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We investigated the association between respiratory symptoms and psychological distress in the context of a prolonged smoke event, and evaluated whether smoke exposure, or pre‐existing respiratory and mental health conditions, influenced the association. Three thousand ninety‐six residents of a rural town heavily exposed to smoke from the 6‐week Hazelwood coal mine fire, and 960 residents of a nearby unexposed town, completed Kessler's psychological distress questionnaire (K10) and a modified European Community Respiratory Health Survey. Logistic regression models evaluated associations between distress and respiratory symptoms, with interactions fitted to evaluate effect modification. Smoke exposed participants reported higher levels of distress than those unexposed, and participants reporting respiratory symptoms recorded higher levels of distress than participants without respiratory symptoms, irrespective of exposure. 5‐unit increments in K10 scores were associated with 21%–48% increases in the odds of reporting respiratory symptoms. There were significant interactions with pre‐existing asthma, chronic obstructive pulmonary disease and mental health conditions, but not with smoke exposure. Although participants with pre‐existing conditions were more likely to report respiratory symptoms, increasing distress was most strongly associated with respiratory symptoms among those without pre‐existing conditions. Communities exposed to landscape fire smoke could benefit from interventions to reduce both psychological and respiratory distress. [ABSTRACT FROM AUTHOR]

Context: Providing year‐long rural immersion as part of the medical degree is commonly used to increase the number of doctors with an interest in rural practice. However, the optimal duration and setting of immersion has not been fully established. This paper explores associations between various durations and settings of rural immersion during the medical degree and whether doctors work in rural areas after graduation. Methods: Eligible participants were medical graduates of Monash University between 2008 and 2016 in postgraduate years 1‐9, whose characteristics, rural immersion information and work location had been prospectively collected. Separate multiple logistic regression and multinomial logit regression models tested associations between the duration and setting of any rural immersion they did during the medical degree and (i) working in a rural area and (ii) working in large or smaller rural towns, in 2017. Results: The adjusted odds of working in a rural area were significantly increased if students were immersed for one full year (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.15–2.79), for between 1 and 2 years (OR, 2.26; 95% CI, 1.54–3.32) and for 2 or more years (OR, 4.43; 95% CI, 3.03–6.47) relative to no rural immersion. The strongest association was for immersion in a mix of both regional hospitals and rural general practice (OR, 3.26; 95% CI, 2.31–4.61), followed by immersion in regional hospitals only (OR, 1.94; 95% CI, 1.39–2.70) and rural general practice only (OR, 1.91; 95% CI, 1.06–3.45). More than 1 year's immersion in a mix of regional hospitals and rural general practices was associated with working in smaller regional or rural towns (<50 000 population) (relative risk ratios [RRR] 2.97; 95% CI, 1.82–4.83). Conclusion: These findings inform medical schools about effective rural immersion programmes. Longer rural immersion and immersion in both regional hospitals and rural general practices are likely to increase rural work and rural distribution of early career doctors. [ABSTRACT FROM AUTHOR]

Objectives. Regional centres and their rural hinterlands support significant populations of non-metropolitan Australians. Despite their importance in the settlement hierarchy and the key medical services provided from these centres, little research has focused on their issues of workforce supply and long-term service requirements. In addition, they are a critical component of the recent growth of 'regional' hub-and-spoke specialist models of service delivery. Methods. The present study interviewed 62 resident specialists in four regional centres, seeking to explore recruitment and retention factors important to their location decision making. The findings were used to develop a framework of possible evidence-informed policies. Results. This article identifies key professional, social and locational factors, several of which are modifiable and amenable to policy redesign, including work variety, workplace culture, sense of community and spousal employment; these factors that can be targeted through initiatives in selection, training and incentives. Conclusions. Commonwealth, state and local governments in collaboration with communities and specialist colleges can work synergistically, with a multiplicity of interdigitating strategies, to ensure a positive approach to the maintenance of a critical mass of long-term rural specialists. [ABSTRACT FROM AUTHOR]

Globally, wound care costs the health care system 2-3% of the total expenditure on health, which equates to several billion dollars annually. To date, there are little data on the cost and healing rates of various wounds. This has been partly because of the difficulty in tracking wound management as the majority of wound care data has been focused on retrospective data from hospitals, general practice clinics and aged care facilities. This study reports on wound healing and cost of wounds collected from a larger project using the mobile wound care (MWC) electronic documentation system, which has been described elsewhere. The study involved 2350 clients from four health service districts in the Gippsland region in rural Australia who received treatments as part of the MWC research project (2010-2012), with a total of 3726 wounds identified (so an average of 1·6 wounds per client). By the end of the data collection period, 81% of these wounds had healed. A significant drop in healing time, cost of consumables and number of visits was found across the 3-year period. [ABSTRACT FROM AUTHOR]

The purpose of this study was to identify the predominant client factors and comorbidities that affected the time taken for wounds to heal. A prospective study design used the Mobile Wound Care (MWC) database to capture and collate detailed medical histories, comorbidities, healing times and consumable costs for clients with wounds in Gippsland, Victoria. There were 3,726 wounds documented from 2,350 clients, so an average of 1.6 wounds per client. Half (49.6%) of all clients were females, indicating that there were no gender differences in terms of wound prevalence. The clients were primarily older people, with an average age of 64.3 years (ranging between 0.7 and 102.9 years). The majority of the wounds (56%) were acute and described as surgical, crush and trauma. The MWC database categorized the elements that influenced wound healing into 3 groups-factors affecting healing (FAH), comorbidities, and medications known to affect wound healing. While there were a multitude of significant associations, multiple linear regression identified the following key elements: age over 65 years, obesity, nonadherence to treatment plan, peripheral vascular disease, specific wounds associated with pressure/friction/shear, confirmed infection, and cerebrovascular accident (stroke). Wound healing is a complex process that requires a thorough understanding of influencing elements to improve healing times.© 2015 by the Wound Healing Society [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study reported here was to determine the frequency of prescribing of immediate-release (IR) opioids, and benzodiazepines, with both oral sustained-release (SR) and transdermal (TD) opioid maintenance treatment, in a rural population with chronic non-cancer pain (CNCP). Subjects and methods: A longitudinal study measuring IR opioid and benzodiazepine dispensed prescriptions (scripts) by route of maintenance opioid administration over time (monthly for 1 year). Subjects were opioid-treated CNCP patients from Northwest Tasmania. The outcome measures of mean monthly scripts were analyzed using generalized estimating equations with robust standard errors. Results: Details of 12,191 dispensed scripts were obtained from 140 subjects over 12 months. Mean monthly IR scripts with oral SR opioid maintenance were 0.21 (95% confidence interval [CI] 0.10; 0.32). With TD opioid maintenance, this was nonsignificantly lower (P = 0.06) at 0.04 (95% CI 0.00; 0.15). Mean monthly benzodiazepine scripts with oral SR opioids were 0.47 (95% CI 0.32; 0.62), and unchanged (P = 0.84) for TD opioids at 0.45 (95% CI 0.28; 0.62). Conclusion: There was a nonsignificant trend toward reduced prescribing of IR opioids with TD opioid-maintained, compared with oral SR opioid-maintained, CNCP rural patients. Benzodiazepine prescribing was similar for both groups. The rationale for use and the provision of breakthrough opioid analgesia for CNCP patients are complex, both for patients and their prescribers, while the regular use of benzodiazepines compounds the sedation from the subjects' maintenance opioid. The prolonged analgesic affect of TD opioids may benefit rural and remote CNCP populations and reduce the risk of diversion associated with oral opioids. [ABSTRACT FROM AUTHOR]

ABSTRACTSince 1996, University Departments of Rural Health (UDRH) have been established at Broken Hill, Mount Isa, Shepparton, Launceston, Whyalla, Alice Springs and Geraldton. Each UDRH is underpinned by Commonwealth funding for an initial period of 5 years. The role of the UDRHs is to contribute to an increase in the rural and remote health workforce through education and training programs, as well as a reduction in the health differentials between rural and urban people and between indigenous and non-indigenous peoples. A strong population health focus involving partnerships between existing health providers in a targeted region and the university sector underpins their operation. While UDRHs have been established as a means of addressing a national workforce problem, their organisational arrangements with universities and local service providers vary widely, as does the program mix of activities in education, research service development, facilitation and advocacy. This article outlines some of the activities and progress of the UDRHs to date. [ABSTRACT FROM AUTHOR]

It is well known that rural communities do not have access to the same range of healthcare services as urban communities and that health status is poorer in rural areas. As models of health service delivery are changing from treatment and illness prevention to wellness models, health providers are under increasing pressure to re-engineer healthcare services to rural and remote areas in a climate of shrinking resources and community skepticism. The purpose of this article is to examine a developing madel of partnership in rural Tasmania in the context of these changes to health service delivery, changes to health professional training and the application of information and telecommunications technology. The partners are the Tasmanian Department of Health and Human Services and the University of Tasmania. The establishment of the university ' s Rural Health Teaching Sites in conjunction with the Tasmanian Telehealth Network provides a demonstration of this partnership in action. [ABSTRACT FROM AUTHOR]

This paper describes the process and results of a study to gauge the potential impact of the Open Learning initiative on people with disabilities. A problem‐solving approach was employed, using nominal group technique. Due to the nature of the study this was conducted at a distance, by written correspondence. The ideas generated suggested that the Open Learning initiative's impact will lie in its claim to flexibility, with its potential to give all people an opportunity to gain a university degree, to relieve physical access barriers and to reduce geographical isolation. Aspects of Open Learning which may not improve quality and/or access were identified as potential difficulties in gaining access to support and advice services, library and research facilities and academic support. The opinions generated were as much a reflection of the inflexibility of the current university structure as a request to the Open Learning Agency to respond to suggestions for greater accessibility. The Commonwealth's investment in Open Learning could be interpreted as a shift in policy from a belief that access and equity in Australian higher education should be addressed by specifically targetting perceived disadvantaged groups, to a policy encouraging more open and flexible forms of learning. [ABSTRACT FROM PUBLISHER]

The actual use of telehealth, particularly for clinical consultations, has in many cases been less than anticipated. The literature identifies a number of factors or barriers. These include legal issues, technical difficulties, time and convenience, cost and training/familiarity with the equipment. No single factor has been identified as being consistently present. Rogers' diffusion of innovation theory suggests that organizational structures and cultures will affect health professionals' perceptions of telehealth. The introduction of telehealth services affects existing work practices and workflows. We believe that it is necessary to develop strategies for the introduction of telehealth applications which take into account the idiosyncrasies of the health service sector, and the particular structures and cultures of individual organizations within that sector. [ABSTRACT FROM AUTHOR]