bluuebunny/crossref_metadata_2025 huggingface dataset:
CONDOM USE IN A GROUP OF ABORIGINAL WOMEN
Authors: Roberts Kathryn L. , Cahill Selina
Published: March 2008

ABSTRACT: This exploratory study investigated the attitudes of Aboriginal women in Darwin to the use of condoms to prevent HIV and other sexually transmitted diseases. An Aboriginal research assistant interviewed twelve women regarding their usage of and attitudes to the male condom and their attitude to the possibility of using a female condom. These women, like their ethnic minority counterparts in Africa and North America, had a fair level of knowledge about HIV, a low level of perceived risk of HIV and other sexually transmitted diseases, infrequent usage of male condoms with their partner, and negative attitudes to the male condom. Their attitude to the female condom was more positive. Educational programs and further research into the attitudes of women in remote communities are recommended.
REFLECTIONS ON NATIONAL RURAL HEALTH POLICY: THE ‘BIG PICTURE’ FRAMEWORK
Authors: Humphreys John S.
Published: March 2008

ABSTRACT: A major concern of many rural and remote communities, as they struggle to cope with the impacts of social, economic and demographic changes, is the effect of government policies on health services. The National Rural Health Strategy has evolved as the key framework guiding action for improving health services for people in rural and remote Australia. The importance of maintaining an awareness of the ‘big picture’ of rural health remains paramount if interventions designed to bring about improved health status are to tackle the underlying causes of the problems, minimise problems associated with lack of co‐ordination between health authorities, and avoid duplication of activity. Given the communality of rural health problems across Australia, close co‐operation and collaboration among rural health groups is vital in developing appropriate national rural health policy. At the same time rural communities must continue to participate actively in the policy formulation and implementation process.
THE CONCEPT OF WELL‐BEING IN A RURAL SETTING: UNDERSTANDING HEALTH AND ILLNESS
Authors: Elliot‐Schmidt Rachael , Strong Jenny
Published: March 2008

ABSTRACT: Attitudes to health and illness may differ between rural and urban dwellers. Issues that may relate to the provision of health services to rural dwellers are raised for consideration. The response of urban dwellers to illness or disability has often been linked to discomfort caused by pain or cosmetic attractiveness, while for rural dwellers the response to illness or disability is often related to the degree to which the illness or disability affects productivity. Often the rural resident will postpone seeking medical or associated services until it is economically or socially convenient. The notion of exposing their private lives to strangers or acquaintances from the local based services or to undertake the journey to distant services where the cultural or behavioural differences could be misunderstood, may impact on rural dwellers' well‐being. Health service providers in rural areas need to understand such differences and difficulties when offering services.
CONTACT DERMATITIS AND IN‐FEED EXPOSURE TO ANTIBIOTICS AMONG PIG FEED HANDLERS
Authors: Pirkis Jane E. , O'Reagan Kerry K. , Bailie Ross
Published: March 2008

ABSTRACT: This study aimed to determine the prevalence of contact dermatitis among pig feed handlers, explore the association with exposure to in‐feed antibiotics, and determine farmers' awareness of product safety information. One representative from each piggery in Queensland's Wide Bay Burnett Region was interviewed by telephone. Just over 21% of respondents had experienced dermatitis symptoms within the previous two years; 14.8% within the previous 12 months; and 6.7% had current symptoms. Use of at least one in‐feed antibiotic was reported by 83.7%. The only antibiotic to show an association with the occurrence of dermatitis was tylosin. Precautionary behaviours were more common among those with dermatitis. Only 18% of respondents were aware of material safety data sheets. The relatively high prevalence of contact dermatitis, high use of antibiotics, low level of precautionary behaviours and poor awareness of material safety data sheets indicates a need for farmer education.
GENERAL PRACTITIONERS‘ NEEDS AND PERCEPTIONS IN RURAL MENTAL HEALTH CARE
Authors: Aoun Samar
Published: March 2008

ABSTRACT: The objective of this needs analysis was to explore the ‘upskilling’ needs of rural general practitioners in specified areas of mental health. Their perceptions of the difficulties in managing special groups of patients and in referring to the mental health services were reported. Fifty‐six per cent of general practitioners servicing four rural areas in the south‐west of Western Australia participated in completing a structured questionnaire. The unmet educational needs consisted of Jive types of counselling: crisis, individual, family, marital and parenting. Groups that the GPs perceived as being difficult to manage were adolescents and youth, and Aboriginals and migrants. The shortage of referral services and the poor communication with mental health specialists were of concern to the GPs in this study. Proposed strategies to overcome these barriers were discussed.
BASIC RADIOLOGICAL SYSTEM: A CASE STUDY IN ‘APPROPRIATE TECHNOLOGY FOR BETTER HEALTH’
Authors: Leggat Peter A.
Published: March 2008

ABSTRACT: Radiology continues to play an important role in diagnosis and management of disease. The provision of radiology services to rural areas has represented a challenge to rural communities all over the world, particularly in developing countries. In 1980, the World Health Organization (WHO) introduced the Basic Radiological System (BRS) project to provide the specifications for a safe, inexpensive diagnostic imaging system for rural areas, together with radiological manuals. Several manufacturers now produce imaging equipment to the WHO‐BRS standard and are meeting the WHO goal for providing ‘appropriate technology for better health’ in rural areas of developing countries. With the improvement in access to radiological systems, the WHO is now turning to improving the provision of ultrasound manuals and equipment.
VALUE OF AN ORTHOPAEDIC PREADMISSION CLINIC FOR TOTAL KNEE AND HIP REPLACEMENTS IN A RURAL HEALTH SERVICE
Authors: Lewis Clare
Published: March 2008

ABSTRACT: The emphasis on orthopaedic pre‐admission clinics within hospital settings is very recent in Australia. Tamworth Base Hospital, a large rural hospital, started a compulsory clinic in mid‐1995. The purpose of this study was to determine the value of orthopaedic education in a pre‐admission clinic for patients who were undergoing total knee and total hip replacements. Regarding total knee replacement patients, the average length of stay for those who attended the clinic after it had become compulsory, compared with before, was 3.8 days shorter. For total hip replacement patients, the reduction was 1.1 days. This study found that the major value of the clinic was not so much in reduced lengths of stay, rather it related more to increased patient satisfaction, and perhaps more so in the rural setting where patients are disadvantaged in many cases by the large distances they travel for services.
CLINICAL PRIVILEGES FOR RURAL GENERAL PRACTITIONERS
Authors: Hays Richard B.
Published: March 2008

ABSTRACT: Improved training programs and registrable qualifications are now available for graduates wishing to pursue a career in rural practice. In the near future, newly established rural doctors will be able to furnish documentation on substantial additional training, which will include competence in a range of procedural skills. In an environment of increasing regulation and litigation awareness, hospitals are developing systems for recognising the skills and experience of medical staff. However, most clinical privileges systems have been developed for larger hospitals and with procedural sub‐specialists in mind. This paper proposes an approach to developing clinical privileges systems that are more appropriate to smaller rural hospitals, so that the skills of rural doctors are fully utilised by their communities.
THE FEASIBILITY OF ESTABLISHING AN AUSTRALIAN COLLEGE OF RURAL AND REMOTE HEALTH
Authors: Clark Steve
Published: March 2008

ABSTRACT: The establishment of an Australian College of Rural and Remote Health was recommended at the Third National Rural Health Conference and subsequently endorsed by the National Rural Health Alliance. This paper outlines the progress of a feasibility study, conducted by the National Association of Rural Health Training Units, to determine the prospective role and level of support for the establishment of such a college among health professional groups in Australia. The findings of two national workshops indicated strong support for ‘an organizational structure’ to facilitate the development of national standards for rural and remote health education and training. While the exact nature of an organizational structure is yet to be determined, it was clear from the workshops that the formation of a college is not feasible at this time. The paper recommends an alternative collaborative forum: an Australian Consortium of Rural and Remote Health.
SOCIAL AND CULTURAL PATTERNS OF SUICIDE IN YOUNG PEOPLE IN RURAL AUSTRALIA
Authors: Baume P. J. M. , Clinton M. E.
Published: March 2008

ABSTRACT: The purpose of this paper is to describe patterns of suicide in young people in rural communities. Australian Institute for Suicide Research and Prevention and Australian Bureau of Statistics data are used to discuss regional and gender differences in suicide rates, with particular attention to completed suicides in young people. The regional distribution of completed suicide in young people and gender differences in suicide rates are identified. Trends in the methods of suicide chosen by young people are also described. Patterns of male self‐destructive behaviour are emphasised. The paper, as a whole, draws attention to the complex factors that influence deaths by suicide in young people. The factors implicated are associated mainly with suicide in young males, but much of the literature speculates on rather than demonstrates their influence. As the competing explanations have not been systematically evaluated, further research is required to establish the causal processes involved and to provide a firmer foundation for suicide prevention programs and services for those who live in suicide s aftermath.
AMBULATORY SERVICES IN AN ABORIGINAL COMMUNITY AND A WEST QUEENSLAND RURAL AREA
Authors: Anderson Mark , Dugdale Alan
Published: March 2008

ABSTRACT: The aim of this study was to compare the incidence/prevalence of diseases in persons attending for ambulatory care at a Queensland Aboriginal community and a farming area in western Queensland. Data were analysed for attendances for disease management from 1 May 1994 to 31 April 1995 at Cherbourg Hospital and from 1 March 1995 to 28 February 1996 at Alpha Hospital. Over these periods the hospitals and associated clinics were the only local ambulatory services available to each community. The numbers of visits for management of disease were 6.0 per person per year at Cherbourg and 4.3 per person per year at Alpha. At each location 78% of the population visited the service for disease management. At Cherbourg, the commonest diagnoses were skin diseases, mainly associated with scabies, accidents and injuries, and respiratory diseases. At Alpha the commonest problems were accidents and injuries, and respiratory disorders, followed by musculoskeletal, skin and CNS disorders. The rate of diabetes was higher in the Cherbourg group, bid involved only 5% of the population and was thus not a major cause for the use of health services. The rate of visits for cardiovascular disease at Alpha and Cherbourg were similar, but the percentage of persons involved was smaller at Cherbourg. Accidents and injuries, and respiratory diseases were common in both locations. Skin disease, mainly due to scabies, was a major problem in the Aboriginal community and led to many admissions. Many visits involved potentially preventable diseases.
METHODOLOGICAL CONSIDERATIONS FOR A PSYCHOSOCIAL ILLNESS SURVEY IN GENERAL PRACTICE
Authors: Aoun Samar
Published: March 2008

ABSTRACT: A survey of psychosocial morbidity in general practice was undertaken in a rural West Australian community. Twenty‐two general practitioners collected information on 487 patients in a period of 5 weeks. The information comprised the socio‐demographic characteristics of the patients, their illness profile and patterns of treatment and referral. The methodological issues considered for such a survey related to the selection of participating doctors, the identification of appropriate cases, the acceptability of a diagnostic classification and the definition of the population at risk. The methodology assessment established the plausibility of the findings compared to other studies, and hence the adequacy of the methodology used. The patterns of distribution of the psychosocial illness in relation to sex, age, diagnostic category, chronicity, the level of reporting of morbidity and treatment and referral were consistent with the findings of other studies.
FROM SHANGHAI TO DURBAN: INTERNATIONAL RURAL HEALTH CONFERENCES
Authors: Strasser Roger
Published: March 2008

ABSTRACT: The First International Conference on Rural Medicine held at Shanghai, China in May 1996 was a turning point in the growing international rural health movement. The first 3 days of the conference were held in the Shanghai Science Hall followed by 3 days in Fengxian County, including site visits and seminars about health services in that part of rural China. There were approximately 300 participants in the conference, which included presentations from 70 invited speakers and over 50 free‐standing poster/papers involving personnel from 22 countries. Group discussions during the conference developed recommendations that were considered by plenary sessions and subsequently adopted as the final resolutions of the whole conference. It is remarkable that, despite the great differences between developed and developing countries, many issues of concern in rural practice and rural health services are the same around the world. The Second World Rural Health Congress will be held in Durban, South Africa, 14–17 September 1997.
DECLARE THE PAST, DIAGNOSE THE PRESENT, FORETELL THE FUTURE: RURAL HEALTH FOR ALL AUSTRALIANS BY 2000?
Authors: Kamien Max
Published: March 2008

ABSTRACT: The health status of rural people still lags behind that of urban dwellers, and Aboriginal children have an equivalent health status to that of non‐Aborigines 40 years ago. Yet, the shortage of country doctors is nearly as acute today as it was 100 years ago. Past ‘solutions’ to these problems are replete with mistakes, misjudgements, false messiahs and transient fashions. The failure to know about the rural past and to learn from it has resulted in a 20‐year cycle of rediscovery. The most efficient way to solve future rural health problems is to have a scholarly appreciation of rural history and build on what we already know but haven't worked out how to apply.
WORKING TOGETHER: THE ADVANCED RURAL NURSE PRACTITIONER AND THE RURAL DOCTOR
Authors: Keyzer Dirk M.
Published: March 2008

ABSTRACT: This paper discusses the complex and interrelated roles of the rural nurse and doctor. These roles are viewed as being complementary to each other in any healthcare setting, but more so within the context of rural Australia. The current move towards the development of advanced nurse practitioner roles is often clouded by unnecessary medical fears that nurses are attempting to displace doctors. In contrast, this paper argues that the development of new rural nursing roles identifies rural nursing as a major specialist area within the wider profession of nursing and, at the same time, recognises the reality of practice for many rural nurses. Individual public figures may perceive the solution to the shortage of rural doctors to lie in their replacement with nurses. The nursing profession, however, will resist this approach. Nursing is not the first rung on the ladder to a career in medicine. Nurses are educated and acknowledged to focus their practice on the clients' responses to healthcare problems and not the practice of medicine. The primary role of the nurse is to provide care. The primacy of care should not be set aside by those nurses seeking to develop their practice, nor should advanced practice be defined in terms of taking on tasks previously carried out by other healthcare professionals.
VALUE‐ADDING IN THE RURAL TRAINING STREAM: A RELEASE PROGRAM FOR HOSPITAL‐BASED RURAL TRAINING STREAM REGISTRARS
Authors: Holmwood Chris , Thompson David
Published: March 2008

ABSTRACT: This paper describes a release program developed in 1995 for year 1 hospital based GP registrars in the Rural Training Stream of the Royal Australian College of General Practitioners Training Program in South Australia. Background, objectives, content and organisation, and evaluation are described. The 1996 program that developed from this pilot is also described.
RECRUITING GENERAL PRACTITIONERS TO RURAL AREAS: ONE COMMUNITY'S EXPERIENCE
Authors: Mills Irene
Published: March 2008

ABSTRACT: The rural community of Dalwallinu found itself without a medical practitioner early in 1995. Believing recruitment of a replacement practitioner would be relatively straightforward, the Shire and the Hospital Board combined for this process. Little did we realise that there would be many factors that would impinge upon our ability to recruit a general practitioner (GP) other than the availability of a suitably qualified practitioner. Locum availability, providing a furnished house, a motor car, becoming the employer of the locum practitioner, community reactions, government regulations on recruiting doctors trained overseas, Health Department restructures and the arbitrary regulations of professions all had a significant impact, not to mention the cost to the local council to provide a community service.
WHY DOCTORS LEAVE RURAL PRACTICE
Authors: Hays Richard B. , Veitch P. Craig , Cheers Brian , Crossland Lisa
Published: March 2008

ABSTRACT: Retention of rural doctors remains difficult because of complex factors that influence decisions of medical families. This study explores the reasons why Queensland rural doctors left their communities during 1995. Semi‐structured interviews were conducted with contactable former rural doctors who claimed that they had entered rural practice with the intention to stay for a substantial period of time. The interviews were audiotaped, transcribed and analysed using NUD.IST software. Participants appeared to be subject to a dynamic balance between opposing pressures to stay and pressures to leave. In time, they became susceptible to ‘triggers’ to leave. These triggers were sometimes locality‐specific and could be difficult to address, particularly without early intervention. We believe that it should be possible to develop strategies that address specific concerns of rural doctors, particularly if they are identified early. The optimum period of stay in rural practice should be reconsidered, such that moderate stays should be rewarded in a way that retains the doctors in some form of rural, or near‐rural, practice.
AN UPDATE ON RURAL GENERAL PRACTICE EDUCATION INITIATIVES TO MEET RURAL WORKFORCE NEEDS: PROGRESS AND RECENT DEVELOPMENTS
Authors: Norington Margaret
Published: March 2008

ABSTRACT: A number of Federal Government initiatives have focused on education as one of the key elements in addressing rural general practice workforce needs. This article provides an historical overview and recent developments.
1997/98 BUDGET: RURAL AND REMOTE HEALTH INITIATIVES AND OTHER PROGRAMS
Authors: Anderson John
Published: March 2008

ABSTRACT: This article provides an outline of the Commonwealth Governments 1997/98 Budget intitiatives and existing rural and remote health support programs.
MOVING FORWARD WITH UNIVERSITY DEPARTMENTS OF RURAL HEALTH
Authors: Lyle David
Published: March 2008

ABSTRACT: This paper outlines recent developments in relation to the proposed university departments of rural health, and highlights how the principles (articulated by the Commonwealth government) for the establishment of these departments are being addressed in Broken Hill. The approach taken by the Broken Hill centre is focused on providing practical, population‐based training and education that should enable health professionals to apply their knowledge and skills in ways appropriate to the needs of remote communities.
RATES OF DENTAL SERVICE PROVISION BETWEEN CAPITAL CITY AND NONCAPITAL LOCATIONS IN AUSTRALIAN PRIVATE GENERAL PRACTICE
Authors: Brennan David , Spencer A. John , Szuster Fearnley
Published: March 2008

ABSTRACT: Variations in service provision between geographical locations may be associated with factors such as imbalances in the availability of health services. The aim of this analysis was to examine differences in dental service provision between capital city and non‐capital locations. Data were used from a survey collected in 1993/94 from a random sample of Australian dentists, providing 817 responses (a response rate of 74%). Dentists from capital city locations comprised 71.8% of responding private general practitioners. Significantly more services per visit (Mann‐Whitney, P < 0.05) were provided at capital city locations (mean = 2.16, 95% CI = 2.08–2.24) compared to non‐capital locations (mean = 1.84, 95% CI = 1.74–1.94). Controlling for age of patient, insurance status and visit type, capital city locations included significantly higher rates of service per visit (P < 0.05) for adult dentate patients (rate ratios, 95% CI) of diagnostic (1.17, 1.09–1.25), preventive (1.20, 1.09–1.32), periodontal (2.71, 1.72–4.26), and crown and bridge (1.25, 1.03–1.53) services, but lower rates of prosthodontic (0.80, 0.67–0.94) services compared to non‐capital locations. These findings indicate that compared to non‐capital locations, capital city patients received care that was more orientated towards prevention and maintenance of teeth, rather than replacement by dentures.
RURAL YOUTH: HIV/STD KNOWLEDGE LEVELS AND SOURCES OF INFORMATION
Authors: Hillier Lynne , Warr Deborah , Haste Ben
Published: March 2008

ABSTRACT: Though it is recognised that a sound knowledge of HIV/STD transmission is insufficient on its own to ensure that young people practise safer sex, knowledge of this sort is a necessary prerequisite to safe sex behaviours. Research on the HIV/STD knowledge levels of young people has shown that, while they have high levels of HIV knowledge, they generally have little idea about the transmission of other STDs. Moreover, most of this research has been conducted with more accessible youth in large urban centres. The research reported in this paper focused on HIV/STD knowledge levels, awareness of safe and unsafe sexual practices, and the information sources accessed by 1168 young people living in small rural towns in Queensland, Tasmania and Victoria. As with mainstream youth, the participants in this study had high levels of HIV knowledge and very low levels of knowledge about the transmission of other STDs, their names and symptoms. Practical knowledge of the safety of sexual practices was good, although a number of students confused high risk practices with high risk groups. Students mainly accessed informal information sources such as parents, peers and magazines and took little advantage of more formal sources even when they were available in their towns. There were few gender differences in levels of knowledge; however, girls accessed more information sources and knew more names of STDs. The implications of these findings are discussed in relation to young people developing critical attitudes towards more informal sources, and the better use of more formal sources.
REMOTE AREA HEALTH SERVICE DELIVERY IN CENTRAL AUSTRALIA: PRIMARY HEALTH CARE AND PARTICIPATORY MANAGEMENT
Authors: Wakerman John , Field Pat
Published: March 2008

ABSTRACT: This paper provides a description of initiatives and changes made in remote primary healthcare service delivery in Central Australia. These changes included the introduction of an orientation and Aboriginal cultural awareness program, revising the recruitment process to include communities in staff selection, developing policies and protocols to support practice, and increasing support for remote area staff through managers being out and about in remote areas. The change from centralised management to an increasingly decentralised participatory management model, and involving local communities and local staff in decision making, was initiated early in the change process and continues to be of prime importance. After 5 years of intensive effort, it is clear that despite these initiatives sustainable change has been elusive and some problems remain. Further change and development is necessary. A number of new initiatives are described, including a Menzies School of Health Research project that examines structural issues, which will provide direction for the future by providing better support for remote area staff and facilitating greater community participation.
International Perspective: ISSUES FOR NURSES IN RURAL AND REMOTE CANADA
Authors: MacLeod Martha , Browne Annette J. , Leipert Beverly
Published: March 2008

ABSTRACT: Canada is a vast country with great diversity in its landscape, industry, culture and communities. The healthcare issues and concerns of people living in rural and remote areas are as fully diverse as the people and the landscape. This article describes the context of rural and remote nursing practice in Canada and discusses issues of health status and the social determinants of health, geographical isolation, professional isolation and cultural safety. It concludes with current initiatives in practice, education, research and policy. Particular issues facing nurses in rural and remote First Nations communities are highlighted.
REFLECTIONS ON PRACTICE: DEFINING RURAL NURSING CARE
Authors: Keyzer Dirk M.
Published: March 2008

ABSTRACT: This paper is the result of reflection on and content analysis of five studies in rural nursing by two independent research teams: one in south‐west Victoria (three studies), the other in southern Queensland (two studies). The studies explored the nature of rural nursing work, the experiences of rural nurses and patients, and one attempt to promote an alternative mode of rural nursing service delivery. The major focus of this paper is the world view of nursing contained in the participants' experiences of rural health care and nursing in particular. The findings of the studies are examined to identify the concepts of care expressed by the participants and the role these concepts have in building a much needed conceptual framework for rural nursing education and practice.
EVALUATION OF MEDICAL LOCUM TENENS
Authors: Hoyal Francis M. D.
Published: March 2008

ABSTRACT: The medical and educational literature reveals no helpful material on applying quality assurance principles to the evaluation of medical locums tenens. The present preliminary study describes the development and analysis of a questionnaire designed to indicate measures of competence in locums and satisfaction by those who supervise them. The sample consisted of 53 doctors recruited from overseas by a single locums agency. No similar studies have been reported and further research would elucidate whether locums who have trained overseas and those trained in Australia are regarded as equally acceptable and competent. Very high scores confirm the perceived skills and knowledge of the locums to be excellent. An overall rating above 4.5 out of 5 and the fact that 41 of 53 doctors had ratings entirely in the 4–5 range indicates that these locums have received excellent acceptance and are regarded as competent.
UNDERSTANDING RURAL AND REMOTE DIVISIONS UNDER A WORKFORCE FRAMEWORK
Authors: Williams Jenny
Published: March 2008

ABSTRACT: In Australia, divisions of general practice are the organisational structures for local networks of general practitioners. They facilitate communication across the profession and with other parts of the health system and are established in urban, rural and remote areas. Funding is provided contractually to divisions through the Federal Government's Divisions and Projects Grants Program. The under‐supply of doctors and other health professionals in rural and remote areas of Australia is a serious problem that has far‐reaching effects. The present paper argues that if the Divisions and Projects Grants Program is to be effective in achieving its aims and objectives, then the Program's policies must be responsive to the different needs, roles, constraints, expectations and capabilities of divisions and their members as well as the structural impediments imposed by the medical workforce.
DIFFERENCES BETWEEN METROPOLITAN AND COUNTRY PUBLIC HOSPITAL ALLIED HEALTH SERVICES
Authors: Grimmer Karen , Bowman Paula
Published: March 2008

ABSTRACT: This paper compares patient and episode characteristics in allied health services delivered in country and metropolitan hospitals. Eight public hospitals (46 allied health services) participated in the study (three country and five metropolitan sites, situated in South Australia, Queensland and Tasmania). Standardised rates of patient throughput were similar for country and metropolitan allied health services, despite smaller numbers of country staff providing services to larger geographical areas. Although the differences were not significant, country patients were generally older and had more chronic conditions than metropolitan patients. Fewer country patients than metropolitan patients were eligible for rebates in the private sector. In addition, fewer alternative services were available in country communities, which heightened the role of the public hospital outpatients services within the community. This paper provides an argument for similar funding arrangements for country and metropolitan ambulatory allied health services.
HEALTH EDUCATION ACTIVITIES CONDUCTED BY PHYSIOTHERAPY STUDENTS ON FIELD TRIPS TO RURAL AREAS: A CASE STUDY
Authors: Boucaut Rose
Published: March 2008

ABSTRACT: Field trips to country communities have formed part of the final year physiotherapy undergraduate curriculum at the University of South Australia since 1995. These trips have aimed to give students an experience in primary health care. This paper evaluates these activities within the framework of the health promotion model from the perspective of those involved and evaluates feedback from these people. The activities met four of the five criteria of the health promotion model to some degree. Evaluation from all those participating has been mainly positive, with some aspects of organisation of the field trips requiring improvement. All involved felt they had gained benefits from the field trips; however, further work is needed to align the activities with local health promotion infrastructure.
DELIMITING ‘RURAL’: IMPLICATIONS OF AN AGREED ‘RURALITY’ INDEX FOR HEALTHCARE PLANNING AND RESOURCE ALLOCATION
Authors: Humphreys John S.
Published: March 2008

ABSTRACT: Rural and remote Australia is characterised by considerable geographical and social diversity. There is no ‘natural’ classification of what constitutes ‘rural’ or ‘remote’, and precise definition of what is meant by the term ‘rural’ has proved to be an elusive goal. Nonetheless, it is recognised that the differentiation of rural areas has important implications for healthcare planning and the research that underpins it. Whether it be the development of resource allocation formulae that determine the provision, location and type of rural health services, measuring service utilisation rates as an indicator of need for services or health outcome measures, the way in which populations and communities are delimited as urban, rural and remote will always influence and sometimes may even determine the assessment. The time is ripe for the development of an agreed classification for the investigation of rural health issues.
INCREASED CARDIAC SYMPATHETIC DRIVE AND REDUCED VAGAL MODULATION FOLLOWING ENDOTHELIN RECEPTOR ANTAGONISM IN HEALTHY CONSCIOUS RATS
Authors: Souza Hugo CD , Terzini Geisa CSV , Da Silva Valdo JD , Martins‐Pinge Marli C , Salgado Helio C , Salgado Maria‐Cristina O
Published: March 2008

The present study evaluated changes in autonomic control of the cardiovascular system in conscious rats following blockade of endothelin (ET) receptors with bosentan.

Rats were treated with bosentan or vehicle (5% gum arabic) for 7 days by gavage.

Baseline heart rate (HR) was higher in the bosentan‐treated group compared with the control group (418 ± 5 vs 357 ± 4 b.p.m., respectively; P < 0.001). This baseline tachycardia was associated with a lower baroreflex sensitivity of the bradycardiac and tachycardiac responses in the bosentan‐treated group compared with the control group. Sequential blockade of the parasympathetic and sympathetic autonomic nervous system with methylatropine and propranolol showed a higher intrinsic HR in the bosentan‐treated group compared with the control group (411 ± 5 vs 381 ± 4 b.p.m., respectively; P < 0.05). This was accompanied by a higher cardiac sympathetic tone (31 ± 1 vs 13 ± 1%, respectively; P < 0.01) and a lower vagal parasympathetic tone (69 ± 2 vs 87 ± 2%, respectively; P < 0.01) in the bosentan‐treated group compared with the control group. Variance and high‐frequency oscillations of pulse interval (PI) variability in absolute and normalized units were lower in the bosentan‐treated group than in the control group. Conversely, low‐frequency (LF) oscillations of PI variability in absolute and normalized units, as well as variance and LF oscillations of systolic arterial pressure variability, were greater in the bosentan‐treated group than the control group.

Overall, the data indicate an increased cardiac sympathetic drive, as well as lower vagal parasympathetic activity and baroreflex sensitivity, in conscious rats after chronic blockade of ET receptors with bosentan.
CARDIOPROTECTION BY l‐GLUTAMATE DURING POSTISCHAEMIC REPERFUSION: REDUCED INFARCT SIZE AND ENHANCED GLYCOGEN RESYNTHESIS IN A RAT INSULIN‐FREE HEART MODEL
Authors: Kristiansen Steen B , Løfgren Bo , Støttrup Nicolaj B , Kimose Hans‐Henrik , Nielsen‐Kudsk Jens E , Bøtker Hans E , Nielsen Torsten T
Published: March 2008

Previously, we found that administration of high‐dose l‐glutamate during postischaemic reperfusion improves haemodynamic recovery and enhances glycogen resynthesis. In the present study, we investigated whether the same effect occurs in an insulin‐free model and whether glutamate administration reduces infarct size. Further, we studied whether the cardioprotective effect of glutamate depends on preserved glutamate transamination and KATP channel activity.

In a rat isolated, insulin‐free, perfused heart model, we compared the effects of administration of l‐glutamate (10 mmol/L) during either 45 min no‐flow regional ischaemia plus 120 min reperfusion or reperfusion alone on infarct size and left ventricular (LV) recovery. The effect of glutamate on glycogen metabolism was studied in a model of 30 min global no‐flow ischaemia and 60 min reperfusion. In both models, the effects of inhibition of glutamate transamination and KATP channel activity were examined by adding amino‐oxyacetate (an aminotransferase inhibitor; 0.1 mmol/L) and glibenclamide (a KATP blocker; 10 mmol/L), respectively.

Administration of l‐glutamate reduced infarct size by 60% (P < 0.01) and improved postischaemic LV function (developed pressure and rate pressure product; P < 0.05). l‐Glutamate increased glycogen content after 60 min reperfusion by 65% (P < 0.01). Amino‐oxyacetate, as well as glibenclamide, abolished the glutamate‐mediated reduction in infarct size, haemodynamic improvement and glycogen resynthesis during reperfusion.

In conclusion, l‐glutamate administration from the start of postischaemic reperfusion exerts cardioprotective effects, including reduced infarct size, improved haemodynamic recovery and enhanced glycogen resynthesis. These effects depend on preserved transamination of glutamate and KATP channel activity, but not on insulin administration.
INHIBITION OF ADP‐INDUCED PLATELET AGGREGATION BY CLOPIDOGREL IS RELATED TOCYP2C19GENETIC POLYMORPHISMS
Authors: Chen Bi‐Lian , Zhang Wei , Li Qing , Li Ya‐Lin , He Yi‐Jing , Fan Lan , Wang Lian‐Sheng , Liu Zhao‐Qian , Zhou Hong‐Hao
Published: March 2008

Clopidogrel is one of the most important antithrombotic drugs but has different efficacies in different populations. The aim of the present study was to evaluate the contribution ofCYP2C19genetic polymorphisms to the inhibition of ADP‐induced platelet aggregation by clopidogrel in healthy Chinese volunteers.

Eighteen healthy male volunteers (sixCYP2C19*1/CYP2C19*1, sixCYP2C19*1/CYP2C19*2and*3and sixCYP2C19*2/CYP2C19*2and*3) were enrolled in the study. Each subject took 300 mg clopidogrel on the first day and then 75 mg once daily for 2 consecutive days. Blood samples were taken to measure ADP‐induced platelet aggregation at baseline and 4, 24 and 72 h after administration of the first dose of clopidogrel.

There were significant decrease in 2 and 5 mmol/L ADP‐induced platelet aggregation at 4, 24 and 72 h after clopidogrel among the three CYP2C19 genotypes compared with baseline (P < 0.001). The change in 5 mmol/L ADP‐induced platelet aggregation in subjects with theCYP2C19*1/CYP2C19*1genotype was greater than that in subjects with theCYP2C19*2/CYP2C19*2and*3genotype at 4 h (49.0 ± 15.5vs29.7 ± 17.4%, respectively;P = 0.029), 24 h (48.7 ± 20.5vs25.0 ± 17.6%, respectively;P = 0.035) and 72 h (45.5 ± 15.2vs26.5 ± 15.8%, respectively;P = 0.030) after clopidogrel administration.

In conclusion,CYP2C19*2andCYP2C19*3genetic polymorphisms reduced clopidogrel inhibition of ADP‐induced platelet aggregation, with the degree of inhition dependent on the genetic polymorphism present.
CHRONIC OUABAIN TREATMENT ENHANCES CARDIAC MYOSIN ATPase ACTIVITY IN RATS
Authors: Padilha Alessandra S , Moreira Cleci M , Meira Eduardo F , Siman Fabiana DM , Stefanon Ivanita , Vassallo Dalton V
Published: March 2008

Chronic ouabain administration increases blood pressure and produces a positive inotropic effect. However, the temporal changes capable of affecting both arterial and ventricular pressures and myosin ATPase activity during the induced hypertension have not been determined.

The aim of the present study was to investigate the time‐course of the induction of hypertension to define when changes occur in Wistar rats treated with 25 mg/kg per day, s.c., ouabain for 3, 7, 15 or 30 days.

In anaesthetized rats, diastolic blood pressure increased after 7 days treatment with ouabain and after 15 and 30 days treatment, increases were observed in systolic blood pressure, left ventricular systolic pressure and myosin ATPase activity. After 15 days treatment, heart rate (HR) also increased, but after 30 days treatment HR returned to control levels. However, only after 30 days treatment did the left ventricular positive and negative first derivatives of intraventricular pressure (dP/dtmax and dP/dtmin, respectively) increase. Increased arterial and left ventricular systolic pressures and myosin ATPase activity observed after 15 days treatment maintained similar levels as those after 30 days treatment.

The results suggest that changes in arterial and left ventricular pressures, HR and myosin ATPase activity induced by chronic ouabain treatment are time dependent, increasing after 15 days treatment. After 30 days treatment, the increase in systolic and diastolic arterial and ventricular pressures remained stable, as did inotropism. Normalization of HR after 30 days treatment suggests that during the period from Day 16 to Day 30 ouabain‐induced hypertension is dependent, at least in part, on increased sympathetic activity.
CYP2D6*3, *4, *5 AND *6 POLYMORPHISMS AND ANTIPSYCHOTIC‐INDUCED EXTRAPYRAMIDAL SIDE‐EFFECTS IN PATIENTS RECEIVING ANTIPSYCHOTIC THERAPY
Authors: Crescenti Anna , Mas Sergi , Gassó Patricia , Parellada Eduard , Bernardo Miquel , Lafuente Amalia
Published: March 2008

The aim of the present study was to examine the relationship between CYP2D6 polymorphisms and the risk of antipsychotic (AP)‐induced extrapyramidal symptoms (EPS) in patients receiving AP treatment. The allele status for CYP2D6*3, CYP2D6*4, CYP2D6*5 and CYP2D6*6 was determined in 267 patients receiving AP therapy. Seventy‐nine cases presenting with EPS (Simpson–Angus > 3) and 188 controls without EPS (Simpson‐Angus £ 3) took part in the study.

We found a non‐significant over‐representation of poor metaboliser genotypes among cases, but a significant association between the mutant homozygous genotype for CYP2D6*4 (odds ratio (OR) 4.1, 95% confidence interval (CI) 1.01–16, permutated P value 0.01) and the heterozygous genotype for CYP2D6*6 (OR 5.4, 95% CI 1.13–18, permutated P value 0.003) and the risk of suffering EPS.

These results suggest that the CYP2D6 genotype may be a contributory factor in the development of EPS in patients undergoing AP therapy.
A NEW ELECTROPHYSIOLOGICAL TOOL TO INVESTIGATE THE SPATIAL NEURONAL PROJECTIONS WITHIN THE MYENTERIC ASCENDING REFLEX OF THE MOUSE COLON
Authors: Sibaev Andrei , Yüce Birol , Allescher Hans‐Dieter , Göke Burkhard , Storr Martin
Published: March 2008

The intestinal peristaltic reflex is regulated by local microcircuits that, upon activation, result in an oral contraction and anal relaxation of the circular muscle. This contractile response is associated with typical electrophysiological changes in membrane potential resulting from excitatory and inhibitory myenteric pathways.

The aim of the present study was to investigate the influence of local electrical stimulation (ES; single pulses, 15 V, 0.3 msec duration) on the ascending gastrointestinal electrophysiological potentials of the mouse colon using a novel 12‐channel stimulation electrode in a newly designed model of the ascending myenteric pathways with simultaneous intracellular recording.

Local myenteric reflex responses in the proximal colon were initiated by ES (12 bipolar stimulation electrodes (SE) 0.7 mm apart from each other) and excitatory and inhibitory junction potentials (EJP and IJP, respectively) were recorded from circular smooth muscle cells with intracellular recording techniques. In vivo colonic propulsion was determined by measuring the time to expulsion of a 3 mm glass bead inserted 2.5 cm into the distal colon of mouse.

Under basal conditions, circular smooth muscle cells displayed a stable membrane potential (–56.7 ± 6.9 mV; n = 13). Electrical stimulation elicited a tetrodotoxin (3 µmol/L)‐sensitive, neuronal‐induced EJP (cholinergic; atropine (1 µmol/L) sensitive) and a biphasic IJP. Both the EJP and IJP showed characteristic responses dependent on the distance between stimulation and recording sites. The EJP could be recorded over long distances, resulting in a maximal EJP amplitude at a distance of 10 mm distance (represented by stimulation electrodes (SE) number 6/7) and a maximal projection distance of 18–20 mm. Both components of IJP were maximal during direct stimulation (at SE1; stimulation at the recording site) and gradually decreased to SE6/7 (10 mm). At distances greater than 10 mm apart, ES did not produce IJP. The ganglionic blocker hexamethonium (10–100 µmol/L) concentration dependently abolished all inhibitory junction potentials at distances greater than 10 mm and significantly reduced the amplitude of EJP for the first 10 mm. Colonic propulsion was decreased by hexamethonium (40 mg/kg) and atropine (0.7 mg/kg).

Neuronal circuits of the ascending myenteric reflex functionally project distances ranging up to 18–20 mm. Our newly designed setup allows simultaneous electrophysiological investigations of neuronal microcircuitry within the myenteric plexus over short and long distances and enables conclusions to be drawn regarding neuroneuronal and neuromuscular transmission.
MITEMCINAL (GM‐611), AN ORALLY ACTIVE MOTILIN RECEPTOR AGONIST, IMPROVES DELAYED GASTRIC EMPTYING IN A CANINE MODEL OF DIABETIC GASTROPARESIS
Authors: Onoma Mitsu , Ozaki Ken‐ichi , Yogo Kenji , Monnai Makoto , Muramatsu Hiroyasu , Kamei Kenshi , Kawabe Yoshiki , Hayashi Shuji , Shiga Toshihiko , Matsuo Saori , Suzuki Masami , Itoh Zen , Ōmura Satoshi , Takanashi Hisanori
Published: March 2008

The aim of the present study was to evaluate the effects of mitemcinal (GM‐611), an orally active motilin receptor agonist, on delayed gastric emptying in a canine model of diabetic gastroparesis and to compare these effects with those of cisapride.

Moderate hyperglycaemia was induced by a single intravenous injection of a mixture of streptozotocin (30 mg/kg) and alloxan (50 mg/kg). Dogs that maintained moderate hyperglycaemia (fasting plasma glucose 200–300 mg/dL) without insulin treatment were selected and gastric emptying in these dogs was determined by the paracetamol method.

One year after the onset of diabetes, there was no difference in the gastric emptying of normal and diabetic dogs. However, after 5 years, the diabetic dogs showed delayed gastric emptying. The motor nerve conduction velocity of the tibial nerve was significantly lower in diabetic dogs comapred with normal dogs at both time points.

Histopathological examination at the end of the study showed that there were fewer nerve fibres in both dorsal vagal and tibial nerves of diabetic dogs comapred with normal dogs. The onset of delayed gastric emptying is thought to have occurred gradually, in parallel with abnormal autonomic nerve function induced by the long period of moderate hyperglycaemia.

Oral administration of mitemcinal (0.125, 0.25 or 0.5 mg/kg) dose‐dependently accelerated delayed gastric emptying, significant at 0.5 mg/kg, in diabetic dogs, whereas cisapride (1, 3 or 10 mg/kg) had no significant effect. These results add to the existing evidence that mitemcinal is likely to be useful for treating diabetic gastroparesis.
The mitochondrial and nuclear genetic structure of Myotis capaccinii (Chiroptera: Vespertilionidae) in the Eurasian transition, and its taxonomic implications
Authors: Bilgin Raşit , Karataş Ahmet , ÇOraman Emrah , Morales Juan Carlos
Published: March 2008

Allopatric isolation in glacial refugia has caused differentiation and speciation in many taxa globally. In this study, we investigated the nuclear and mitochondrial genetic differentiation of the long fingered bat, Myotis capaccinii during the ice ages in south‐eastern Europe and Anatolia. The mitochondrial DNA (mtDNA) analyses indicated a suture zone similar to those recorded in other animal species, including bats, suggesting the association of more than one refugium with the region. Contrary to most of the other species where a suture zone was seen in Anatolia, for M. capaccinii the geographical location of the genetic break was in south‐eastern Europe. This mitochondrial differentiation was not reflected in the nuclear microsatellites, however, suggesting that the lack of contact during the ice ages did not result in reproductive isolation. Hence taxonomically, the two mitochondrial clades cannot be treated as separate species.