Carrington Sally B.Pharm, Grad Dip Rural Generalist Practice, Chau Gabrielle B. Pharm, MClinPharm, Miller Waugh Sidony BPharm, GCPharmPrac, Symmons Christopher MBBS, FRACGP, Titmarsh Justin BN, MBBS, FRACGP, DRANCOG (Adv), AFRACMA, Minyon L. Avent B Pharm, BSc (Hons), Pharm D, FSHP, FANZCAP (InfDis, Steward), GradCertHlthSc
Problem
In Australia, inappropriate prescribing of antimicrobials is higher in rural and regional areas than in major city hospitals. Inappropriate prescribing is defined as the prescription of antimicrobial agents that do not adhere to guidelines in terms of type of antimicrobial chosen, dose and/or duration or are deemed unnecessary. A review of antimicrobial prescribing in a Queensland rural Hospital and Health Service (HHS) identified that respiratory infections were an area for potential improvement.
Setting
The study was performed in a rural HHS in Queensland.
Key Measures for Improvement
Appropriateness of antimicrobial prescribing for baseline and post-implementation phases of the study was evaluated according to Therapeutic Guidelines: antibiotic recommendations for community acquired pneumonia (CAP).
Strategies for Change
Quality improvement strategy to implement a multifaceted package of interventions for CAP.
Effects of Change
Post-implementation, overall appropriateness of antimicrobial prescribing improved and there was a decrease in duration of antimicrobial therapy.
Lessons Learnt
A quality improvement strategy to implement a multifaceted package of interventions for CAP has shown to be acceptable and effective in improving the antimicrobial prescribing in a rural setting. Our findings highlight the importance of utilising a multifaceted package of interventions which can be tailored to the prescribers and the patients at hand. It is also valuable to engage with local clinicians to promote the optimal management of common infections in the rural setting.
问题：在澳大利亚，农村和地区的抗菌药物处方不当率高于大城市医院。不适当处方的定义是，处方中的抗菌剂在所选抗菌剂的类型、剂量和/或持续时间方面不符合指南要求，或者被认为是不必要的。对昆士兰州一家农村医院和卫生服务机构（HHS）的抗菌药处方进行的审查发现，呼吸道感染是一个有可能改进的领域：研究在昆士兰州的一家农村医院和医疗服务机构进行：主要改进措施：根据《治疗指南：社区获得性肺炎（CAP）的抗生素建议》，对基线阶段和研究实施后阶段的抗菌药物处方的适当性进行评估：质量改进战略：针对 CAP 实施多方面的一揽子干预措施：实施后，抗菌药物处方的总体适当性得到改善，抗菌药物治疗的持续时间缩短：针对 CAP 实施多方面一揽子干预措施的质量改进策略在改善农村地区的抗菌药物处方方面显示出了可接受性和有效性。我们的研究结果凸显了利用多层面一揽子干预措施的重要性，这些措施可根据处方者和患者的具体情况量身定制。此外，与当地临床医生合作以促进农村地区常见感染的优化管理也很有价值。
{"title":"Implementation of a quality improvement strategy to optimise the management of community acquired pneumonia in a rural health setting","authors":"Carrington Sally B.Pharm, Grad Dip Rural Generalist Practice, Chau Gabrielle B. Pharm, MClinPharm, Miller Waugh Sidony BPharm, GCPharmPrac, Symmons Christopher MBBS, FRACGP, Titmarsh Justin BN, MBBS, FRACGP, DRANCOG (Adv), AFRACMA, Minyon L. Avent B Pharm, BSc (Hons), Pharm D, FSHP, FANZCAP (InfDis, Steward), GradCertHlthSc","doi":"10.1111/ajr.13116","DOIUrl":"10.1111/ajr.13116","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Problem</h3>\u0000 \u0000 <p>In Australia, inappropriate prescribing of antimicrobials is higher in rural and regional areas than in major city hospitals. Inappropriate prescribing is defined as the prescription of antimicrobial agents that do not adhere to guidelines in terms of type of antimicrobial chosen, dose and/or duration or are deemed unnecessary. A review of antimicrobial prescribing in a Queensland rural Hospital and Health Service (HHS) identified that respiratory infections were an area for potential improvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>The study was performed in a rural HHS in Queensland.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Key Measures for Improvement</h3>\u0000 \u0000 <p>Appropriateness of antimicrobial prescribing for baseline and post-implementation phases of the study was evaluated according to <i>Therapeutic Guidelines: antibiotic</i> recommendations for community acquired pneumonia (CAP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Strategies for Change</h3>\u0000 \u0000 <p>Quality improvement strategy to implement a multifaceted package of interventions for CAP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Effects of Change</h3>\u0000 \u0000 <p>Post-implementation, overall appropriateness of antimicrobial prescribing improved and there was a decrease in duration of antimicrobial therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Lessons Learnt</h3>\u0000 \u0000 <p>A quality improvement strategy to implement a multifaceted package of interventions for CAP has shown to be acceptable and effective in improving the antimicrobial prescribing in a rural setting. Our findings highlight the importance of utilising a multifaceted package of interventions which can be tailored to the prescribers and the patients at hand. It is also valuable to engage with local clinicians to promote the optimal management of common infections in the rural setting.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13116","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337762","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}
Natasha J. Downing BPharm, AACP, MPS, Gemma Skaczkowski PhD, Donna Hughes-Barton PhD, Helen Stone BPharm, BSc, MPS, GAICD, Leah Robinson, Kate M. Gunn PhD
Introduction
Pharmacists are often not recognised as a core part of palliative care teams, despite their ideal placement to assist with the burden of medication management.
Objective
This study explored the role of pharmacists working in the rural palliative care team, in the home-based setting.
Design
Health care professionals working with palliative care patients in rural South Australia participated in semi-structured interviews. Data were analysed using thematic analysis.
Findings
Data from 20 participants identified 10 themes. Theme 1: This model of care gives patients a choice. Theme 2: The pharmacist is a trusted source of support and information. Theme 3: Patient, carer and family distress is reduced. Theme 4: Enables patients to stay at home by improving medication knowledge and decreasing burden; 4.1—Patient, carer and family's understanding about medication management is improved, 4.2—Patient, carer and family travel is decreased, 4.3—Burden associated with getting to the doctor is decreased. Theme 5: Communication between all parties is enhanced; 5.1—Enhanced communication between the patient and health care team, 5.2—Enhanced communication within the health care team. Theme 6: Patient, carer and family burden of coordinating prescriptions and medications is reduced. Theme 7: Benefits health care professionals by improving medication knowledge, reducing workload and stress; 7.1—Understanding about medications and their management is improved, 7.2—Workload is reduced, 7.3—Work-related stress is reduced. Theme 8: The disparity of care between rural and urban patients is reduced. Theme 9: Helps to address rural workforce shortages. Theme 10: Challenges of this model of care; 10.1—A need for greater pharmacist capacity to meet demand, 10.2—A need for increased and sustained funding for the pharmacist role, 10.3—Large amount of travel to get to patients.
Conclusion
Rural health care professionals are supportive of pharmacists working as part of the palliative care team in home-based settings and identified many benefits of this model of care.
{"title":"A qualitative exploration of the role of a palliative care pharmacist providing home-based care in the rural setting, from the perspective of health care professionals","authors":"Natasha J. Downing BPharm, AACP, MPS, Gemma Skaczkowski PhD, Donna Hughes-Barton PhD, Helen Stone BPharm, BSc, MPS, GAICD, Leah Robinson, Kate M. Gunn PhD","doi":"10.1111/ajr.13115","DOIUrl":"10.1111/ajr.13115","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Pharmacists are often not recognised as a core part of palliative care teams, despite their ideal placement to assist with the burden of medication management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study explored the role of pharmacists working in the rural palliative care team, in the home-based setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Health care professionals working with palliative care patients in rural South Australia participated in semi-structured interviews. Data were analysed using thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Data from 20 participants identified 10 themes. Theme 1: <i>This model of care gives patients a choice</i>. Theme 2: <i>The pharmacist is a trusted source of support and information</i>. Theme 3: <i>Patient, carer and family distress is reduced</i>. Theme 4: <i>Enables patients to stay at home by improving medication knowledge and decreasing burden;</i> 4.1—Patient, carer and family's understanding about medication management is improved, 4.2—Patient, carer and family travel is decreased, 4.3—Burden associated with getting to the doctor is decreased. Theme 5: <i>Communication between all parties is enhanced</i>; 5.1—Enhanced communication between the patient and health care team, 5.2—Enhanced communication within the health care team. Theme 6: <i>Patient, carer and family burden of coordinating prescriptions and medications is reduced</i>. Theme 7: <i>Benefits health care professionals by improving medication knowledge, reducing workload and stress;</i> 7.1—Understanding about medications and their management is improved, 7.2—Workload is reduced, 7.3—Work-related stress is reduced. Theme 8: <i>The disparity of care between rural and urban patients is reduced</i>. Theme 9: <i>Helps to address rural workforce shortages</i>. Theme 10: <i>Challenges of this model of care</i>; 10.1—A need for greater pharmacist capacity to meet demand, 10.2—A need for increased and sustained funding for the pharmacist role, 10.3—Large amount of travel to get to patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Rural health care professionals are supportive of pharmacists working as part of the palliative care team in home-based settings and identified many benefits of this model of care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13115","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140307931","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}
Jennifer Luke PhD, Cristy Bartlett PhD, Sonja March PhD, Peter McIlveen PhD
Objective
To systematically review evaluated local, community or peer-delivered well-being and employment interventions delivered within regional, rural and remote Australia.
Design
Searches within nine databases retrieved peer-reviewed and grey literature from an initial pool of 3186 papers published between 2012 and 2022. PRISMA guidelines were adhered to, and the Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the well-being or employment (or both) articles.
Findings
A total of 19 items met the inclusion criteria, which included two quantitative, 12 qualitative and five mixed-methods evaluations. Intervention cohorts included Indigenous Australians, youth, older people, workers and the general community. The average methodological rating was 83%. The overall level of evidence for the interventions was low due to mostly descriptive studies.
Discussion
Interventions that appeared effective in improving well-being tended to focus on addressing social connectedness and self-determination. Unexpected employment outcomes were evident across many of the studies, which highlighted the reciprocity between well-being and employment.
Conclusion
This review highlights promising interventions for improving well-being by focusing on social connectedness and self-determination. Further empirical evidence is encouraged to explore the reciprocal relationship between well-being and employment, emphasising the significance of social connectedness and self-determination in this context.
{"title":"A systematic review of effective local, community or peer-delivered interventions to improve well-being and employment in regional, rural and remote areas of Australia","authors":"Jennifer Luke PhD, Cristy Bartlett PhD, Sonja March PhD, Peter McIlveen PhD","doi":"10.1111/ajr.13113","DOIUrl":"10.1111/ajr.13113","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To systematically review evaluated local, community or peer-delivered well-being and employment interventions delivered within regional, rural and remote Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Searches within nine databases retrieved peer-reviewed and grey literature from an initial pool of 3186 papers published between 2012 and 2022. PRISMA guidelines were adhered to, and the Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the well-being or employment (or both) articles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>A total of 19 items met the inclusion criteria, which included two quantitative, 12 qualitative and five mixed-methods evaluations. Intervention cohorts included Indigenous Australians, youth, older people, workers and the general community. The average methodological rating was 83%. The overall level of evidence for the interventions was low due to mostly descriptive studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Interventions that appeared effective in improving well-being tended to focus on addressing social connectedness and self-determination. Unexpected employment outcomes were evident across many of the studies, which highlighted the reciprocity between well-being and employment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This review highlights promising interventions for improving well-being by focusing on social connectedness and self-determination. Further empirical evidence is encouraged to explore the reciprocal relationship between well-being and employment, emphasising the significance of social connectedness and self-determination in this context.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13113","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140307932","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}
Kelly Trearty PhD, Brendan Bunting PhD, John Mallett PhD
Introduction and Objective
Farmers experience a specific set of unique dangers, which increases their risk of mortality compared with any other occupation. This study hypothesised that Northern Ireland's (NIs) agriculturally saturated Wards have a higher risk of mortality compared against non-agriculturally based Wards.
Design
The Population Census and Farm Census information were downloaded from the Northern Ireland Neighbourhood Service (NINIS) online depository to compile three mortality-based data sets (2001, 2011, pooled data sets). Assessing the impact of socio-demographics and farming activity on Ward-level mortality patterns using farm and population decennial censuses. This study analysed all 582 Ward areas of NI, which enclosed the entire populace of the country in 2001 and 2011.
Findings
Path analysis was utilised to examine direct and indirect paths linked with mortality within two census years (2001; 2011), alongside testing pathways for invariance between census years (pooled data set). Ward-level results provided evidence for exogenous variables to mortality operating through three/four endogenous variables via: (i) direct effects (age), (ii) summed indirect effects (age; males; living alone; farming profit; and deprivation) and (iii) total effects (age; males; living alone; and deprivation). Multi-group results cross-validated these cause-and-effect relationships relating to mortality.
Discussion and Conclusion
This study demonstrated that farming intensity scores, farming profits and socio-demographics' influence on mortality risk in a Ward were dependent on the specific social-environmental characteristics within that area. In line with earlier area level research, results support the aggregated interpretation that higher levels of farming activity within a Ward increase the risk of mortality within those Wards of NI. This was an essential study to enable future tailoring of new strategies and upgrading of current policies to bring about significant mortality risk change at local level.
{"title":"Assessing the impact of socio-demographics and farming activity on ward-level mortality patterns using farm and population decennial censuses","authors":"Kelly Trearty PhD, Brendan Bunting PhD, John Mallett PhD","doi":"10.1111/ajr.13098","DOIUrl":"10.1111/ajr.13098","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction and Objective</h3>\u0000 \u0000 <p>Farmers experience a specific set of unique dangers, which increases their risk of mortality compared with any other occupation. This study hypothesised that Northern Ireland's (NIs) agriculturally saturated Wards have a higher risk of mortality compared against non-agriculturally based Wards.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>The Population Census and Farm Census information were downloaded from the Northern Ireland Neighbourhood Service (NINIS) online depository to compile three mortality-based data sets (2001, 2011, pooled data sets). Assessing the impact of socio-demographics and farming activity on Ward-level mortality patterns using farm and population decennial censuses. This study analysed all 582 Ward areas of NI, which enclosed the entire populace of the country in 2001 and 2011.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Path analysis was utilised to examine direct and indirect paths linked with mortality within two census years (2001; 2011), alongside testing pathways for invariance between census years (pooled data set). Ward-level results provided evidence for exogenous variables to mortality operating through three/four endogenous variables via: (i) <i>direct effects</i> (age), (ii) <i>summed indirect effects</i> (age; males; living alone; farming profit; and deprivation) and (iii) <i>total effects</i> (age; males; living alone; and deprivation). Multi-group results cross-validated these cause-and-effect relationships relating to mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion and Conclusion</h3>\u0000 \u0000 <p>This study demonstrated that <i>farming intensity scores, farming profits and socio-demographics'</i> influence on <i>mortality</i> risk in a Ward were dependent on the specific social-environmental characteristics within that area. In line with earlier area level research, results support the aggregated interpretation that higher levels of farming activity within a Ward increase the risk of mortality within those Wards of NI. This was an essential study to enable future tailoring of new strategies and upgrading of current policies to bring about significant mortality risk change at local level.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13098","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140289775","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}
Nicole O'Reilly. The ongoing role of a peak body for rural and remote health in Australia. Australian Journal of Rural Health 2024; 32: 206–207. https://doi.org/10.1111/ajr.13088
In the last paragraph, the sentence, ‘Three years after its establishment…’ should be ‘Thirty years after its establishment…’
We apologize for the error.
妮可-奥莱利澳大利亚农村和偏远地区健康高峰机构的持续作用。Australian Journal of Rural Health 2024; 32: 206-207。https://doi.org/10.1111/ajr.13088In 最后一段中的 "成立三年后...... "应为 "成立三十年后......"，我们对此错误表示歉意。
{"title":"Correction to ‘The ongoing role of a peak body for rural and remote health in Australia’","authors":"","doi":"10.1111/ajr.13106","DOIUrl":"10.1111/ajr.13106","url":null,"abstract":"<p>Nicole O'Reilly. The ongoing role of a peak body for rural and remote health in Australia. <i>Australian Journal of Rural Health</i> 2024; 32: 206–207. https://doi.org/10.1111/ajr.13088</p><p>In the last paragraph, the sentence, ‘Three years after its establishment…’ should be ‘Thirty years after its establishment…’</p><p>We apologize for the error.</p>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13106","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140289776","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}
Allison Turnock MPH, MHM, Alison Fielding PhD, Dominica Moad MPH, Ashley Blowes BND, Amanda Tapley MMedStat, Andrew Davey MClinEpid, Elizabeth Holliday PhD, Jean Ball GradDipMedStats, Michael Bentley DrPH, Kristen FitzGerald MPH & TM, Catherine Kirby PhD, Neil Spike FRACGP, Mieke L. van Driel PhD, Parker Magin PhD
Objective
To establish prevalence and associations of provision of nursing home visits (NHV) and home visits (HV) by early-career specialist GPs. Of particular interest were associations of rurality with performing NHVs and HVs.
Methods
A cross-sectional study.
Design
A questionnaire-based study.
Setting
Australian general practice.
Participants
Early-career specialist GPs, practising in Australia, who attained Fellowship between January 2016 and July 2018, inclusive, having completed GP training in NSW, the ACT, Eastern Victoria or Tasmania.
Main Outcome Measures
Current provision of NHV and HV.
Results
NHV were provided by 34% of participants (59% in rural areas) and HV by 41% of participants (60% in rural areas). Remote, rural or regional practice location, as compared to major-city practice, was strongly associated with performing NHV as an early-career specialist GP; multivariable OR 5.87 (95% CI: 2.73, 12.6), p < 0.001, and with the provision of HV; multivariable OR 3.64 (95% CI: 1.63, 8.11), p = 0.002. Rurality of GP training (prior to attaining Fellowship) was significantly univariably associated with providing NHV and with providing HV as an early-career specialist GP. On multivariable analyses, these were no longer statistically significant.
Conclusion
Early-career specialist GPs located in regional/remote areas are more likely than their urban colleagues to provide NHV and HV.
{"title":"Prevalence and associations of provision of nursing home visits and home visits by early-career specialist general practitioners","authors":"Allison Turnock MPH, MHM, Alison Fielding PhD, Dominica Moad MPH, Ashley Blowes BND, Amanda Tapley MMedStat, Andrew Davey MClinEpid, Elizabeth Holliday PhD, Jean Ball GradDipMedStats, Michael Bentley DrPH, Kristen FitzGerald MPH & TM, Catherine Kirby PhD, Neil Spike FRACGP, Mieke L. van Driel PhD, Parker Magin PhD","doi":"10.1111/ajr.13112","DOIUrl":"10.1111/ajr.13112","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To establish prevalence and associations of provision of nursing home visits (NHV) and home visits (HV) by early-career specialist GPs. Of particular interest were associations of rurality with performing NHVs and HVs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A questionnaire-based study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Australian general practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Early-career specialist GPs, practising in Australia, who attained Fellowship between January 2016 and July 2018, inclusive, having completed GP training in NSW, the ACT, Eastern Victoria or Tasmania.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Current provision of NHV and HV.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>NHV were provided by 34% of participants (59% in rural areas) and HV by 41% of participants (60% in rural areas). Remote, rural or regional practice location, as compared to major-city practice, was strongly associated with performing NHV as an early-career specialist GP; multivariable OR 5.87 (95% CI: 2.73, 12.6), <i>p</i> < 0.001, and with the provision of HV; multivariable OR 3.64 (95% CI: 1.63, 8.11), <i>p</i> = 0.002. Rurality of GP training (prior to attaining Fellowship) was significantly univariably associated with providing NHV and with providing HV as an early-career specialist GP. On multivariable analyses, these were no longer statistically significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Early-career specialist GPs located in regional/remote areas are more likely than their urban colleagues to provide NHV and HV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13112","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177911","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}
Andrew J. Hamilton, Lisa Bourke, Geetha Ranmuthugala, Kristen M. Glenister, David Simmons
Objective
The relationship between chronic pain and complementary and alternative medicine (CAM) use is poorly understood, and the situation in rural Australia is particularly unclear. The objective here was to determine the socio-demographic factors associated with the use of CAM for the treatment of chronic pain in a region of rural Australia.
Methods
This secondary analysis used data from a population health survey, Crossroads-II, to assess the relationships of various socio-demographic factors with the use of CAM by those suffering from chronic pain.
Design
Face-to-face surveys at households randomly selected from residential address lists.
Setting
A large regional centre and three nearby rural towns in northern Victoria, Australia.
Participants
Sixteen years of age and older.
Main Outcome Measures
Use of a CAM service to treat chronic pain.
Results
Being female (2.40 [1.47, 3.93], p < 0.001) and having a bachelorʼs degree (OR 2.24 [1.20, 4.20], p < 0.001) had a significant positive relationship with the use of CAM overall to redress chronic pain and those 50 years and older had greater odds of using manipulation therapies relative to those below 50 years (50–64: OR 0.52 [0.32, 0.86], p = 0.010; 65+: 0.37 [0.18, 0.75], p = 0.005).
Conclusion
In the studied region, females and those with university education have the greatest odds of using CAM to treat chronic pain. This study needs to be complemented with more mechanistic investigations into the reasons people make the decisions they make about using CAM for the management of chronic pain.
{"title":"Chronic pain and the use of complementary and alternative medicine in rural Victoria, Australia","authors":"Andrew J. Hamilton, Lisa Bourke, Geetha Ranmuthugala, Kristen M. Glenister, David Simmons","doi":"10.1111/ajr.13114","DOIUrl":"10.1111/ajr.13114","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The relationship between chronic pain and complementary and alternative medicine (CAM) use is poorly understood, and the situation in rural Australia is particularly unclear. The objective here was to determine the socio-demographic factors associated with the use of CAM for the treatment of chronic pain in a region of rural Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This secondary analysis used data from a population health survey, Crossroads-II, to assess the relationships of various socio-demographic factors with the use of CAM by those suffering from chronic pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Face-to-face surveys at households randomly selected from residential address lists.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>A large regional centre and three nearby rural towns in northern Victoria, Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Sixteen years of age and older.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Use of a CAM service to treat chronic pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Being female (2.40 [1.47, 3.93], <i>p</i> < 0.001) and having a bachelorʼs degree (OR 2.24 [1.20, 4.20], <i>p</i> < 0.001) had a significant positive relationship with the use of CAM overall to redress chronic pain and those 50 years and older had greater odds of using manipulation therapies relative to those below 50 years (50–64: OR 0.52 [0.32, 0.86], <i>p</i> = 0.010; 65+: 0.37 [0.18, 0.75], <i>p</i> = 0.005).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In the studied region, females and those with university education have the greatest odds of using CAM to treat chronic pain. This study needs to be complemented with more mechanistic investigations into the reasons people make the decisions they make about using CAM for the management of chronic pain.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13114","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177906","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}
Emily Grahn MPHTM, Jacqueline Picard MSc, Lars Henning PhD
Introduction
Yellow fever is caused by an RNA flavivirus. Immunisation in conjunction with vector control is at the forefront of yellow fever control and elimination.
Objective
This narrative review describes the impact and importance of yellow fever vaccinations for northern Australian health practitioners.
Design
Selected key policies, studies and medical guidelines are reviewed and presented.
Finding
Large yellow fever outbreaks, associated with vector spread, have occurred in the last decade in Africa and South America, increasing the risk of international spread of the virus. Mobile populations, like travellers or migrant workers, continue to be at risk of yellow fever. Quality assurance, including yellow fever centre accreditation and initiatives to decrease fraudulent yellow fever vaccination documentation, has evolved in the past few years. Fractional dosing of yellow fever vaccines has been shown to provide protection for 1 year in outbreak scenarios, but further studies are needed.
Discussion
Although Australia is yellow fever-free, the disease could be introduced by viraemic persons as a competent Aedes mosquito vector is present in northern Australia. In addition to surveillance and vector control, health education and yellow fever vaccination remain the best lines of defence. In the event of an outbreak, a response via fractional dosing could prove to be effective in controlling the virus.
Conclusion
Health care providers in northern Australia should be aware of the risks of yellow fever and its introduction to northern Australia and be able to discuss vaccination status with their clients when needed.
{"title":"Yellow fever – An old foe with new developments","authors":"Emily Grahn MPHTM, Jacqueline Picard MSc, Lars Henning PhD","doi":"10.1111/ajr.13101","DOIUrl":"10.1111/ajr.13101","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Yellow fever is caused by an RNA flavivirus. Immunisation in conjunction with vector control is at the forefront of yellow fever control and elimination.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This narrative review describes the impact and importance of yellow fever vaccinations for northern Australian health practitioners.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Selected key policies, studies and medical guidelines are reviewed and presented.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Finding</h3>\u0000 \u0000 <p>Large yellow fever outbreaks, associated with vector spread, have occurred in the last decade in Africa and South America, increasing the risk of international spread of the virus. Mobile populations, like travellers or migrant workers, continue to be at risk of yellow fever. Quality assurance, including yellow fever centre accreditation and initiatives to decrease fraudulent yellow fever vaccination documentation, has evolved in the past few years. Fractional dosing of yellow fever vaccines has been shown to provide protection for 1 year in outbreak scenarios, but further studies are needed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Although Australia is yellow fever-free, the disease could be introduced by viraemic persons as a competent <i>Aedes</i> mosquito vector is present in northern Australia. In addition to surveillance and vector control, health education and yellow fever vaccination remain the best lines of defence. In the event of an outbreak, a response via fractional dosing could prove to be effective in controlling the virus.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Health care providers in northern Australia should be aware of the risks of yellow fever and its introduction to northern Australia and be able to discuss vaccination status with their clients when needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13101","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177871","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}
Kara L. Holloway-Kew PhD, Timothy R. Baker FACEM, Muhammad A. Sajjad PhD, Tewodros Yosef MPH, Mark A. Kotowicz FRACP, Jessie Adams PhD, Susan Brumby PhD, Richard S. Page FRACS, Alasdair G. Sutherland FAOA, Bianca E. Kavanagh PhD, Sharon L. Brennan-Olsen PhD, Lana J. Williams PhD, Julie A. Pasco PhD
Introduction
Farm workers are at high risk for injuries, and epidemiological data are needed to plan resource allocation.
Objective
This study identified regions with high farm-related injury rates in the Barwon South West region of Victoria, Australia, for residents aged ≥50 yr.
Design
Retrospective synthesis using electronic medical records of emergency presentations occurring during 2017–2019 inclusive for Local Government Areas (LGA) in the study region. For each LGA, age-standardised incidence rates (per 1000 population/year) were calculated.
Findings
For men and women combined, there were 31 218 emergency presentations for any injury, and 1150 (3.68%) of these were farm-related. The overall age-standardised rate for farm-related injury presentations was 2.6 (95% CI 2.4–2.7); men had a higher rate than women (4.1, 95% CI 3.9–4.4 versus 1.2, 95% CI 1.0–1.3, respectively). For individual LGAs, the highest rates of farm-related emergency presentations occurred in Moyne and Southern Grampians, both rural LGAs. Approximately two-thirds of farm-related injuries occurred during work activities (65.0%), and most individuals arrived at the hospital by transport classified as “other” (including private car, 83.3%). There were also several common injury causes identified: “other animal related injury” (20.2%), “cutting, piercing object” (19.5%), “fall ⟨1 m” (13.1%), and “struck by or collision with object” (12.5%). Few injuries were caused by machinery (1.7%) and these occurred mainly in the LGA of Moyne (65%).
Discussion and Conclusion
This study provides data to inform future research and resource allocation for the prevention of farm-related injuries.
导言：农场工人是受伤的高危人群，需要流行病学数据来规划资源分配：本研究确定了澳大利亚维多利亚州巴原西南地区与农场相关的受伤率较高的地区，这些地区的居民年龄≥50岁：利用研究地区地方政府区域（LGA）2017-2019年（含）期间发生的急诊病例的电子医疗记录进行回顾性综合分析。计算每个地方政府区域的年龄标准化发病率（每千人/年）：男性和女性合计共有 31 218 例任何伤害的急诊，其中 1150 例（3.68%）与农场有关。与农场有关的受伤病例的总体年龄标准化比率为 2.6（95% CI 2.4-2.7）；男性的比率高于女性（分别为 4.1，95% CI 3.9-4.4 和 1.2，95% CI 1.0-1.3）。就单个地方行政区而言，与农场有关的急诊就诊率最高的地区是莫伊恩和南格兰皮安，这两个地方行政区都是农村地区。大约三分之二的农场相关伤害发生在工作期间（65.0%），大多数人是乘坐 "其他 "交通工具（包括私家车，83.3%）到达医院的。此外，还发现了几种常见的受伤原因："其他与动物有关的伤害"（20.2%）、"切割、刺穿物体"（19.5%）、"从 1 米高处跌落"（13.1%）和 "被物体击中或与物体碰撞"（12.5%）。由机械造成的伤害很少（1.7%），这些伤害主要发生在莫伊恩地方行政区（65%）：本研究为今后预防农场相关伤害的研究和资源分配提供了数据。
{"title":"Emergency presentations for farm-related injuries in older adults residing in south-western Victoria, Australia","authors":"Kara L. Holloway-Kew PhD, Timothy R. Baker FACEM, Muhammad A. Sajjad PhD, Tewodros Yosef MPH, Mark A. Kotowicz FRACP, Jessie Adams PhD, Susan Brumby PhD, Richard S. Page FRACS, Alasdair G. Sutherland FAOA, Bianca E. Kavanagh PhD, Sharon L. Brennan-Olsen PhD, Lana J. Williams PhD, Julie A. Pasco PhD","doi":"10.1111/ajr.13110","DOIUrl":"10.1111/ajr.13110","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Farm workers are at high risk for injuries, and epidemiological data are needed to plan resource allocation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study identified regions with high farm-related injury rates in the Barwon South West region of Victoria, Australia, for residents aged ≥50 yr.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective synthesis using electronic medical records of emergency presentations occurring during 2017–2019 inclusive for Local Government Areas (LGA) in the study region. For each LGA, age-standardised incidence rates (per 1000 population/year) were calculated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>For men and women combined, there were 31 218 emergency presentations for any injury, and 1150 (3.68%) of these were farm-related. The overall age-standardised rate for farm-related injury presentations was 2.6 (95% CI 2.4–2.7); men had a higher rate than women (4.1, 95% CI 3.9–4.4 versus 1.2, 95% CI 1.0–1.3, respectively). For individual LGAs, the highest rates of farm-related emergency presentations occurred in Moyne and Southern Grampians, both rural LGAs. Approximately two-thirds of farm-related injuries occurred during work activities (65.0%), and most individuals arrived at the hospital by transport classified as “other” (including private car, 83.3%). There were also several common injury causes identified: “other animal related injury” (20.2%), “cutting, piercing object” (19.5%), “fall ⟨1 m” (13.1%), and “struck by or collision with object” (12.5%). Few injuries were caused by machinery (1.7%) and these occurred mainly in the LGA of Moyne (65%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion and Conclusion</h3>\u0000 \u0000 <p>This study provides data to inform future research and resource allocation for the prevention of farm-related injuries.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13110","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177907","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}
Nurse Navigators were introduced in Queensland, Australia, in 2016. Nurse Navigators coordinate person-centred care, create partnerships, improve care coordination and outcomes and facilitate system improvement, independently of hospital or community models. They navigate across all aspects of hospital and social services, liaising, negotiating and connecting care as needed. People stay with Nurse Navigators for as long as required, though the intent is to transition them from high-care needs to self-management. Nurse Navigators are a working model in rural and remote areas of Queensland.
Objective
To describe where the rural and remote Nurse Navigator position fits within the Rural Remote Nursing Generalist Framework and to define the depth and breadth of the rural and remote Nurse Navigator's scope of practice.
Design
Using template analysis, data from focus groups and interviews were analysed against the domains of the recently released National Rural and Remote Nursing Generalist Framework. Navigators working in rural and remote areas across Queensland Health were invited to an interview (n = 4) or focus group (n = 9), conducted between October 2019 and August 2020.
Findings
Rural and remote Nurse Navigators are proficient in all domains of the framework and actively champion for their patients, carers and the communities where they live and work.
Discussion
This research demonstrates that rural and remote Nurse Navigators are a working model of advanced nursing practice, acting as ‘champions’ of The Framework.
Conclusion
The Nurse Navigator model of care introduced to Queensland exemplifies proficient registered nurse practice to the full extent of their knowledge and skill.
{"title":"Nurse Navigators – Champions of the National Rural and Remote Nursing Generalist Framework: A solution","authors":"Amy-Louise Byrne PhD, Janie Brown PhD, Eileen Willis PhD, Adele Baldwin PhD, Clare Harvey PhD","doi":"10.1111/ajr.13107","DOIUrl":"10.1111/ajr.13107","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Nurse Navigators were introduced in Queensland, Australia, in 2016. Nurse Navigators coordinate person-centred care, create partnerships, improve care coordination and outcomes and facilitate system improvement, independently of hospital or community models. They navigate across all aspects of hospital and social services, liaising, negotiating and connecting care as needed. People stay with Nurse Navigators for as long as required, though the intent is to transition them from high-care needs to self-management. Nurse Navigators are a working model in rural and remote areas of Queensland.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To describe where the rural and remote Nurse Navigator position fits within the Rural Remote Nursing Generalist Framework and to define the depth and breadth of the rural and remote Nurse Navigator's scope of practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Using template analysis, data from focus groups and interviews were analysed against the domains of the recently released National Rural and Remote Nursing Generalist Framework. Navigators working in rural and remote areas across Queensland Health were invited to an interview (<i>n</i> = 4) or focus group (<i>n</i> = 9), conducted between October 2019 and August 2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Rural and remote Nurse Navigators are proficient in all domains of the framework and actively champion for their patients, carers and the communities where they live and work.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>This research demonstrates that rural and remote Nurse Navigators are a working model of advanced nursing practice, acting as ‘champions’ of The Framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The Nurse Navigator model of care introduced to Queensland exemplifies proficient registered nurse practice to the full extent of their knowledge and skill.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13107","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177910","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