我国西部农村HIV感染者、AIDS患者家庭生活状况的研究

目的 深入了解在西部农村特定的经济、文化、社会因素影响下,HIV感染者、AIDS患者(people living with HIV/AIDS, PLWHA)的家庭生活状况.方法 对西部农村的16例PLWHA进行深入访谈,使用框架法分析访谈资料.结果 经资料分析提炼出3个主题:履行家庭角色的责任、义务;关爱家人多于关爱自己;努力改善家庭贫困.结论 西部农村PLWHA家庭经济贫困,由于PLWHA具有强烈的家庭责任感,身为患者依然要为家庭做出积极的努力.建议医护人员和帮扶政策制定者了解PLWHA真实的家庭生活状况,根据其需求提供积极、可行的帮助.     

Unstructured cardiac rehabilitation and secondary prevention in rural South Australia: does it meet best practice guidelines?

Comprehensive cardiac rehabilitation programs that address risk factors, psychological problems, and physical activity are essential in optimizing health and reducing the risk of further cardiac events. Behavioural and lifestyle modification support offered through these programs is predicated on initial identification of risk. Many rural populations in Australia do not have access to structured cardiac rehabilitation (CR) programs, and the level of support available to them in the form of unstructured CR is unclear. A retrospective analysis of medical records of patients presenting to hospital with myocardial infarction in rural South Australia over a 12 month period was undertaken to identify documented evidence of assessment of and intervention for lifestyle and behavioural risk factors in-hospital and at follow up in general practice (GP) clinics. Of 77 eligible participants, permission was received to access the medical records of 55 patients in the hospital setting, and 34 of these 55 patients in GP clinic follow up. Documented evidence of assessment of modifiable risk factors was inadequate for the majority of participants, with the exception of smoking status, hypertension and diabetes. This suggests that the majority of these participants did not receive lifestyle and behavioural interventions in line with current National Heart Foundation Recommendations for Cardiac Rehabilitation. Barriers to comprehensive CR and secondary prevention services in Australia must be addressed, particularly in high risk rural and remote populations. Future research must focus on the ongoing monitoring and evaluation of rural health care services to analyse existing levels of CR and secondary prevention to ensure current guidelines are being implemented, to support the further development and resourcing of CR services and to evaluate the subsequent impact on patient outcomes.     

Supply of health care in the Australian bush: human resources and government policy

The Australian bush--the heart of Australian folklore and a fascinating attraction for tourists, whether from within Australia or other countries--does not enjoy the same attraction for professionals across a range of industries including health, where there is a chronic shortage of human resources. Whilst data vary considerably between regions, in many cases, Australians from rural and remote regions have a lower health status than the overall population. This is particularly true of the population of Indigenous origin. There are about 250 medical practitioners for 100,000 people in Australia. This number varies between about 300 in the capital cities and just over 100 in the remote areas, the latter being mostly general practitioners as there are hardly any hospitals and specialists in those remote areas. The data change across professions--for example the number of nurses is about the same in capital cities and in remote areas: about 1000 full time equivalent for 100,000 people. They change too when we consider rural regions that are less or not isolated: in some instances, these are less supplied than remote areas, where access to care however remains more critical because of distance. The demographic profile of the professions examined in this paper also vary between regions, giving more urgency to workforce planning issues. The Australian government has embarked on the delivery of a major rural health strategy aimed at increasing access to health care in the rural and remote regions--through the provision of more and better services (specialist services; multipurpose centres); attracting more health professionals (scholarships for health students; setting up of rural universities); and retaining and supporting those professionals in rural and remote areas (on-going training; support programs for families and overseas trained doctors; practice management and financial incentives).     

Rural acquired immunodeficiency syndrome in low and high prevalence areas

BACKGROUND: Too little is understood about the spread of the acquired immunodeficiency syndrome (AIDS) in rural America. This study focuses on changes over 5 years in two low prevalence and two high prevalence human immunodeficiency virus (HIV) rural service areas. METHODS: An initial study conducted in 1993 provided a base line for the study. Each site was revisited in the summer of 1998. Data were analyzed by degree of rurality of the site, prevalence levels, and risk categories. RESULTS: Changes in the number of AIDS cases ranged from slow steady growth to increases of an epidemic magnitude. Some settings were characterized primarily by white homosexual men, and others had a more diverse population living in poverty. CONCLUSIONS: Populations receiving priority for national AIDS funding should be expanded to include rural America as a target group, and funding should provide the latitude for communities to match their local needs.     

Emergency department use by the rural elderly

This study uses Medicare data to compare emergency department (ED) use by rural and urban elderly beneficiaries. The U.S. Health Care Financing Administration's National Claims File was used to identify services provided to Medicare beneficiaries in Washington State in 1994. Patients were classified by urban, adjacent rural, or remote rural residence. We identified ED visits and associated diagnostic codes, assigned severity levels for presenting conditions, and determined the specialties of physicians providing ED services. The rural elderly living in remote areas are 13% less likely to visit the ED than their urban counterparts. Causes of ED use by the elderly do not vary meaningfully by location. Most ED visits by this group are for conditions that seem appropriate for this setting. Given the similarity of diagnostic conditions associated with ED visits, rural EDs must be capable of dealing with the same range of emergency conditions as urban EDs.     

Competencies and skills for remote and rural maternity care: a review of the literature

AIM: This paper reports a review of the literature on skills, competencies and continuing professional development necessary for sustainable remote and rural maternity care. BACKGROUND: There is a general sense that maternity care providers in rural areas need specific skills and competencies. However, how these differ from generic skills and competencies is often unclear. METHODS: Approaches used to access the research studies included a comprehensive search in relevant electronic databases using relevant keywords (e.g. 'remote', 'midwifery', 'obstetrics', 'nurse-midwives', education', 'hospitals', 'skills', 'competencies', etc.). Experts were approached for (un-)published literature, and books and journals known to the authors were also used. Key journals were hand searched and references were followed up. The original search was conducted in 2004 and updated in 2006. FINDINGS: Little published literature exists on professional education, training or continuous professional development in maternity care in remote and rural settings. Although we found a large literature on competency, little was specific to competencies for rural practice or for maternity care. 'Hands-on' skills courses such as Advanced Life Support in Obstetrics and the Neonatal Resuscitation Programme increase confidence in practice, but no published evidence of effectiveness of such courses exists. CONCLUSION: Educators need to be aware of the barriers facing rural practitioners, and there is potential for increasing distant learning facilitated by videoconferencing or Internet access. They should also consider other assessment methods than portfolios. More research is needed on the levels of skills and competencies required for maternity care professionals practising in remote and rural areas.     

Is telehealth the right tool for remote communities? Improving health status in rural Australia

The health status of people in rural and remote areas, particularly of Indigenous Australians, has been widely reported to be poorer than their urban counterparts. Health care in rural and remote Australia has relied on the work of nurses, often in the absence of medical or allied health personnel other than via telecommunication. Over the last 5 years telehealth has been heavily promoted as an innovative and effective way of improving the health status of people in rural and remote areas by providing improved access to specialist care. Through national infrastructure development and funding for a vast array of pilot projects, telehealth provision has been promoted as progressive, effective, and modern. This Editorial reviews the literature and highlights a need for additional research around telehealth-mediated patient practitioner relationships.     

Addressing the barriers to accessing therapy services in rural and remote areas

Abstract

Purpose: Throughout the world, people with a disability who live in rural and remote areas experience difficulty accessing a range of community-based services including speech-, physio- and occupational therapy. This paper draws on information gathered from carers and adults with a disability living in a rural area in New South Wales (NSW), Australia to determine the extent to which people living in rural areas may receive a person-centred therapy service. Methods: As part of a larger study in rural NSW into the delivery of therapy services, focus groups and individual interviews were conducted with 78 carers and 10 adults with a disability. Data were analysed using constant comparison and thematic analysis. Results: Three related themes emerged: (i) travelling to access therapy; (ii) waiting a long time to get therapy; and (iii) limited access to therapy past early childhood. The themes overlaid the problems of recruiting and retaining sufficient therapists to work in rural areas. Conclusions: Community-based rehabilitation principles offer possibilities for increasing person-centred therapy services. We propose a person-centred and place-based approach that builds on existing service delivery models in the region and involves four inter-related strategies aimed at reducing travel and waiting times and with applicability across the life course.

• Implications for Rehabilitation

• Therapy service delivery in rural and remote areas requires:

• Place-based and person centred strategies to build local capacity in communities.

• Responsive outreach programs working with individuals and local communities.

• Recognition of the need to support families who must travel to access remotely located specialist services.

• Innovative use of technology to supplement and enhance service delivery.

     

The impact of resident physician coverage on emergency department visits in South Carolina

BACKGROUND: This study examines emergency department (ED) visits to assess the potential impact on rural and minority patients if the practice of resident moonlighting was limited. METHODS: Billing data from all South Carolina ED visits in 1998 were linked to the physician licensure file. Logistic regression analysis was performed to determine patient characteristics predictive of being seen by a resident physician. RESULTS: Resident physicians attended 3.4% of visits for patients residing in rural areas and 1.4% of those from urban areas. The odds of being treated by a resident were higher among persons living in health professional shortage-designated or rural areas, minorities, and persons with government insurance. CONCLUSION: Patients from vulnerable populations have greater odds of being seen by a resident physician for an ED visit. These populations may be placed at risk for reduced access to health care services if limitations on resident physician moonlighting impair the ability of rural hospitals to staff EDs.     

Building resilience in regional youth: Impacts of a universal mental health promotion programme

Mental health is a leading health issue facing young people today, particularly those living in rural and regional areas. Although public policy supports schools‐based health promotion, there is limited evidence of the efficacy of such programmes and the elements that enhance successful implementation in rural and regional areas. A study was designed to evaluate a mental health promotion programme, delivered collaboratively by nurses, guidance officers, and teachers, to 850 young people from 23 rural and regional high schools in Queensland, Australia. The study aims were to determine what effect the intervention had on young peoples’ resilience, coping, and self‐efficacy, and to understand the implications of delivering the programme in the regional Queensland school setting. Students completed self‐report measures of self‐efficacy, resilience, and coping strategies pre‐ and postprogramme, as well as at 8‐week follow‐up. We found that after programme completion there was a significant increase in self‐efficacy and in the number of positive coping strategies used by the participating young people. Qualitative data indicated that participants benefited from the collaboration between health and education sectors; that is, nurses, guidance officers, and teachers delivered the programme together in ways that were perceived to be respectful of young people and effectively discussion‐based, and engaging.     

Relative professional roles in antenatal care: results of a survey in Scottish rural general practice

There is evidence of variation and some ambiguity about self-perceived relative professional roles in antenatal care in the UK. There is little information about models of antenatal care provision in UK rural areas. In rural areas, in particular, women have limited choice in accessing health care professionals or alternative primary care delivery settings. In the light of a recent review of Scottish maternity services, it is important and timely to examine models of care and interprofessional working in antenatal care in rural areas. This study explores midwives' and GPs' perceptions about their relative professional roles in remote and rural general practice in Scotland. A questionnaire survey involving all 174 Scottish remote and rural general practices (using one definition of rurality) was conducted, followed by 20 interviews. At least one professional returned a completed questionnaire from 91% of rural practices. A number of areas of dissonance were noted between GPs' and midwives' perceptions of their roles in maternity care and, given the context of service provision, these may impact upon rural patients. Findings are relevant to wider debates on extending the primary care team and strengthening inter-disciplinary working, particularly in rural areas.     

Need for an Australian Indigenous disability workforce strategy: review of the literature

Purpose: To identify approaches for developing workforce capacity to deliver the National Disability Insurance Scheme (NDIS) to Indigenous people with disability in Australian rural and remote communities.

Method: A narrative review of peer-reviewed and gray literature was undertaken. Searches of electronic databases and websites of key government and non-government organizations were used to supplement the authors’ knowledge of literature that (a) focused on Indigenous peoples in Australia or other countries; (b) referred to people with disability; (c) considered rural/remote settings; (d) recommended workforce strategies; and (e) was published in English between 2004 and 2014. Recommended workforce strategies in each publication were summarized in a narrative synthesis.

Results: Six peer-reviewed articles and 12 gray publications met inclusion criteria. Three broad categories of workforce strategies were identified: (a) community-based rehabilitation (CBR) and community-centered approaches; (b) cultural training for all workers; and (c) development of an Indigenous disability workforce.

Conclusion: An Indigenous disability workforce strategy based on community-centered principles and incorporating cultural training and Indigenous disability workforce development may help to ensure that Indigenous people with a disability in rural and remote communities benefit from current disability sector reforms. Indigenous workforce development requires strategies to attract and retain Aboriginal workers.

• Implications for Rehabilitation

• Indigenous people with disability living in rural and remote areas experience significant access and equity barriers to culturally appropriate supports and services that enable them to live independent, socially inclusive lives.

• A workforce strategy based on community-centered principles has potential for ensuring that the disability services sector meets the rehabilitation needs of Aboriginal people with disability living in rural and remote areas.

• Cultural training and development of an Indigenous disability workforce may help to ensure a culturally safe disability services sector and workforce.

     

广东省城乡残疾人个体生活能力的分析

目的:通过分析广东省各类残疾人的生活自理和生活活动，探讨城乡之间各类残疾人个体生活能力的异同并提出对策。方法:采用广东省第二次全国残疾人抽样调查中残疾人活动与参与评定的生活自理和生活活动分项目数据进行等级资料的统计处理。结果:城市与乡村视力残疾人的生活自理和生活活动的等级差异有显著性意义；肢体残疾人的生活自理的等级差异有显著性意义，而生活活动的等级差异无显著性意义；听力、言语、智力及精神残疾人的生活自理和生活活动在城乡之间的等级差异无显著性意义。结论:城市与乡村视力、肢体残疾人的个体生活能力有差异；而听力、言语、智力及精神残疾人的生活状况在城乡之间差异不明显，可采取相应的康复对策。     

Work Setting, Community Attachment, and Satisfaction Among Rural and Remote Nurses

ABSTRACT Objectives: To describe community satisfaction and attachment among rural and remote registered nurses (RNs) in Canada.
Design and Sample: Cross-sectional survey of rural and remote RNs in Canada as part of a multimethod study.The sample consisted of a stratified random sample of RNs living in rural areas of the western country and the total population of RNs who worked in three northern regional areas and those in outpost settings. A subset of 3,331 rural and remote RNs who mainly worked in acute care, long-term care, community health, home care, and primary care comprised the sample.
Measures: The home community satisfaction scale measured community satisfaction, whereas single-item questions measured work community satisfaction and overall job satisfaction. Community variables were compared across practice areas using analysis of variance, whereas a thematic analysis was conducted of the open-ended questions.
Results: Home care and community health RNs were significantly more satisfied with their work community than RNs from other practice areas. RNs who grew up in rural communities were more satisfied with their current home community. Four themes emerged from the open-ended responses that describe community satisfaction and community attachment.
Conclusions: Recruitment and retention strategies need to include mechanisms that focus on community satisfaction, which will enhance job satisfaction.     

Meanings of being old,living on one's own and suffering from incurable cancer in rural Norway

PurposeThe aim of this study was to explore and understand the lived experience of older people living alone and suffering from incurable cancer in rural Norway.Methods and sampleNarrative interviews were conducted with five older people with incurable cancer (three women and two men, aged 71–79), receiving outpatient and life-prolonging chemotherapy and living alone in their homes in rural areas. A phenomenological hermeneutical approach was used to interpret the meaning of the lived experience.Key resultsFour main themes were found: enduring by keeping hope alive, becoming aware that you are on your own, living up to expectations of being a good patient and being at risk of losing one's identity and value. Enduring this situation means struggling with terminal illness and facing death in a brave manner, and replacing former ways of living. The process of providing treatment may threaten dignity and cause additional distress.ConclusionsThese results show a complex and comprehensive situation where physical symptoms and emotions are interwoven. Further the results describe how the ways of suffering caused by the manner in which care is delivered, suffering related to the cancer disease and existential suffering, may increase each other's impact. The social and rural context calls for special attention as the patients may lack recourses to gain sufficient care. Their comfort depends to a large extent on the health professionals' sensitivity.     

Accelerating the Implementation of the Incheon Strategy to Make the Right Real for Persons with Disabilities

The Background of the Asian and Pacific Decade of Persons with Disabilities The Asia and Pacific Region Asia and Pacific is a vast region.It has about 60％of the world population.In Asia,you can find some of the oldest civilizations and religions;some of the most advanced as well as poorest economies,and many Asians living in rural and mountainous areas.Diversities and differences among governments and peoples of Asia are the norm rather than the exception. Poverty situation of people with disabilities in Asia:People with disabilities in the region are facing critical and severe situations.About 80％ of Asian people with disabilities live in rural or remote areas.Among the 900million very poor people in the Region,the disabled are among the most discriminated against and the most impoverished.     

通过改进挽留政策提高农村和边远地区卫生人力的可及性:WHO2010全球政策建议解读

农村和边远地区卫生人力资源不足是世界各国普遍关注的卫生问题之一,严重影响卫生公平的实现.对此,WHO提出全球政策建议——通过改进挽留政策提高农村和边远地区卫生人力的可及性.本文重点从循证医学方法学和指南制定角度,对该政策指南制定的关键步骤进行解读,主要包括背景及问题的提出、证据的检索与遴选、证据质量分级与推荐方案形成,从而进一步探讨卫生决策过程中如何正确认识、获得、评价与应用当前可得的研究证据,以及如何基于证据,利用GRADE系统做出科学可行的推荐,强调证据及GRADE系统在循证卫生决策中的重要作用.     

Consumers' proposed solutions to barriers to access of rural and remote speech pathology services

Barriers inhibiting the equitable delivery of health services to rural and remote areas of Australia have been well documented. Yet the literature has not discussed health care consumers' proposed solutions to these barriers. This is especially the case when considering rural and remote speech pathology services. This paper reports on a study that investigated potential solutions to perceived barriers experienced by consumers when attempting to access paediatric speech pathology services in rural and remote New South Wales (NSW). The study consisted of a self-administered questionnaire mailed to members of the NSW branch of the Isolated Children's and Parents' Association (ICPA). Key findings from this study suggest consumer-based solutions to barriers to access in an attempt to maximize the effectiveness of sparse rural and remote speech pathology services, by matching the beliefs and expectations of consumers with the characteristics of services provided.