Tsunami alert : the mobile phone difference

Substantial growth has occurred in the telecommunication sector in Papua New Guinea (PNG) since 2007. Mobile telephony has spread to rural and remote localities, following decades of inadequate telephone services. This paper examines the introduction of mobile telephones into a rural village in PNG, and focuses on information access during emergency situations. It considers three tsunami alerts: one immediately prior to the introduction of mobile phone services in the area, and two which occurred after mobile phone reception became available. The research shows that for people with limited access to information, responses to threats such as tsunamis can be inappropriate and driven by fear and panic. By contrast, when there is reliable, timely information available, measured responses can be adopted. This research demonstrates how the use of newly-introduced communication technologies for handling emergencies may work in practice, benefitting people in poorer, rural communities.

The increasing cost of the basic foods required to promote health in Queensland

Objective: To assess changes in the cost and availability of a standard basket of healthy food items (the Healthy Food Access Basket [HFAB]) in Queensland over time. Design and participants: A series of four cross-sectional surveys (in 1998, 2000, 2001 and 2004) describing the cost and availability of foods in the HFAB over time. In the latest survey, 97 Queensland food stores across the five Australian Bureau of Statistics remoteness categories were compared. Main outcome measures: Cost comparisons for HFAB items by remoteness category for the 97 stores surveyed in 2004; changes in cost and availability of foods in the 81 stores surveyed since 2000; comparisons of food prices in the 56 stores surveyed in 1998, 2000, 2001 and 2004. Results: In 2004, the Queensland mean cost of the HFAB was $395.28 a fortnight. The cost of the HFAB was 29.6%($113.89) higher in “very remote” areas than in “major cities” (P<0.001). Between 2001 and 2004, the Queensland mean cost of the HFAB increased by 14.0% ($48.45), while in very remote areas the cost increased by 18.0% ($76.93) (P<0.001). Since 2000, the annualised per cent increase in cost of the HFAB has been higher than the increase in Consumer Price Index for food in Brisbane. The cost of healthy foods has risen more than the cost of some less nutritious foods, so that the latter are now relatively more affordable. Conclusions: Consumers, particularly those in very remote locations, need to pay substantially more for basic healthy foods than they did a few years ago. Higher prices are likely to be a barrier to good health among people of low socioeconomic status and other vulnerable groups. Interventions to make basic healthy food affordable and accessible to all would help reduce the high burden of chronic disease.

Australian Diabetes Foot Network : practical guideline on the provision of footwear for people with diabetes

Trauma, in the form of pressure and/or friction from footwear, is a common cause of foot ulceration in people with diabetes. These practical recommendations regarding the provision of footwear for people with diabetes were agreed upon following review of existing position statements and clinical guidelines. The aim of this process was not to re-invent existing guidelines but to provide practical guidance for health professionals on how they can best deliver these recommendations within the Australian health system. Where information was lacking or inconsistent, a consensus was reached following discussion by all authors. Appropriately prescribed footwear, used alone or in conjunction with custom-made foot orthoses, can reduce pedal pressures and reduce the risk of foot ulceration. It is important for all health professionals involved in the care of people with diabetes to both assess and make recommendations on the footwear needs of their clients or to refer to health professionals with such skills and knowledge. Individuals with more complex footwear needs (for example those who require custom-made medical grade footwear and orthoses) should be referred to health professionals with experience in the prescription of these modalities and who are able to provide appropriate and timely follow-up. Where financial disadvantage is a barrier to individuals acquiring appropriate footwear, health care professionals should be aware of state and territory based equipment funding schemes that can provide financial assistance. Aboriginal and Torres Strait Islanders and people living in rural and remote areas are likely to have limited access to a broad range of footwear. Provision of appropriate footwear to people with diabetes in these communities needs be addressed as part of a comprehensive national strategy to reduce the burden of diabetes and its complications on the health system.

Agentive motility meets structural viscosity: Australian families relocating in educational markets

This paper will develop and illustrate a concept of institutional viscosity to balance the more agentive concept of motility with a theoretical account of structural conditions. The argument articulates with two bodies of work: Archer’s (2007, 2012) broad social theory of reflexivity as negotiating agency and social structures; and Urry’s (2007) sociology of mobility and mobility systems. It then illustrates the concept of viscosity as a variable (low to high viscosity) through two empirical studies conducted in the sociology of education that help demonstrate how degrees of viscosity interact with degrees of motility, and how this interaction can impact on motility over time. The first study explored how Australian Defence Force families cope with their children’s disrupted education given frequent forced relocations. The other study explored how middle class professionals relate to career and educational opportunities in rural and remote Queensland. These two life conditions have produced very different institutional practices to make relocations thinkable and doable, by variously constraining or enabling mobility. In turn, the degrees of viscosity mobile individuals meet with over time can erode or elevate their motility.

Tools for successful NRM in the Lake Eyre Basin : achieving effective engagement

This chapter was developed as part of the ‘People, communities and economies of the Lake Eyre Basin’ project. It has been written for communities, government agencies and interface organisations involved in natural resource management (NRM) in the Lake Eyre Basin (LEB). Its purpose is to identify the key factors for successful community engagement processes relevant to the LEB and present tools and principles for successful engagement processes. The term ‘interface organisation’ is used here to refer to the diverse range of local and regional organisations (such as Catchment Committees or NRM Regional Bodies) that serve as linkages, or translators, between local communities and broader Australian and State Governments. The importance of fostering and harnessing effective processes of community engagement has been identified as crucial to building a prosperous future for rural and remote regions in Australia. The chapter presents an overview of the literature on successful community engagement processes for NRM, as well as an overview of the current NRM arrangements in the LEB. The main part of the chapter presents findings of the series of interviews conducted with the government liaison officers representing both state and federal organisations who are responsible for coordinating and facilitating regional NRM in the LEB, and with the members of communities of the LEB.

Development of the OnTrack Diabetes program

Background: Type 2 diabetes affects an estimated 347 million people worldwide and often leads to serious complications including blindness, kidney disease, and limb amputation. Comorbid dysphoria is common and is an independent risk factor for poor glycaemic control. Professional support for diabetes self-management and dysphoria has limited availability and involves high costs, especially after regular hours, and in rural and remote areas. Web-based cognitive behavior therapy offers highly accessible, acceptable, and cost-effective support for people with diabetes. This paper describes the development of OnTrack Diabetes, a self-guided, Web-based program to promote improved physical and emotional self-management in people with Type 2 diabetes. Objective: The objective of the study is to describe the development of the OnTrack Diabetes program, which is a self-guided, Web-based program aimed to promote euthymia and improved disease self-management in people with Type 2 diabetes. Methods: Semistructured interviews with 12 general practitioners and 13 patients with Type 2 diabetes identified enablers of and barriers to effective diabetes self-management, requirements for additional support, and potential program elements. Existing resources and research data informed the development of content, and consultants from relevant disciplines provided feedback on draft segments and reviewed the program before release. Using a self-guided delivery format contained costs, in addition to adapting program features and modules from an existing OnTrack program. Results: A separate paper describes the protocol for a randomized controlled trial to provide this required evaluation. Conclusions: Development of the OnTrack Diabetes program demonstrates strategies that help ensure that a program is acceptable to users. The next stages involve testing users’ experiences and examining the program’s effectiveness and cost-effectiveness in randomized controlled trials.

See you in class: Promoting a quality program for pre-service educators in regional locations through a virtual classroom

The quality of an online university degree is paramount to the student, the reputation of the university and most importantly, the profession that will be entered. At the School of Education within Curtin University, we aim to ensure that students within rural and remote areas are provided with high quality degrees equal to their city counterparts who access face-to-face classes on campus.In 2010, the School of Education moved to flexible delivery of a fully online Bachelor of Education degree for their rural students. In previous years, the degree had been delivered in physical locations around the state. Although this served the purpose for the time, it restricted the degree to only those rural students who were able to access the physical campus. The new model in 2010 allows access for students in any rural area who have a computer and an internet connection, regardless of their geographical location. As a result enrolments have seen a positive increase in new students. Academic staff had previously used an asynchronous environment to deliver learning modules housed within a learning management system (LMS). To enhance the learning environment and to provide high quality learning experiences to students learning at a distance, the adoption of synchronous software was introduced. This software is a real-time virtual classroom environment that allows for communication through Voice over Internet Protocol (VoIP) and videoconferencing, along with a large number of collaboration tools to engage learners. This research paper reports on the professional development of academic staff to integrate a live e-learning solution into their current LMS environment. It involved professional development, including technical orientation for teaching staff and course participants simultaneously. Further, pedagogical innovations were offered to engage the students in a collaborative learning environment. Data were collected from academic staff through semi-structured interviews and participant observation. The findings discuss the perceived value of the technology, problems encountered and solutions sought.

Practice location of physicians: a discrete choice model approach

Economists and policymakers have long been concerned with increasing the supply of health professionals in rural and remote areas. This work seeks to understand which factors influence physicians’ choice of practice location right after completing residency. Differently from previous papers, we analyse the Brazilian missalocation and assess the particularities of developing countries. We use a discrete choice model approach with a multinomial logit specification. Two rich databases are employed containing the location and wage of formally employed physicians as well as details from their post-graduation. Our main findings are that amenities matter, physicians have a strong tendency to remain in the region they completed residency and salaries are significant in the choice of urban, but not rural, communities. We conjecture this is due to attachments built during training and infrastructure concerns.

Practising Arithmetic Using Educational Video Games with an Interpersonal Computer

Studies show the positive effects that video games can have on student performance and attitude towards learning. In the past few years, strategies have been generated to optimize the use of technological resources with the aim of facilitating widespread adoption of technology in the classroom. Given its low acquisition and maintenance costs, the interpersonal computer allows individual interaction and simultaneous learning with large groups of students. The purpose of this work was to compare arithmetical knowledge acquired by third-grade students through the use of game-based activities and non-game-based activities using an interpersonal computer, with knowledge acquired through the use of traditional paper-and-pencil activities, and to analyze their impact in various socio-cultural contexts. To do this, a quasi-experimental study was conducted with 271 students in three different countries (Brazil, Chile, and Costa Rica), in both rural and urban schools. A set of educational games for practising arithmetic was developed and tested in six schools within these three countries. Results show that there were no significant differences (ANCOVA) in the learning acquired from game-based vs. non-game-based activities. However, both showed a significant difference when compared with the traditional method. Additionally, both groups using the interpersonal computer showed higher levels of student interest than the traditional method group, and these technological methods were seen to be especially effective in increasing learning among weaker students.

Buone pratiche e Tecnologie Appropriate per la gestione delle risorse idriche ed il risparmio energetico in ambito urbano e rurale

Questa tesi di dottorato tratta il tema delle Tecnologie Appropriate e delle Buone Pratiche per la gestione delle risorse idriche ed il risparmio energetico nell’ambito dell’abitato urbano e rurale. Viene fatta una breve panoramica sulle principali teorie e metodologie che fino ad oggi hanno fatto da linee guida per la progettazione sostenibile e il corretto utilizzo delle risorse. Questa visione d'insieme servirà per esprimere delle valutazioni e trovare dei comuni dominatori per proporre una nuova metodologia d'approccio alla gestione delle risorse con particolare attenzione rivolta alla condizione presente e alla zona d’intervento. Site specific sustainability Approach (S3A). I casi studio: • Un progetto di approvvigionamento idrico e di desalinizzazione delle acque per un’oasi del Sahara marocchino. • Un progetto di ricerca della Columbia University e della NASA legato alla sostenibilità urbana di New York che analizza i benefici apportati dall'installazione di coperture verdi nell'area di Manhattan da un punto di vista della gestione delle risorse idriche, energetiche e delle componenti ambientali. • Un progetto di verde verticale e giardino pensile a Milano. • Un progetto di approvvigionamento idrico sostenibile e gestione del verde per la città di Porto Plata in Repubblica Domenicana. Approfondimenti e sperimentazioni. • E’ stato approfondito il tema della distillazione solare per la dissalazione e potabilizzazione delle acque in zone rurali desertiche ed isolate. • E’ stato progettato e realizzato un prototipo innovativo di distillatore tubolare con collettore solare parabolico. Il prototipo è stato testato nei laboratori della Columbia University di New York. • Sono state approfondite le Khettaras o Qanat, tunnel sotterranei per l’approvvigionamento idrico nelle zone aride. • Infine sono stati approfonditi i benefici apportati dalle coperture a verde (tetti verdi) e dal verde verticale nelle zone urbane dal punto di vista della gestione delle risorse idriche ed il risparmio energetico.

Capacitación turística en comunidades indígenas. Un caso de Investigación Acción Participativa (IAP)

La literatura académica subraya la importancia de involucrar a la comunidad en los procesos de capacitación turística. Sin embargo, apenas hay reflexiones sobre cómo diseñar e implementar la formación en áreas rurales y remotas. En este trabajo se exponen las cuatro fases de un ciclo de Investigación Acción Participativa (IAP), desarrollada en la Selva Lacandona de México con la colaboración de los grupos originarios lacandones y ch’oles. El objetivo de estudio fue la capacitación humana en las áreas de sistemas turísticos, interpretación del patrimonio natural y cultural, y creación de producto. Todo ello complementado con una capacitación específica para mujeres y jóvenes, grupos tradicionalmente relegados en estas comunidades. El relato de las distintas fases de la IAP nos muestra cómo el conocimiento ancestral es la base para una capacitación turística sólida. La involucración de jóvenes estudiantes en los procesos de formación en comunidades, los formatos adaptados a los contextos locales, y los ejercicios de reciprocidad científica, sirven además para la revitalización cultural, el refuerzo de la autoestima y el desarrollo endógeno de los pueblos indígenas.

The use of online health techniques to assist with the delivery of specialist paediatric diabetes services in Queensland

We have tested an alternative method of delivering health services to regional areas of Queensland. By integrating telepaediatrics into an existing outreach programme for children with diabetes and endocrine conditions, we were able to reduce travel for specialist hospital staff while maintaining (and sometimes increasing) the contact patients had with the specialist team. In the first 28 months, we facilitated 160 patient consultations and 10 education sessions via videoconference through the telepaediatric service. By the end of the study, site visits were taking place annually and routine videoconference clinics were scheduled quarterly for the review of new patients and follow-up. Telepaediatric services in endocrinology and diabetes were established at three levels: the coordination of routine specialist clinics via videoconference; ad hoc patient consultations for collaborative management during acute presentations and at times of urgent clinical need; and the delivery of education to staff and patients throughout the state. The net result was improved access to specialist services from rural and remote areas of Queensland.

Influences on doctors' prescribing: Is geographical remoteness a factor?

Objective: To identify factors influencing the prescribing of medicines by general practitioners in rural and remote Australia. Design: A qualitative study using a questionnaire to determine attitudes about prescribing, specific prescribing habits and comments on prescribing in ‘rural practice’. Setting: General practice in rural and remote Queensland. Subjects: General practitioners practising in rural and remote settings in Queensland (n = 258). Main outcome measures: The factors perceived to influence the prescribing of medicines by medical practitioners in rural environments. Results: A 58% response rate (n = 142) was achieved. Most respondents agreed that they prescribe differently in rural compared with city practice. The majority of respondents agreed that their prescribing was influenced by practice location, isolation of patient home location, limited diagnostic testing and increased drug monitoring. Location issues and other issues were more likely to be identified as ‘influential’ by the more isolated practitioners. Factors such as access to continuing medical education and specialists were confirmed as having an influence on prescribing. The prescribing of recently marketed drugs was more likely by doctors practising in less remote rural areas. Conclusion: Practising in rural and remote locations is perceived to have an effect on prescribing. These influences need to be considered when developing quality use of medicines policies and initiatives for these locations. What is already known: Anecdotal and audit based studies have shown that rural general practice differs to urban-based practice in Australia, including some limited data showing some variations in prescribing patterns. No substantiated explanations for these variations have been offered. It is known that interventions to change prescribing behaviour are more likely to be effective if they are perceived as relevant and hence increasing our knowledge of rural doctors’ perceptions of differences in rural practice prescribing is required. What this study adds: Rural doctors believed that they prescribe differently in rural compared with city practice and they described a range of influences. The more remotely located doctors were more likely to report the ‘rural’ influences on prescribing, however, most results failed to reach statistical significance when compared to the less remotely located doctors. These perceptions should be considered when developing medicines policy and education for rural medical practitioners to ensure it is perceived rurally relevant.

Uncovering a hidden epidemic: A study of the current burden of heart failure in Australia

Background. Australia, like other countries, is experiencing an epidemic of heart failure (HF). However, given the lack of national and population-based datasets collating detailed cardiovascular-specific morbidity and mortality outcomes, quantifying the specific burden imposed by HF has been difficult. Methods. Australian Bureau of Statistics (ABS data) for the year 2000 were used in combination with contemporary, well-validated population-based epidemiologic data to estimate the number of individuals with symptomatic and asymptomatic HF related to both preserved (diastolic dysfunction) and impaired left ventricular systolic (dys)function (LVSD) and rates of HF-related hospitalisation. Results. In 2000, we estimate that around 325,000 Australians (58% male) had symptomatic HF associated with both LVSD and diastolic dysfunction and an additional 214,000 with asymptomatic LVSD. 140,000 (26%) live in rural and remote regions, distal to specialist health care services. There was an estimated 22,000 incidents of admissions for congestive heart failure and approximately 100,000 admissions associated with this syndrome overall. Conclusion. Australia is in the midst of a HF epidemic that continues to grow. Overall, it probably contributes to over 1.4 million days of hospitalization at a cost of more than $1 billion. A national response to further quantify and address this enormous health problem is required.

A survey of e-mentoring among New Zealand midwives

Mentoring is a strategy that may assist the midwifery profession to support new graduates and midwives working in rural and remote areas. We conducted a survey of 1577 New Zealand midwives about their opinions and experiences of mentoring. The questionnaire comprised 33 questions, nine of which were open questions. There was a 44% response rate. While the telephone was commonly utilized by mentors (37%) and mentored midwives (37%), the Internet and email played only a small part. Participants acknowledged the potential of these avenues for communication, but midwives felt that mentoring could be provided only by immediate, face-to-face contact. Nevertheless, e-mentoring could be a viable option and requires further investigation. About one-third of midwives identified geographical isolation as a barrier to being a mentor (38%) and being mentored (36%). The use of e-mentoring could remove the barrier of location and allow the midwife to chose a mentor who meets her needs, rather than because she is the only mentor available.