Experience of overseas-trained health professionals in rural and remote areas of destination countries: A literature review

This study aimed to review and synthesise existing literature that investigated the experience of overseastrained health professionals (OTHPs) in rural and remote areas of destination countries. A systematic literature review was conducted using electronic databases and manual search of studies published from January 2004 to February 2011. Data were analysed from the final 17 original report articles that met the inclusion criteria. The reviewed research studies were conducted in Australia, Canada, New Zealand, the UK and the USA. Overseas-trained medical practitioners were the most frequently researched (n = 14); two studies involved nurses and one study included several health professionals. Three main themes emerged from the review and these were: (i) expectations; (ii) cultural diversity; and (iii) orientation and integration to rural and remote health work environment. The OTHPs were expected to possess the appropriate professional and cultural skills while they themselves expected recognition of their previous experiences and adequate organisational orientation and support. A welcoming and accepting community coupled with a relaxed rural lifestyle and the joy of continued patient care resulted in successful integration and contributed to increased staff retention rates. Recognition of expectations and cultural diversity by all parties and comprehensive orientation with sufficient organisational support are important elements in the integration of OTHPs and subsequent delivery of quality health care to people living in rural and remote areas.

A review of the educational needs of nurses administering cancer chemotherapy in rural and remote areas of Queensland

This paper describes current issues in chemotherapy nursing practice in rural and remote Australia. There is a trend to refer chemotherapy clients back to their rural and remote health facility for treatment from major oncology centres in Australia. However, it is increasingly apparent that the majority of nurses administering chemotherapy in smaller centres lack the theoretical and clinical knowledge to ensure optimum client outcomes and nurse/client safety. There are also issues unique to rural and remote life which will influence optimum chemotherapy service delivery. The research program described in the paper will ascertain the education requirements of rural and remote nurses administering chemotherapy and the design and delivery of a chemotherapy education package specific to the rural and remote context. Similar programs will ensure the best standards of chemotherapy practice in non-metropolitan areas by enhancing the practical and theoretical knowledge base of rural and remote nurses.

Higher uptake of long-acting reversible and permanent methods of contraception by Australian women living in rural and remote areas

Objectives: To examine factors associated with the uptake of i) long-acting reversible, ii) permanent and iii) traditional contraceptive methods among Australian women. Methods: Participants in the Australian Longitudinal Study on Women's Health born in 1973–78 reported on their contraceptive use at three surveys: 2003, 2006 and 2009. The participants were 5,849 women aged 25–30 in 2003 randomly sampled from Medicare. The main outcome measure was current contraceptive method at age 28–33 years categorised as long-acting reversible methods (implant, IUD, injection), permanent (tubal ligation, vasectomy), and traditional methods (oral contraceptive pills, condoms, withdrawal, safe period). Results: Compared to women living in major cities, women in inner regional areas were more likely to use long-acting (OR=1.26, 95%CI 1.03–1.55) or permanent methods (OR=1.43, 95%CI 1.17–1.76). Women living in outer regional/remote areas were more likely than women living in cities to use long-acting (OR=1.65, 95%CI 1.31–2.08) or permanent methods (OR=1.69, 95%CI 1.43–2.14). Conclusions: Location of residence is an important factor in women's choices about long-acting and permanent contraception in addition to the number and age of their children. Implications: Further research is needed to understand the role of geographical location in women's access to contraceptive options in Australia.

Refining low-volume, high-concentration herbicide applications to control Chromolaena odorata (L.) King & Robinson (Siam weed) in remote areas

Chromolaena odorata (L.) King and Robinson (Siam weed) is a highly invasive plant and a high priority for control in north Queensland. It can be effectively treated using high-volume, groundbased herbicide spray equipment, but operational information shows that this control method becomes increasingly difficult in areas where vehicle access is prevented by rougher terrain. Low-volume, high-concentration herbicide applications have proven capable of causing high mortality in these remote situations. Two trials were undertaken between May 2010 and May 2012 to refine effective rates of aminopyralid/fluroxypyr, fluroxypyr and metsulfuron-methyl, only using low-volume, high-concentration applications on Siam weed. Fluroxypyr on its own was as effective as aminopyralid/fluroxypyr as both herbicides caused 95-100% mortality at overlapping rates containing 5 to 18.85 g a.i. L-1 of fluroxypyr. Metsulfuron-methyl caused 100% mortality when applied at 3 and 6 g a.i. L-1. Effective control was achieved with approximately 16 to 22 mL of the solutions per plant, so a 5 L mixture in a backpack could treat 170 to 310 adult plants. There are several options for treating Siam weed on the ground and the choice of methods reflects the area, plant density and accessibility of the infestation. Control information from Siam weed field crews shows that low volume, high concentration herbicide applications applied using a splatter gun are a more efficient method for controlling larger, denser remote infestations than physical removal. By identifying effective herbicides that are applied through low-volume equipment, these trials provide an additional and more efficient tool for controlling Siam weed in remote areas.

A personal perspective on literature searches in remote areas

The article is focused on the author's personal perspective on literature searches in remote areas. Topics covered are: literature searching; collection of key articles; catalog local fisheries library holdings; budgets; documentation of research results; and the author's thought for the future.

A hybrid power system for remote areas in Jordan

This paper presents a techno-economic assessment for a unique Isolated Hybrid Power System (IHPS) design for remote areas isolated from the grid which also has the capability of being operated as a smart μ-grid. The share of renewable energy sources in resource poor developing countries is low. In these countries an increase in the share of alternative energy (wind, water and sun) delivered with inexpensive operationally robust generation and delivery systems is seen to the way forward. In our design also incorporates a novel storage system to increase the effectiveness of the Isolated IHPSs previously reported in the literature. The configuration reported is a system consisting of, the wind and sun powered generation complemented with batteries, fuel cell unit and a diesel generator. The modelling design and simulations were based on Simulations conducted using MATLAB/SIMULINK, and HOMER Energy Planning and Design software tools. The design and simulation of a new storage approach incorporating Hydrogen Peroxide (H2O2) fuel cell (increasing the efficiency of the fuel cell from 35% to 65%) and a single board computer (Raspberry Pi) used for the energy management and control the system are the novel features of our design. The novel control strategy implemented also includes a synchronization capability that facilitates IHPS to IHPS or IHPS to Main-Grid connection. In the paper after briefly but comprehensively detailing the design and simulations we will present the results on which we conclude that smart independent systems that can utilize indigenous renewable energy with a capability of being able to synchronize with the grid or each other are the most optimal way of electrifying resource poor developing countries in a sustainable way with minimum impact on the environment and also achieve reductions in Green House Gases.

Higher incidence of childhood-onset type 1 diabetes mellitus in remote areas: a UK regional small-area analysis

Aims/hypothesis: We investigated the association between the incidence of type 1 diabetes mellitus and remoteness (a proxy measure for exposure to infections) using recently developed techniques for statistical analysis of small-area data.

Subjects, materials and methods: New cases in children aged 0 to 14 years in Northern Ireland were prospectively registered from 1989 to 2003. Ecological analysis was conducted using small geographical units (582 electoral wards) and area characteristics including remoteness, deprivation and child population density. Analysis was conducted using Poisson regression models and Bayesian
hierarchical models to allow for spatially correlated risks that were potentially caused by unmeasured explanatory variables.

Results: In Northern Ireland between 1989 and 2003, there were 1,433 new cases of type 1 diabetes, giving a directly standardised incidence rate of 24.7 per 100,000 personyears. Areas in the most remote fifth of all areas had a significantly (p=0.0006) higher incidence of type 1 diabetes mellitus (incidence rate ratio=1.27 [95% CI 1.07, 1.50]) than those in the most accessible fifth of all areas. There was also a higher incidence rate in areas that were less deprived (p<0.0001) and less densely populated (p=0.002). After adjustment for deprivation and additional adjustment for child population density the association between diabetes and remoteness remained significant (p=0.01 and p=0.03, respectively).

Conclusions/interpretation: In Northern Ireland, there is evidence that remote areas experience higher rates of type 1 diabetes mellitus. This could reflect a reduced or delayed exposure to infections, particularly early in life, in these areas.

An Economic Analysis of Wind Energy Production in the Remote Areas of Quebec.

Rapport de recherche

Cost effectiveness of OptiMal® rapid diagnostic test for malaria in remote areas of the Amazon Region, Brazil

Abstract Background In areas with limited structure in place for microscopy diagnosis, rapid diagnostic tests (RDT) have been demonstrated to be effective. Method The cost-effectiveness of the Optimal® and thick smear microscopy was estimated and compared. Data were collected on remote areas of 12 municipalities in the Brazilian Amazon. Data sources included the National Malaria Control Programme of the Ministry of Health, the National Healthcare System reimbursement table, hospitalization records, primary data collected from the municipalities, and scientific literature. The perspective was that of the Brazilian public health system, the analytical horizon was from the start of fever until the diagnostic results provided to patient and the temporal reference was that of year 2006. The results were expressed in costs per adequately diagnosed cases in 2006 U.S. dollars. Sensitivity analysis was performed considering key model parameters. Results In the case base scenario, considering 92% and 95% sensitivity for thick smear microscopy to Plasmodium falciparum and Plasmodium vivax, respectively, and 100% specificity for both species, thick smear microscopy is more costly and more effective, with an incremental cost estimated at US$549.9 per adequately diagnosed case. In sensitivity analysis, when sensitivity and specificity of microscopy for P. vivax were 0.90 and 0.98, respectively, and when its sensitivity for P. falciparum was 0.83, the RDT was more cost-effective than microscopy. Conclusion Microscopy is more cost-effective than OptiMal® in these remote areas if high accuracy of microscopy is maintained in the field. Decision regarding use of rapid tests for diagnosis of malaria in these areas depends on current microscopy accuracy in the field.