Alcohol consumption among urban, suburban, and rural Veterans Affairs outpatients

Purpose: United States rural residents tend toward poorer health than urban residents. Although alcohol use is associated with multiple medical conditions and can be reduced via brief primary care‐based interventions, it is unknown whether alcohol consumption differs by rurality among primary care patients. We sought to describe alcohol consumption among urban, suburban, and rural Veterans Affairs (VA) outpatients. Methods: Outpatients from 7 VA facilities responded to mailed surveys that included the validated Alcohol Use Disorders Identification Test Consumption (AUDIT‐C) screening questionnaire. The ZIP code approximation of the US Department of Agriculture's rural‐urban commuting area (RUCA) codes classified participants into urban, suburban, and rural areas. For each area, adjusted logistic regression models estimated the prevalence of past‐year abstinence among all participants and unhealthy alcohol use (AUDIT‐C ≥ 3 for women and ≥ 4 for men) among drinkers. Findings: Among 33,883 outpatients, 14,967 (44%) reported abstinence. Among 18,916 drinkers, 8,524 (45%) screened positive for unhealthy alcohol use. The adjusted prevalence of abstinence was lowest in urban residents (43%, 95% CI 42%‐43%) with significantly higher rates in both suburban and rural residents [45% (44%‐46%) and 46% (45%‐47%), respectively]. No significant differences were observed in the adjusted prevalence of unhealthy alcohol use among drinkers. Conclusions: Abstinence is slightly more common among rural and suburban than urban VA outpatients, but unhealthy alcohol use does not vary by rurality. As the VA and other health systems implement evidence‐based care for unhealthy alcohol use, more research is needed to identify whether preventive strategies targeted to high‐risk areas are needed.     

Dementia, disability and contact with formal services: a comparison of dementia sufferers and non-sufferers in rural and urban settings

This paper is based on data from studies conducted in the City of Liverpool and in a rural area of North Wales, relating to people aged 75 years and over living in the community. It compares those identified in these studies as suffering from cognitive brain disorders with other older people identified as being cognitively unimpaired and looks at levels of competence with activities of daily living and the subsequent levels of contact with a range of health and social services personnel and other community workers. It shows that although levels of contact with formal services are generally higher for people with dementia than for non-sufferers, most of these differences are below the level of statistical significance. It was found that levels of contact for people receiving most services are low, especially for specialist mental health services and social work. The implications for community care are discussed, it is suggested that expansion of domiciliary care services for people with dementia and for their carers would demand more resources than are currently being made available but that it would be better value for money on a case by case basis.     

Understanding where we come from: Occupational therapy with urban Indigenous Australians

Background:  This article outlines issues of service provision for Indigenous families in Brisbane, Australia. It presents guidelines for the development of a socially and culturally appropriate occupational therapy service for urban Indigenous children.
Methods:  A mixed methodology was used in two independent components of the research. Part 1 comprised a survey of paediatric occupational therapists in Brisbane. Part 2 consisted of focus groups and interviews with recipients of a newly established occupational therapy service for Indigenous children.
Results:  Survey findings indicated that very few Indigenous families access mainstream occupational therapy services. Issues and strategies for developing culturally appropriate practice emerged around five main themes. These were the need to develop effective relationships, develop particular personal qualities, understand the background of both the client and the therapist, both gain and give knowledge, and address logistical issues of service delivery.
Conclusions:  Service providers need to understand the social and cultural context of both their Indigenous clients and themselves. Recommendations for future education and practice are provided.     

成都市农转非与城市居民的卫生服务需要与利用分析

目的 了解成都市农转非与城市居民的卫生服务需要与利用情况,为改善居民的健康状况提供政策建议。方法 采用多阶段分层抽样方法抽取该市6188名农转非居民以及3482名城市居民进行问卷调查。结果 成都市的城市居民慢性病患病率(28.3%)稍高于农转非居民(26.1%),但城市与农转非居民的慢性病患病类型前5位排序大体相同。农转非居民的两周患病率(16.1%)、两周就诊率(15.2%)、年住院率(9.7%)分别高于城市居民的两周患病率(12.7%)、两周就诊率(12.2%)、年住院率(6.2%)。农转非居民和城市居民在两周患病后分别有44.7%、41.7%的人去基层医疗机构就诊,在需要住院时分别有50.0%、73.4%的人去三级医院或专科医院就诊。结论 农转非居民的两周患病率更高,城市居民的慢性病患病率更高。农转非和城市居民在两周患病后都更倾向于去基层医疗机构就诊,在住院机构的选择上更倾向于三级医院或专科医院,说明分级诊疗政策的实施在成都取得一定效果。农转非居民的卫生服务利用率高于城市居民,建议政府根据实际情况在新修的农转非社区合理规划医疗机构和分配卫生资源,改善居民健康。     

The mental health of rural Australians: developing a framework for strategic research

ABSTRACT: This paper argues that lack of adequate research is a barrier to the long-term improvement of the mental health and well-being of rural Australians. Following from national mental health policy, potential research avenues in four broad domains (prevention and early intervention, pathways to care, outcome of illness and aetiology) are defined. These four broad domains are interdependent and research into them can be brought together into a simple framework or model. This model could be used to guide research into rurality and mental health. The proposed model uses the inclusive concept of place to capture the potential complexities of the rural locale as a variable in mental health and disorder. The model's predictor variables include both risk and resilience factors, and the outcome variables extend beyond morbidity to positive psychological wellness. It is proposed that this provisional model, and the strategic research that it directs, will act as a useful counterpoint to the more immediate evaluation and resourcing needs that confront rural mental health.     

北京市2012年城乡常住居民健康素养水平分析

目的 比较北京市城乡居民健康素养水平及影响因素,为制定干预策略提供参考。方法 采用分层多阶段随机抽样方法,确定11374名15~69岁常住人口为调查对象。采用自填与访谈相结合的方式,使用全国统一的《全国居民健康素养监测调查问卷》进行问卷调查。单因素分析使用χ²检验,多因素采用logistic回归分析,数据按照北京市六普人口数据进行标准化。结果 北京市城市居民健康素养水平为34.2%(3284/9592),标化率为27.2%;农村为14.2%(252/1770),标化率为9.3%,差异具有统计学意义(χ²=278.822,P<0.01)。多因素logistic回归结果显示,女性(OR=1.138)、大专及以上文化程度(OR=2.735~3.243)、年龄≥25岁(OR=1.398~1.824)、家庭年收入≥5万元(OR=1.532~1.797)、自我感知健康状况为一般(OR=1.415)、医务人员(OR=4.424)是城市居民健康素养水平的保护因素。高中/中专及以上文化程度(OR=3.025~6.123)、家庭年收入≥5万元(OR=1.785~2.400)、医务人员(OR=8.571)是农村居民健康素养水平的保护因素。无论是城市居民还是农村居民,患慢病(OR=0.866/0.697)均是健康素养水平的危险因素。结论 以农村居民、慢性病患病人群为重点人群,开展广泛的、有针对性的健康素养促进活动。     

‘Nowadays you don’t even see your neighbours’: loneliness in the everyday lives of older Australians

Loneliness is a pressing social issue for older people globally. Despite this, there is a paucity of studies on how older people themselves perceive loneliness and how service providers can support them. This study sought to address the gap using in‐depth and semi‐structured interviews with 60 older people and eight focus groups with aged care service providers in Australia in 2007. A purposive sampling strategy was employed to incorporate maximum participant variation. People 65 years and over were recruited from four large service providers in two Australian states. Our findings show that loneliness is influenced by private, relational and temporal dimensions and whether older people feel that they have, or are seen by others as having, a sense of connectedness with the wider community. Participants expressed the importance of maintaining social contact and having a sense of connection and belonging to the community. Our study highlights both the significance of gathering the views of older people to generate an understanding about loneliness and the need to recognise loneliness as a diverse and complex experience, bound to the context in which it is understood and perceived and not synonymous with social isolation. Such an understanding can be used to both evaluate and improve upon programmes that address loneliness and to help maintain an integration of older people in the community.     

富阳市某镇农民健康状况及卫生服务需求调查

目的：了解富阳市某镇农民健康状况及卫生需求。方法：采用整群随机抽样方法,抽取富阳市里山镇3个行政村6个自然村2047名农民进行健康检查,对1181名农民上门调查;召开30名代表（镇干部、社区卫生服务中心代表、村干部和村民代表）参加的座谈会。结果：农民慢性患病率高;社区卫生服务内容仍需不断拓展,补偿机制不合理,专业人员素质不高;健康教育工作未能满足广大农民需求。结论：应增加投入全面实施农民健康工程;推进包括调整和制定相应政策、加快人才队伍建设、研究和制定相应评价体系在内的农村社区卫生服务工作;建立农村健康教育体系,提高健康教育效率。     

西北五省（自治区）城乡卫生保健服务研究

目的为我国中西部地区乃至全国范围内的基本医疗保健制度的建立提供经验和政策建议。方法采用了快速政策研究方法、文献分析法、结构式访谈和现场考察等定性方法;在课题组内部开展了"头脑风暴法"的专家讨论会。结果与结论就农村卫生投入政策、发展新型农村合作医疗制度、城乡居民基本卫生保健服务体系建设、农村卫生人力政策和农村公共卫生服务均等化五个方面总结了现有经验并提出了政策建议。     

A comparison of health-risk behaviors of rural migrants with rural residents and urban residents in China

OBJECTIVE: To determine whether rural-to-urban migrants in China are more likely than rural and urban residents to engage in risk behaviors. METHODS: Comparative analysis of survey data between migrants and rural and urban residents using age standardized rate and multiple logistic regression. RESULTS: The prevalence and frequency of tobacco smoking, alcohol intoxication, and commercial sex involvement among migrants were generally lower than or equal to those among the 2 comparison groups. Gender, education, and income were associated with risk behaviors in most cases. CONCLUSION: Socioeconomic status appears to be more important than migration or residential locations in affecting risk behavior.     

城乡居民医保、老年人健康与医疗服务利用——来自五期CLHLS数据的证据

医疗保险作为我国社会保险制度的重要组成部分,其能否有效改善参保人的健康水平及医疗服务利用状况一直是国内外学者们争论的焦点。本研究基于2005—2018年中国老年健康影响因素跟踪调查的五期平衡面板数据,运用固定效应模型等方法,分析城乡居民医保对参保老年人健康水平及医疗服务利用状况的影响。研究发现,参加城乡居民医保并不能有效改善老年人的健康水平,但却可以改善他们的医疗服务利用状况,且对身体健康状况出现恶化的老年人影响更大。除此之外,本文并未发现支持城乡居民医保影响存在滞后的证据。基于此,本文认为我国城乡居民医保制度的实际效果与其预期目标间仍存在一定的差距。在我国医保扩面工作已取得长足进展的基础上,未来我国的城乡居民医保制度建设应将重心转移至进一步提高保障水平、实现可持续发展上,提升城乡居民医保的综合待遇,重视发挥医保的疾病预防功能。     

Social engagement,setting and alcohol use among a sample of older Australians

The harms associated with risky alcohol consumption have long been researched and recognised in the health field. However, little available research has focused on older people or extended analysis of alcohol use by this segment of the population beyond a biomedical perspective. With the rapid ageing of the global population, research that investigates alcohol use among older people from a social perspective is important. This article reports on research with a group of older women and men, to identify and explain factors that influence alcohol consumption. In‐depth interviews were conducted in Perth, Western Australia with 20 men and 22 women aged 65–74 years who were living in either private residences or retirement villages. The study findings indicated that alcohol use was linked with social engagement in activities across both settings, and that moderate alcohol use appeared to serve an important function as a ‘social lubricant’. The major facilitating factors for alcohol use included the frequency of opportunities for social engagement and access to a ready‐made social group in retirement villages. The major constraining factor across both settings was driving. Interestingly, health was not viewed as a major facilitating or constraining factor for alcohol consumption. Conclusions from the research were that alcohol serves an important role in enhancing social engagement, and there appear to be important associations between residential setting and alcohol use.     

Internet access for delivery of health information to South Australians older than 50

OBJECTIVE: An exploratory study to determine the proportion of people aged 50-76 years who have Internet access, the location of this access, predictive characteristics of such access, and preparedness to receive unsolicited health information through this medium. METHODS: A random sample of 1,000 South Australians was identified from the Australian Electoral Commission roll and contacted by telephone in 2006. They were invited to answer questions about their access to the Internet and attitude towards receiving unsolicited health information via the Internet. RESULTS: Of those contacted, 41% provided information. Of this group, 59% indicated that they had Internet access, mostly at home. Men were more likely than women to have home access (p<0.05). Higher educational achievement, higher economic status and younger age were all significantly associated with access. Of those who had access, 65% would be willing to receive health information through the Internet. CONCLUSIONS: More than half the population older than 50 years has access to the Internet at some location, and there is a general acceptance of the possibility of receiving health-promoting material via this medium. However, delivery via the Internet alone would disadvantage those who are less educated, less financially well off and older. IMPLICATIONS: It is likely that a generational change in the entire nature of public communication will influence the efficiency and effectiveness of preventive health promotion delivery via the Internet. In order to facilitate improved health outcomes, issues of disparity of access must be addressed.     

Demoralisation, distress and pain in older Western Australians

OBJECTIVE: To assess the relationship of psychiatric morbidity, morale, physical activity and the presence of pain in older people. METHOD: Older people attending senior citizens' clubs were administered the 28-item General Health Questionnaire (GHQ-28), the Revised Philadelphia Geriatric Centre Scale (RPGCS) and five self-report questions from the Brief Disability Questionnaire. They also rated the presence of pain on a five-point scale. Multiple and logistic regression were used to adjust for socio-demographic factors and identify variables independently associated with psychological status and morale. RESULTS: Of 112 people approached, 86% agreed to take part (n = 96). The sample showed a wide range in total GHQ scores (mean = 2.9, range = 0-19) and RPGCS scores (mean = 2.3, range = 1.1-3.0). Twenty-one per cent had psychological distress as defined by a score of > or = 6 on the GHQ-28 (n = 19). Fifty-four respondents (56%) reported low morale as defined by a score < 2 on the RPGCS. There was a close relationship between psychological distress, low morale on the RPGCS (OR = 5.5 [1.5-20.5]) and moderate to severe pain (OR = 5.3 [1.8-15.9]). When adjusted odds ratios were calculated to control for confounding factors, moderate to severe pain remained independently associated with psychological distress (OR = 1.6 [1.3-2.4] p = 0.02), and limitations in daily activities with low morale (OR = 3.64 (1.001-8.4) p = 0.05). CONCLUSIONS: There is a close relationship between physical disability, low morale and psychological distress. IMPLICATIONS: An increased index of suspicion for psychological distress is warranted in all older people with physical disability, particularly in the presence of moderate to severe pain.     

Disadvantage and discontent: a review of issues relevant to the mental health of rural and remote Indigenous Australians

OBJECTIVE: To provide an overview of the mental health of Aboriginal and Torres Strait Islander residents of rural and remote Australia and to identify associated factors. FINDINGS: Indigenous Australians have higher rates of serious mental disorders and of mental health problems associated with social disadvantage. This disadvantage is greater for Indigenous Australians living outside metropolitan centres. Contrary to romanticised constructions of remote Aboriginal Australia, those living in such settings are not immune to such hardship - which is often unrelenting. The psychological and behavioural problems that emerge as a result are compounded by narrowly focused and inadequate mental health services, with children being particularly vulnerable. CONCLUSION: Indigenous residents of rural and remote Australia experience high levels of mental disorder. Although addressing the predisposing social disadvantage will demand significant whole-of-government investment, ensuring equitable access to effective mental health services is an immediate priority.     

Management of episodes of incapacity by families in rural and remote Queensland

ABSTRACT: People in rural and remote areas have relatively poor health, so limited availability of and accessibility to doctors are major health issues. This cross-sectional study was conducted in rural and remote areas of Central Queensland. Using telephone interviews, the study described the use of formal and informal health services by families in response to episodes of incapacity. An episode of incapacity was defined as inability to conduct ordinary activities for at least half a day due to new or continued illness. Of the 394 households contacted, 270 (68.5%) provided information about 698 household members, of whom 269 (38.5%) reported at least one episode of incapacity in the previous 12 months. The respondents could report more than one type of management of an illness episode. The management of the most recent episode in each member included 68% visiting doctors and 8.2% using services at an accident and emergency unit. Persons living in 'least' medically resourced areas were more likely than persons in relatively 'high' and 'moderate' areas to consult doctors, but were also more likely to first consult books and delay their visits. They also consulted by telephone three times more frequently. Only 7% consulted other health practitioners including nurses and chemists, suggesting that these health practitioners were not used by families in rural and remote areas during episodes of incapacity. Increasing the availability and accessibility of medical care resources in rural and remote areas, using alternative delivery methods such as telemedicine, may meet the health needs of rural populations.