Regional Community Research Articles

Nats'eji (healing): Examining patient and provider experiences with hospital-based Indigenous wellness services in Northwest Territories, Canada.

This study aimed to examine how Indigenous patients and biomedical healthcare providers understand and experience the Indigenous wellness services at a hospital in the Northwest Territories. The qualitative study (May 2018-June 2022) was overseen by a regional Indigenous Community Advisory Committee. Guided by Two-Eyed Seeing and post-colonial theory, the study employed a community-engaged research design, and included two strategies for data generation: (1) interviews with Indigenous Elders, patient advocates, biomedical healthcare providers, policy makers, and hospital administrators (n = 41), and (2) iterative sharing circles with Indigenous Elders (n = 4). Data from the interviews and first sharing circle were transcribed, thematically analyzed, and presented to the sharing circle Elders for validation. The study revealed three overarching and related themes: (1) Elders and patient advocates emphasized that while the Indigenous wellness services at the hospital play a pivotal role connecting patients with cultural supports, the hospital was still not effectively bringing Indigenous healing practices into hospital care; (2) participants identified that structural factors (i.e., policy and governance decisions) shaped patients' experiences with the wellness services; and (3) participants underscored that deeply rooted forces (i.e., racism, colonialism, and biomedical dominance) inhibit the integration of Indigenous healing practices. The findings extend understandings of hospital-based Indigenous wellness services by surfacing relationships between deeply rooted forces, organizational structures, and Indigenous patients' experiences. Altogether, they suggest that to advance care for Indigenous patients and improve the integration of Indigenous healing practices, a system-wide transformation is necessary, which includes Indigenous governance at the hospital and a recognition of the value of Indigenous healing practices.

Geoenvironmental determinants influencing chronic kidney disease of unknown etiology in the dry zone of Sri Lanka: a study based on a cohort of at-risk communities.

Chronic kidney disease of unknown origin (CKDu) has emerged as a serious health risk for farming communities in remote semi-arid lowland regions of Sri Lanka, with geoenvironmental factors widely believed to be associated with the etiology. Although numerous case-control studies have been carried out to determine the causes of CKDu, none have been conducted in at-risk communities. The main objective of this study is to identify the potential geo-environmental risk factors associated with the at-risk community in the Wilgamuwa region, a CKDu endemic area in Sri Lanka. The study collected and analyzed 92 water sources currently or previously used in the study area for major cations, anions, and trace elements, mainly As, Cd, Pd, Mn, Zn, Ba and Sr. The major cations and anions in CKDu-susceptible groundwater varied Si4+ > Ca2+ > Na+ > Mg2+ > K+ and HCO3- > Cl- > SO42- > NO3- > F- > PO43- > Br-. The higher average values of Si4+, F- and total hardness (TH) were reported in groundwater consumed by communities at risk of CKDu, with average values (in mg/L) of Si4+-46, F--0.62, and TH-178. Considering the Water Quality Index (WQI) values, 73% of groundwater sources are classified as poor water quality, and the groundwater quality mainly depends on the fluoride distribution in the region. According to the Hazard Quotient (HQ), the risk of adverse health effects from exposure to F- and SiO2 increased in magnitude in the order of male < female < children. Health hazards due to As, Cd and Pb exposure fell between the 'no-risk' and 'low-risk' categories. As outlined in this study, continuous monitoring of vulnerable communities for environmental exposures to key groundwater constituents is important in the dry zone of Sri Lanka.

Racial discrimination and Aboriginal and Torres Strait Islander suicide mortality rates in Queensland.

The study aimed to examine the associations between experiences of racial discrimination within communities with suicide mortality rates for Aboriginal and Torres Strait Islander people. Age-standardised suicide rates (ASRs) were calculated using suicides recorded by the Queensland Suicide Register (QSR) of Aboriginal and Torres Strait Islander people in Queensland from 2009 to 2015. Rate Ratios (RRs) were used to compare ASRs in areas with high and low levels of reported discrimination, and other comparative community-level risk and protective factors (remoteness, socio-economic resources, and Indigenous language use). The age-standardised suicide rate was 31.74 deaths per 100 000 persons/year for Aboriginal and Torres Strait Islander people for the years 2009-2015. ASRs were significantly higher in areas where more of the First Nations residents experienced recent discrimination (RR = 1.33; 95%CI = 1.05-1.70, p = 0.02), and the age-specific suicide rate was significantly higher for those aged 25-34 in areas with more discrimination (RR = 1.67; 95%CI = 1.04-2.74, p = 0.03). By comparison, the ASRs were not significantly higher in areas with regional and remote communities (RR = 1.10, CI 95%=0.75-1.61, p = 0.60), or areas with lower socioeconomic resources (RR = 0.86, 95%CI = 0.66-1.13, p = 0.28). Areas in which more First Nations residents spoke Indigenous languages had significantly lower ASRs (RR = 0.71; CI95%=0.53-0.95, p = 0.02). Suicide mortality rates for Aboriginal and Torres Strait Islander people in Queensland were influenced by experiences of racial discrimination within communities and Indigenous language use, with greater associations reported than with socio-economic resources or remoteness. The findings reflect the public health risk of discrimination and provide evidence for enacting strategies to reduce institutional and personal discrimination to reduce suicide.

Diabetes Control and Clinical Outcomes among Children Attending a Regional Paediatric Diabetes Service in Australia.

Australian children with diabetes commonly struggle to achieve optimal glycaemic control, with minimal improvement observed over the past decade. The scarcity of research in the rural and regional Australian context is concerning, given high incidence rates and prominent barriers to healthcare access in these areas. We conducted a retrospective audit of 60 children attending a regional Australian paediatric diabetes service between January 2020 and December 2023. The majority of patients had type 1 diabetes (n = 57, 95.0%); approximately equal numbers were managed with continuous subcutaneous insulin infusion (CSII) pumps vs. multiple daily injections (MDIs), whilst 88.3% (n = 53) also utilised continuous glucose monitoring (CGM). The mean age at last visit was 14.0 years (SD, 3.4), mean diabetes duration 5.8 years (SD, 4.6), and mean HbA1c level 8.1% (65.3 mmol/mol); only 36.8% achieved the national target of 7.5% (58 mmol/mol). Mean BMI-SDS was 0.8 (SD, 1.0); almost half (n = 27, 45.0%) were overweight or obese. Many patients had mental health conditions (31.7%), which were associated with higher hospitalisation rates (p = 0.007). The attendance rate was 83.2%, with a mean of 3.3 clinic visits per year (SD, 0.7); higher attendance rates were associated with increased CGM sensor usage (r = 0.395, p = 0.007 Overall, the diabetes service performed similarly to other clinics with regards to glycaemic control. Whilst achieving treatment targets and addressing comorbidities remains a challenge, the decent attendance and the high uptake of healthcare technologies is commendable. Further efforts are needed to improve diabetes management for this regional community.

Professional and personal development of newly-qualified teachers as a factor in sustainable development of the region

Introduction. The article is devoted to the problem of newly-qualified teachers’ professional development. The aim of the study is to identify the difficulties of novice teachers during their adaptation in educational settings of the region and to substantiate the ways to improve the quality of initial teacher education in the system of continuous teacher education. Materials and Methods. The methodological basis of the study consists of contextual biographical and cluster approaches. The contextual biographical approach involves studying teachers’ professional biographies in the system of continuing education, taking into account complex external conditions. The cluster approach defines the principles of interaction between various stakeholders within the regional community in order to ensure the sustainable development of the regional educational system. In order to achieve the research goal, the following methods were used: theoretical (analysis of scholarly literature, comparison, generalization) and empirical (online questionnaire, focus group method, method of independent expert assessments). Results. Based on the analysis of scholarly literature, the authors provide their definition of professional and personal teachers’ development as a basic component of their professional development during the period of initial teacher education and at the initial stage of professional development. The authors argued that the main difficulty of novice teachers during the adaptation period is their interaction with various subjects of the educational process at school - students and their parents. The article substantiates the necessity of creating a regional educational cluster as an effective mechanism for improving the quality of initial teacher education at different stages of continuous teacher education. Conclusions. Based on the authors’ idea about professional and personal development of teachers as a basic component of their professional development in the initial period of their working life, the study reveals the main difficulties of novice teachers during their adaptation in educational settings of the region, overcoming of which requires changes in the system of psychological, teacher and methods education at universities and colleges. As an effective mechanism for improving the quality of teacher education, the authors substantiated the idea of creating a pedagogical scientific and educational cluster in the region, which unites the participants of the territorial educational community interested in providing the regional education system with highly qualified teaching staff.

Perceived Impacts of Climate Change on Coastal Aquaculture in the Cyclone Prone Southwest Region of Bangladesh

The southwest region of Bangladesh is particularly vulnerable to a range of climatic threats, including cyclones, prolonged flooding, sea level rise, saltwater intrusion, drought, and riverbank erosion. The study investigates how these different drivers affect aquaculture systems and aims to provide critical insights for sustainable management. The survey work focused on the problems, vulnerabilities, migration, and adaptive strategies of communities of the southwest region of Bangladesh, that rely heavily on shrimp, fish, and crab production for their livelihoods. Data were collected from the 80 respondents across four unions (Atulia, Burigoalini, Gabura, and Bhurulia) in Shyannagar Upazila, Satkhira District, using a structured questionnaire survey and focus group discussions. Findings reveal that climate change events have significantly changed shrimp farming in enclosures, pond aquaculture, and crab point management, and negatively impacted livelihoods. Pond aquaculture appeared to be the most vulnerable to climate change conditions, followed by shrimp farming in enclosures and crab points. Furthermore, the adverse effects of climate change compelled human migration within the study area, primarily driven by the search for employment. This study provides evidence of the effects of various climate change stressors on shrimp, fish, and crab production systems and the adaptive difficulties of the communities dependent on aquatic ecosystems. As the natural calamity like cyclone cannot be prevented, understanding the impact of previous events may help people of the affected area as well as the policy makers to plan for better survival.

The Capital Region in the Unfinished Taiping War

Abstract In 1853, a Taiping army infiltrated North China, threatening Beijing and the Qing dynasty itself. Though this army never reached Beijing, its northern siege had acute and lasting impacts on communities in the capital region (jifu 畿輔). Attention to the capital region invites reflection on the temporality and strategic nature of commemoration. Focusing on Cangzhou 滄州, I examine how capital region communities memorialized the northern chapter of the Taiping Civil War, even as for the rest of the empire, the war remained unfinished until 1864. In gazetteers, private histories, and commemorative records, local authors reframed ambiguous realities to write their localities into a story of northern victory, regardless of the fate of the south. The timeline for commemoration in Cangzhou was interrupted, not seamless, and took place over decades. Initially addressed to Beijing and elites along the Grand Canal, Cangzhou's commemorative project was later brought into the orbit of ascendant Tianjin.

An international comparison of Long-term Care Facility outcomes during the COVID-19 pandemic

Abstract Background The COVID-19 pandemic has had huge repercussions for public health internationally and different countries had different outcomes based on preconceived policy interventions. Lessons influencing future policy have been learned, notably how best to manage vulnerable populations, particularly those living in long-term care facilities (LTCFs). In Ireland LTCF residents accounted for 56% of deaths during the first wave of the pandemic and it is imperative to establish the causes of this. International research has highlighted how factors including county incidence rate, facility size, occupancy, LTCF ownership and compliance with health inspection regulations influenced LTCF COVID-19 outcomes. The aim of this research is to explore the impact of these factors in an Irish context and compare to best international standards. Methods The main outcome considered was deaths per 100 beds. Data on crude mortality were available for 580 Irish LTCFs up to 28 May 2020. Data regarding occupancy, ownership, facility size and compliance with regulations were obtained for these LTCFs from a novel dataset of 1130 available LTCF regulatory inspection reports between 2018- 2022. Regression analysis was carried out to show how LTCF mortality was predicted by examined variables. Results The most significant predictor of deaths from COVID-19 in Irish LTCFs resulting from this research was LTCF occupancy (Odds ratio:1.029, significance &amp;lt;0.001). Regional community incidence, in concordance with international literature was also an important factor. Other stated predictors in this model were either non-significant or only marginally significant. These results are analysed in conversation with international research of the same variables. Conclusions To protect LTCF residents for potential future pandemics, attention should be paid to monitoring and suppressing local incidence rates and moves should be implemented towards designing smaller facilities with individual rooms for vulnerable residents. Key messages • Irish long-term care pandemic mortality was predicted by high occupancy of facilities and high regional COVID-19 incidence. • Comparing International COVID-19 outcomes in long-term care facilities can provide guidelines for the future.

Stroke is Not an Accident: An Integrative Review on the Use of the Term 'Cerebrovascular Accident'.

Cerebrovascular accident (CVA) is an outdated term for describing stroke as it implies stroke is an accident. We conducted an integrative review to determine use of CVA in terms of 1) frequency in major medical journals over time; 2) associated publication characteristics (e.g., number of authors, senior author country, topic); and 3) frequency in medical records. We searched Google Scholar for publications in leading neurology and vascular journals (Quartile 1) across two 5-year periods (1998-2002 and 2018-2022) using the terms "cerebrovascular accident" or "CVA." Two reviewers independently reviewed full-text publications and recorded the frequency of CVA use. Rates of use (per 1,000 articles/year) were calculated for each journal and time period. Associations of publication characteristics with CVA use were determined using multivariable logistic regression models. In addition, admission and discharge forms in the Auckland Regional Community Stroke Study (ARCOS V) were audited for frequency of use of the term CVA. Of the 1,643 publications retrieved, 1,539 were reviewed in full. Of these, CVA was used ≥1 time in 676 publications, and ≥2 times in 276 publications (129 in 1998-2002; 147 in 2018-2022). The terms CVA and stroke both appeared in 57% of publications where CVA was used ≥2 times in 1998-2002, compared to 65% in 2018-2022. Majority of publications were on the topic of stroke (22% in 1998-2002; 20% in 2018-2022). There were no associations between publication characteristics and the use of CVA. The highest rate of CVA use in 2018-2022 was in Circulation, and increased over time from 1.3 uses per 1,000 publications in 1998-2002 to 1.8 uses per 1,000 publications in 2018-2022. The largest reduction the use of CVA was in Neuroepidemiology (2.0 uses per 1,000 publications in 1998-2002 to 0 uses in 2018-2022). The term CVA was identified in 0.2% of stroke admission and discharge forms audited (17/7808). We found evidence of changes in the use of CVA in the scientific literature over the past two decades. Editors, authors and clinicians should avoid the use of the term CVA as it perpetuates the use of a non-specific, non-diagnostic, and non-scientific term.

ANALISIS PENDAPATAN USAHA PETERNAKAN SKALA MENENGAH PROGRAM UMKM PADA RUMAH PEMOTONGAN AYAM KAMPUNG(STUDI KASUS RPA LA’TANSA DI KECAMATAN PALU SELATAN KELURAHAN BIROBULI UTARA)

Central Sulawesi Province has an area of ​​61,841.29 km^2 consisting of 13 Regencies/Cities with a population of 2,921,715 people or 719,031 households and a population of 77,004 free-range chickens spread across several areas of Palu City (Central Statistics Agency, 2016). Palu City as an autonomous region has various resources that can be developed to achieve the main goal of economic development, so that it can increase the number and types of employment opportunities for regional communities so that community welfare is more equitable. In an effort to achieve this goal, the government must be able to develop potential economic sectors, one of which is free-range chicken farming so that it develops as a leading sector. With the hope that this sector will be able to contribute to the community's economy, especially medium-sized farms with MSME capital. Extensive-traditional or free range chicken rearing system. Even though there are breeders who carry out intensive cultivation, they are still very limited in terms of capital and marketing. This is what makes the total production of the free-range chicken population in the city of Palu lower when compared to other cities, so it is necessary to conduct a study on income analysis of the medium-scale free-range chicken business for the UMKM program in the City of Palu. The aim of this research is to find out how much income middle-scale chicken traders earn from the MSME program at RPA LA Tansa, South Palu District, North Bureaubuli Village and to find out the feasibility of selling free-range chickens at RPA Latansa. This research will be carried out at RPA Latansa from February to April 2024 . This research method uses a survey method. The research design uses a type of quantitative descriptive research, namely a research procedure that uses descriptive data in the form of written or spoken words (interviews) with respondents, then the research data obtained is simplified in table form by displaying the number and average, then analyzed again sequentially. descriptive. The data analysis used is Revenue Analysis, Cost Analysis, Income Analysis and R/C Ration business feasibility analysis. Based on an analysis of income calculations, the Latan'sa chicken slaughterhouse (RPA) business income for one month is IDR. 38,722,708 which shows that the Latan'sa chicken slaughterhouse (RPA) business is making a profit

Genealogy in social media: navigating time and space

ABSTRACT Driven by the increasing use of social media by people seeking to reconstruct family histories and preserve historical, cultural, and societal legacy, genealogy-based online communities are experiencing a surge in popularity. This study explores how trauma-affected communities use online communities to reconstruct their identities and histories, demonstrating the resilience and adaptability of these groups in the digital age. Based on the theory of Knowledge Co-Creation, this paper presents a novel conceptual framework designed to categorize the content in such communities. This framework is composed of two axes. The first axis, ‘Time,’ reflects the evolving character of participants’ involvement, starting with an exploration of immediate family history and gradually expanding to encompass a broader interest in ancestral and communal history of the past. The second axis, ‘Space,’ explores the interplay between online interactions and offline activities. To demonstrate the applicability of this framework, the paper focuses on the case study of the WhatsApp community dedicated to collaborative research of the descendants of annihilated Jewish communities of the Upper Silesia region of southwestern Poland.This research contributes to the literature on digital genealogy and online communities by offering a structured approach to analyzing the dynamics of trauma-affected populations engaging in collaborative genealogical research.

THE ROLE OF PUBLIC ORGANIZATIONS IN PROVIDING SOCIAL ASSISTANCE TO INTERNALLY DISPLACED PERSONS (ON THE EXAMPLE OF ODESSA REGION)

The article presents the results of a study on determining the role of public organizations in providing social assistance to internally displaced persons on the example of Odesa region. The concepts of «social assistance» and «social assistance to internally displaced persons» are defined. A diagnostic cross-section was carried out on the basis of administrative service centers during monitoring visits to communities, which covered IDPs of Zatyshansk, Bolgradsk, Znamyansk and Sergiivsk communities of Odessa region. Also, the survey was conducted directly among social workers of the public organization «Tenth of April». The purpose of the article is to conduct research on determining the role of public organizations in providing social assistance to internally displaced persons on the example of Odesa region. The research used questionnaire and semi-structured interview methods. The results of the survey showed that: a large part of respondents (78%) experience financial difficulties; 65% are satisfied with their level of adaptation to life in the host community, although they do not rule out that the situation could have been better; the most acute security problem in the respondents' previous places of residence was the destruction of property due to military actions (78%); respondents' most important needs are access to housing and employment, as well as basic needs such as food and clothing; the main types of assistance that public organizations can provide are assistance in finding a job, filing documents, receiving social benefits, care for the elderly and people with disabilities, support for families with children, psychological support, etc. Also, the majority of respondents (52%) experience difficulties in obtaining assistance due to a lack of information about available services, the procedure for obtaining them, contacts of public organizations, etc. Based on the results of the research, the authors developed a number of conclusions and recommendations addressed to state authorities, local self-government and civil society organizations.

Care ethics and contemporary art: Imagining and practising care

Feminist care ethicshas for some time guided contemporary artists and curators in their search for sustaining and sustainable practices in the current neoliberal backwash and climate crisis. With a focus on current Australian art in the context of recent care ethics scholarship, this article considers what contemporary art – in its processes as well as aesthetic outcomes – can offer in imagining and practising care for the human and more-than-human world. The article focuses on a series of exhibitions that comprised a key exploratory methodology of The Care Project: Feminism and art in neoliberal times (La Trobe University, 2019–2022). The exhibitions featured the work of regionally based artists. This accent on creative practices emerging from the experience of living in regional communities that are often on the frontline of climate change and social inequality offers unique perspectives on care ethics in practice.

A Review of the Indigenous Medicinal Plants Used by Scheduled Tribe Communities of North-East India

Background: North-eastern India is renowned for its rich bio-diversity of indigenous medicinal plants and its therapeutic properties. The tribal communities and ethnic groups residing in this region genuinely depend on the indigenous systems of medicine. They have extensive knowledge and comprehension of plants, both conventional and non-conventional, for their food and medicine, and they practice their own traditional healthcare system. Objectives:This study aims to give a systematic overview of traditional medicinal plants along with their properties used by the Scheduled Tribe (ST) communities of north-eastern region and their potential for upliftment of the socio economic status of the community. Methods: The data were collected from published paper through electronic databases viz, Google scholar, PubMed, Science Direct based on traditional medicinal plants used by the ethnic groups. Results: In this study, 236 medicinal plants were summarized with their medicinal properties used by the Scheduled Tribe people of northeastern region. Conclusion: This study provides the information on therapeutic plants which will be a valuable resource for creating an action plan and development for the herbal drug sector, with the goal of enhancing and boosting the state's economy and quality of life.

Ecological and taxonomic dissimilarity in species and higher taxa of reptiles in western Mexico.

Reptiles are one of the most diverse groups of vertebrates in the world that are distributed in almost all ecosystems. Many of these studies have focused on exploring their diversity patterns across different environments; and recent studies on reptile alpha and beta diversity have incorporated a multifaceted approach into their analysis to have more comprehensive evaluations. This study presents an assessment of the taxonomic diversity of reptile patterns using methods that incorporate the assessment of higher taxa. Likewise, the taxonomic dissimilarities between reptile communities in the physiographic regions of the state of Jalisco were analyzed. Evaluations for the groups of snakes and lizards independently are presented. We use the taxonomic distinctiveness index that assesses the complexity of the taxonomic structure of communities through hierarchical classification above the species level to measure the relationships between taxa. The dissimilarity of the taxonomic structure in each community was also analyzed. Beta diversity partitions were performed to identify the contribution of turnover and the differences in richness. We determined that alpha diversity of species and higher taxa maintain different patterns, indicating that Jalisco presents regions with overrepresentation of reptile families and genera, as well as regions with an opposite trend. The representation of higher taxa is higher in the lizard group, although in terms of species richness snakes are the most prominent group. The turnover is the most important component at species and higher taxa, with similar values for lizards and snakes. The findings presented show that incorporating phylogenetic information about species through taxonomic relationships provides complementary information that species diversity per se, especially at the level of alpha diversity.

ЗАБЕЗПЕЧЕННЯ ЖИТТЄЗДАТНОСТІ ТЕРИТОРІАЛЬНИХ ГРОМАД УКРАЇНИ В УМОВАХ ПОДОЛАННЯ ФІНАНСОВИХ ТА ІННОВАЦІЙНИХ ВИКЛИКІВ

Decentralization of power in Ukraine is one of the priority reforms of the modern state system, which has caused serious changes in the financial and innovation policy of territorial communities, and also acts as an institutional basis for the economic progress of territories, which requires an in-depth analysis of the financial capacity of territorial units and their innovative activity to identify potential and threats on the way to sustainable development. The purpose of the research is theoretical substantiation and development of management approaches to eliminate financial and innovative challenges of territorial units in conditions of decentralization of power, in particular in Transcarpathian region, as well as providing practical recommendations on strengthening local budgets and promoting innovative progress. The object of the research is the financial self-sufficiency and innovative activity of the territorial units of Ukraine, in particular the Transcarpathian region. The methods of the research used in the research are general scientific methods, in particular, historical, dialectical, comparative, phenomenological, systemic analysis and the method of generalization. The hypothesis of the research is that effective management of financial resources and purposeful development of innovative activity in territorial communities will contribute to stable economic growth in conditions of decentralization. The statement of basic materials. The decentralization of power in Ukraine has led to significant changes in the financial and innovation policy of territorial communities, providing greater autonomy in the management of local budgets and increasing responsibility for their effective use. In Transcarpathian region, the reform process took place more slowly due to the uneven distribution of resources and economic assets, which limited the even development of communities. Despite these difficulties, decentralization has created conditions for strengthening financial independence and stimulating innovation at the local level. During 2021-2022, a general increase in revenues to the budgets of territorial communities was observed, in particular due to the contributions of six districts of Transcarpathia, which confirms the positive impact of the reform on economic development. However, the war in Ukraine negatively affected the financial capacity of communities, creating new challenges that require innovative solutions and adaptation to ensure sustainable economic growth. The originality and practical significance of the research lies in the development of management mechanisms for overcoming financial and innovative challenges of territorial communities, in particular in the Transcarpathian region. Conclusions and perspectives of further research. Decentralization of power is a positive change for the financial and innovative development of territorial communities, as it has managed to significantly increase their self-sufficiency. Further scientific research should focus on a more detailed thorough analysis of the impact of decentralization on the financial capacity of territorial communities of the Transcarpathian region, as well as an assessment of the effectiveness of existing and potential innovative strategies at the local level.

A review of emergency laparoscopic cholecystectomies in Far North Queensland.

Access to laparoscopic cholecystectomy is more limited for remote communities and Indigenous patients internationally. To date, studies exploring the incidence of gallstone disease and access to laparoscopic cholecystectomy in Australian regional communities are limited. This study examined the rates and outcomes of emergency laparoscopic cholecystectomy (EMLC) in Far North Queensland, specifically in Indigenous and remote populations. We retrospectively examined all patients who underwent an EMLC at Cairns Hospital between 2016 and 2021. Over the study period, 634 EMLCs were undertaken. The average annual rate of 56 cases per 100 000 was considerably lower than national estimates. However, rates of EMLC were significantly higher in remote communities and Indigenous patients compared with the remaining cohort. Patients from remote communities were more likely to have pre-existing gallstone disease but were less likely to have been seen in a surgical outpatient clinic prior to admission. Despite this, surgical outcomes for EMLC were comparable to national and international standards. This study highlights the challenges in surgical healthcare provision for gallstone disease in a regional centre. The requirement for EMLC disproportionately effects geographically isolated communities and Australian Indigenous people. Addressing the healthcare barriers to management of GD in regional Australia should be a priority.

Influencing physician distribution through education: a qualitative study on retention in Japan’s rural hospitals

BackgroundAddressing the shortage of healthcare professionals in rural Japan poses significant challenges. At Sanmu Medical Center, incorporating resident physicians into a general medicine training program has proved effective in retaining them as supervising physicians. This study aims to identify the key factors contributing to the success of such programs.MethodsWe used a qualitative research design to comprehensively understand the factors contributing to physician retention in regional community hospitals in areas with physician shortages. Interviews were conducted with four experienced physicians, including the center director, who participated in the general or family medicine training programs at Sanmu Medical Center. Using a semi-structured questionnaire, we explored the factors influencing physician retention in community-based hospitals experiencing shortages. Two physicians specializing in community medicine conducted a content analysis under the supervision of three experts in community-oriented medical education and qualitative research. This approach helped compare retention factors perceived by physicians and the center director.ResultsContent analysis revealed 10 categories and 47 subcategories. The analysis revealed that “Educational activity” and “Supervising physicians and guidance system” are crucial for physician retention in rural hospitals in Japan. The study highlighted key educational factors contributing to retention: engagement in educational activities led to personal and professional growth, creating a rewarding experience for the physicians. Furthermore, a structured supervising physician system provided essential guidance and mentorship, improving the educational environment. Diverse learning opportunities and protected learning times were identified as critical for fostering a sustainable commitment among physicians to work in rural settings. These findings contribute to existing literature by detailing how structured educational activities and mentorship programs in rural hospital settings can significantly impact physician retention.ConclusionsCommunity-based medical education programs that focus on diverse clinical settings, mentorship, and a supportive work environment can enhance physician retention in rural areas. By fostering such educational and professional environments, healthcare institutions can address physician maldistribution and improve care quality in underserved communities. Our study offers practical insights that can be replicated or adapted by other rural hospitals facing similar challenges. It offers targeted strategies to address the unique challenges faced by female physicians in rural healthcare settings.

Improve time to anti-coagulation reversal for hemorrhagic strokes

BackgroundOral anticoagulation (OAC) is a risk factor for intracerebral hemorrhage (ICH) which is an important source of disability and mortality. OAC-associated ICH (OAC-ICH) patients have worse outcomes as compared to ICH patients not on OAC, likely because of the associated larger stroke volumes, higher propensity to intraventricular hemorrhage, and a higher risk of rebleeding. Although current guidelines recommend that OAC should be reversed quickly, many health care systems have not developed a process for optimizing that aspect of care. MethodsThrough the IMPROVE Stroke Care Consortium, a group of nine Hub hospitals and their 57 regional community hospitals, a systems of care improvement project was implemented. Performance reviews identified best practices which were disseminated throughout all centers. We compared the median door-to-reversal (DTR) time before and after an institutional campaign to speed the process with a target time of 60 min. ResultsOver two years of the study, there were 6,699 ischemic strokes, 152 subarachnoid hemorrhages, and 889 intracerebral hemorrhages. During that time, 73 ICH patients received reversal agents emergently. The overall baseline median DTR time was 123 min (IQR 99, 361 minutes). By the end of the program, the median DTR time had trended down to 84 min (IQR 58.5, 151 min) which is a 31.7 % reduction of DTR from baseline, though times remained somewhat variable (p=0.08). ConclusionsAn integrated stroke systems of care approach was associated with a reduction in DTR times for patients presenting with acute ICH and concurrent use of anticoagulants despite lack of definitive guidelines around targets for OAC reversal times or operational guidance on protocols and agents.

Distinct bacterial and eukaryotic communities reflect the specificity of different coral reefs in the South China Sea

The microbial composition of surrounding waters is crucial for the health of coral reefs and holds significant value for understanding the complexity and environmental adaptability of coral reef ecosystems. This study reveals the spatial heterogeneity and diversity characteristics of bacterial and eukaryotic communities in different coral reef regions of the South China Sea. Chao and Shannon indices showed significant differences (p < 0.05) in diversity of bacterial and eukaryotic communities across different coral reefs. PCoA (principal coordinate analysis) indicates significant differences in community composition among regions, highlighting the crucial role of coral reef environmental heterogeneity on microbial community. NST (normalized stochasticity ratio) analysis indicates that community assembly in coral reef areas is more influenced by ecological stochastic processes. Major bacterial groups include Proteobacteria, Cyanobacteria, and Bacteroidota, while dominant eukaryotic groups include Dinophyceae, Apicomplexa, Bacillariophyta, Florideophyceae, Mamiellophyceae, Syndiniales, Prasino-Clade-VII, and Ascomycota, each showing significant abundance differences across coral reef regions (p < 0.05). High abundance of Rhodobacterales and Flavobacteriales are detected in all coral reef waters. Correlation analysis indicates that temperature, pH, and salinity are important factors affecting the bacterial and eukaryotic communities. This study reveals the spatial heterogeneity of microbial communities in coral reef regions of South China Sea and underscores the significant impact of marine environmental heterogeneity on community structure.