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AbstractIntroductionObjectivesMethodsResultsConclusionPlanetary health is deteriorating rapidly and climate change is one of the core boundaries for planetary health. Climate change is associated with worsening human health and physiotherapists are involved in managing its downstream effects on patients. Meanwhile, health care is a significant contributor to global carbon emissions.Identify and map the existing literature that explores the relationship between physiotherapy and planetary health.Four databases and grey literature were systematically searched. Material was eligible if it explored physiotherapy theory or practice related to a change in the environment. Two independent reviewers screened article title and abstracts, then assessed the full-text for eligibility for inclusion. Characteristics and nature of the literature were extracted and synthesised descriptively.Thirty-four of 4510 outputs met the inclusion criteria. Twenty were journal publications and fourteen were available on websites. A common theme related to the concept of physiotherapy as an environmentally friendly healthcare practice (n = 8) which may be through promoting interventions that are environmentally friendly (n = 7) and encouraging sustainable practice as a profession (n = 6).There is a strong global call for the physiotherapy profession to advocate for environmentally sustainable practice at individual and organisational realms. More empirical research on the relationship between physiotherapy and planetary health is now needed to strengthen knowledge of accessible and effective interventions to address this health crisis. [ABSTRACT FROM AUTHOR]

Context: Beyond providing temporary staffing, National Health Service Corps (NHSC) clinicians are believed by some observers to contribute to the long-term growth of the non-NHSC physician workforce of the communities where they serve; others worry that NHSC clinicians compete with and impede the supply of other local physicians. Purpose: To assess long-term changes in the non-NHSC primary care physician workforce of rural underserved counties that have received NHSC staffing support relative to workforce changes in underserved counties without NHSC support. Methods: Using data from the American Medical Association and NHSC, we compared changes from 1981 to 2001 in non-NHSC primary care physician to population ratios in 2 subsets of rural whole-county health professional shortage areas: (1) 141 counties staffed by NHSC physicians, nurse practitioners, and/or physician assistants during the early 1980s and for many of the years since and (2) all 142 rural health professional shortage area counties that had no NHSC clinicians from 1979 through 2001. Findings: From 1981 to 2001, counties staffed by NHSC clinicians experienced a mean increase of 1.4 non-NHSC primary care physicians per 10,000 population, compared to a smaller, 0.57 mean increase in counties without NHSC clinicians. The finding of greater non-NHSC primary care physician to population mean ratio increase in NHSC-supported counties remained significant after adjusting for baseline county demographics and health care resources (P less than 0.001). The estimated number of extra non-NHSC physicians in NHSC-supported counties in 2001 attributable to the NHSC was 294 additional physicians for the 141 supported counties, or 2 extra physicians, on average, for each NHSC-supported county. Over the 20 years, more NHSC-supported counties saw their non-NHSC primary care workforces grow to more than 1 physician per 3,500 persons, but no more NHSC-supported than nonsupported counties lost their health professional shortage area designations. Conclusions: These data suggest that the NHSC contributed positively to the non-NHSC primary care physician workforce in the rural underserved counties where its clinicians worked during the 1980s and 1990s.

Objective: This study assesses whether the National Health Service Corps's legislated goals to see health improve and health disparities lessen are being met in rural health professional shortage areas for a key population health indicator: age-adjusted mortality. Methods: In a descriptive study using a pre-post design with comparison groups, the authors calculated age-adjusted mortality rates at baseline (1981-1983) and follow-up (1996-1998) for the populations of 448 rural whole-county health professional shortage areas arrayed into 3 groups based on the number of study years they were staffed by National Health Service Corps physicians, physician assistants, and nurse practitioners (terms of 1 to 7, 8 to 11, and 12 to 15 years). The authors compared changes over time in age-adjusted mortality rates in the 3 county groups that had National Health Service Corps staffing with rate changes in 172 whole-county rural health professional shortage areas and 772 non-health professional shortage area rural counties that had no National Health Service Corps. Results: At baseline, age-adjusted mortality was higher in all 4 health professional shortage area county groups than in the non-health professional shortage area county group. Age-adjusted mortality rates improved with time in all groups, including health professional shortage area counties both with and without National Health Service Corps support, and non-health professional shortage area counties. Essentially, baseline differences in age-adjusted mortality rates between health professional shortage areas and non-health professional shortage area counties did not diminish with time, whether or not there was National Health Service Corps support. Conclusions: From the early 1980s through the mid-1990s, the National Health Service Corps's goal to see health improve in rural health professional shortage areas was met, but its goal to diminish geographical health disparities was not. Because age-adjusted mortality rates improved in all county groups, the authors conclude that improvement was likely due to a variety of factors, including decreasing poverty and unemployment rates and increasing primary care physician-to-population ratios, to which the National Health Service Corps may have contributed.

There is a high prevalence of persistent pain following SCI yet insights into its impact and the quality of pain care are limited. We aimed to explore, in-depth, the problem of persistent pain in Australian community-dwelling adults with a spinal cord injury (SCI). Our objectives were to investigate (i) how individuals experience persistent pain, (ii) how they experience pain care and (iii) the concordance between clinical practice guidelines for managing pain and reported care practices. We conducted a mixed-methods convergent parallel study. Adults with SCI and persistent pain completed a survey (n = 43); a subset of participants completed interviews (n = 10). We analysed the data from each method separately and then integrated the findings. Results indicated that the life impact of persistent pain is variable but it can be more disabling than physical impairments and compound a sense of isolation and despair. Community-based management was reported to predominantly have a pharmacological focus, with occurrences of opioid misuse apparent in the data. Access to expert, comprehensive and individualised care was frequently reported as inadequate. While some people with SCI and persistent pain can effectively self-manage their pain, for others the impact on quality of life is profound and complex care needs are commonly unmet. Persistent pain is a common consequence of SCI and profoundly impacts quality of life. Complex pain care needs are commonly unmet. Individuals require regular, comprehensive, biopsychosocial assessment. The effectiveness of pain management strategies must be monitored on an ongoing basis. Opportunities for personal self-management support must be available long-term. [ABSTRACT FROM AUTHOR]

This study examined temporal-geographic patterns among 830 confirmed incidents of child abuse in 31 rural Colorado counties during 1986-90. Findings suggest that a first incident of abuse or neglect serves as a sentinel event, predicting a period of more frequent receipt and substantiation of maltreatment cases by child protection professionals in the area. (Author/JDD)

Examination of the cases of 24,507 children in Colorado's Child Abuse and Neglect Registry for evidence of revictimization found greater risk for young children, for females, and for physically neglected children. Although greatest risk of revictimization was immediately after the reported incident, the children remained at greater risk of mistreatment for years. (Author/DB)

A nationwide survey of 84 child protection workers found that 92 percent of the counties represented had a problem meeting their medical needs and would be willing to hire a physician assistant as medical consultant. Needs most commonly identified were providing parent education, interviewing, and interpreting medical information to a multidisciplinary child protection team. (Author/JDD)