Rural and remote health最新文献

Introduction: Despite investment in maternal-child health programs, there has been little impact on the health outcomes of Indigenous mothers and their children, creating a need to understand how programs can be successfully implemented. Community input is essential for successful programs; however, there is little research exploring the perspectives of frontline workers providing these programs. To gain a better understanding of how to support maternal-child health program success a research partnership was formed with the KidsFirst North program in Northern Saskatchewan, Canada. Using a community-based participatory research approach, this study was codeveloped to (1) explore families', frontline workers', and administrators' perceptions of factors that contribute to the success and barriers of a program for Indigenous families; and (2) describe the current role of frontline workers within health program planning, implementation, and evaluation.

Methods: From September 2019 to January 2020, data were collected through in-person meetings, focus groups, and semi-structured interviews with KidsFirst North families (n=9), frontline workers (n=18), and administrators (n=7) from 11 sites in Northern Saskatchewan. Data were analyzed using the Collective Consensual Data Analytic Procedure.

Results: The identified factors of program success included the importance of staff, where staff demonstrated certain positive characteristics and created a welcoming atmosphere for families; community events that were open to the entire community; and the integration of Indigenous culture in the program. Program barriers included jurisdictional policy that negatively impacted frontline workers, a lack of father inclusion in program activities, and community challenges such as a lack of access to other services within the community. All frontline workers had a role in program delivery, most reported involvement in program development and planning, and approximately half were included in program evaluation.

Conclusion: Factors of success and barriers from the KidsFirst North project have illustrated elements to build on and areas to address in public health program planning, implementation, and evaluation of maternal-child health programs that serve Indigenous families. KidsFirst North has demonstrated ways a contemporary maternal-child health program can utilize frontline workers outside of program delivery to influence all aspects of health program planning, implementation, and evaluation. Contributing to the evidence base of maternal-child health programs for Indigenous families may help foster the success of public health programs; inform the role of frontline workers in health program planning, implementation, and evaluation; and positively impact the health of Indigenous children and families.

Introduction: Young people with unaddressed legal matters are at risk of adverse consequences to their health and wellbeing. Health justice partnerships (HJPs) can support young people in regional areas to address their legal matters and reduce consequential deleterious impacts. A health justice partnership for youth (HJPY) was established in western Victoria, Australia. The program was unique for both its regional location and focus on supporting young people with their legal matters. This article reports on research that was conducted alongside the program, examining (1) the perceptions of regional young people and workers about the impact of legal matters on the health and wellbeing of young people and (2) the role of this HJPY in addressing these legal matters on the health of young people.

Methods: Surveys were used to collect data from young people (n=64) attending the HJPY, and youth and allied health workers (n=48) from partner and other agencies. Data about the program were collected by the legal service operating at the time. Data were collected across multiple time points over 6 years, upon commencement and completion of the program.

Results: The findings showed that young people attending the program required assistance for a wide range of legal matters. Upon attending the HJPY, most young people indicated that their unresolved legal matters influenced their health and wellbeing including sleep, stress, concentration and relationships. After attending the program, young people reported perceived improvements in their health and wellbeing, with workers observing improvements in young people's mental health, mood and self-confidence.

Conclusion: The research highlights the importance of HJPs to young people in addressing their unmet legal needs, with resolution of these matters supporting improved health and wellbeing and enabling them to move forward and focus on other areas of their lives. Youth and allied health workers in regional areas are integral in the early identification of young people with legal matters. They are integral to facilitating suitable referral pathways and services that support young people with their unresolved legal matters.

Introduction: Australians living in isolated communities are more likely to experience poorer health outcomes as a result of rurality. This article provides a needs assessment of healthcare services in a geographically isolated region of Victoria, Australia.

Methods: The research project employed a mixed-methods design. The study population consisted of members of the isolated communities in Victoria. The incorporation of qualitative data added depth to the quantitative data, ensuring that voices of community members were adequately represented in the needs assessment. Data analysis was undertaken using descriptive statistics and thematic analysis techniques.

Results: Survey respondents from isolated regional locations highlighted the extended travel time and increasing wait times to see a medical practitioner, leading to a delay in seeking healthcare assistance. Respondents were less likely to have access to and use telehealth services, yet highlighted the service as beneficial to isolated regions. Survey findings were supported by in-depth interviews, with participants stating access to care was difficult, providing place-based suggestions of services to remove barriers to care such as a virtual care model and mobile services visiting the isolated regions.

Conclusion: Access, use and facilitation of appropriate place-based health care within isolated Australia has the potential to increase wellbeing and enables residents to remain in regions that hold long historical and familial connections. By incorporating innovative technologies and models of care that have been evaluated across other isolated regions of Australia and globally, there is an opportunity to adapt existing models to conform to a post-COVID world.

Introduction: The third objective of the UN Sustainable Development Goals (SDGs), 'ensure healthy lives and promote well-being for all at all ages', is manifest in Indonesia's commitment to health. One of the SDG3 targets is to reduce under-five mortality and infant mortality. In rural areas of Indonesia, there is a lack of access to medical facilities (healthcare services, anthropometry tools) and health workers, so low birth weight (LBW, <2500 g) in rural areas remains high. This study aimed to determine the profile of and test the factors that cause LBW in Indonesia.

Methods: This study used secondary data from the National Socio-Economic Survey/Survei Sosial Ekonomi Nasional (SUSENAS) 2021 with a national sample of 4 711 455 women (weighted), which is analyzed descriptively and inferentially. The analysis was conducted descriptively to determine the profile and distribution of LBW at the national and provincial levels, while inferential analysis was performed using logistic regression to determine the variables that most influence LBW.

Results: The prevalence of LBW in Indonesia was found to be 11.7%. North Maluku was the province with the highest LBW rate (20.1%), and West Java had the highest number of LBW infants in Indonesia, with 104 585 infants. This study found that smoking, rural areas, poor nutrition, age of childbirth, age and birth spacing significantly affected the incidence of LBW in Indonesia. In rural Indonesia, women tend to give birth to LBW babies (adjusted odds ratio: 1.249; 95%CI: 1.241-1.256). The incidence of LBW babies in rural areas was higher than in urban areas (12.9% v 10.8%) in Indonesia.

Conclusion: This study concluded that smoking behavior is the main variable that influences the incidence of LBW in Indonesia. Therefore, there should be assistance to families by prioritizing significant factors for LBW (living in a village/rural area, low education, smoking behavior, not or rarely consuming nutritious food, maternal age at first birth 35 years and birth spacing <33 months). Especially for rural areas, governments need to improve access to healthcare facilities including availability of anthropometry tools, health workers, and healthcare services.

Introduction: UN Sustainable Development Goal 3 and the nurturing care framework highlight the importance of healthcare services and preventive measures to ensure optimal health outcomes for children, including those with disabilities. However, the contributions of male caregivers in the general care of children with disabilities in Sub-Saharan African contexts are often overlooked. This article therefore aims to understand how male caregivers navigate and negotiate healthcare options for their children with disabilities in rural Kenya.

Methods: A qualitative approach was adopted, following the phenomenological tradition, to collect data from 22 male caregivers of children with neurodevelopmental disabilities in rural Kenya using four focus group discussions. The data were analyzed using inductive thematic analysis. The interpretation of the findings was guided by the theoretical approach of critical disability studies.

Results: The article contributes new knowledge to the understanding of the roles and experiences of male caregivers in the healthcare of children with disabilities in rural Sub-Saharan African contexts. Four emergent themes are presented: '... hospitals around cannot offer a solution to their problems ...', '... regarding finances, I have to struggle alone ...', '... the only place one can pity you is the traditional herbalist ...' and 'I pray to God to heal him'.

Conclusion: Faced with significant challenges in accessing conventional healthcare services, male caregivers employ the local cultural resources available to them to address the healthcare needs of their children with disabilities. This emphasizes the need to complement their efforts by mobilizing the healthcare system to offer quality, equitable, culturally sensitive and inclusive healthcare solutions.

Introduction: Factors influencing mortality in patients with COVID-19 treated in a community hospital in a rural region in south-eastern Poland during the first and the second wave of the pandemic were analyzed.

Methods: A retrospective observational study based on a hospital-based registry of Holy Spirit Specialist Hospital in Sandomierz was conducted. The study population consisted of patients treated between 1 March 2020 and 31 May 2021.

Results: We analyzed data of 24 057 Caucasian patients including 798 patients with COVID-19. During both waves of the COVID-19 pandemic 22.4% of patients hospitalized in the community hospital in Sandomierz died due to COVID-19. The multivariate logistic regression model showed that older age (p<0.001), fever (p<0.001), diagnosis of sepsis (p<0.001) and high levels of C-reactive protein (p=0.041) were factors related to mortality. In the group of patients in whom oxygen therapy (p<0.001) and invasive mechanical ventilation (p<0.001) were used more frequently, mortality was higher, whereas treatment with convalescent plasma increased the chance of survival (p<0.001).

Conclusion: Fever and high laboratory values of inflammation, in particular coexisting sepsis, worsened the prognosis in patients with COVID-19. Most traditional methods of treating the infection did not affect the course of the disease.

Introduction: As the numbers of, and interest for, decentralized medical curricula increase, the need for knowledge about enrolled students' experiences becomes increasingly urgent. Concerns have been raised that the learning environment may be impaired when educational programs are moved from urban to less central locations. Previous research investigating this issue has revealed discrepant findings, and no such studies have been conducted in Scandinavia.

Methods: In this cross-sectional study, the 50-item Dundee Ready Education Environment Measure (DREEM) was used to compare learning environment perceptions of students in a decentralized medical program in Norway to that of their urban peers. DREEM includes statements about different aspects of a learning environment. Three student cohorts were included, and students responded to the questionnaire during the final 2 months of year 4. The original English DREEM was translated to Norwegian as a part of the study. Independent t-test was used for comparison of DREEM overall scores and subscale scores.

Results: Both student groups perceived the learning environment as good, and the educational atmosphere was seen as particularly positive. The decentralized group obtained a significantly higher overall DREEM score, as well as significantly higher scores for all subscales. The largest intersite difference was found for students' perception of learning, while students' academic and social self-perceptions were subject to less score differences.

Conclusion: Despite concerns about suboptimal learning environment conditions in decentralized curricula, this study indicated the opposite. Plausible explanations include integration of students in a clinical community, development of continuous longitudinal relations between students and teachers, and the use of flipped classroom activities in small student groups. Considering the learning environment's importance for student learning and wellbeing, these findings are valuable in the further establishment and development of decentralized medical education.

Context: Promoting rural development can pose numerous policy and governance challenges. However, rural proofing offers a vital solution. It helps policymakers create strategies that cater to rural needs, which is particularly relevant to health care. It involves making policy decisions based on evidence on rural dynamics available in a timely fashion to enable changes and adjustments.

Issues: Governments should consider rural proofing health sector policies and strategies because making health policies rural-friendly encourages innovation and ensures access to services in rural and remote communities.

Lessons learned: Effective rural proofing mechanisms give policymakers the necessary information and data to assess how policies affect rural areas, allowing for timely adjustments early in the policy design phase. The key to this process is timing, evidence and flexibility - one size does not fit all. The rural proofing requires experimentation to find the best solutions and modalities that fit a country's context.