 qualitative) evaluated digital health interventions including video consultations, telephone coaching, apps, wearables and web platforms. Telemonitoring significantly reduced HbA1c (MD = −5.5%), with modest reduction via telephone support (RR = 0.96). Telestroke programs were associated with lower stroke mortality at 6 months (HR = 0.53) and 12 months (HR = 0.58). The review also demonstrated the feasibility and acceptability of digital health interventions, particularly when culturally tailored and delivered by local providers, with successful remote adaptation and high initial engagement. Interventions such as tele-endocrinology and the “Healthy Weight” program were cost-effective, contributing to improved HbA1c and quality of life. However, challenges included limited physical assessments, technical barriers and declining patient engagement over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Digital health technologies, ranging from telehealth to mobile and web-based tools, can enhance cardiometabolic outcomes in rural and remote settings, though barriers such as technology access and sustained engagement remain.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12742273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835396","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号