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Introduction: Parkinson's disease (PD) is associated with a range of non‐motor symptomologies such as anxiety and depression. Objective: The purpose of this research was to investigate the prevalence and factors associated with mental health status in persons with PD. Design: This retrospective data linkage study analysed a subset of data from the Sax Institute's 45 and Up Study based in the population of the state of New South Wales (NSW), Australia. Data was analysed between 2005‐2009 of persons who self‐identified with PD. Secure data access was provided through the Sax Institute's Secure Unified Research Environment (SURE). Participants were aged 45+ years of age and living in NSW, Australia. Regression analysis was performed on psychological distress (K10), previous diagnosis of anxiety, and/or depression, with independent variables for locality, demographic, health, medical, and sociocultural factors. Findings: A total of 1676 persons self‐identified with PD from the 45 and Up Study Wave 1 baseline and were linked to the 2010 Social, Economic and Environmental Factors (SEEF) survey dataset. Mental health manifestations are common in PD with 29% and 32% reporting a previous medical diagnosis of anxiety and depression, respectively. Rural locality was associated with an increased likelihood of psychological distress, anxiety, and depression compared to metropolitan locality. Discussion: Mental health status in PD was associated with living in rural areas, medical service access, female gender, ageing, physical mobility, Australian born, social interactions, and in a coupled relationship. Conclusion: Further research is required on the longitudinal impact of these associations on mental health in PD. [ABSTRACT FROM AUTHOR]

Objectives: To compare processes of care and clinical outcomes of community‐based management of TIAs and minor strokes (TIAMS) between rural and metropolitan Australia. Design: Inception cohort study between 2012 and 2016 with 12‐month follow‐up after index event (sub‐study of INSIST). Setting: Hunter and Manning valley regions of New South Wales, within the referral territory of the John Hunter Hospital Acute Neurovascular Clinic (JHHANC). Participants: Consecutive patients of 16 participating general practices, presenting with possible TIAMS to either primary or secondary care. Main Outcome Measures: Processes of care (referrals, key management processes, time‐based metrics) and clinical outcomes. Results: Of 613 participants with possible TIAMS who completed the baseline interview, 298 were adjudicated as having TIAMS (119 from rural, 179 from metropolitan). Mean age was 72.3 years (SD, 10.7) and 127 (43%) were women. Rural participants were more likely to be managed solely by a general practitioner (GP) than metropolitan participants (34% v 20%) and less likely to be referred to a JHHANC specialist (13% v 38%) or have brain magnetic resonance imaging (MRI) [24% v 51%]. Those rural participants who were referred, also waited longer (both p < 0.001). Recurrent stroke, myocardial infarction and death at 12 months were not significantly different between rural and metropolitan participants. Conclusions: Although TIAMS prognosis in rural settings where solely GP care is common is very good, the processes of care in such areas are inferior to metropolitan. This suggests there is further scope to support rural GPs to optimise care of TIAMS patients. [ABSTRACT FROM AUTHOR]

Objective: To assess awareness and risk of Q fever among agricultural show attendees. Setting: University of New England's Farm of the Future Pavilion, 2019, Sydney Royal Agricultural Show. Participants: Participants were ≥18 years, fluent in English, Australian residents, and gave their informed consent. Main Outcome Measures: Participants reported whether they had ever heard of Q fever and then completed the 'Q Tool' (www.qfevertool.com), which was used to assess participants' demographics and risk profiles. Cross‐tabulations and logistic regression analyses were used to examine the relationship between these factors. Results: A total of 344 participants were recruited who, in general, lived in major NSW cities and were aged 40–59 years. 62% were aware of Q fever. Living in regional/remote areas and regular contact with livestock, farms, abattoirs and/or feedlots increased the likelihood of Q fever awareness. Direct or indirect contact with feral animals was not associated with Q fever awareness after controlling for the latter risk factors. 40% of participants had a high, 21% a medium, and 30% a low risk of exposure. Slightly less than 10% reported a likely existing immunity or vaccination against Q fever. Among those who were not immune, living in a regional or remote area and Q fever awareness were independently associated with increased likelihood of exposure. Conclusions: Awareness of Q fever was relatively high. Although 61% of participants had a moderate to high risk of exposure to Q fever, they had not been vaccinated. This highlights the need to explore barriers to vaccination including accessibility of providers and associated cost. [ABSTRACT FROM AUTHOR]

Problem: Patients have not traditionally partnered in the design of their discharge plans, with discharge summaries at times not completed. In rural settings, discharge planning communicates care to a complex geographic area with fragmented resources. Patients may also be socially disadvantaged, with relatives and friends sometimes excluded. Design: Situational analysis and liaison with key partners occurred in the months prior to the core project. Opportunities for improvement were noted. An audit of all discharges in May 2020 was planned to assess rates of discharge completion, co‐design and inclusion of next of kin. Qualitative feedback was also noted from staff. Setting: Dubbo inpatient mental health units (Gundaymarra and Barraminya). Key measures for improvement: Rates of discharge summary completion, co‐design of discharge plan, engagement of next of kin. Qualitative measures included reflections of clinical staff involved. Strategy for change: Junior doctors were key in facilitating each patient to co‐design their discharge plan and collaborate with all biological and psychosocial treatments and providers in a forum for open discussion. The inclusion of nominated next of kin was core. Effects of change: Discharge summary completion rates were high; co‐design of discharge plans occurred frequently; and next of kin were involved with few exceptions. The adoption of the person as expert in modifying their plan became a norm. Medical staff wanted this care frame for each person. Lessons learnt: Engaging patients and their next of kin directly in their discharge planning improves care opportunities in a rural setting, as well as understanding for all parties. This approach also prioritises the process of discharge completion. [ABSTRACT FROM AUTHOR]

Objectives: (i) To quantify geographic variation in selected health system performance indicators across local government areas of rural New South Wales and (ii) to compare relationships between sociodemographic factors and health system performance indicators across the regions. Design: Ecological study. Setting: Rural New South Wales communities. Participants: Eighty‐nine local government areas in rural areas comprising 47 inner regional, 33 outer regional, 6 remote and 3 very remote areas. Main outcome measures: Deaths from avoidable causes, public hospital admissions for potentially preventable conditions, screening program participation, immunisation coverage. Results: The largest geographic variation between rural areas of New South Wales was seen for avoidable mortality and potentially preventable hospital admissions. The average annual avoidable age‐standardised mortality rate (2013‐2017) ranged from 78.1 per 100 000 population to 493.7 per 100 000 population and the age‐standardised rate of potentially preventable hospitalisations (2016‐2017) ranged from 1491 to 5797 per 100 000 population. Approximately three quarters of local government areas had bowel and breast cancer screening participation rates equivalent to or better than the overall New South Wales rate; however, only 34% of local government areas met the New South Wales rate for cervical cancer screening. The least variation was seen for immunisation coverage; Byron had the lowest immunisation coverage for all 3 ages. The most common explanations for variation between rural local government areas in New South Wales were remoteness and socioeconomic characteristics. Conclusions: The analysis of health system performance indicators reveals differences among New South Wales rural local government areas. The results highlight specific areas that might benefit from targeted intervention to improve inequities particularly for avoidable mortality and potentially preventable hospitalisations. [ABSTRACT FROM AUTHOR]

Objective To describe the geographical distribution of physiotherapy clinical placements and investigate the relationship between geographical setting and clinical placement marks in physiotherapy students. Design A retrospective cohort design was used for this study. Setting The University of Newcastle, New South Wales. Participants Data from entry-level Bachelor of Physiotherapy student clinical placements. Main outcome measure(s) Data from all clinical placements in the Physiotherapy program between 2003 and 2014 were included. For all clinical placements, student assessment mark, year of study, type of placement and placement location were collected. Placement location was then classified using the Modified Monash Model ( MMM) categories: one (most metropolitan) to seven (most remote). Results Over the 12 year period of the study 3964 placements were completed. Between 2003 and 2005 the average proportion of clinical placements occurring in metropolitan areas ( MMM1) was 78% and in rural areas ( MMM categories 3-6) was 22%. In 2014 these proportions had changed to 59% ( MMM1) and 40% ( MMM3-6). There were significant differences in clinical placement grades between MMM1 and all other categories except MMM2, with lower assessment marks in MMM1 than other categories. Conclusions The changing distribution of physiotherapy clinical placements may be reflective of increasing student numbers and greater efforts to support students completing rural and remote placements. This change may lead to a positive effect on the rural and remote physiotherapy workforce. Further research is required to determine the specific training and support needs of students and clinical educators in rural and remote settings. [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]

This study examines differences in uptake of the Medicare items rolled out in 2006 under the ' Better Access Scheme' ( BAS) between rural and non-rural Australian women. It compares differences in women's uptake of the BAS services by area of residence ( ARIA +) across time using the Australian Longitudinal Study of Women's Health ( ALSWH) survey data linked to Medicare data. Women aged 28-33 years at the time the BAS was introduced that responded to the self-reported question on depression/anxiety and consented to linkage of their survey data with Medicare data ( n = 4316). Participants were grouped by ARIA + according to BAS use, diagnoses of anxiety/depression but no BAS use and other eligible women. Across all areas, women born 1973-1978 with a self-reported diagnosis of depression/anxiety or having treatment under the BAS had a significantly lower mean mental health score compared to other women. Significantly more women living in non-rural areas had used at least one service provided under the BAS initiative compared to women in outer regional, inner regional or remotes areas (21% versus 18% versus 13% versus 7%, respectively), and across all areas, 12% of women reported having a diagnosis of depression/anxiety but not been treated under the BAS. While there is a gradual uptake of the new BAS services, a large percentage of women who have a diagnosis of depression/anxiety have not been treated under the BAS. The data suggest that women in urban areas have been better able to take up the services compared to non-urban women. [ABSTRACT FROM AUTHOR]

Objective Only one third of clinically eligible patients attend a cardiac rehabilitation ( CR) program. Few studies have looked at participation in rural cardiac patients. This paper examines the risk profile and participation in CR of rural and urban residents with cardiac disease who enrolled in a telephone coaching program. Design, setting and participants Comparison of baseline characteristics of 173 urban and 140 rural Australians referred to CR, and who enrolled in a telephone-based coaching program. Main outcome measures Sociodemographic characteristics, health behaviours and participation in CR programs. Results Rural residents were more likely to enrol in a telephone coaching secondary prevention program (44.7% versus 25.5%, P < 0.001) than urban residents. For those enrolling in the telephone-based program, rural participants were more likely to be obese (42.0% rural versus 28.8% urban, P = 0.02), to rate their health as fair or poor (45% versus 24.3%, P < 0.001) and less likely to be sufficiently physically active (35.3% versus 53.2%, P = 0.002), or follow a special diet for their heart (40.0% versus 56.6%, P = 0.003) compared with urban participants. Those who attended a CR program were more likely to be from an urban location and live closer to a CR program. Conclusions Rural participants in this study had poorer health profiles and attendance at outpatient CR compared with urban participants. This poses challenges for the provision of secondary prevention programs for rural cardiac patients and highlights opportunities to trial innovative delivery models, such as telephone-based programs, to reach people that would otherwise not have access. [ABSTRACT FROM AUTHOR]

Objective: To describe travel burden and travel-related financial burden experienced by cancer patients over the first year after diagnosis. Design, setting, participants: Population-based longitudinal cohort of recent adult cancer patients diagnosed with the eight most incident cancers recruited from New South Wales and Victorian Cancer Registries. Self-report survey data were collected at 6 and 12 months after diagnosis from 1410 participants (city: n = 890; regional/remote: n = 520). Main outcome measures: Travel time to cancer treatment, living away from home for treatment, travel-related treatment decisions, extent of financial issues, unmet need for financial help. Results: During the first 12 months after diagnosis, outer regional/remote residents had the greatest travel burden; 61% (n = 79) travelled at least 2 hours one way to receive treatment, and 49% (n = 66) lived away from home to receive treatment. Strongest associates of travel burden were living in regional/remote areas (odds ratio (OR) = 18.9-135.7), having received surgery (OR = 6.7) or radiotherapy (OR = 3.6). Between 6 and 12 months after diagnosis, 2% (n = 24) of patients declined cancer treatment because of the time it would take to get to treatment. Patients who travelled more than 2 hours or lived away for treatment reported significantly greater financial difficulties (38%; 40%) than those who did not (12%; 14%), even after adjusting for covariates. Conclusions: Travel burden is greatest for rural patients, and is associated with greater financial burden. Appropriate and adequate provision of travel and accommodation assistance schemes remains paramount to achieving equitable delivery of cancer services. [ABSTRACT FROM AUTHOR]

Objective: NSW has just experienced its worst drought in a century. As years passed with insufficient rain, drought-related mental health problems became evident on farms. Our objective is to describe how, in response, the Rural Adversity Mental Health Program was introduced in 2007 to raise awareness of drought-related mental health needs and help address these needs in rural and remote NSW. The program has since expanded to include other forms of rural adversity, including recent floods. Setting: Rural NSW. Design, participants, interventions: Designed around community development principles, health, local service networks and partner agencies collaborated to promote mental health, education and early intervention. Strategies included raising mental health literacy, organising community social events and disseminating drought-related information. Priority areas were Aboriginal communities, older farmers, young people, women, primary health care and substance use. Results: Over 3000 people received mental health literacy training in the four years of operation from 2007 to 2010. Stakeholders collaborated to conduct hundreds of mental health-related events attended by thousands of people. A free rural mental health support telephone line provided crisis help and referral to rural mental health-related services. Conclusion: Drought affected mental health in rural NSW. A community development model was accepted and considered effective in helping communities build capacity and resilience in the face of chronic drought-related hardship. Given the scale, complexity and significance of drought impacts and rural adjustment, and the threats posed by climate change, a long-term approach to funding such programs would be appropriate. [ABSTRACT FROM AUTHOR]

Objective: Complementary and alternative medicine (CAM) use is high in rural health and an agenda for research in the geography of CAM has been outlined. Unfortunately, no studies to date have mapped the geographic distribution of CAM practitioners in rural areas. For the first time we investigate CAM practitioner distributions across a large district/region in rural Australia. Setting and design: A CAM infrastructure audit of practitioners was performed in rural Divisions of General Practice in New South Wales, Australia. Results: CAM providers form a significant part of the health care system in rural New South Wales with substantial representation across all degrees of rurality and in both under‐serviced and well‐serviced areas. CAM practitioners outnumbered GPs in four NSW Divisions of General Practice and in no Division numbered less than half of the total number of GPs. Conclusions: Given the challenges of access to and recruitment and retention of conventional health care providers in rural settings and the significant presence of CAM practitioners, it is possible to consider such practitioners as an untapped resource in rural health care delivery. Assuming appropriate regulatory and quality standards are in place this resource should attract careful attention as part of future rural health policy and planning. The significant presence and high prevalence of use of CAM practitioners should also serve as an impetus to reform CAM service delivery in Australia. [ABSTRACT FROM AUTHOR]

Research regarding psychological distress has often underestimated the importance of contextual social factors. This research aims to investigate patterns of psychological distress within the family system (parent dyads) across rural and remote communities and the influence of remoteness on such distress. Self-report survey data from the Australian Rural Mental Health Study was used to examine the distress levels of cohabitating parental figures in rural and remote Australia. The survey was conducted across rural and remote communities within New South Wales. The sample consisted of 129 adult couples (mean age = 42.66 years, SD = 8.11), 43 from Inner Regional areas, 48 from Outer Regional areas, 24 from Remote areas and 14 from Very Remote areas. Distress levels (Kessler-10). A significant association was detected between the levels of psychological distress among parents within a household. The strength of this relationship increased with increasing remoteness of residence. Identifying the influence of spousal factors on mental health in rural and remote areas allows health services in such regions to be aware of the needs of rural couples and families. These results support the need to consider partner/spouse mental health in clinical assessment and support the importance of household factors especially in remote communities. [ABSTRACT FROM AUTHOR]