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Australian Journal of Rural Health最新文献

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Farmer wants a skin check: Improving skin cancer surveillance in rural Australia 农民要做皮肤检查:改善澳大利亚农村地区的皮肤癌监测。
IF 1.9 4区 医学 Q2 NURSING Pub Date : 2024-07-24 DOI: 10.1111/ajr.13172
Andjela Arandjelovic MD
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引用次数: 0
Assessment, diagnosis and management characteristics of people with acute Charcot neuro-osteoarthropathy in a regional Australian health service: A 3-year retrospective audit 澳大利亚地区医疗服务机构对急性夏科神经关节病患者的评估、诊断和管理特点:为期三年的回顾性审计。
IF 1.9 4区 医学 Q2 NURSING Pub Date : 2024-07-23 DOI: 10.1111/ajr.13168
Dimitri Diacogiorgis MApplSc, Byron Matthew Perrin PhD, Michael Ian Charles Kingsley PhD

Objective

Acute Charcot neuro-osteoarthropathy (CN) is highly destructive, causing bone and joint damage that can result in devastating structural changes to the foot. The objective of this study was to determine the characteristics of assessment, diagnosis and management of people with acute CN attending a large regional Australian health service.

Design

Three-year retrospective medical record audit.

Setting

Large regional health service with catchment area of >250 000 people in regional Australia.

Participants

People with acute CN who attended emergency, orthopaedic clinics or High Risk Foot Clinic (HRFC).

Main Outcome Measures

Participant characteristics and acute CN assessment, diagnosis and management characteristics. Trends in characteristics were investigated according to rurality as measured by the Modified Monash Model (MMM) scale.

Results

Seventeen participants (20 presentations) of acute CN were identified. Mean age was 57.1 ± 10.8 years, with 11 female participants. Median duration to seek help was 31 (IQR 14–47) days. Total Contact Casting was undertaken for 85% of cases, with those who resided in MMM1-2 regions experienced significantly shorter time to TCC therapy compared to those residing in MMM3-7 regions (U = 3.0, p < 0.01). Resolution of acute CN with or without deformity occurred in 70% of cases.

Conclusions

Those who lived in smaller regional and rural communities were more likely to experience delayed access to gold standard treatment for acute CN. Regional models of care for acute CN should include activities to improve the knowledge of people at risk of acute CN about the condition and upskill regional health professionals for timely and local TCC therapy.

目的:急性夏科神经骨关节病(CN)具有高度破坏性,会造成骨和关节损伤,从而导致足部结构发生破坏性变化。本研究旨在确定在澳大利亚大型地区医疗服务机构就诊的急性夏科氏神经关节病患者在评估、诊断和管理方面的特点:设计:三年回顾性病历审计:环境:澳大利亚地区的大型区域医疗服务机构,服务范围超过 25 万人:主要结果测量指标:主要结果测量:参与者特征以及急性 CN 评估、诊断和管理特征。根据 "修正莫纳什模型"(MMM)量表测量的农村地区特征对特征趋势进行了调查:共发现 17 名急性 CN 患者(20 例病例)。平均年龄为 57.1 ± 10.8 岁,其中 11 人为女性。求助时间中位数为 31 天(IQR 14-47 天)。居住在较小区域和农村社区的人更有可能延迟获得急性 CN 的金标准治疗。急性氯化萘的区域治疗模式应包括开展各种活动,提高急性氯化萘高危人群对该病的认识,并提高区域卫生专业人员的技能,以便及时在当地进行TCC治疗。
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引用次数: 0
Building research capacity at a rural place-based community service organisation in southwest Victoria, Australia 澳大利亚维多利亚州西南部一个以地方为基础的农村社区服务组织的研究能力建设。
IF 1.9 4区 医学 Q2 NURSING Pub Date : 2024-07-23 DOI: 10.1111/ajr.13170
Bianca E. Kavanagh PhD, Kevin P. Mc Namara PhD, Penny Bolton MPH, Carly Dennis BPH, Vincent L. Versace PhD
<p>Due to their unique ability to appreciate the local context, rural place-based health and community services are central to the prevention and management of health and social issues.<span><sup>1</sup></span> Place-based approaches allow relevant evidence to be generated locally; however, at present, there is a lack of evidence generated from rurally based health services<span><sup>1</sup></span> and arguably less evidence produced from the community services sector.<span><sup>2</sup></span> This lack of evidence limits the ability for policy-makers to make evidence-informed decisions about how to improve outcomes for rural populations.<span><sup>3</sup></span> There is an increasing need to provide evidence of outcomes within the community services sector, and the need to have mechanisms in place to capture, analyse and report data has been identified.<span><sup>4</sup></span> However, the complexities of this sector—including that services are delivered within complex, dynamic and multifaceted social contexts, with multiple funding sources—have led to challenges for community services to conduct research. This impedes the opportunity to enhance service performance and outcomes.<span><sup>4</sup></span> The experiences of rural health services might inform a framework for generating evidence in the community services sector. Rural health services are reported to be motivated to build research capacity to attract and retain the rural workforce,<span><sup>5</sup></span> and parallels with the community services sector may exist.</p><p>Research capacity building is an effective approach to generating and applying new knowledge to improve outcomes.<span><sup>6</sup></span> Cooke et al.<span><sup>6</sup></span> suggested that if research questions are developed through consultation with users (i.e. service providers and policy-makers), then the research generated is relevant to fundamental health issues and concerns; this may be particularly relevant to regional, rural and remote (RRR) areas. The embedded research (ER) model may support evidence acumen by bridging the disparity between research and service delivery.<span><sup>7</sup></span> Embedded researchers (i.e. when a researcher is embedded into a ‘host’ organisation) may assist in building research capacity through their function of conducting collaborative and ‘on the ground’ research.<span><sup>7</sup></span> This model differs from the bench-to-bedside model and may be a sustainable approach to research capacity building in RRR contexts.<span><sup>1</sup></span> The ER model may circumvent the need for lower-resourced health and community services from consulting with external researchers to generate evidence. Despite being a relatively new approach to building research capacity in RRR contexts, the ER model has gained traction and demonstrated success in recent years.<span><sup>8</sup></span></p><p>An ER model was recently implemented at Brophy Family and Youth Services (Brophy) in south
星光基金会是澳大利亚规模较大的非营利性组织,在多边环境协定和研究方面拥有较为成熟的文化。这次咨询为当前的工作和方法提供了宝贵的见解。因此,主要的 MEL 和研究活动是分阶段进行的,最初的重点是了解准备情况,并促成能力、决策和合作方面的变革。迄今为止,嵌入式研究员的活动主要集中在建立全机构范围的 MEL 和研究方法、为选定的计划提供支持以及对特定计划的成果进行试点监测(表 S2)。这些活动为提高研究素养提供了一个途径--这一点很重要,因为一般而言,社区服务部门可被视为一个研究新兴行业,而提高循证实践的举措应有助于提高研究素养。11 尽管这些活动还处于初步阶段,但员工的认同和兴趣以及领导团队的支持都很高(正如应急专家在与员工访谈时就 Brophy 的初步研究和评估需求所报告的那样)。这表明,社区服务人员参与和开展研究的积极性很高,尽管在这样做的过程中会遇到各种挑战。该急诊室职位的初步成功得益于布罗菲与迪肯农村医疗机构之间的紧密合作,包括通过各组织之间现有的地方关系。此外,迪肯农村医疗机构也是一个以地方为基础的组织,拥有联合医疗能力建设的授权和资源。这些因素支持了基于相互信任、共同目标和长期合作承诺的共同愿景,并促成了共同出资的 ER 角色。这项工作的成果将使证据得以公布,并有助于改善西南部人口的健康和社会成果:构思;调查;项目管理;资源;写作--原稿;写作--审阅和编辑。Kevin P. Mc Namara:项目管理;资源;监督;写作--原稿;写作--审阅和编辑。彭妮-博尔顿项目管理;资源;监督;写作--审阅和编辑。Carly Dennis:项目管理;写作--审阅和编辑;监督;资源。文森特-L-范思哲BEK 由 Brophy 家庭与青少年服务机构和澳大利亚政府的农村卫生多学科培训计划 (RHMT) 资助。VLV 也得到了 RHMT 的资助。
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引用次数: 0
Who carries the extra load? The added responsibility of end-of-life care for rural families 谁来承担额外的负担?农村家庭临终关怀的额外责任
IF 1.9 4区 医学 Q2 NURSING Pub Date : 2024-07-23 DOI: 10.1111/ajr.13171
Kristina Thomas BA (Hons); DPsych (Health), Margaret Deerain BBus (Mgmt); MLitt; MLS
<p>There are over 7 million Australians (28%) living outside of major cities,<span><sup>1</sup></span> and these people have poorer health outcomes and poorer access to and use of primary health care services.<span><sup>2</sup></span> Just like most areas of health, there are common barriers to accessing end-of-life health care for rural Australians including geographical distance to services, lack of stable workforce and difficulty accessing culturally appropriate care.<span><sup>3-5</sup></span> While it is more difficult to access end-of-life health care for rural Australians, we know that the proportion of older Australians is higher in rural Australia so there a is significant need for end-of-life care.<span><sup>1</sup></span></p><p>When access to end-of-life health services is more challenging, who picks up the increased load? Like many areas of social and health care, family, friends and community networks end up playing an increased role in end-of-life care in rural areas.<span><sup>3</sup></span> The family ‘carer’, the person who is most involved in the person's day-to-day care, is even more vital in a rural area. Compared to carers from urban areas, rural carers are more likely to be friends or distant relatives.<span><sup>6</sup></span></p><p>Rural carers report exhaustion, lack of self-care and a need for respite.<span><sup>7</sup></span> This may be due to the fact that rural carers are likely to do more of the care tasks themselves (rather than using services).<span><sup>8</sup></span> A quarter of rural carers want more physical support with caring.<span><sup>6</sup></span> They report unmet needs such as treatment near home (37%), help with economic burden (32%) and concerns about the person being cared for (32%).<span><sup>9</sup></span></p><p>A review of studies<span><sup>3</sup></span> showed that rural end-of-life patients receive fewer home visits from doctors, less home care services, less palliative care, less respite and less allied health; however, there was increased reliance on general practitioners, pharmacy and emergency hospital. Rural carers report that local services have longer wait times, high turnover of staff, and families received late referral to palliative care.<span><sup>4</sup></span></p><p>Rural carers of cancer patients (60% of whom required end-of-life care)<span><sup>4</sup></span> report that one of the biggest stressors is travelling for health services highlighting dealing with the stress of going to the city, organising the actual travel and time away from work, family or the farm. Rural carers also find metropolitan health services difficult to navigate.<span><sup>10</sup></span> Health professionals do not always consider the effort involved in travel which may cause additional inconveniences and stress for rural carers.<span><sup>4</sup></span> Rural carers also report a strong connection to their community and miss being away from their community when travelling for health services.<span><sup
墨尔本圣文森特医院与全国农村健康联盟(National Rural Health Alliance)、澳大利亚悲伤协会(Grief Australia)和 CareSearch(弗林德斯大学)合作,目前正通过 CarerHelp Rural Connect 项目扩大对农村的关注。CarerHelp 正向农村照护者和社区伸出援手,提供新的资源和与医疗专业人员的在线会议,帮助他们为照护生命末期的人做好准备,并为他们作为农村或偏远地区的照护者可能遇到的挑战做好准备。欲了解更多信息,请访问: www.carerhelp.com.au.The 全国农村健康联盟很荣幸能参与该项目,该项目将为我们的农村照护者和他们在农村社区照护的亲人提供实用而重要的支持:构思;写作--原稿;写作--审阅和编辑。Margaret Deerain:写作--审阅和编辑。
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引用次数: 0
Towards a home-grown rural health workforce: Evidence from Tasmania, Australia 建立一支本土化的农村医疗卫生队伍:来自澳大利亚塔斯马尼亚州的证据。
IF 1.9 4区 医学 Q2 NURSING Pub Date : 2024-07-23 DOI: 10.1111/ajr.13169
B. Jessup PhD, N. Tran PhD, T. Stevens, P. Allen PhD, T. Barnett PhD

Objective

To examine the association between place of origin and principal place of practice (PPP) of domestic Tasmanian health graduates who received end-to-end training with the University of Tasmania (UTAS).

Methods

The 2022 PPP for all UTAS domestic Tasmanian graduates from medicine, nursing, pharmacy, psychology, medical radiation science and paramedicine between 2011 and 2020 was identified using the online Australian Health Practitioner Regulation Agency (Ahpra) registration database. The graduate's place of origin (home address at the time of course application), together with their 2022 PPP, was described using the Modified Monash Model (MM) classification system of remoteness. Data were analysed using STATA.

Results

Over the 10-year period, 4079 domestic Tasmanians graduated from health courses at UTAS, of which 3850 (94.4%) were matched to an Australian PPP. In all, 78.3% of graduates were working in Tasmania, while the remainder (21.7%) were employed interstate. Of those with a Tasmanian PPP, 81.4% were working in a regional setting (MM2), while 77.6% of interstate employed graduates recorded a metropolitan (MM1) PPP. Rural place of origin (MM3-7) was associated with rural employment (MM3-7) in both Tasmania (OR, 37.08; 95% CI 29.01–47.39, p < 0.001), and on the Australian mainland (OR, 21.4; 95% CI 17.4–26.3, p < 0.001).

Conclusions

Most domestic Tasmanian origin UTAS health graduates contribute to the state's health workforce after qualifying. Further research is needed to explore PPP over time and to understand why some graduates are motivated to seek employment on the Australian mainland and in particular, metropolitan cities.

目的研究在塔斯马尼亚大学(UTAS)接受端到端培训的塔斯马尼亚国内健康专业毕业生的原籍地与主要执业地点(PPP)之间的关联:通过澳大利亚卫生从业者监管局(Ahpra)在线注册数据库,确定了 2011 年至 2020 年间塔斯马尼亚州国内所有UTAS 医学、护理、药学、心理学、医学放射科学和辅助医疗毕业生的 2022 年主要执业地点。毕业生的原籍地(申请课程时的家庭住址)及其 2022 年的 PPP 采用修改后的莫纳什模型(MM)偏远地区分类系统进行描述。数据使用 STATA 进行分析:10 年间,共有 4079 名塔斯马尼亚州本地人从UTAS 的健康课程毕业,其中 3850 人(94.4%)与澳大利亚 PPP 匹配。总共有 78.3% 的毕业生在塔斯马尼亚州工作,其余的毕业生(21.7%)在州际就业。在塔斯马尼亚州 PPP 的毕业生中,81.4% 在地区环境(MM2)工作,而 77.6% 跨州就业的毕业生的 PPP 记录为大都市(MM1)。在塔斯马尼亚州,农村原籍(MM3-7)与农村就业(MM3-7)相关(OR,37.08;95% CI 29.01-47.39,p 结论):大多数来自塔斯马尼亚州国内的UTAS卫生专业毕业生在取得资格后都为该州的卫生事业做出了贡献。我们需要进一步开展研究,探讨随着时间推移的 "PPP",并了解为什么一些毕业生会选择到澳大利亚本土,尤其是大都市就业。
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引用次数: 0
Clinical presentation and management of enterovirus and parechovirus infection in children: A single-centre study in regional Australia 儿童肠道病毒和帕累托病毒感染的临床表现和处理:澳大利亚地区单中心研究。
IF 1.9 4区 医学 Q2 NURSING Pub Date : 2024-07-19 DOI: 10.1111/ajr.13160
Tharmarajah Sorubarajan MBBS (Sri Lanka), MD (Sri Lanka), DCH (Sri Lanka), DCH (Sydney), FRACP (Australia), Sivapriyan Sorubarajan

Objective

This study aims to analyse the clinical presentation caused by enterovirus (EV) and/or human parechovirus (HPeV) infection in children, as well as the management of such cases admitted to a regional hospital in Australia.

Methods

Retrospective study reviewing medical records.

Setting

Single hospital in regional Australia.

Participants

All children under 18 years admitted over the 5-year period beginning from 1 January 2017 with confirmed EV and/or HPeV infection. Cases with clinically insignificant EV/HPeV isolation were excluded.

Main Outcome Measures

Data collected included demographic data, signs and symptoms present, specimens of EV/HPeV isolation, co-occurring pathogens, peak C-reactive protein (CRP), antibiotic therapy, discharge diagnosis and follow-up after discharge.

Results

Overall, 27 patients fulfilled the inclusion criteria; 81.5% of the patients were ≤3 months of age with a median of 2 months (interquartile range 1–3); 74.1% were males. The most common clinical features were a fever ≥38°C and irritability/lethargy/high-pitched cry. 29.6% of the patients had co-occurring pathogens detected, and a CRP ≤10 mg/L was observed in 77.8% of cases. All but two children were treated with antibiotics while awaiting polymerase chain reaction results. The most common discharge diagnosis was meningitis. In all, 74.1% of the children attended follow-up appointments.

Conclusions

EV and HPeV should be considered as a possible aetiology of fever and irritability/lethargy/high-pitched cry in children under 3 months.

研究目的本研究旨在分析儿童感染肠道病毒(EV)和/或人类帕累托病毒(HPeV)后的临床表现,以及澳大利亚一家地区医院对此类病例的处理情况:方法:回顾性研究,审查医疗记录:环境:澳大利亚地区的一家医院:自 2017 年 1 月 1 日起的 5 年间,所有 18 岁以下确诊 EV 和/或 HPeV 感染的儿童。排除了临床症状不明显的EV/HPeV分离病例:收集的数据包括人口统计学数据、出现的体征和症状、EV/HPeV分离标本、并发病原体、C反应蛋白(CRP)峰值、抗生素治疗、出院诊断和出院后随访:共有 27 名患者符合纳入标准;81.5% 的患者年龄小于 3 个月,中位数为 2 个月(四分位数间距为 1-3 个月);74.1% 为男性。最常见的临床特征是发烧≥38°C和烦躁/嗜睡/高声哭闹。29.6%的患者同时检测到病原体,77.8%的病例CRP≤10 mg/L。除两名患儿外,其他患儿在等待聚合酶链反应结果期间均接受了抗生素治疗。最常见的出院诊断是脑膜炎。74.1%的患儿接受了后续治疗:结论:EV 和 HPeV 应被视为 3 个月以下儿童发烧和烦躁/嗜睡/高声哭闹的可能病因。
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引用次数: 0
'I am more than my diagnosis': Amplifying the voice of consumers in the design and delivery of mental health services. 我不只是我的诊断":在心理健康服务的设计和提供过程中放大消费者的声音。
IF 1.9 4区 医学 Q2 NURSING Pub Date : 2024-07-19 DOI: 10.1111/ajr.13150
Joy Paton, Amie Carrington, Emma Gentle, Debbie Horsefall

Objective: In line with the Australian Government's Vision 2030, this research foregrounds consumer experiences of recovery to inform the (co)design and delivery of mental health services for people living with complex needs and/or a severe and persistent mental health condition.

Setting: The research takes a specialist focus on the regional setting, with data collected from client experiences within Western NSW, Australia, in the context of the National Disability Insurance Scheme (NDIS) implementation and inclusion of psycho-social disability within the NDIS service environment.

Participants: Thirty-seven people aged 19-70 years living with complex needs and/or a diagnosis of a severe and persistent mental health condition were recruited from services where they had a care plan or where they were members of a consumer reference group for recovery-oriented services.

Design: A tripartite framework integrating recovery oriented, trauma-informed and collective impact approaches for a qualitative, arts-based (photovoice) study.

Results: In areas of the mental health service system that had not yet applied a personalised understanding of recovery or embraced trauma-informed practice there were a range of issues and gaps in service delivery relating to authentic relationships, belonging and connection, service cultures, trauma-informed care, and workforce investment.

Conclusion: Clinical and non-clinical services need to ensure consistent person-centred and trauma-informed practice is implemented throughout the mental health service system to meet the needs of the consumer. An eight-point checklist serves as the basis for services to reflect on how they are working with consumers and to support the review of systems and clinical governance frameworks.

目标:根据澳大利亚政府的 "2030 年愿景",本研究将消费者的康复体验作为研究重点,以便为有复杂需求和/或严重且持续的精神健康状况的人设计和提供精神健康服务:本研究以地区环境为专业重点,在国家残疾保险计划(NDIS)实施以及将社会心理残疾纳入 NDIS 服务环境的背景下,从澳大利亚新南威尔士州西部的客户体验中收集数据:37 名年龄在 19-70 岁之间、有复杂需求和/或被诊断出患有严重和持续性精神疾病的人被招募到他们有护理计划的服务机构,或者他们是以康复为导向的服务消费者参考小组的成员:设计:一个三方框架,整合了以康复为导向、创伤知情和集体影响的方法,用于一项定性的、以艺术为基础的(摄影选言)研究:结果:在心理健康服务体系中,尚未对康复进行个性化理解或尚未接受创伤知情实践的领域,在提供服务时存在一系列问题和差距,这些问题和差距与真实关系、归属感和联系、服务文化、创伤知情护理以及劳动力投资有关:临床和非临床服务需要确保在整个心理健康服务体系中实施一致的以人为本和创伤知情实践,以满足消费者的需求。八点核对表可作为服务机构反思如何与消费者合作的基础,并为系统和临床治理框架的审查提供支持。
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引用次数: 0
Conducting mental health research with rural and regional older Australians: Reflections and recommendations 对澳大利亚农村和地区老年人进行心理健康研究:思考与建议。
IF 1.9 4区 医学 Q2 NURSING Pub Date : 2024-07-14 DOI: 10.1111/ajr.13165
Daniel P. Wadsworth PhD, Belinda Cash PhD, Kristen Tulloch PhD, Rebekah Couper BSc (Hons), Kristy Robson PhD, Sally Fitzpatrick PhD

Aims

This commentary aims to assist emerging leaders of mental health research with older rural Australians through (i) affirmation that others share the barriers, pitfalls and challenges being faced; (ii) reinforcing the rationale making this a pertinent area for research; and (iii) opening a dialogue for best practice to engage older rural Australians in mental health research.

Context

Supporting the mental health of older adults is a pertinent global challenge, none more so than in rural Australia where restricted access to services and supports are compounded by limited help-seeking behaviours and capacity to engage with support. Paradoxically, such limitations also extend to impact researchers' ability to engage rural older Australians in mental health research, particularly when combined with the stoicism and stigma that often envelopes mental health, and the contemporary challenges posed by the emergence of technology. Such challenges are however not often discussed, more-often sidelined in favour of reporting positive research outcomes, or seeing emerging researchers eschew such focus entirely.

Approach

Through this paper, the authors utilised critical self-appraisal and iterative reflection to identify four recommendations for undertaking contemporary mental health research with rural older Australians, namely to: plan realistically through a collaborative, authentic and respectful approach; identify community champions and build/maintain trust; diversify thought, approaches and methodology; and cast the research net far, wide and often.

Conclusion

By adopting recommendations, researchers can maximise accessibility to and possible participation in mental health research, providing foundations for older rural Australians' contributions to inform the development of policies and strategies to promote their health and well-being.

目的:这篇评论旨在通过以下方式,帮助针对澳大利亚农村老年人开展心理健康研究的新兴领导者:(i) 肯定其他人也面临着同样的障碍、陷阱和挑战;(ii) 强化使这一领域成为相关研究领域的理由;(iii) 展开对话,探讨让澳大利亚农村老年人参与心理健康研究的最佳实践:为老年人的心理健康提供支持是一项相关的全球性挑战,在澳大利亚农村地区,由于求助行为和参与支持的能力有限,获得服务和支持的途径受到限制,情况更为严重。矛盾的是,这些局限性也影响了研究人员让澳大利亚农村老年人参与心理健康研究的能力,尤其是当这些局限性与心理健康问题上经常出现的委曲求全和耻辱感,以及当代技术的出现所带来的挑战结合在一起的时候。然而,这些挑战并不经常被讨论,更多的时候是被搁置一边,只报道积极的研究成果,或者看到新兴研究人员完全回避这种关注:通过本文,作者利用批判性的自我评价和迭代反思,确定了针对澳大利亚农村地区老年人开展当代心理健康研究的四项建议,即:通过合作、真实和尊重的方法制定切实可行的计划;确定社区拥护者并建立/保持信任;实现思想、方法和方法论的多样化;以及将研究网撒得更远、更广、更频繁:通过采纳这些建议,研究人员可以最大限度地提高心理健康研究的可及性和可能的参与度,为澳大利亚农村老年人为制定促进其健康和福祉的政策和战略提供信息奠定基础。
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引用次数: 0
A scoping review of early childhood support for Aboriginal and Torres Strait Islander children living with a disability in regional, rural and remote settings 对地区、农村和偏远地区为土著居民和托雷斯海峡岛民残疾儿童提供的早期儿童支持进行范围界定审查。
IF 1.9 4区 医学 Q2 NURSING Pub Date : 2024-07-11 DOI: 10.1111/ajr.13164
Anita D’Aprano PhD, Kim McRae DipEd, Suzanne Dayton MSW, Catherine Lloyd-Johnsen MPH, John Gilroy PhD

Introduction

Many experts and communities have concerns about how National Disability Insurance Scheme services are provided to Aboriginal and Torres Strait children. This study was undertaken at the request of the NPY Women's Council in partnership with the researchers, to explore supports for Aboriginal and Torres Strait Islander children living with a disability in their remote areas.

Objective

This scoping review aims to (a) explore the barriers and enablers to accessing disability support services for families of young Aboriginal and Torres Strait Islander children (0–8 years) living in regional, rural and remote settings, and (b) summarise best practice approaches for accessing support for young children in these settings.

Design

The search was run in three electronic databases, as well as grey literature sources. We assessed the quality of included publications using the Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange tool. A narrative synthesis was supported by thematic analysis.

Findings

From an initial search (557 citations), we identified 13 eligible documents. Most documents were peer-reviewed articles of qualitative studies. Key themes identified included the following: (1) Holistic approach, (2) Understanding disability, (3) Consistent relationships, (4), Flexibility, (5) Simplify system and (6) Enhance communication.

Discussion/Conclusion

This scoping review has revealed gaps in the provision of quality, culturally responsive disability services for families of Aboriginal and Torres Strait Islander children living in regional, rural and remote areas of Australia. A family-centred, flexible approach will help address their needs. Future research is required to design and evaluate models of care for Aboriginal and Torres Strait Islander children.

导言:许多专家和社区对如何向土著儿童和托雷斯海峡儿童提供国家残疾保险计划服务表示担忧。这项研究是应 NPY 妇女理事会的要求,与研究人员合作开展的,目的是探讨如何为偏远地区的土著居民和托雷斯海峡岛民残疾儿童提供支持:本次范围界定审查旨在:(a) 探讨生活在地区、农村和偏远环境中的土著居民和托雷斯海峡岛民幼儿(0-8 岁)家庭在获得残疾支持服务方面遇到的障碍和有利因素;(b) 总结在这些环境中为幼儿提供支持的最佳实践方法:设计:我们在三个电子数据库以及灰色文献来源中进行了搜索。我们使用原住民慢性病知识转化与交流卓越研究中心的工具对收录出版物的质量进行了评估。通过主题分析进行了叙述性综合:通过初步检索(557 条引文),我们确定了 13 篇符合条件的文献。大多数文献都是经同行评审的定性研究文章。确定的关键主题包括以下内容:(1) 整体方法;(2) 理解残疾;(3) 一致的关系;(4) 灵活性;(5) 简化系统;(6) 加强沟通:本次范围界定审查揭示了在为居住在澳大利亚地区、农村和偏远地区的土著居民和托雷斯海峡岛民儿童家庭提供优质的、符合其文化背景的残疾服务方面存在的差距。以家庭为中心的灵活方法将有助于满足他们的需求。未来需要开展研究,以设计和评估针对土著和托雷斯海峡岛民儿童的护理模式。
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引用次数: 0
Rural community-centred co-planning for sustainable rural health systems 以农村社区为中心,共同规划可持续的农村医疗系统。
IF 1.9 4区 医学 Q2 NURSING Pub Date : 2024-07-11 DOI: 10.1111/ajr.13162
Nerida Hyett PhD, Mandy Hutchinson Grad Cert, Donna Doyle Post Grad Healthcare Leadership, Trevor Adem MBA, Dallas Coghill Grad Dip Critical Care, Pamela Harvey PhD, Catherine Lees PhD, Belinda O'Sullivan PhD

Objective

Sustaining rural healthcare services is challenging because of numerous systemic factors. Rural communities can inform the design of sustainable rural health models; however, further evidence of effective co-design is needed to guide implementation. The study aim was to co-design a series of place-based and evidence-informed rural health models, to improve local health system sustainability.

Setting

A rural region (categorised as Modified Monash Model 5) defined by three adjoining Shires in Central and Northwest Victoria, Australia.

Participants

A health executive co-planning network led the co-design, with input and oversight from a broader cross-sector group. Healthcare professionals (n = 44) and consumers and carers (n = 21) participated in interviews, and an online survey was completed by healthcare professionals (n = 11) and consumers and carers (n = 7) to provide feedback on the preliminary results.

Design

Community-based participatory action research was applied incorporating co-design methods and systems thinking. Data were collected through qualitative interviews followed by an online feedback survey. Mixed method data analysis (QUAL-quant) was conducted with qualitative directed content analysis of interview transcripts and quantitative descriptive analyses of survey responses to aid prioritisation.

Results

Healthcare priorities, strengths and challenges, and proposed rural health models are described. A rural health system sustainability strategy was developed with three integrated pillars: 1. Workforce strengthening, 2. Integrated health services and 3. Innovative models of care.

Conclusion

Community-centred co-design with rural health stakeholders was effective for generating locally tailored ideas and potential health models that emulate community strengths and resources, and provide a foundation for further planning, implementation and evaluation.

目的:由于诸多系统性因素,农村医疗服务的可持续发展具有挑战性。农村社区可以为可持续农村医疗模式的设计提供信息;但是,还需要更多有效共同设计的证据来指导实施。本研究旨在共同设计一系列以地方为基础、以证据为依据的农村医疗模式,以改善当地医疗系统的可持续性:研究地点:澳大利亚维多利亚州中部和西北部的一个农村地区(被归类为 "莫纳什模式 5"),该地区由三个相邻的郡组成:卫生行政人员共同规划网络领导共同设计工作,更广泛的跨部门小组提供意见和监督。医疗保健专业人员(44 人)、消费者和护理人员(21 人)参加了访谈,医疗保健专业人员(11 人)、消费者和护理人员(7 人)完成了在线调查,就初步结果提供反馈:设计:采用基于社区的参与式行动研究,并融入共同设计方法和系统思维。通过定性访谈收集数据,然后进行在线反馈调查。采用混合方法进行数据分析(QUAL-quant),对访谈记录进行定性内容分析,对调查反馈进行定量描述性分析,以帮助确定优先事项:结果:描述了医疗保健的优先事项、优势和挑战以及拟议的农村医疗保健模式。制定了农村医疗系统可持续发展战略,包括三个综合支柱:1.加强劳动力,2. 综合医疗服务,3.创新医疗模式:结论:以社区为中心,与农村卫生利益相关者共同设计,能有效地产生适合当地情况的想法和潜在的卫生模式,这些想法和模式可借鉴社区的优势和资源,并为进一步的规划、实施和评估奠定基础。
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引用次数: 0
期刊
Australian Journal of Rural Health
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