Acceptability of home-assessment post medical abortion and medical abortion in a low-resource setting in Rajasthan, India : Secondary outcome analysis of a non-inferiority randomized controlled trial

Background: Studies evaluating acceptability of simplified follow-up after medical abortion have focused on high-resource or urban settings where telephones, road connections, and modes of transport are available and where women have formal education. Objective: To investigate women's acceptability of home-assessment of abortion and whether acceptability of medical abortion differs by in-clinic or home-assessment of abortion outcome in a low-resource setting in India. Design: Secondary outcome of a randomised, controlled, non-inferiority trial. Setting Outpatient primary health care clinics in rural and urban Rajasthan, India. Population: Women were eligible if they sought abortion with a gestation up to 9 weeks, lived within defined study area and agreed to follow-up. Women were ineligible if they had known contraindications to medical abortion, haemoglobin < 85mg/l and were below 18 years. Methods: Abortion outcome assessment through routine clinic follow-up by a doctor was compared with home-assessment using a low-sensitivity pregnancy test and a pictorial instruction sheet. A computerized random number generator generated the randomisation sequence (1: 1) in blocks of six. Research assistants randomly allocated eligible women who opted for medical abortion (mifepristone and misoprostol), using opaque sealed envelopes. Blinding during outcome assessment was not possible. Main outcome measures: Women's acceptability of home-assessment was measured as future preference of follow-up. Overall satisfaction, expectations, and comparison with previous abortion experiences were compared between study groups. Results: 731 women were randomized to the clinic follow-up group (n = 353) or home-assessment group (n = 378). 623 (85%) women were successfully followed up, of those 597 (96%) were satisfied and 592 (95%) found the abortion better or as expected, with no difference between study groups. The majority, 355 (57%) women, preferred home-assessment in the event of a future abortion. Significantly more women, 284 (82%), in the home-assessment group preferred home-assessment in the future, as compared with 188 (70%) of women in the clinic follow-up group, who preferred clinic follow-up in the future (p < 0.001). Conclusion: Home-assessment is highly acceptable among women in low-resource, and rural, settings. The choice to follow-up an early medical abortion according to women's preference should be offered to foster women's reproductive autonomy.

Faster, richer, better: rapid appraisal techniques for the study of IS implementation in virtual communities

A major issue in Information Systems (IS) research is how to combine relevance and rigor (Benbasat and Zmud, 1999) and reduce the widening gap between research results and adoption (Dunn, 1994). Qualitative researchers make use of interpretivist methods to add richness and depth to their understanding of user problems. Interpretivist methods applied to IS implementations can thus result in research which communicates those findings more effectively. However standard interpretivist data-collection and analysis methods can be time-consuming and expensive. Findings based on these methods may be irrelevant to practitioners by the time they reach publication stage. A potential solution to this problem lies in Rapid Appraisal or RA, a qualitative appraisal methodology derived from rural development-related research. It offers IS researchers an additional technique for learning and acquiring relevant information in a limited period of time that  supplements current data collection and analysis techniques. RA adds value to the traditional approach for studying diffusion of innovation, supporting and extending the IS researcher’s qualitative ‘tool-kit’. In this paper we review an electronic gateway designed to facilitate the diffusion of an Australian government to business [G2B] export documentation system, EXDOC, which was first implemented with meat producers. RA techniques were used to collect and analyse data regarding the implementation of the first regional Electronic Trade Facilitation Center [ETFC] successfully established for Australian exporters in the horticulture sector. The findings from the original EXDOC implementation in the meat sector were confirmed and extended through this study. These include the importance of developing a governance structure that ensures all community members share the benefits of an implementation and the fact that virtual trading communities are attractive to users only if they add value to their business and extend standard ways of operating. Interactive interviews, part of the RA approach; also enabled us to expand our understanding of the way in which procedures developed in the course of implementing an electronic market represent value-adding opportunities for virtual trading communities. The paper has special relevance for researchers investigating adoption and diffusion issues experienced by small-scale producers with low exposure to technology in remote and rural settings.

Barriers to effective management of depression in general practice

Objective: The aim of this study was to investigate the effects of prior general practice training in mental health and practice location on general practitioner (GP) attitudes toward depression, self-confidence in assessing and treating depressed patients, identification of doctor, patient and practice barriers to the effective care of depressed patients in general medical practice and GP-reported current clinical practice.

Method: Fifty-two (out of 123) Divisions of General Practice that responded to an invitation to participate in the study distributed 608 anonymous surveys to a representative sample of GPs; 420 (69%) were returned. The questionnaire focused on current clinical practice, perceived barriers to care of depressed patients and doctors' self-efficacy for assessing and treating depressed patients. It also consisted of two scales, based upon previous research, designed to assess doctors' attitudes towards depression and depressed patients.

Results: General practitioners who had undertaken mental health education and training more often used non-pharmacological treatments (p = 0.00), as did female GPs (p = 0.00). Male GPs (p = 0.00) and those in rural settings (p = 0.01) more often prescribed medication for depression. Those without mental health training more often identified incomplete knowledge about depression as a barrier to its effective management (p = 0.00). Urban-based GPs (p = 0.04) and those with prior mental health training (p = 0.00) were more confident in the use of non-pharmacological treatments. Female GPs without mental health training were the least confident in the use of these methods (p = 0.01). Overall, GPs with mental health training were more positive in their attitudes toward depression and their treatment of these patients (p = 0.00). Female GPs appeared more positive in their attitudes toward depression than male GPs (p = 0.01), although the results were not entirely consistent.

Conclusions: Participation in mental health training by GPs appears to be related to their attitudes toward depressed patients and to their confidence and abilities to diagnose and manage the common mental disorders effectively.

Educating for the future : technological advantages?

Educating students for the future involves providing them with skills to cope with technological change. Schools and teachers have been adapting their practices in mathematics and science to incorporate information and communication technology (ICT) as a routine aspect of learning. However, recent research indicates that not all students have equal access to the technologies they need. A number of reasons are investigated: the location of the schools (regional and rural settings), the capabilities of the teachers and access by staff and students to high quality resources. This paper presents the findings of this research.

Population mixing and the risk of childhood leukaemia in Switzerland: a census-based cohort study.

Childhood leukaemia (CL) may have an infectious cause and population mixing may therefore increase the risk of CL. We aimed to determine whether CL was associated with population mixing in Switzerland. We followed children aged <16 years in the Swiss National Cohort 1990-2008 and linked CL cases from the Swiss Childhood Cancer Registry to the cohort. We calculated adjusted hazard ratios (HRs) for all CL, CL at age <5 years and acute lymphoblastic leukaemia (ALL) for three measures of population mixing (population growth, in-migration and diversity of origin), stratified by degree of urbanisation. Measures of population mixing were calculated for all municipalities for the 5-year period preceding the 1990 and 2000 censuses. Analyses were based on 2,128,012 children of whom 536 developed CL. HRs comparing highest with lowest quintile of population growth were 1.11 [95 % confidence interval (CI) 0.65-1.89] in rural and 0.59 (95 % CI 0.43-0.81) in urban municipalities (interaction: p = 0.271). Results were similar for ALL and for CL at age <5 years. For level of in-migration there was evidence of a negative association with ALL. HRs comparing highest with lowest quintile were 0.60 (95 % CI 0.41-0.87) in urban and 0.61 (95 % CI 0.30-1.21) in rural settings. There was little evidence of an association with diversity of origin. This nationwide cohort study of the association between CL and population growth, in-migration and diversity of origin provides little support for the population mixing hypothesis.

El Paisaje como Servicio Ambiental que otorgan las zonas agrícolas de la provincia de Mendoza, Argentina

Los ecosistemas proveen de servicios ambientales necesarios para la satisfacción de las necesidades tanto materiales, como no materiales de los seres humanos. Aportan al crecimiento económico y también a otros aspectos intangibles, que hacen al bienestar humano. Este flujo de bienes y servicios es vital para la economía. Los ecosistemas rurales, satisfacen las necesidades humanas y generan bienestar, incidiendo directamente sobre calidad de vida de las personas. En Argentina, existen conflictos sociales, económicos y ecológicos estrechamente relacionados. Por ello, no es correcto separar la sociedad de la naturaleza y tratar los problemas como si existieran escindidos. Por este motivo se recurre a la valoración de los ecosistemas y del medio ambiente, como instrumento preventivo ante posibles amenazas que vienen alterando el funcionamiento y la estructura de los ecosistemas rurales, por medio de estrategias y políticas sostenidas para el tratamiento y corrección de esta situación. Mendoza es considerada actualmente en un lugar destacado a nivel turístico. Teniendo en cuenta los caminos del vino y la Fiesta Nacional de la Vendimia. Actividades distintivas de la identidad provincial y de sus pobladores. En la última década, el departamento de Maipú ha sufrido una notoria pérdida de tierras agrícolas que se destinaron a la urbanización. Los problemas típicos de la ciudad ya han alcanzado a las zonas rurales. La inseguridad alcanzada, es un claro ejemplo de ésta situación. La elección del territorio de estudio, surgió al analizar el avance urbano en los censos 2001 y 2010, en zonas agrícolas representativas de Mendoza. Se observó que el departamento de Maipú obtuvo un incremento poblacional del 93%. Siendo el mismo, el departamento del Gran Mendoza, con mayor crecimiento de la última década. Además se tuvo en cuenta que Maipú es uno de los departamentos más importantes en el aspecto agrícola de la provincia, conocido como la cuna del vino y del olivo. Se toma como referencia la opinión de habitantes de un departamento que ha sufrido este cambio más recientemente para calificar el avance urbano y pérdida de servicios ambientales en zonas agrícolas de toda la provincia de Mendoza. La presente investigación se centra en el estudio de la provisión de servicios ambientales, por parte de los ecosistemas rurales de la provincia de Mendoza, Argentina. Se estudia la valoración social de los beneficios ambientales y sociales que la sociedad maipucina, le otorga a las zonas agrícolas de Mendoza. Se realiza a través de entrevistas enmarcadas en una técnica de Valoración Contingente en la que se obtienen resultados para el análisis de la Valoración Social de los servicios ambientales, sin llegar al análisis de una Valoración Económica. Los resultados obtenidos muestran que existe una preferencia de los habitantes de Maipú hacia paisajes naturales y agrícolas. Se sienten beneficiados y atraídos por la sensación de bienestar, otorgándoles valor social de existencia. Sin embrago, se percibe que están siendo afectados por problemas típicos de un paisaje urbanizado como lo son la contaminación visual, sonora y la pérdida de servicios ambientales como lo son la belleza escénica y la cultura mendocina. Los datos obtenidos de las encuestas quedan a disposición como herramienta para la toma de decisiones y para la correcta aplicación de la Ley 8051 de Ordenamiento Territorial y Uso del Suelo en Mendoza.

Exclusive breastfeeding practices in the Coast region, Tanzania.

Background: Although breastfeeding in general is common and culturally accepted in many sub-Saharan countries, recommended exclusive breastfeeding infants to 6 months is rare. In rural Tanzania, data on infant feeding practices is rare. Objective: To examine and describe exclusive breastfeeding practices in rural settings (Coast Region) of Tanzania. Methods: A cross-sectional study was conducted in Coast Region of Tanzania involving 342 mothers. Only mothers with children aged between 6 and 23 months were interviewed in their residences. Data analyses included descriptive and logistic regression analyses. Results: The majority, 66%, of mothers reported to have breastfed their new born within the first hour of life. About 30% reported to have breastfed exclusively for up to at least six months. Those who did not practice complete exclusive breastfeeding mentioned insufficient milk as the main reason. Correlates of exclusive breastfeeding included maternal education and attitudes towards exclusive breastfeeding. Conclusion: The rate of exclusive breastfeeding in rural areas like the Coast Region of Tanzania is still very low. Programs aimed to promote exclusive breastfeeding must take multi-factorial considerations.

Cultural respect encompassing simulation training: being heard about health through broadband

BACKGROUND: Cultural Respect Encompassing Simulation Training (CREST) is a learning program that uses simulation to provide health professional students and practitioners with strategies to communicate sensitively with culturally and linguistically diverse (CALD) patients. It consists of training modules with a cultural competency evaluation framework and CALD simulated patients to interact with trainees in immersive simulation scenarios. The aim of this study was to test the feasibility of expanding the delivery of CREST to rural Australia using live video streaming; and to investigate the fidelity of cultural sensitivity - defined within the process of cultural competency which includes awareness, knowledge, skills, encounters and desire - of the streamed simulations. DESIGN AND METHODS: In this mixed-methods evaluative study, health professional trainees were recruited at three rural academic campuses and one rural hospital to pilot CREST sessions via live video streaming and simulation from the city campus in 2014. Cultural competency, teaching and learning evaluations were conducted. RESULTS: Forty-five participants rated 26 reliable items before and after each session and reported statistically significant improvement in 4 of 5 cultural competency domains, particularly in cultural skills (P<0.05). Qualitative data indicated an overall acknowledgement amongst participants of the importance of communication training and the quality of the simulation training provided remotely by CREST. CONCLUSIONS: Cultural sensitivity education using live video-streaming and simulation can contribute to health professionals' learning and is effective in improving cultural competency. CREST has the potential to be embedded within health professional curricula across Australian universities to address issues of health inequalities arising from a lack of cultural sensitivity training. Significance for public healthThere are significant health inequalities for migrant populations. They commonly have poorer access to health services and poorer health outcomes than the Australian-born population. The factors are multiple, complex and include language and cultural barriers. To address these disparities, culturally competent patient-centred care is increasingly recognised to be critical to improving care quality, patient satisfaction, patient compliance and patient outcomes. Yet there is a lack of quality in the teaching and learning of cultural competence in healthcare education curricula, particularly in rural settings where qualified trainers and resources can be limited. The Cultural Respect Encompassing Simulation Training (CREST) program offers opportunities to health professional students and practitioners to learn and develop communication skills with professionally trained culturally and linguistically diverse simulated patients who contribute their experiences and health perspectives. It has already been shown to contribute to health professionals' learning and is effective in improving cultural competency in urban settings. This study demonstrates that CREST when delivered via live video-streaming and simulation can achieve similar results in rural settings.

MIGRATION PATTERNS AMONG YOUNG ADULTS IN THE UNITED STATES: ENVIRONMENTAL, SOCIAL, AND ECONOMIC EXPLANATIONS

Young adult migration is a key factor in community development. The goal of this paper is to study what kinds of places attract young adults and what kinds are losing them. Linear regression is conducted to analyze what place-specific factors explain migration patterns among young adults. These factors include economic, social, and environmental variables. This study finds that social and environmental factors are just as important as economic ones. Specifically, employment in the arts increases young adult net migration. Environmental variables, for example, natural amenities and protected federal lands are particularly important in rural settings in attracting young adults. These findings suggest that policy makers interested in attracting and retaining young adults should pay closer attention to social and environmental factors and consider creating more opportunities for arts employment in general. For rural areas, improving the attractiveness of natural amenities and better protection of federal lands is also recommended.

Getting better teachers in the bush

This chapter explores concepts of identity, difference and disadvantage through a self-study that focuses on preparing teachers to teach for diversity. I consider influences of my rural, working class background in a homogeneous setting as it shapes my professional identity as a teacher educator. I begin the self-study by reflecting on my early career and work as a language and literacy teacher educator at a regional university where I began to carefully consider the discursive resources that students in regional and rural settings bring to teacher education a decade ago. A decade on, in a different but somewhat similar university, I am still grappling with ways of raising awareness of diversity and discussing issues of race, social class, gender and ability and implications for teaching and learning. In this chapter I use the process of self-study to examine my own practice as a teacher educator using the implications from my doctoral studies as a focus.

Palliative care nursing in rural and urban community settings:A comparative analysis

Nurses have key roles in the coordination and delivery of community-based palliative care. The purpose of this study was to examine the differences between rural and urban community nurses' delivery of palliative care services. A survey was distributed to 277 nurses employed by a community agency in Ontario, Canada, and a 60% response rate was obtained. Nurses reported spending 27% of their time providing palliative care. Rural and urban nurses had similar roles in palliative care but rural nurses spent more time travelling and were more confident in their ability to provide palliative care. Both groups of nurses reported moderate job satisfaction and moderate satisfaction with the level of interdisciplinary collaboration in their practice. Several barriers to and facilitators of optimal palliative care provision were identified. The study results provide information about the needs of nurses that practise in these settings and may provide a basis for the development of strategies to address these needs.

Safer injections, fewer infections : management of needles and sharps and occupational blood exposure in rural north Indian health settings

This study investigated injection practices and occupational exposure to blood in rural north Indian health settings. The findings highlighted a range of practices potentially contributing to the transmission of hepatitis and HIV to both patients and staff in these settings. Interventions need to focus on the development of organisational structures to support and facilitate safer practices.

Supporting ICT based pedagogies in science in rural school settings

Recent research has demonstrated a significant disadvantage for rural teachers in a variety of aspects of ICT use. This context provides a backdrop for two professional learning programs designed to support ICT-based pedagogies in teaching science in Victorian rural primary and secondary schools. In both programs the school-based workshops initiated a community of learners supported with online web-presence. One program used an intensive five-day workshop focused on developing teachers’ knowledge, pedagogical expertise and leadership skills in embedding ICT into classroom practice. The second program provided a one-day workshop focused on integrating ICT skills in teaching science. Factors that affected the uptake of ICT included the considerable diversity in ICT availability and use, teacher competence, lack of support in schools, and online support. To redress rural disadvantage in ICT use, school commitment and focused leadership were identified as central to programs that supported and developed teacher skills and pedagogies over time.