Volume twenty-four, Issue 3

Remote health services in Australia struggle to recruit and retain enough skilled, dedicated staff to provide a stable service. In very remote primary health clinics, small teams of Remote Area Nurses (RANs), Aboriginal and Torres Strait Islander Health Practitioners and Aboriginal Health Workers provide or facilitate all health care for their local community. Poor personal safety has been identified as a contributing factor to burnout and high turnover of staff and is linked to reduced quality of patient care. Many Work Health and Safety (WHS) recommendations and strategies have been developed for the remote health sector in Australia but there is very little evidence of their implementation. This Original Research study investigates which WHS recommendations have been implemented in very remote primary health clinics in Australia, from the perspectives of RANs.

The increasing proportion of older adults in the world demands greater attention to healthy aging. Sarcopenia, an age-related decline in musculoskeletal system function, can lead to adverse health outcomes and higher health system costs, but inconsistencies in assessment tools means that there is limited clear knowledge about its prevalence. This Original Research article reports on the prevalence of sarcopenia and its associated factors among rural older adults in Brazil using European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria.

O aumento da proporção de idosos no mundo demanda grande atenção para o envelhecimento saudável. A sarcopenia, um declínio na função do sistema musculoesquelético, pode levar a desfechos adversos à saúde e a altos custos aos sistemas de saúde. Contudo, inconsistências nas ferramentas de avaliação indicam que não há clareza quanto à sua prevalência. Este artigo original apresenta a prevalência e os fatores associados à sarcopenia em idosos rurais do Brasil, utilizando o critério do Grupo de Trabalho Europeu sobre Sarcopenia em Idosos 2 (EWGSOP2).

La creciente proporción de adultos mayores en el mundo exige una mayor atención al envejecimiento saludable. La sarcopenia, un deterioro de la función del sistema musculoesquelético relacionado con la edad, puede conducir a resultados adversos y mayores costos del sistema de salud. Por otro lado, las inconsistencias en las herramientas de evaluación nos muestran que existe un conocimiento limitado sobre su prevalencia. Este artículo de investigación original informa sobre la prevalencia de la sarcopenia y sus factores asociados entre los adultos mayores rurales de Brasil utilizando los criterios del Grupo de Trabajo Europeo sobre Sarcopenia en Personas Mayores 2 (EWGSOP2).

Household food insecurity (HFI) describes inadequate food access, availability, and utilization due to insufficient financial resources and is an important social determinant of health. Other aspects of food security, such as the availability of, and physical access to, healthy foods, are uniquely challenging to achieve in remote regions. This Scoping Review provides a unique global exploration and comment on the literature surrounding HFI in remote and circumpolar remote communities. Through examining initiatives and outcomes that have been conducted to decrease HFI, and factors that contribute, a fulsome picture of the current evidence is created and critiqued. Suggestions both regarding further research, as well as informing current policy based on work done thus far, are made.

Ambulance Services within Australia frequently use a combination of first responders, volunteer ambulance officers (VAOs), registered paramedics, critical care/extended care paramedics and aeromedical rescue services. In rural regions, emergency care may be provided by a blended service of paramedics and VAOs or a complete VAO model. Many maternity units have been centralised to larger regional centres, impacting accessibility of antenatal care for rural and remote communities. Longer travel times are associated with increased risk of out-of-hospital births (OOHBs) and life threatening complications such as postpartum haemorrhage and neonatal mortality.

Registered paramedics perceive a lack of adequate training, exposure and confidence with managing OOHBs, but there is limited research about VAO experiences. This Original Research study investigates VAO perceptions of training, experience and confidence regarding management of unplanned OOHBs.

Australia’s medical workforce problem is primarily one of maldistribution, with both the geographic distribution of doctors and the relative supply of medical specialities not currently meeting the health needs of Australian rural communities. Recent studies from Australian universities that have prioritised recruiting students from the region in which they are located, rather than just the ASGS-RA or MM classifications, have demonstrated promising results for ‘grow your own’ workforce strategies, with students who grew up and also trained in a region being up to 17 times as likely to work in the same region after graduation. With growing evidence supporting strategic ‘grow your own’ approaches to recruiting, training and retaining health professionals from and for underserviced rural communities, there is a need for sound methodologies by which universities with a social accountability mandate can accurately describe their region of rural focus, or ‘footprint’. This Project Report describes the process, outcomes and lessons learned through a project undertaken to formally describe Deakin University’s rural health activity footprint.

Magnesium is required for almost all body system functions, including cardiovascular, neurological, endocrine, musculoskeletal and immune systems. Dysmagnesemia, or disorder in serum magnesium levels (hypermagnesemia or hypomagnesemia), is associated with poor health outcomes in hospitalised patients, including the need for longer hospital stays and increased risk of mortality. This register-based study assessed the prevalence of dysmagnesemia and associated health outcomes among hospitalised patients in the Northern Territory, Australia.

Pakistan's government and development organizations aim to accomplish equitable access to family planning services by 2030, in line with Sustainable Development Goals, by enhancing the availability and quality of family planning services, increasing awareness and education, and addressing cultural and social barriers. These endeavors are anticipated to support reproductive health outcomes and lower maternal and infant mortality rates in Pakistan. A first crucial step in facilitating the development of effective policies and programs is to understand the diversity of fertility patterns, family planning preferences, and behaviors that exist. This Original Research article examines the factors influencing contraceptive use and family planning behaviors in rural and urban regions of Pakistan.

Discharge against medical advice (DAMA), when a patient chooses to discharge themselves before their recommended treatment is complete, occurs in only a small fraction (<2%) of total hospital admissions in Australia but is linked with significant human and financial cost (eg higher rates of mortality and morbidity and significantly higher healthcare costs than non-DAMA cases). Reducing rates of DAMA is therefore an important goal in health service improvement. Factors associated with DAMA include a mix of patient, health service and environmental factors, and can be compounded in rural and remote areas, where health workforce shortages are common. Because a DAMA event signifies a potential breakdown in the patient-provider relationship, perspectives of both patients and providers are important to understand current practice and identify opportunities for improvement. This Original Research study explores healthcare providers' views on DAMA and identifies strategies for preventing and/or better managing DAMA cases.

COVID-19 was the leading cause of maternal deaths in Mexico and Colombia during the pandemic and many Latin American countries reported disruptions to maternal and newborn services. In Guatemala, only 10% of the population is vaccinated and there are many misconceptions about COVID-19 and the vaccine. More information is needed about misconceptions patients might still harbor about the virus and the vaccine. Lay midwives attend the majority of births in Guatemala, including most births at home, and are in an optimal position to offer front-line support to pregnant women and newborns regarding COVID-19. Lay midwives are a particularly important source of information inrural and Indigenous Mayan populations, which disproportionately suffer poor health outcomes. This Original Research article reports on a program of study that aimed to dispel myths about COVID-19 and provide culturally relevant educational activities to low-literacy Guatemalan lay midwives in Peten, which is the largest department in Guatemala, but among the most remote regions and where >60% of residents live in poverty and lack access to basic health care. 

COVID-19 fue la principal causa de muerte materna en México y Colombia durante la pandemia y muchos países de América Latina informaron discontinuidad en los servicios maternos y neonatales. En Guatemala sólo el 10% de la población está vacunada y existen muchos conceptos erróneos sobre el COVID-19 y la vacuna. Se necesita más información sobre conceptos erróneos que aún persisten en los pacientes sobre el virus y la vacuna. Las parteras no profesionales atienden la mayoría de los partos en Guatemala, incluidos gran parte de los partos en el hogar, y están en una posición óptima para ofrecer apoyo de primera línea a las mujeres embarazadas y a los recién nacidos en relación con el COVID-19. Las parteras no profesionales son una fuente de información particularmente importante en las poblaciones rurales e indígenas mayas, que tienen los peores resultados de salud, en relación al resto del país. Este artículo original de investigación informa sobre un programa de estudio cuyo objetivo es disipar mitos sobre COVID-19 y brindar actividades educativas culturalmente pertinentes a parteras no profesionales guatemaltecas con bajo nivel de alfabetización en Petén, que es el departamento más grande de Guatemala, y se encuentra entre las regiones más remotas, donde >60% de los residentes viven en la pobreza y carecen de acceso a atención médica básica.

Durante a pandemia, a COVID-19 foi a principal causa de mortalidade materna no México e na Colômbia e muitos países latino-americanos relataram interrupções nos serviços maternos e neonatais. Na Guatemala, apenas 10% da população está vacinada e existem muitos conceitos errados sobre a COVID-19 e a vacina, sendo necessárias mais informações sobre estes equívocos. As parteiras, que assistem à maioria dos partos na Guatemala, incluindo os domiciliares, estão numa posição ideal para oferecer apoio de primeira linha sobre a COVID-19 às mulheres grávidas e aos recém-nascidos. As parteiras são uma fonte de informação particularmente importante nas populações rurais e indígenas maias, que sofrem com piores indicadores de saúde. Este artigo original relata um programa de estudo que teve como objetivo dissipar mitos sobre a COVID-19 e fornecer atividades educacionais culturalmente relevantes para parteiras guatemaltecas com baixo nível de alfabetização em Peten, que é o maior departamento da Guatemala, mas que está entre as regiões mais remotas, onde >60% dos residentes vivem na pobreza e não têm acesso a cuidados básicos de saúde.