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Objective To examine the association between residential remoteness and stage of cancer at diagnosis, treatment uptake, and survival within the Australian Indigenous population. Design Systematic review and matched retrospective cohort study. Setting Australia. Participants Systematic review: published papers that included a comparison of cancer stage at diagnosis, treatment uptake, mortality and/or survival for Indigenous people across remoteness categories were identified (n = 181). Fifteen papers (13 studies) were included in the review. Original analyses: new analyses were conducted using data from the Queensland Indigenous Cancer Study (QICS) comparing cancer stage at diagnosis, treatment uptake, and survival for Indigenous cancer patients living in rural/remote areas (n = 627, 66%) and urban areas (n = 329, 34%). Main Outcome Measures Systematic review: Papers were included if there were related to stage of disease at diagnosis, treatment, mortality and survival of cancer. Restrictions were not placed on the outcome measures reported (e.g. standardised mortality ratios versus crude mortality rates). Original analyses: Odds ratios (OR, 95%CI) were used to compare stage of disease and treatment uptake between the two remoteness groups. Treatment uptake (treated/not treated) was analysed using logistic regression analysis. Survival was analysed using Cox proportional hazards regression. The final multivariate models included stage of cancer at diagnosis and area-level socioeconomic status (SEIFA). Results Existing evidence of variation in cancer outcomes for Indigenous people in remote compared with metropolitan areas is limited. While no previous studies have reported on differences in cancer stage and treatment uptake by remoteness within the Indigenous population, the available evidence suggests Indigenous cancer patients are less likely to survive their cancer the further they live from urban centres. New analysis of QICS data indicates that Indigenous cancer patients in rural/remote Queensland were less likely to be diagnosed with localised disease and less likely to receive treatment for their cancer compared to their urban counterparts. Conclusion More research is needed to fully understand geographic differentials in cancer outcomes within the Indigenous population. Knowing how geographical location interacts with Indigenous status can help to identify ways of improving cancer outcomes for Indigenous Australians. [ABSTRACT FROM AUTHOR]

Objective This study aims to ascertain if differences exist in the perception of the professional practice environment and personal well-being of nurses across different geographical areas in Queensland. Design This paper was performed on a prospective, self-report cross-sectional on-line survey. Setting The study was conducted among the nurses employed in public and private health care settings: acute hospitals, community health and aged care in Queensland, Australia. Participants Participants of this study were 1608 registered and enrolled nurses and assistants in nursing, current members of the Queensland Nurses Union in 2013 and who provided a workplace postcode. One thousand eight of these participants worked in major cities, while 382 in rural locations and 238 in remote areas. Interventions None. Main outcome measures Scores of well-being as determined by the following scales: the Depression, Anxiety and Stress Scale, the Professional Quality of Life Scale version 5, the Connor-Davidson Resilience Scale and of the Professional Practice Environment using the Practice Environment Scale - Nursing Work Index Revised. Results Nurses employed in major cities perceived 'nursing foundations for quality care' more favourably than those from other settings. Remote area nurses had lower levels of secondary traumatic stress than nurses in major cities and rural areas. There was no difference between nurses across their geographical locations for stress, anxiety, depression, compassion satisfaction, burnout, resilience and the four other measures of the Practice Environment Scale. Conclusions The study findings provide new data suggesting that, with the exception of secondary traumatic stress, the personal well-being of nurses does not differ across geographical settings. Similarly, with the exception of the subscale of 'nursing foundations for quality care' there was no difference in perceptions of the professional practice environment. As secondary traumatic stress is associated with burnout, this finding needs to be investigated further. [ABSTRACT FROM AUTHOR]

Objective: To explore reasons for survival disparities for patients with prostate cancer in the Barwon South West area of Victoria. Design, Setting and Participants: We have described incidence, diagnostics, treatment pathways, and survival for four regions of the Barwon South Western Victoria. Analysis included all newly diagnosed prostate cancer patients from 2009 to 2015 in the Evaluation of Cancer Outcomes Barwon South West Registry. Regions included 1: Queenscliffe 2: Geelong, Colac Otway and Corangamite 3: Moyne, Warrnambool and Southern Grampians and 4: Glenelg. Across the four regions, variables were compared using a chi square statistic or analysis of variance and survival data was assessed with the Kaplan–Meier curves. Main Outcome Measures: Incidence, treatment pathways and survival for prostate cancer patients. Results: A total of 1776 patients were diagnosed with prostate cancer from 2009 to 2015 in the Barwon South West area. In regions 1–4, there were 298 (1.04%), 1085 (0.92%), 273 (0.97%) and 120 (1.2%) cases, respectively. There was no significant difference in Gleason score and treatment. The 5‐year survival rate was 85%, 76%, 71% and 80%, respectively, as compared with the national average of 95%. PSA scores >20 ng/ml at diagnosis, as a surrogate for high‐risk disease, occurred in 23%, 29%, 22% and 21%, respectively (p < 0.01). The proportions presenting with stage IV disease were 17%, 26%, 21% and 6%, respectively (p = 0.10). Conclusion: Men diagnosed with prostate cancer in South West Victoria have a considerably lower 5‐year survival compared with the national average with later disease at presentation in some areas. [ABSTRACT FROM AUTHOR]

Objective: Early intervention with appropriate first aid following burn injury improves clinical outcomes. Previous evidence suggests geographic remoteness may be a barrier to receiving appropriate burns first aid. This study investigated the prevalence of gold standard first aid in patients managed in Australian burn services and whether geographic remoteness was associated with receiving gold standard first aid. Design: Registry‐based cohort study. Setting: Binational clinical quality registry. Participants: Burn‐injured patients admitted to a specialist Australian burn service. Main outcome measures: Receiving gold standard first aid following a burn injury. Results: Approximately two‐thirds of patients received gold standard first aid. Patients whose burns were sustained in very remote regions had a greater risk of receiving no first aid, compared to gold standard first aid, relative to patients who sustained their burn injuries in major cities. Conclusions: Nearly two‐thirds of patients received gold standard burns first aid following injury. However, patients who were injured in the most remote regions of Australia were at an increased risk of not receiving gold standard first aid treatment within 3 hours of injury. Further examination of factors contributing to poorer first aid standards in remote areas is required. [ABSTRACT FROM AUTHOR]

Objective: To explore self reported knowledge and attitudes to insulin treatment among a group of adults with poorly controlled diabetes in the Torres Strait islands. Design: Cross-sectional survey in 2014, interviews with 29 adults with HbA1c ≥ 8.5% (69 mmol mol-1) and not taking insulin, using Insulin Treatment Appraisal Scale (ITAS) and Barriers to Insulin Treatment Questionnaire (BITQ) scores. Setting: Five remote Torres Strait Island communities in the Torres Strait region. Participants: Poorly controlled insulin-naïve type 2 diabetics. Main outcome measures: BITQ and ITAS scores on items related to knowledge and attitudes to insulin treatment, clinical and demographic measures. Results: Overall, 34% of the cohort had poor glycaemic control. Compared to those with HbA1c ≥ 8.5% and taking insulin (n = 37), the 29 insulin-naïve participants were more obese, more likely to smoke and drink alcohol, have lower mean HbA1c and fewer years with diabetes. Among the insulin-naïve group, those reporting higher 'barriers' (BITQ scores) were older and with lower formal education than those reporting fewer barriers. Torres participants consistently scored low on 'knowledge' items in the ITAS, especially those which would guide insulin initiation (insulin improves glucose control and prevents complications). Conclusion: Compared to other published studies, the Torres participants had higher scores for BITQ 'barrier' items and lower 'knowledge' scores. This suggests better education around glycaemic control with medication and discussion of perceptions and exchange of experiences with peers who are taking insulin might improve the uptake of insulin in this high-risk group. [ABSTRACT FROM AUTHOR]

Objective This study aims to compare survival from breast, colon, lung, ovarian and rectal cancer by geographical remoteness in New South Wales ( NSW). Design Retrospective population-wide registry study. Setting NSW, Australia. Participants A total of 107 060 NSW residents, who were diagnosed with any of the five cancers between 01 January 2000 and 31 December 2008. Main outcome measures Kaplan- Meier survival curves and proportional hazards regression were used to compare survival by geographical remoteness of residence at diagnosis, controlling for gender, age and extent of disease at diagnosis. Remoteness was classified using standard definitions: major city, inner regional ( InnReg), outer regional ( OutReg) and remote (including very remote). Results Significant differences in survival (likelihood of death) were identified in all five cancers: breast (adjusted hazard ratio( HR) = 1.22 (95% confidence interval ( CI), 1.001-1.48) in regionalised and HR = 1.30 (1.02-1.64) in metastatic disease for OutReg areas); colon ( HR = 1.14 (1.01-1.29) for OutReg areas in metastatic disease); lung ( HR range = 1.08-1.35 (1.01-1.48) for most non-metropolitan areas in all stages of disease excepting regionalised); ovarian ( HR = 1.32 (1.06-1.65) for OutReg areas in metastatic disease, HR = 1.40 (1.04-1.90) for InnReg areas and HR = 1.68 (1.02-2.77) for OutReg areas in unknown stage of disease) and rectal ( HR = 1.37 (1.05-1.78) for OutReg areas in localised and HR = 1.14 (1.002-1.30) for InnReg areas in regionalised disease). Where significant differences were found, major cities tended to show the best survival, whereas OutReg areas tended to show the worst. Although no definitive interpretation could be made regarding remote areas due to small patient numbers, their survival appeared relatively favourable. Conclusions Reasons that contribute to the differences observed and the disparate results between cancer types need to be further explored in order to facilitate targeted solutions in reducing survival inequality between NSW regions. [ABSTRACT FROM AUTHOR]

Objective The present article aimed to explore and evaluate the epidemiology and determine the status of hypertension awareness, treatment and control in Henan province, China. Design Cross-sectional survey. Setting Thirty counties in Henan province of China. Participants There were 18 772 randomly selected 15-74 years old. Main outcome measures The distribution of blood pressure and prevalence, awareness, treatment and control of hypertension based on automated electronic monitor and questionnaire. Results The crude prevalence of hypertension was 24.9%, and the standardised rate was 26.6%, meaning about 25 million were hypertensive in Henan province. Of which, 46% were aware of their hypertension diagnosis, 35.7% were having antihypertensive medicine, only 10.4% had their blood pressure controlled less than 140/90 mmHg, and 29.1% were being controlled when they were having antihypertensive medicine. Conclusions Hypertension is highly prevalent in Henan province, but the levels of hypertension awareness, treatment and control are low. Therefore, necessary actions including prevention, detection and treatment must be taken to keep the situation from worsening. [ABSTRACT FROM AUTHOR]

Objective Little is known about whether rural-urban differences exist in patients after hip and knee joint replacement surgery. We compared patient characteristics, pain and functional outcomes of rural and urban patients undergoing joint replacement surgery in a single high-volume metropolitan centre. Design Prospective cohort study conducted in patients who underwent primary elective hip ( THJR) or knee replacement ( TKJR) between 1 January 2006 and 31 December 2009. Setting A university-affiliated tertiary referral centre situated in the central metropolitan region of Melbourne, Australia. Participants One thousand nine hundred fifty-five consecutive patients undergoing primary total joint replacement. Main outcome measure Pain and function were assessed preoperatively and 12 and 24 months postoperatively. The main independent variable was geographic location specifically comparing patients residing in rural/regional compared with urban communities. Results A total of 2193 primary joint replacements were performed (981 THJR and 1212 TKJR) in 1955 patients. Rural patients presented at a younger age and with earlier radiographic disease than their urban counterparts. There was a higher rate of rheumatoid arthritis among rural patients presenting for TKJR. There was no difference in pain and function scores between groups at 12 and 24 months post-surgery. Conclusion In our series of 1955 patients undergoing total hip and knee joint replacement surgery, rural patients presented at a younger age and an earlier stage of disease progression. At 24 months, rural patients had pain and functional outcomes as good as their urban counterparts. More research is required to determine which factors lead to the early presentation of rural patients. [ABSTRACT FROM AUTHOR]

Objective To describe factors predicting James Cook University ( JCU) medical graduates having a rural practice location at postgraduate year ( PGY) 5. Participants JCU MBBS graduates who had completed their PGY 5 in Australia ( n = 260). Design Multiple logistic regression analysis involving graduates' application data (age, gender, location of hometown, School Leaving Score, interview score, ethnicity), undergraduate data (scholarship awarded, honours program), and postgraduation data (internship location, specialty training undertaken). Main outcome measure Predictors of practice in a 'rural' town ( Australian Standard Geographic Classification Remoteness Area ( ASGC-RA)) 3-5 at PGY 5. Results Practice in a 'rural' town in PGY 5 was predicted by 'internship in an ASGC-RA 3-5 location' (prevalence odds ratios ( POR) = 3.9, P < 0.001), 'undertaken postgraduate training as a general practitioner or rural generalist' ( POR = 3.4, P < 0.001), 'hometown at application located in ASGC-RA 3-5 area' ( POR = 2.9, P = 0.023), ' Aboriginal & Torres Strait Islander ancestry' ( POR = 5.6, P = 0.031), and NOT undertaken postgraduate training in surgery ( POR = 5.4, P = 0.055). Conclusions This study provides evidence that likelihood of early career rural medical practice in Australia is enhanced by education strategies, such as providing rurally located internship places, supporting rural general practice, and selecting applicants with rural origins, Aboriginal or Torres Strait Islander ancestry, and/or a genuine interest in rural, remote, Indigenous, and tropical medicine. This early evidence supports the proposition that investing in rural medical education will produce an appropriately trained medical workforce to meet the needs of rural Australia. Findings also suggest rural workforce may be further enhanced with additional specialty training opportunities in rural tertiary hospitals, in particular, surgery. [ABSTRACT FROM AUTHOR]

Objective To examine demographic and clinical characteristics of diabetic patients undergoing diabetes-related major amputation in Far North Queensland to identify those at risk. Design A cohort was examined for differences between Indigenous and non-Indigenous groups in age, co-morbidities, indication for amputation and mortality. Attendance at the High Risk Foot Service was also reported. Setting Far North Queensland. Participants individuals with major amputations between 1998 and 2008. Main outcome measures Diabetes-related major amputations and mortality. Results Of the 143 individuals who underwent major amputation during the study period, 52% were Indigenous. On average, Indigenous amputees were 14 years younger than non-Indigenous amputees. There were more female Indigenous amputees compared with Indigenous male amputees. Indigenous amputees were more likely to suffer from chronic kidney disease ( P < 0.000) and reside in a remote community ( P < 0.000). Sepsis as an indication for amputation was more frequent in Indigenous subjects ( P = 0.019). There was no statistically significant difference in mortality related to the procedure between Indigenous and non-indigenous amputees. Conclusion Indigenous patients with renal disease living in remote communities are at higher risk of developing limb-threatening diabetic foot complications. Further improvements in self-care, diabetes management and foot-care are required to reduce major amputation rates, particularly for those residing in remote areas. [ABSTRACT FROM AUTHOR]

Objective To describe the personality (temperament and character traits) of remote Australian allied health professionals ( AHPs) . Recent research shows that health professionals can be differentiated by personality traits but little is known about the personality traits of AHPs. Design Cross-sectional (online) survey design with snowball sampling of participants. Setting and Participants Australian AHPs ( N = 561; women, n = 502) classified into Remote ( n = 266), Not Remote ( n = 295). Main outcome measure(s) Demographic variables and the Temperament and Character Inventory ( TCI R-140). Results Remote AHPs were higher in novelty seeking ( P = 0.037) and self-transcendence ( P = 0.042). Remote women were lower in harm avoidance ( P = 0.042). Older remote AHPS were lower in reward dependence ( P = 0.001); younger remote AHPs were lower in self directedness ( P = 0.001) and higher in harm avoidance ( P < 0.001). Women were more reward dependent ( P < 0.001) and cooperative ( P = 0.008) than men. Conclusions The sample demonstrated personality trait levels aligned with research on rural doctors and nurses and which might be advantageous for working in a challenging environment. Exploring the more stable nature of temperament traits coupled with the modifiable potential of character traits provides new insight into people who choose to work as a remote AHP. These findings might contribute to a better understanding of the personality trends in these AHPs which might provide clues to improve recruitment and retention strategies. [ABSTRACT FROM AUTHOR]

Objective To elucidate the differences in job stress and burnout status of Japanese hospital physicians between large cities, small cities, and towns and villages. Design Cross-sectional study. Setting Postal self-administered questionnaires were distributed to 2937 alumni of Asahikawa Medical University. Participants Four hundred and twenty-two hospital physicians. Main outcome measures The Brief Job Stress Questionnaire was used to evaluate job demand, job control and social support. The Japanese version of the Maslach Burnout Inventory- General Survey ( MBI-GS) was used to evaluate burnout. An analysis of covariance was conducted on the mean scores on the Brief Job Stress Questionnaire and the MBI-GS scales after adjusting for sex, age and specialties. Results In adjusted analyses, the job demand score was significantly different among physicians in the three areas. In Bonferroni post-hoc tests, scores in large cities was significantly higher than those in small cities and towns and villages. The job control score showed a significant difference and a marginally significant trend, with large cities associated with lower job control. There were significant differences in support from supervisors and that from family/friends, and scores in large cities was significantly higher than those in small cities in the post-hoc test. There was a significant effect on the exhaustion scale of the MBI-GS, with large cities associated with higher exhaustion, and scores in large cities was significantly higher than those in small cities. Conclusions Urban hospital physicians had more job demand, less job control and exhaustion caused by burnout, and rural hospital physicians had less social support. [ABSTRACT FROM AUTHOR]

Objective: To identify factors influencing the choice of practice location for early career pharmacists working and living in Victoria. Design: Survey. Setting: Victorian pharmacies. Participants: Pharmacists living in Victoria in April 2009, who had registered with the Pharmacy Board of Victoria after 1 October 2004, stratified into major city and rural areas. Main outcome measures: Questionnaire responses analysed via descriptive statistics, chi-square and direct logistic regression. Results: Early career pharmacists were more likely to practice in a rural location if they had undertaken a rural internship, had a spouse or partner with a non-metropolitan background and were not practicing in a hospital pharmacy. Pharmacists who had lived in a rural area during their childhood and had studied pharmacy at a rural university were four times more likely to have undertaken a rural internship than those that studied at a major city university. Conclusions: The strongest indicator for future practice location was a pharmacist's internship location. Childhood location and pharmacy education location were indicators of internship location. Pharmacists with a rural childhood location, especially those who study at rural universities, are more likely to work in rural areas. [ABSTRACT FROM AUTHOR]