The latest medical research on Rural & Remote

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about rural & remote gathered by our medical AI research bot.

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Gastroschisis in a premature infant in Papua New Guinea: initial treatment with a normal saline bag silo.

Rural and Remote Health

This case report describes the staged management gastroschisis in a low-birthweight baby in Papua New Guinea, where a silo was fashioned using a no...

Comment: Sedation as part of secondary prophylaxis to prevent recurrent rheumatic fever in Aboriginal and Torres Strait Islander peoples: time for a reset?

Rural and Remote Health

Australia's national clinical practice guidelines recommend intramuscular (IM) penicillin every 28 days for persons diagnosed with an initial episo...

Sociodemographic factors associated with knowledge of type 2 diabetes in rural Tamil Nadu, India.

Rural and Remote Health

This study aimed to investigate awareness of type 2 diabetes and how sociodemographic factors influence diabetes knowledge in a rural population of Tamil Nadu, India. Previous research has identified poor awareness of diabetes in several low and middle-income countries, which can lead to a high prevalence of undiagnosed diabetes. India having the second highest prevalence of diabetes globally, it is increasingly important to assess how diabetes can be addressed in rural Indian populations.

Systematic random sampling was used to gather study participants in 17 villages within the Krishnagiri district of Tamil Nadu, India. Data on diabetes knowledge was collected using a validated questionnaire. Knowledge score range was 0-8; a score of zero was designated as 'low knowledge', scores 1-4 as 'moderate knowledge', and scores 5-8 as 'good knowledge'. Associations between sociodemographic factors and composite diabetes knowledge score were assessed using a multinomial logistic GLLAMM model in Stata.

A total of 753 individuals participated in the study. The average age of participants was 47 years and 55% were women. Overall awareness of diabetes was low, with 66% of individuals having no knowledge of diabetes. Only 16% and 17% achieved a moderate and a good knowledge score, respectively. Achieving a moderate knowledge score was significantly positively associated with education, wealth, participation in the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), and business ownership as a source of income. Achieving a good knowledge score was significantly positively associated with education, wealth, rurality, participation in MGNREGA, business ownership as a source of income, and frequency of healthcare utilization. Rurality was significantly negatively associated (relative risk ratio (95% confidence interval)) with both moderate knowledge score (0.34 (0.19-0.59)), and good knowledge score (0.43 (0.24-0.74)). The strongest predictor of having a good knowledge score was having a high-school graduate or post-secondary education (11.07 (4.44-27.61)). Enrolment in MGNREGA employment was the strongest predictor for having a moderate knowledge score (3.27 (1.93-5.54)), as well as strongly associated with having a good knowledge score (2.39 (1.31-4.36)).

The low awareness of diabetes among participants of this study raises serious concerns for public health in India. Public health efforts must prioritize health equity to lessen the impacts of diabetes in rural populations, where individuals face systemic barriers to receiving prevention and treatment for conditions such as diabetes.

Bakmaranhawuy - the broken connection. Perspectives on asking and answering questions with Yolŋu patients in healthcare contexts.

Rural and Remote Health

Questioning is a key method in general information-seeking behaviour and teaching used by the dominant culture in Australia. Within an Australian health context the fundamental diagnostic tool used by medical staff is the biomedical interview or history taking, which is based on a battery of direct questions. Similarly, many health professionals rely on patient questions to prompt the sharing of information, or to make them aware of gaps in communication. This is problematic for many First Nations peoples, including Yolηu (First Nations people of North-East Arnhem Land), who are culturally less inclined to use direct questioning as it is deemed impolite within their cultural context.

Semi-structured conversational interviews using culturally congruent communication processes were conducted with participants in their preferred language. Interviews were translated, transcribed and analysed inductively using NVivo v12.

A total of 30 participants were interviewed (10 health staff and 20 Yolηu with recent experience in engaging with health services). All participating health staff believed that questioning was essential for determining how to best treat patients but many felt that questions created problems for some Yolηu patients. They also felt that Yolηu patients ask fewer questions related to their health issues than patients of other cultures. Yolηu participants conveyed overwhelmingly negative experiences with the health system and at the tertiary hospital in particular. Yolηu participants described feelings of frustration, fear and trauma when talking of their experiences, and these feelings were often direct outcomes of poor communication with staff. Regarding the use of questions in health care specifically, Yolηu participants identified four key and interrelated conditions within which questioning was deemed an acceptable communication mechanism. Dhämanapan (connection) was identified as an essential condition for effective communication between health staff and patients. This connection was established and maintained through a shared understanding of matha (language), dukmaram (Yolηu understandings of healing) and djuηuny (Yolηu norms of polite communication). Strategies for overcoming barriers to effective communication related to the concept of dhuwurr (skill) in health communication, which could increase the acceptability of health staff asking questions of Yolηu and the confidence of Yolηu patients in asking questions of health staff.

The findings from this study indicate a fundamental disconnect between the current health system and the needs of the Yolηu patients it seeks to serve. In order for this to change, Yolηu patients and health staff need to develop dhuwurr in health communication, which incorporates the four key conditions for effective communication identified in this study. To achieve this, ongoing and mandatory intercultural communication training for health staff is needed, just as mandatory training is required for hygiene and resuscitation training. Intercultural communication training must be comprehensive - reflecting the complexity involved in developing this dhuwurr - and sustained, for example with ongoing support from cultural communication mentors.

Development and implementation of the Bachelor of Nursing (Conversion) course in Vanuatu.

Rural and Remote Health

Vanuatu, a Pacific Island nation in the Western Pacific region, has to date educated its nurses by diploma program. Research evidence in developed countries has consistently shown that nurses educated by bachelor degree improve patient health outcomes and reduce hospital length of stay. In seeking to improve health outcomes, the Vanuatu Ministry of Health decided to introduce a new Bachelor of Nursing degree to provide a skilled, safe nursing workforce for the provision of health care to its peoples{1-3}. The curriculum for this degree was to be developed by Ni-Vanuatu nurse educators with the collaboration of educators from the WHO Collaborating Centre, University of Technology Sydney. However, it was first necessary to upgrade (from diploma to bachelor level) the qualifications of teachers and senior nursing practitioners who would lead the new degree course by introducing a Bachelor of Nursing (Conversion) course.

In order to design and implement a Bachelor of Nursing (Conversion) course that would be relevant for the educational and healthcare context in Vanuatu and that would meet qualification requirements of the local regulatory bodies, it was essential to build collaborative relationships with key stakeholders in Vanuatu. A second key concern was to design a program that would cater for participants who were working full time, who were not all living in the same physical location, and who had limited access to internet technology and resources. The course also needed to take into account that participants were multilingual, and that English was not their first language.

Lessons learned included the importance of coming to understand the sociocultural nexus within which this course was developed and implemented, as well as appreciating the constraints that affect nursing education within the Pacific.

Telehealth use in rural and remote health practitioner education: an integrative review.

Rural and Remote Health

For rural and remote clinicians, quality education is often difficult to access because of geographic isolation, travel, time, expense constraints and lack of an onsite educator. The aims of this integrative review were to examine what telehealth education is available to rural practitioners, evaluate the existence and characteristics of telehealth education for rural staff, evaluate current telehealth education models, establish the quality of education provided through telehealth along with the facilitators or enablers of a successful service and develop recommendations for supporting and developing an education model for rural and remote health practitioners through telehealth.

An integrative review was conducted following the five-stage integrative review process. Searches were conducted in the electronic databases CINAHL, Medline, Nursing & Allied Health (Proquest), PubMed, Johanna Briggs Institute Evidence Based Practice (JBI EBP) and Embase.

Initial searches revealed more than 7000 articles; final inclusion and exclusion criteria refined results to 60 articles to be included in this review. Included articles were original research, case studies, reviews or randomised controlled studies. Countries of origin were countries in North and Central America, the UK, Europe, and Africa, and Australia and India. One issue noted with this review was classifying rural and remote; contexts used included rural, remote, regional, isolated, peripheral, native communities and outer regional or inner regional. Sample sizes in the studies ranged from 20 to more than 1000 participants, covering a broad range of health education topics. Delivery was mostly by a didactic approach and case presentations. Some included a mix of videoconferencing with face-to-face sessions. Overall, telehealth education was well received, with participants reporting mostly positive outcomes as signified by feeling less isolated and more supported. One interesting result was that quality in telehealth education is poorly established as there appears to be no definitions or consensus on what constitutes quality in the delivery of telehealth education. Very few studies formally tested increase in skill or knowledge, which is usual with professional development programs that do not result in further qualifications. For those that did assess these, formal knowledge and skills assessment indicated that telehealth using videoconferencing is comparable to face-to-face training with significant benefits related to travel reduction and therefore cost. Recommendations were difficult to synthesise because of the broad issues uncovered and lack of quality in many of the studies.

The applications for telehealth are still evolving, with some applications having poor evidence to support use. Overall, telehealth education is well received and supported, with positives far outweighing negatives. Anything that can improve connection with a community and decrease isolation experienced by rural clinicians can only be beneficial. However, further planning and evaluation of the quality of delivery of telehealth education and addressing how education outcomes can be measured needs to be addressed in this widely growing area of telehealth.

Qualitative study of barriers and facilitators of health entrepreneurship in rural and semirural communities of Armenia.

Rural and Remote Health

Low- and middle-income countries often face the issue of unequal distribution of healthcare services and human resources between rural and urban areas. Globally, there are many factors negatively affecting the willingness of physicians to work in remote and rural areas, such as low wages, poor living conditions, poorer and sicker patients, suboptimal equipment and supplies, and a lack of quality infrastructure and transportation.

This study explored the perceptions of barriers and facilitators of medical entrepreneurship and the impact of medical entrepreneurship on the served communities among the owners of private medical practices in rural and semirural areas of Armenia. The researchers conducted qualitative in-depth interviews with the 13 owners of 12 private practices. The interviews were transcribed in the original language (Armenian). Only the quotes were translated into English. The direct content analysis approach was used for analyzing textual data.

The findings of the study suggest that high investment cost, intense competition with state facilities, unfavorable laws and regulations, and a lack of entrepreneurship and healthcare quality assurance skills were perceived as barriers to establishing and running private healthcare practices. The dissatisfaction of healthcare providers with their work conditions in state facilities, the instability of the job market in Armenia, and the development of clear marketing strategies by the entrepreneurs facilitated opening and operating private practices. All of the interviewees felt that their practices had a positive impact on the communities they served, in terms of creating new jobs and introducing up-to-date and in-demand services into these communities.

The study recommended providing potential entrepreneurs with training in entrepreneurship and healthcare quality assurance and mentorship opportunities, as well as with tools to support financing their enterprises.

Effectiveness of patient activation interventions on chronic obstructive pulmonary disease self-management outcomes: A systematic review.

Australian Journal of Rural Health

Chronic obstructive pulmonary disease is the third leading cause of death worldwide. Although there is currently no cure for chronic obstructive pulmonary disease, the available self-management strategies can result in improving the symptoms, slowing the disease progression, reducing the frequency of acute exacerbations, improving the patients' quality of life and minimising health care utilisation-associated costs. Patient activation is often considered an essential driver of self-management; however, there are contradictory evidence about its impact on chronic obstructive pulmonary disease self-management.

This review aims to fill this gap by collating the available evidence on the effectiveness of patient activation-driven chronic obstructive pulmonary disease self-management interventions.

Databases including MEDLINE, Academic Search Complete, CINAHL Plus, Science Citation Index, Social Sciences Citation Index, Scopus, APA PsychInfo, EMBASE and ScienceDirect were searched for randomised controlled trials of patient activation-driven chronic obstructive pulmonary disease self-management interventions between 2004 and July 2020. The search terms included chronic obstructive pulmonary disease, self-management/self-care and patient activation/patient engagement.

The initial search resulted in 645 articles, and after reviewing, 10 randomised controlled trials met the inclusion and exclusion criteria. Our review found that patient activation level had a positive association with chronic obstructive pulmonary disease self-management and clinical outcomes, and higher patient activation levels led to better outcomes. The interventions also led to moderate improvements in patient activation level. However, improved patient activation levels did not improve hospitalisation rates, quality of life and mental health.

Our findings suggest that patient activation can be used as a reliable tool for improving chronic obstructive pulmonary disease self-management and clinical outcomes; however, it should encompass all aspects of patient activation, especially the emotional aspect.

Quality of life, community integration, service needs and clinical outcomes of people with traumatic brain injury in urban, regional and remote areas of Queensland, Australia.

Australian Journal of Rural Health

To understand and explore the traumatic brain injury (TBI) outcomes for people returning to urban versus rural communities post-injury, and if geographical location plays a role in those outcomes.

TBI-related symptoms, quality of life, service obstacles, unmet needs, mental health and community integration.

No group differences in TBI outcomes due to location were found. While the participant's gender, age, and injury severity were significant independent predictors of five of the six outcomes, location did not play a role.

Consistent with previous findings, geographical remoteness did not affect self-reported TBI outcomes. Older people, women and those with severe TBI had worse outcomes and required additional supports, and men require community integration assistance. An Australia-wide study with regular follow-ups is strongly recommended to support direct regional comparisons and improve service planning.

Coordinated speech therapy, physiotherapy, and pharmaceutical care telehealth for people with Parkinson disease in rural communities: an exploratory, 8-week cohort study for feasibility, safety, and signal of efficacy.

Rural and Remote Health

The potential for coordinated, multidisciplinary telehealth to help connect people with Parkinson disease (PD) in rural areas to PD specialists is crucial in optimizing care. Therefore, this study aimed to test the feasibility, safety, and signal of efficacy of a coordinated telehealth program, consisting of speech therapy, physiotherapy, and pharmaceutical care, for people with PD living in some rural US communities.

Fifteen individuals with PD living in rural Wyoming and Nevada, USA, participated in this single-cohort, 8-week pilot study. Participants were assessed before and after 8 weeks of coordinated, one-on-one telehealth using the following outcomes: (1) feasibility: session attendance and withdrawal rate; (2) safety: adverse events; and (3) signal of efficacy: Communication Effectiveness Survey, acoustic data (intensity, duration, work (intensity times duration)), Parkinson's Fatigue Scale, 30 second Sit-to-Stand test, Parkinson's Disease Questionnaire - 39, Movement Disorder Society Unified Parkinson's Disease Rating Scale - Part III, and medication adherence.

Average attendance was greater than 85% for all participants. There were no serious adverse events and only nine minor events during treatment sessions (0.9% of all treatment sessions had a participant report of an adverse event); all nine cases resolved without medical attention. Although 14 of 16 outcomes had effect sizes trending in the direction of improvement, only two were statistically significant using non-parametric analyses: 30 second Sit-to-Stand (pre-test median=11.0 (interquartile range (IQR)=6.0); post-test median=12.0 (IQR=3.0) and acoustic data work (pre-test median=756.0 dB s (IQR=198.4); post-test median=876.3 dB s (IQR=455.5), p<0.05.

A coordinated, multidisciplinary telehealth program was safe and feasible for people in rural communities who have PD. This telehealth program also yielded a signal of efficacy for most of the outcomes measured in the study.

Weaving pathways: talking with our Elders.

Rural and Remote Health

While there exists a relative paucity of completed healthcare directives nationally in the USA, even fewer exist within minority populations. This ...

Self-reported chronic back pain in the elderly living in rural riverine areas in the Amazon.

Rural and Remote Health

The present study aimed to estimate the prevalence of self-reported chronic low back pain and to identify the associated factors in elderly people living in rural riverside areas in the Amazon.

Data from a cross-sectional home-based survey performed in 38 riverside rural locations along the left bank of the Negro River, in the municipality of Manaus, Amazonas, Brazil, were analyzed. The selected elderly people answered a questionnaire comprising items related to the living conditions, socioeconomic and demographic characteristics, health status and utilization of health services. The outcome was self-reported chronic back pain or problem. The association between the outcome and the independent variables was assessed using logistic regression, estimating the odds ratios and respective 95% confidence intervals (CIs).

One hundred and six residents aged 60 years or older out of a total of 277 were included in the study. The prevalence of chronic back pain among the elderly residents was 57.5% (63.3% among men and 50.0% among women). Most of them did not have any treatment related to their chronic condition (77.0%). Occupation in activities other than agricultural activities was protective for the outcome (odds ratio (OR)=0.1, 95%CI=0.0-0.9). The chronic low back pain was also associated with worse self-perceived health (OR=10.3, 95%CI=1.6-67.5).

The high prevalence of chronic low back pain in elderly people living in rural riverside areas, along with limited access to treatment and the different impacts on the performance of daily activities and the quality of life, reveals the relevance of this condition as a public health problem.