Rural Remote Health
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Rural Remote Health · Jan 2011
Junior doctors' and medical students' commitment to working in areas of workforce shortage.
Australian Government initiatives promote rural training placements, supported medical school places, and incentives that attract doctors to areas of need. The purpose of this study was to report on the preparedness of medical students and junior doctors to commit to working in areas of workforce shortage. ⋯ Government policies and incentives may be having an effect on medical students' and junior doctors' preparedness to work in rural and remote areas. Medical educators should encourage students and junior doctors to take up short-term placements/opportunities and to maintain links with rural communities. Practice opportunities that offer varying lengths of commitment should be advertised widely so junior doctors are aware of them and can apply.
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Rural Remote Health · Jan 2011
Comparative StudyTown-level comparisons may be an effective alternative in comparing rural and urban differences: a look at accidental traumatic brain injuries in North Texas children.
Rural areas in the USA are generally poorer, more isolated, less populated, have older populations, and also unique work dynamics that fundamentally set them apart from urban areas. Additionally, funding and resources are limited in rural areas; a problem that may be exacerbated when looking specifically at town-level resources. One of the key problems in comparing US rural and urban areas, particularly at the county level, is that the resources available to individual towns within a particular county may not accurately reflect the resources available to the county as a whole. This leads to questions about the validity of county-level comparisons between rural and urban areas because of differences in town sizes and the resources availability at this level. The authors of this study attempted to assess this difference by analyzing data previously collected for a study examining pediatric traumatic brain injury among four levels of rurality: urban city, large town, small town, and isolated town. ⋯ This study has numerous limitations, yet it demonstrates that comparisons based on the RUCA code designations of large and small towns can be an effective means for understanding the differences at the town level, and also to better establish prevention strategies geared toward these differences.
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Rural Remote Health · Jan 2011
Initial evaluation of rural programs at the Australian National University: understanding the effects of rural programs on intentions for rural and remote medical practice.
Rural health workforce issues are a priority area for the Australian Government and substantial funding has been provided for rural education programs to address health workforce disparities across Australia's rural and remote communities. The Australian Government established a Rural Health Strategy in 2001 and as a result there are now 14 rural clinical schools in Australia. The 2008 Urbis Report highlighted the lack of research on rural programs and workforce outcomes, essential to ensuring that educational efforts, resources and funding are being concentrated appropriately. This study examined the Australian National University (ANU) Medical School's 4 year rural program to identify the impact of elective and compulsory program components on student intentions to practice in a rural and remote location post-graduation. The study also explores factors that affect student decisions to apply for year-long rural placements. METHODS; ANU Medical School's graduating cohort of 2008 fourth year medical students completed an anonymous and voluntary online survey questionnaire. Survey sections included student demographics, compulsory and elective components of the ANU rural program, and an overall evaluation of the ANU rural curriculum. The survey contained a mixture of forced-answer questions and open-ended commentary. Quantitative data were analyzed for descriptive and frequency statistics using EpiInfo V3.5.1 (http://wwwn.cdc.gov/epiinfo/). Qualitative data were reviewed and consistent themes among responses extracted. ⋯ Rural programs at the ANU, and medical school exposure to rural health experiences is important in influencing students' perceptions of a career in rural and remote health. This study provides evidence that both compulsory and elective components contribute to a successful holistic rural program which nurtures the rural interest of all students. Overall, students at the ANU medical school were satisfied with the rural curriculum. The results confirm that there is difficulty in recruiting students with family commitments into year-long rural placement programs, despite incentives. Those students who select long-term rural study for reasons other than an interest in a career in rural health end the program with positive rural intentions.
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Rural Remote Health · Jan 2011
Attitudes of GPs towards Older Adults Psychology Services in the Scottish Highlands.
The mental health of older adults is of increasing concern in an aging population and GPs are frequently the gatekeepers to specialist mental health services. Psychotherapy, social interventions and bibliotherapy all have an evidence-base for treating depression and anxiety in the elderly, as does pharmacological treatment. However, the referral rate from GPs for an Older Adults Clinical Psychology service in the Scottish Highlands in the months prior to the study had been very low and the reasons for this were not clear. General practitioners may have felt that depression and anxiety are 'understandable' in older adults and are therefore unsuitable for treatment, or they may have felt that psycho-pharmacotherapy treatments are more effective than the psychotherapy treatment options. Alternatively, local issues associated with the remote location of many NHS Highland GP practices and patients may have prevented them referring. Therefore, the current study aimed to elicit the therapeutic preferences of Highland GPs, the perceived availability of these options and an estimate of the prevalence of older adults in the area suffering from mild or moderate mental health problems. ⋯ The current study suggests that low awareness of psychological service provision among GPs may have resulted in fewer referrals, rather than low confidence in psychotherapies for this population. The GPs' preference for social interventions may reflect the particular risk of isolation of the elderly in remote communities and may be worthy of consideration when developing services in these areas.
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Rural Remote Health · Jan 2011
Comparative StudyDeterminants of apparent rural-urban differentials in measles vaccination uptake in Indonesia.
Regional differences in vaccination uptake are common in both developed and developing countries, and are often linked to the availability of healthcare services and socioeconomic factors. In 2007, 0.9 million eligible Indonesian children missed measles vaccination, and 19 456 cases of measles were documented among Indonesian children. The authors investigated rural-urban differentials in measles vaccination coverage among young Indonesian children, and sought to identify key factors influencing the probability of a child receiving the first dose of measles vaccination in Indonesia. ⋯ Apart from sustainable initiatives to increase measles vaccination coverage globally, it is important to close the rural-urban gap in Indonesia's measles vaccination uptake. Addressing critical determinants of inferior measles vaccination coverage in Indonesia's rural regions will facilitate major improvements in Indonesia's child health trends. This article suggests initiatives for addressing three of such determinants in Indonesia's rural areas: poverty, parental education and access to skilled health workers.