Rural and remote health最新文献

{"title":"Medical students' perceptions of rural clinical placement: a mixed-methods study.","authors":"Iwona Kołodziejczyk, Stephanie Maima, Sharon Tobessa, Jerzy Kuzma","doi":"10.22605/RRH9468","DOIUrl":"10.22605/RRH9468","url":null,"abstract":"<p><strong>Introduction: </strong>A severe shortage and inequitable distribution of doctors between rural and urban populations leave the rural population in Papua New Guinea deprived of medical care. Our medical school adopted strategies proven in other countries to motivate medical students to undertake rural practice effectively. This study aims to explore medical students' perceptions of rural clinical placement in Papua New Guinea.</p><p><strong>Methods: </strong>We adopted a mixed-methods parallel design. We included 41 students who undertook the rural clinical placement. For the data collection instruments, we employed the semi-structured questionnaire for the quantitative strand and focus group discussion for the qualitative strand.</p><p><strong>Results: </strong>Most students reported positive experiences of rural placement evaluating highly rural supervisors. Among the benefits of rural placement are enhanced confidence and competence level in clinical skills, an opportunity to practise several procedures, hands-on diagnosing and managing patients, a wide variety of cases and taking more responsibility for patients' care. For the students with rural upbringings, rural placement influenced them to consider future work in rural areas. For the urban students, it increased their understanding of health issues in the rural population.</p><p><strong>Conclusion: </strong>This study enhances our understanding of factors affecting medical students' opinions on rural clinical placement and how this experience will likely influence their future career choices. Further study is required to assess the association between rural placement and choosing a rural career path.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"25 2","pages":"9468"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A qualitative evaluation of remote supervision guidelines for Australian general practice registrars in two practice locations.","authors":"Jill Benson, Josephine Borthwick, Tim Linton, Stacey Cotter, Karin Jodlowski-Tan, James Brown","doi":"10.22605/RRH9675","DOIUrl":"10.22605/RRH9675","url":null,"abstract":"<p><strong>Introduction: </strong>The lack of a stable general practice workforce in rural and remote Australia has been a topic of much discussion as there are fewer GPs working in many rural areas, where mortality and morbidity are higher than in urban areas. Doctors who have been trained in rural and remote areas are more likely to continue working there, but in many practices supervision is not available onsite. Good supervision ensures patient safety, an educational alliance between the supervisor and trainee, and adequate clinical and professional support by the supervisor and the onsite team. This project involved the evaluation of the pilot of the newly developed guidelines for the remote supervision of GP trainees (registrars) within the Royal Australian College of General Practitioners (RACGP) Australian General Practice Training program: Remote supervision: Guidelines for safe and effective general practice training utilising remote supervision.</p><p><strong>Methods: </strong>The aim of the evaluation was to assess the appropriateness, effectiveness and efficiency of the remote supervision guidelines and placement processes such as the selection process, risk management plan, face-to-face orientation period, development of the onsite team, communication strategies and increased payment. The guidelines were implemented as a pilot in two practice localities in 2022. The remote supervisors, remotely supervised registrars, practice managers and training organisation stakeholders were interviewed at three time points during the placement: before the placement, after the orientation period and at the conclusion of the placement. Their responses were analysed and organised into themes.</p><p><strong>Results: </strong>Overall, the results were positive, with suggestions for improvement and challenges identified. There was an identified need to ensure that guidelines are flexible and able to be tailored to the context of the registrar, the supervisor and the placement. Both registrars in the pilot continued to work in the remotely supervised practices at the end of their training and the three supervisors were keen to supervise remotely again.</p><p><strong>Discussion: </strong>The RACGP remote supervision guidelines were developed as an evidence-based practical means of supervising registrars in rural and remote locations where there is no onsite supervisor. The guidelines were updated where necessary and have now been published and implemented nationally.</p><p><strong>Conclusion: </strong>The pilot and evaluation of the RACGP remote supervision guidelines demonstrate that they are safe and fit for purpose. These guidelines form one of the training strategies to support the dwindling rural and remote general practice workforce.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"25 2","pages":"9675"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling paramedic confidence: exploring paramedics' perceived confidence in out-of-hospital births and obstetric emergencies - a scoping review.","authors":"Larissa Martin, Chloe Betts","doi":"10.22605/RRH9260","DOIUrl":"https://doi.org/10.22605/RRH9260","url":null,"abstract":"<p><strong>Introduction: </strong>The centralisation of birthing care, driven by the closure of 225 of Australia's rural birthing centres over the past 20 years, has resulted in a 47% increase in births before arrivals at hospitals. This shift positions paramedics as critical primary health providers for out-of-hospital births and obstetric emergencies. Despite the infrequency of such emergencies for paramedics, they demand proficient clinical management due to their severity and potential complications. Confidence is vital for paramedics in managing high-risk obstetric emergencies effectively. However, there is limited research on paramedics' confidence levels and the factors influencing them, particularly in Australia following the introduction of paramedic registration and mandatory obstetric training in 2018. This scoping review seeks to explore paramedics' confidence in managing prehospital obstetric emergencies, identify influencing factors and examine the implications of confidence on both patient and paramedic welfare.</p><p><strong>Methods: </strong>Following Joanna Briggs Institute methodology, a comprehensive literature search across three databases yielded 125 results. Screening of titles and abstracts by two authors, followed by full-text screening of 18 remaining articles, was conducted. Conflicts were resolved by the primary author, and three additional relevant articles were retrieved manually. Thirteen studies met the inclusion criteria and were analysed to inform the review.</p><p><strong>Results: </strong>The findings consistently highlighted feelings of low confidence, insecurity, vulnerability and heightened stress among paramedics when confronted with prehospital obstetric emergencies. These were largely attributed to infrequent and inadequate education and training, leading to skills decay and difficulties in distinguishing normal from complicated obstetric events. Rurality due to various logistical, geographical and resourcing factors was found to exacerbate paramedic insecurity attending and managing obstetric emergencies. The decline in confidence not only affects clinical proficiency but also poses risks to patient safety and contributes to paramedic stress and poor mental health outcomes.</p><p><strong>Conclusion: </strong>Proportional confidence emerges as a crucial factor in medical education, facilitating enhanced clinical competence and better mental health outcomes for patients, clinicians and teams. This is of increased importance in rural areas where logistical barriers to ensuring appropriate care are prevalent. Further research is needed to ascertain the optimal frequency and type of training/education required to bolster paramedic confidence in managing obstetric emergencies effectively.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"25 2","pages":"9260"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring discrepancies in clinical coding between rural and urban hospitals in Aotearoa New Zealand in patients who underwent interhospital transfer.","authors":"Anna Donaldson, Rory Miller, Garry Nixon, Gabrielle S Davie","doi":"10.22605/RRH9309","DOIUrl":"10.22605/RRH9309","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The agreement of clinical coding between rural and urban hospitals in Aotearoa New Zealand (NZ) is unknown, and data from comparable international health systems is scarce, dated or inconclusive. There is a reliance upon administrative datasets that store clinically coded information to complete numerous rural-urban health analyses, which inform health policy and resource allocation decisions. Anecdotally, clinical coding in NZ rural hospitals is often performed by clinicians or reception staff without formal coding training; in urban NZ hospitals this would usually be completed by formally trained clinical coders. This study aimed to determine whether discrepancies existed between the primary diagnosis codes assigned in the National Minimum Dataset (hospital events) (NMDS) of hospital discharges by NZ's publicly funded hospitals, for patients who underwent an interhospital transfer from a rural to an urban hospital.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a retrospective observational study using the NMDS. NZ's publicly funded hospitals were classified into three categories: rural hospitals, hospitals in small urban centres and hospitals in large urban centres. Interhospital transfers were identified by bundling events in the NMDS into healthcare encounters. The primary diagnosis codes assigned at discharge from the rural hospital were compared against the codes assigned at discharge from the urban hospital, and corresponding diagnosis groups based on the WHO chapter definitions were assigned to each code. The number and percentage, with 95% confidence intervals (CIs), of encounters where there was discordance between primary diagnosis codes from the rural and urban hospitals were calculated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study included 31,691 patients, from 54 publicly funded hospitals, who underwent an interhospital transfer from an NZ rural to an urban hospital between 1 January 2015 and 31 December 2019. There were discrepancies in 64.1% (95%CI 63.5-64.6%) of the primary diagnosis codes assigned between the rural and urban hospitals, and in 32.1% (95%CI 31.6-32.6%) of broader diagnosis groups. In both cases, higher discrepancies existed for transfers to hospitals in small urban centres compared to hospitals in large urban centres. The most frequently assigned diagnosis group at discharge from rural hospitals was the non-specific group 'other', constituting 24.4% of all diagnosis groups assigned by a rural hospital. For 4.8% of all healthcare encounters, a specific diagnosis group assigned on discharge from the rural hospital was subsequently changed to 'other' at the urban transfer hospital. This reassignment to 'other' following interhospital transfer occurred within every diagnosis group assigned at a rural hospital.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Two-thirds of primary diagnosis codes and one-third of diagnosis groups were discordant after transfer from rural to urban hospitals in NZ. Further in","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"25 2","pages":"9309"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A community-based intervention to challenge attitudes towards intimate partner violence: results from a randomised community trial in rural South-West Nigeria.","authors":"Olusegun Awolaran, Funmilola M OlaOlorun","doi":"10.22605/RRH9269","DOIUrl":"10.22605/RRH9269","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Intimate partner violence (IPV) is a major public health concern worldwide, with significant repercussions for women's health. In some parts of the world, IPV is considered an acceptable practice, especially in rural areas. Attitudes supportive of IPV have been reported as one of the foremost predictors of IPV, and a shift in the attitudes that permit, promote, and perpetuate IPV is required to substantially reduce its occurrence. Community-based interventions are a feasible strategy to engage community members in efforts to prevent IPV. This study tested a community mobilisation intervention to challenge attitudes towards IPV and prevent violence within intimate relationships.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This randomised community trial was conducted in selected rural communities in Oyo State, Nigeria, between January 2019 and April 2021. The study employed a convergent parallel mixed-methods design and a three-stage sampling technique in selecting two local government areas, eight communities and the study participants. The 6-month community mobilisation intervention, focused on creating awareness and challenging attitudes supportive of IPV, was evaluated using two cross-sectional surveys (pre-and post-intervention), 12 in-depth interviews, and nine focus group discussions. The outcomes for this study, assessed using the WHO Women's Health Questionnaire, included attitudes supportive of IPV, women's experiences of IPV and men's perpetration of IPV. Difference-in-differences (DID) regression models were estimated to compare changes in IPV levels in the intervention and control arms, while qualitative data were analysed using a thematic approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;At baseline, 628 men and 667 women responded to the survey, and 640 men and 658 women responded to the survey at endline. The median age of the respondents was 35 years at baseline and 40 years at endline. In the intervention group, the proportion of women with attitudes supportive of IPV reduced between baseline and endline from 65.2% to 35.1% versus 45.2% to 32.7% in the control group (DID= -0.116, p=0.039). Women's past year experience of IPV also reduced from 30.3% to 1.2% versus 48.4% to 33.2% in the control group (DID= -0.131, p=0.006). Changes in the proportion of men who had attitudes supportive of IPV or perpetrated IPV did not follow this trend. In the intervention group, the proportion of men with attitudes supportive of IPV increased between baseline and endline from 40.1% to 44.6%, as they did in the control group - from 43.7% to 45.8% (DID=0.015, p=0.805). Men's past-year perpetration of IPV reduced from 29.9% to 19.9% versus 43.2% to 10.2% in the control group (DID= -0.050, p=0.155). Respondents to the qualitative interviews in both the intervention and control groups at baseline were aware of the various forms of IPV in their communities, and had attitudes supportive of physical violence; however, those in the interventi","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"25 2","pages":"9269"},"PeriodicalIF":2.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'Services were completely shut down': access to rehabilitation in the rural Eastern Cape Province of South Africa during COVID-19.","authors":"Madri Engelbrecht, Lieketseng Yvonne Ned","doi":"10.22605/RRH9398","DOIUrl":"https://doi.org/10.22605/RRH9398","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Persons with disabilities living in rural areas were disproportionately affected during the COVID-19 pandemic. This population, with a higher propensity for poor health and higher need for health services, bore the brunt of adverse effects of emergency regulations that cancelled or restricted access to rehabilitation. South African legislative and policy frameworks support the availability and promotion of disability and rehabilitation services as priority healthcare programs for all. Rehabilitation services in the country were, however, underresourced prior to the pandemic, and halted during lockdowns because of their non-essential status in the healthcare system. Within this context, this study explored the experiences of rehabilitation practitioners in the Eastern Cape Province of South Africa during the COVID-19 pandemic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Forming part of a mixed study on inclusiveness of pandemic responses to people with disabilities, we reviewed government responses across different African countries, analysed the South African government responses to the pandemic and conducted interviews with rehabilitation practitioners in the rural Eastern Cape Province of South Africa. This article reports on the qualitative interviews, while the reviews and survey findings were published elsewhere. Rehabilitation practitioners were recruited from a provincial rehabilitation forum for practitioners who work in the public health facilities in the province. A combination of online and telephone individual interviews were conducted with participants, as well as three asynchronous interviews using Google Forms and WhatsApp. Transcriptions of interviews were analysed inductively and thematically through coding and categorisation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Eight practitioners participated in the study (a response rate of 8.4%). This included six physiotherapists and two occupational therapists. Three themes developed from data reported by the participants: reconfiguring rehabilitation services, experienced impact on rehabilitation service delivery and exacerbation of pre-pandemic rehabilitation shortfalls.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The low priority of rehabilitation services as part of health services exacerbated pre-pandemic barriers for persons with disabilities. The cessation of such services rendered rehabilitation wholly inaccessible to persons with disabilities in the province, with detrimental effects on their function, health and wellbeing. Practitioners suggested that integrated collaborative health and rehabilitation service delivery enabled the continuation of some service aspects to some persons with disabilities. Initiatives and adaptations to services were driven by practitioners, although often in the absence of clear directives from the Department of Health. Some alternative methods of delivery (eg telerehabilitation) that were deployed elsewhere, were not as accessible and viable ","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"25 2","pages":"9398"},"PeriodicalIF":2.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An integrative review of new nurse practitioners' experiences in rural healthcare practice.","authors":"Candace Stidolph, Jennifer Kawi, Catherine E Dingley, Ann Marie Hart, Jarod Giger, Rebecca Benfield, Andrew Thomas Reyes","doi":"10.22605/RRH9626","DOIUrl":"10.22605/RRH9626","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;A maldistributed primary care workforce and disparities in health outcomes are ongoing concerns for rural populations across the globe. Nurse practitioners (NPs) are a promising solution for mitigating rural healthcare inequities by reducing provider shortages and improving access to essential primary care services. The NP workforce is the fastest growing sector of primary care providers in the US. NPs are more likely than their physician colleagues to spend careers in rural and underserved settings practicing in isolation from other providers, with higher rates of turnover. An indistinct understanding of rural NPs' early career experiences highlights the need for a critical synthesis of the literature and key future recommendations. This integrative review aimed to analyze and synthesize various types of empirical reports and theoretical articles about new NPs' experiences in rural primary healthcare practice; identify current literature gaps; and discuss implications for education, policy, and further research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Whittemore and Knafl's integrative method was used to inform the selection, review, and analysis of the literature. Search keywords were based on the Population, Effect of Interest, Measure, Study Design, Setting framework: (1) population (primary care NPs), (2) effect of interest (early career phase in a rural context), (3) measure (NP perspectives about their experiences), (4) study design (empirical, theoretical), and (5) setting (rural US and countries with a similar healthcare system and NP workforce, such as Australia, Canada, Ireland, Netherlands, and New Zealand). Four key databases (PubMed, Embase, Web of Science and CINAHL) were searched, followed by manual searching of reference lists to identify relevant empirical and theoretical literature; no time delimitation was applied in the search. A total of 174 sources were scanned. Data were iteratively compared, and significant patterns were extracted and organized into thematic clusters.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The literature search yielded five studies that met the eligibility criteria: three phenomenological studies, one descriptive qualitative study, and one descriptive quantitative study. Three themes emerged: the trajectory of early career practice for rural NPs, commitment and persistence of new rural NPs, and adaptive and maladaptive early career factors for rural NPs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This review included articles published in the US, although emergent themes may contribute to global knowledge about early career experiences in rural settings where advanced practice nurses are used. This review reinforced that NPs as a distinct professional population are underrepresented in rural workforce research, particularly during their early career phases. Scholarly literature about new rural NPs emphasized clinical preparedness and competence, workplace recruitment incentives, transition-to-p","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"24 2","pages":"9626"},"PeriodicalIF":2.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Features of lipid metabolism in Arctic residents depending on ethnicity and lifestyle.","authors":"Olga Vlasova, Fatima Bichkaeva, Boris Shengof, Ekaterina Nesterova, Alexandra Strelkova, Nina Baranova","doi":"10.22605/RRH9140","DOIUrl":"https://doi.org/10.22605/RRH9140","url":null,"abstract":"<p><strong>Introduction: </strong>Metabolic adaptations can differ significantly among Arctic residents with different ethnicities, lifestyles and adherences to traditional diets. The objective of this study was to examine the status of saturated fatty acids (SFAs) and triglycerides and the variability of BMI among Russian Arctic residents according to ethnicity and lifestyle.</p><p><strong>Methods: </strong>The study involved adult females and males living in the territories of the Russian Arctic. The participants were divided into three groups: Indigenous reindeer herders leading a nomadic lifestyle (NIP), Indigenous people leading a sedentary lifestyle (SIP) and the Caucasian population (CP). The content of SFAs (C6-C24) and metabolic characteristics was determined using gas chromatographic and spectrophotometric methods. The study also included a quantitative comparison of the consumption of certain categories of food products. To analyze data, we used the descriptive analyses by non-parametric methods, as well as multiple linear regression analysis.</p><p><strong>Results: </strong>The study found that the Caucasian females had higher triglyceride levels (p<0.001), higher total content of long-chain SFAs (LCSFAs) (C13-C18) (p=0.002) and that the SIP females had reduced content of very-long-chain fatty acids (C20-C24) (p=0.039). These changes were not statistically significant for the males, partly due to the almost identical levels of triglycerides C16:0 and C18:0 in the NIP and the CP. The content of medium-chain SFAs (MCSFAs) (C6-C12) was higher in the SIP (p<0.001 for females; p=0.002 for males). The Indigenous males tended to have a lower BMI compared to the Caucasian males, resulting in a lower prevalence of overweight or obesity: 49.3% in the NIP (p=0.006) and 57.4% in the SIP versus 69.3% in the CP. In female participants, these frequencies did not differ, being 64%, 65.4% and 66% respectively. The NIP and SIP groups had higher consumption of traditional foods, carbohydrate-rich foods, meat products and vegetable oils, the latter of which was positively associated with SFA content.</p><p><strong>Conclusion: </strong>The study revealed the dependence of the studied parameters of lipid metabolism on ethnicity (Indigenous v Caucasian) and lifestyle (nomadic v sedentary). The population metabolic variability was expressed as the increase in the levels of LCSFAs and triglycerides in the CP, reflecting, most likely, an imbalance in the processes of their accumulation and consumption with a predominantly western type of nutrition. Indigenous populations, despite changes in diet towards an increased consumption of carbohydrate-rich products, have preserved an adaptive metabolism with the predominant use of lipids as energy resources. Higher levels of MCSFAs in the SIP, who are less adherent to a traditional diet compared to the NIP, may be compensatory, with a growing role of such fatty acids in energy consumption and thermogenesis.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"25 2","pages":"9140"},"PeriodicalIF":2.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prescribing for acute migraine in a rural Australian hospital.","authors":"John J van Bockxmeer, Sarah Briody, Marshall Makate, Jack Kalotas","doi":"10.22605/RRH8686","DOIUrl":"10.22605/RRH8686","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Migraine is an episodic, debilitating form of headache. Guidelines exist for the management of acute migraine, concluding that opioids should be avoided, unless as a last resort. Australian research shows a poor consistency in ED prescribing patterns with no published rural hospital data. Treatment of acute migraine often involves multiple medications used in succession. The overprescription of opioids is reported and often accompanied by an underuse of triptans. Previous studies do not differentiate prescriber intervention over time. It is unclear if opioid medications are routinely selected as first-line therapy in rural Australian EDs. The aim of this research is to complete an evaluation of migraine management in a rural Australian ED and compare trends to pre-existing data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study is a retrospective cohort analysis of clinician-diagnosed migraine patients presenting to a single Australian ED between 1 January 2017 and 31 December 2021. Cases with migraine were defined by a primary G439 diagnosis (International Classification of Diseases 10th Revision). Patients with alternative diagnoses and those who did not wait were excluded. Cases underwent a non-blinded chart review extracting demographic and clinical data. Diagnoses were not evaluated against the international headache society criteria. ED interventions were recorded as first-, second-, third- or fourth-line based on the ordering time by the prescribing doctor. Medications were classified as being compliant or non-complaint with current standards of care. Trends were compared to previous studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 341 patients were diagnosed with migraine, 72.4% female, median 35 years. A total of 6.5% arrived by ambulance, 76.8% had a prior history of migraine, 6.5% were admitted, 36.4% underwent blood investigations and 12.0% neuroimaging. A total of 7.6% of patients received opioids as first-line therapy, 44.3% failed self-medication and 21.7% of patients with migraine history trialled opioids prior to presentation. Regarding prescriptions, 795 were written, 18.1% were non-compliant with guidelines. Seventy percent of patients received dopamine and 5-HT3 antagonists, 43.1% non-steroidal anti-inflammatory drugs (NSAIDs), 27.0% serotonin receptor agonists and 27.0% opioids. There was a statistically significant prescribing difference for aspirin, used in 16.4% of those with a migraine history and 5.1% without (p=0.01). A total of 13.8% reported allergies/contraindications to guideline therapies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Prescribing for acute migraine in Australia is highly variable by context. This single-site study has similarities and differences with prior research. Rates of opioid prescribing were lower, possibly due to the known sparing effect of serotonin receptor agonist usage. Similar rates of NSAID and intravenous hydration prescription occurred. Patterns of intervention o","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"25 2","pages":"8686"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of recent methamphetamine use on treatment outcomes among individuals initiating medications for opioid use disorders in rural treatment settings: a 1-year retrospective cohort study.","authors":"Leslie A Kenefick, Lisa Khairy, Luke Hall, Kibeom Kwon, Nicole Limberg, Kirsi Kirk-Lewis, Megan Lewis, Matt Owen, Sterling McPherson, André Q Miguel","doi":"10.22605/RRH9536","DOIUrl":"10.22605/RRH9536","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Rates of N-methylamphetamine (methamphetamine) use in rural areas of the US have been steadily increasing, particularly among individuals who are already struggling with opioid use disorder. Despite this alarming trend, there remains a significant gap in our understanding of how methamphetamine use affects treatment response for those undergoing treatment with medications for opioid use disorder (MOUD). This study aimed to explore the predictive role of methamphetamine urinalysis (UA) results at intake in treatment retention and in opioid and methamphetamine use over time among individuals seeking MOUD treatment in four clinics located in rural areas. The study was conducted across four clinics situated in rural areas, where access to addiction treatment services is known to be limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Clinical data for this study were collected between January and December 2019. A substantial number of participants were enrolled from those patients initiating treatment in 2019 in four clinics in rural Oregon. Data included intake demographics, attendance, and monthly opioid and methamphetamine UA results over a 1-year period. Our primary outcomes were opioid and methamphetamine use, and treatment retention over a 1-year period. Objective verification of opioid and methamphetamine use was determined using UA results collected once per month. Treatment retention was determined considering the number of days elapsed from treatment intake to treatment dropout. Generalized estimating equations were used to compare methamphetamine and opioid use over time, and Kaplan-Maier survival analysis was used to compare treatment retention by methamphetamine UA result at intake.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 554 patients enrolled at one of the four rural MOUD clinics, of whom 277 (50%) had a negative methamphetamine and 277 (50%) had a positive methamphetamine UA result at intake. Participants were mostly White individuals (89.5%), half of participants were male (54.5%), and the mean age was 36.8 years (standard deviation 10.8 years). About a third were unemployed (32.3%), more than a quarter reported legal problems (26.2%), and 5.4% were currently homeless. Compared to those testing negative for methamphetamine, patients initiating MOUD treatment with a positive methamphetamine UA were more likely to be unemployed (36.5% v 28.2%; p=0.048) and to have a positive opioid UA result at intake (88.4% v 45.8%; p&lt;0.001). A negative methamphetamine UA result at intake was associated with fewer positive methamphetamine UA results over time (p=0.022) but was not associated with either better treatment response for opioid use over time (p=0.849) or treatment retention (p=0.51).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;While patients who had negative methamphetamine UA results when initiating MOUD treatment had higher rates of methamphetamine abstinence over time, methamphetamine UA results at intake did not predict ","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"25 2","pages":"9536"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}