Non-metropolitan Locations Research Articles

Association between rural exposure/experience and practice location 10 years postgraduation, stratified by specialty: evidence from a cohort study of graduates from nine Australian universities

ObjectiveThis study aims to determine the associations between specialty type and practice location at postgraduate year 10 (PGY10), matched with PGY5 and PGY8 work locations, and earlier rural exposure/experience.Design and...

Are recent health, welfare and care graduates part of a rural and remote workforce solution? Evidence from Tasmania, Australia

BackgroundStrong growth in graduate supply from health, welfare and care courses across Australia may bode well for easing rural workforce shortages. However, little is known about the employment opportunities available for recent graduates in non-metropolitan areas. This study aimed to quantify and describe advertised job vacancies for health, welfare and care professions in Tasmania, a largely rural and geographically isolated island state of Australia. Further, it aimed to examine those job vacancies specifying that recent graduates were suitable to apply.MethodsJob advertisements for health, welfare and care professionals were collected weekly throughout 2018 from six online job vacancy websites. Data were extracted on 25 variables pertaining to type of profession, number of positions, location, and graduate suitability. Location of positions were recoded into a Modified Monash Model (MM) category, the Australian geographic standard used to classify rurality. Positions advertised in MM2 areas were considered regional and MM3-7 areas rural to very remote. Data were analysed using descriptive and inferential statistics.ResultsOver the twelve-month period, 3967 advertisements were identified, recruiting for more than 4700 positions across 49 different health, welfare and care professions in Tasmania. Most vacancies were in the non-government sector (58.5%) and located in regional areas (71.7%) of the state. Professions most frequently advertised were registered nurse (24.4%) and welfare worker (11.4%). Eleven professions, including physiotherapist and occupational therapist, recorded a disproportionate number of advertisements relative to workforce size, suggesting discipline specific workforce shortages. Only 4.6% of collected advertisements specified that a recent graduate would be suitable to apply. Of these, most were for the non-government sector (70.1%) and located in regional areas (73.4%). The professions of physiotherapist (26.6%) and occupational therapist (11.4%) were most frequently represented in advertised graduate suitable positions.ConclusionsDespite a range of advertised employment opportunities for health, welfare and care professionals across Tasmania, few specified vacancies as suitable for recent graduates and most were located in regional areas of the state. Health, welfare and care services in non-metropolitan locations may need to develop more employment opportunities for recent graduates and explicitly advertise these to job-seeking graduates to help grow and sustain the rural and remote health workforce into the future.

The rise (in the fall) of Cochin: Provincializing metropolitan spatiality in Salman Rushdie’s The Moor’s Last Sigh

ABSTRACT Indian fiction and critical engagements with it have a metropolitan bias. The preference for representations of big cities such as Mumbai in fiction means that non-metropolitan (“provincial”) spaces in India face neglect, literary and otherwise. This article argues for provincializing Indian fiction by exploring non-metropolitan locations as imagined in works of fiction to unpack alternative spatialities. The example offered is Salman Rushdie’s The Moor’s Last Sigh. In most readings of the novel, Bombay (along with Moorish Spain) is highlighted as a metropolitan model for India. Cochin does not figure in these readings, passed over as if just a random background or setting for the characters to be launched into Mumbai. This article addresses Cochin’s marginalization through investigating the way the island city offers a provincial, alternative, non-metropolitan theorization of spatialities in Indian fiction. The larger objective is to make space for similarly marginalized non-European locales in the discourse of cosmopolitanism.

Non-metropolitan settlement and integration outcomes of humanitarian migrants in Australia: Combining spatial, multidimensional and longitudinal perspectives

Dispersal policies that place humanitarian migrants outside non-metropolitan locations are increasingly common, but evidence of their impact on integration outcomes is mixed. By combining spatial, longitudinal and multidimensional perspectives into a unified analytical framework, this study examines the relationships between non-metropolitan settlement and a diverse range of objective and subjective integration outcomes. To accomplish this, we leverage five waves of panel data from Building a New Life in Australia: The Longitudinal Study of Humanitarian Migrants (2013–2018). Our results indicate that non-metropolitan settlement is related to better access to employment and stable housing and a lower likelihood of being Not in Employment, Education, and Training (NEET), but a higher risk of experiencing discrimination. Over time, humanitarian migrants’ income and English-language proficiency trajectories are flatter in non-metropolitan than metropolitan regions, pointing to potential long-term challenges of rural settlement. Encouragingly, we find no statistically significant differences in physical and mental health, sense of belonging and life satisfaction. While the integration outcomes of humanitarian migrants in non-metropolitan Australia are mixed, their subjective well-being is not negatively impacted. This suggests that, despite challenges, there are opportunities for humanitarian-migrant settlement outside of major cities.

K-pop fandom as ‘sub-visible culture’: Digital work and enjoyment in the precarious present

In this article, I attempt to understand the global K-pop fandom among young women, from the perspective of non-metropolitan locations like the state of Kerala in southern India. I examine the ‘sub-visible’ nature of K-pop fandom and situate it in relation to existing discourses surrounding visibility in youth subcultures and fan cultures, both in India and the West. I argue that the key to understanding this fandom is in the cultural process of feminization that it produces – a feminization of male K-pop idols through the ‘free labour’ (to use a concept by Tiziana Terranova) that K-pop fans engage in on digital spaces – labour that has the structure of work and the function of enjoyment and enthusiasm. Drawing on existing discourses on the ‘feminine’, I analyse the peculiar mode of feminization in K-pop fandom as a response to the precarity and vulnerability experienced by young people in the contemporary world.

Clinical outcomes and predictors of a gap in direct-acting oral anticoagulant therapy in the elderly: A time-varying analysis of a nationwide cohort study

IntroductionAs direct-acting oral anticoagulants (DOACs) have short half-lives of around 12 h, even a short gap in DOAC therapy may diminish anticoagulation effects, increasing risks of adverse clinical outcomes. We aimed to evaluate clinical consequences of a gap in DOAC therapy with atrial fibrillation (AF) and to identify its potential predictors. Materials and methodsIn this retrospective cohort study, we included DOAC users aged over 65 years with AF from the 2018 Korean nationwide claims database. We defined a gap in DOAC therapy as no claim for a DOAC one or more days after the due date of a refill prescription. We used a time-varying-analysis method. The primary outcome was a composite of death and thrombotic events including ischemic stroke/transient ischemic attack or systemic embolism. Potential predictors of a gap included sociodemographic and clinical factors. Results and conclusionsAmong 11,042 DOAC users, 4857 (44.0 %) patients had at least one gap. Standard national health insurance, non-metropolitan locations of medical institutions, history of liver disease, chronic obstructive pulmonary disease, cancer, or dementia, and use of diuretics or non-oral agents were associated with increased risks of a gap. In contrast, history of hypertension, ischemic heart disease, or dyslipidemia were associated with a decreased risk of a gap. A short gap in DOAC therapy was significantly associated with a higher risk of the primary outcome compared to no gap (hazard ratio 4.04, 95 % confidence interval 2.95–5.52). The predictors could be utilized to identify at-risk patients to provide additional support to prevent a gap.

The importance of ticket price in public transport in nonmetropolitan rural areas in Poland

The need to move is an inherent feature of every human life. Public transport should be one of the means of transport available to every human being. A fare-free public transport (FFPT) policy is under constant debate. Research among residents in rural areas provides an opportunity to discover whether FFPT is a key element of socially equitable development and understand the role of price, which can, at the same time, reduce car dependency. This research aims to understand the role of public transport fares in the travel decisions of people living in non-metropolitan rural areas in Poland. The primary data source used in this study is a survey conducted with the residents of 12 peripheral communes. This study revealed that price might not be as crucial in mobility strategies regarding free or paid public transport in non-metropolitan locations. This is mainly due to the poor quality of public transport.

Perceptions of research capacity in public health organisations: comparison of NSW metropolitan and non-metropolitan Local Health Districts.

Objective The aims of this study were to explore and compare the perceptions of research capacity and culture (RCC) in metropolitan and non-metropolitan New South Wales (NSW) Local Health Districts (LHDs). Methods The Research Capacity and Culture Tool was delivered online to clinicians and health managers. A 10-point Likert scale of success or skill at organisational, team and individual level of research capacity was used. An independent t -test assessed differences in domain means between non-metropolitan and metropolitan LHDs. Results A total of 1243 participants responded. Responses to the survey indicated the perception of individual's research skills were greater than the perception of RCC at both the team and organisational levels. Participants from metropolitan locations had significantly higher mean scores across all three domains compared with non-metropolitan locations (P Conclusion Results indicated the perception of individual's research skills were greater than the team and organisational levels. Participants from metropolitan locations had significantly higher perceptions of RCC across all three domains compared with non-metropolitan locations. This was the largest study to date in Australia investigating RCC in NSW LHDs, and the first study to explore multiple professions across multiple organisations while comparing metropolitan and non-metropolitan settings. This research may inform targeted strategies for building research capacity in NSW LHDs.

Population-based utility scores for HPV infection and oropharyngeal squamous cell carcinoma among Indigenous Australians

BackgroundOropharyngeal squamous cell carcinoma (OPSCC) is associated with high mortality. Human papillomavirus (HPV) infection is a significant risk factor for OPSCC. Utilities are fundamental values representing the strength of individuals’ preferences for specific health-related outcomes. Our study aim was to work in partnership with Indigenous communities in South Australia to develop, pilot test and estimate utility scores for health states related to HPV, HPV vaccination, precursor OPSCC and its treatment, and early stage OPSCC among Indigenous Australians.MethodsDevelopment and pilot testing of hypothetical HPV and OPSCC health states, specifically through the lens of being Indigenous Australian, was conducted with an Indigenous Reference Group. Six health states were decided upon, with utility scores calculated using a two-stage standard gamble approach among a large convenience sample of Indigenous Australians aged 18+ years residing in South Australia. The rank, percentage of perfect health and utility score of each health state was summarised using means, and medians at 12 months and lifetime duration. Potential differences by age, sex and residential location were assessed using the Wilcox Rank Sum test.ResultsData from 1011 participants was obtained. The mean utility scores decreased with increasing severity of health states, ranging from 0.91–0.92 in ‘screened, cytology normal, HPV vaccination’ and ‘screened, HPV positive, endoscopy normal’, to less than 0.90 (ranging from 0.87–0.88) in lower grade conditions (oral warts and oral intraepithelial neoplasia) and less than 0.80 (ranging from 0.75–0.79) in ‘early stage throat cancer’. Higher utility scores were observed for ‘screened, cytology normal and HPV vaccination’ among younger participants (18–40 years), for ‘early stage invasive throat cancer’ among females, and for ‘oral intraepithelial neoplasia’ and ‘early stage invasive throat cancer’ among metropolitan-dwelling participants.ConclusionAmong a large sample of Indigenous Australians, utility for oral HPV infection and OPSCC decreased with severity of health states. Older participants, as well as males and those residing in non-metropolitan locations, had decreased utility for high-grade cytology and early invasive cancer states. Our findings are an important contribution to cost-utility and disease prevention strategies that seek to inform policies around reducing HPV infection and OPSCC among all Australians.

Resettlement Stressors for Women of Refugee Background Resettled in Regional Australia.

Women of Refugee Background (WoRB) have been repeatedly identified as an extremely vulnerable population. Within an Australian context, WoRB are increasingly resettled to non-metropolitan locations, otherwise known as regional locations. Despite this, to date, no research has focused on the lived experience and challenges associated with the resettlement of WoRB to regional contexts. This study aimed to address this gap in the literature by investigating the resettlement experience of WoRB resettled in Tasmania—a state in Australia classified as a rural and regional location. Qualitative interviews were conducted with a group of 21 individuals (nine WoRB and 12 service providers). Thematic analysis identified four overarching themes—Communication Barriers and Lack of Fluency in English, Challenges Accessing Everyday Basic Needs, Loss of Connection to Culture of Origin and Inability to Access Mainstream Mental Health Services for Help. Participants also highlighted a number of unique gender-related vulnerabilities experienced during resettlement, which were exacerbated in regional locations due to health services being overstretched and under-resourced. Results of the current study are discussed in regard to policy and practical implications, taking into consideration the unique vulnerabilities experienced by WoRB, which, to date, are often overlooked.

Differences in Clinical Presentation and Outcomes between Metropolitan and Rural Myeloma Patients

Introduction: Australia's largest state, Western Australia (WA), comprises a land area of more than 2.5 million square kilometres, an area than larger than that of Texas and Alaska in the United States combined, with a population of more than 2.6 million. Whilst a large proportion of Western Australians live in the capital city Perth, approximately 20% are dispersed across the state in regional and remote areas. The diagnosis and treatment of myeloma require specialist Haematologist management and frequent follow-up. Access to Haematology specialist services and treatment in WA is centred in metropolitan Perth, with outreach services visiting regional and remote areas limited in location and frequency. Some patients are required to travel long distances or relocate to access treatment. The aim of our study was to assess difference in clinical presentation, treatment and outcomes of myeloma patients living in regional or remote Western Australia compared to metropolitan Perth. Methods: A retrospective chart review of new cases of symptomatic multiple myeloma diagnosed between January 2008 and December 2019 and referred to Royal Perth Hospital and Fiona Stanley Hospital, two tertiary metropolitan hospitals was conducted. Data was obtained regarding patient demographics, disease characteristics, treatment, response and survival outcomes, through review of patient paper and electronic medical records. Patients were grouped into those living inside or outside the Perth metropolitan area (metro or non-metro) according to area codes obtained from the WA government data suite. Results: Two hundred and seventy-five cases were identified, 218 (79%) metro and 57 (21%) non-metro. Baseline characteristics for the two groups are listed in Table 1. The median age at diagnosis was 68.4 years (range 30-91.5 years) and 47% were female, with no significant difference between the groups. There were a higher number of patients with lytic bone disease at diagnosis in the non-metro cohort (75.4% non-metro vs 60.2% metro, p=0.03) as well as a higher proportion of patients with international staging system (ISS) stage II or III disease (77.8% non-metro vs 55.8% metro, p=0.005). Sixty three percent of patients overall received first line bortezomib based therapy and 27% first line imid based therapy, with no significant difference by location. Overall 41% of patients underwent autologous stem cell transplantation, 70% of those ≤70 years of age, with no significant difference between the groups (33.3% non-metro vs 42.5% metro, p=0.21). The median overall survival (OS) was 47 months for the entire cohort. Survival was lower in the non-metro cohort, although this did not reach statistical significance (median OS 52 months for metro vs 40 months for non-metro, p=0.05) Figure 1. Progression free survival (PFS) was similar between the two groups (median PFS 23 months metro vs 12 months non-metro, p=0.12) Figure 2. Early mortality at 6 and 12 months was higher in the non-metro cohort (Six-month mortality was 21.1% non-metro vs 8.3% metro, p=0.01. Twelve-month mortality was 28.1% non-metro vs 13.4% metro, p=0.01) Figure 3. There was a trend in cause of early mortality due to infection being higher in the metro cohort, and cause of early mortality due to renal failure being higher in the non-metro cohort, Table 1. Conclusions: In our cohort, patients living in non-metropolitan locations were more likely to present with higher ISS stage and lytic lesions at diagnosis. Rates of early mortality were significantly higher in the non-metropolitan cohort. There was a trend towards shorter overall survival although this did not meet statistical significance. These differences may represent delays in clinical presentation and diagnostic workup and highlight the need for optimisation of follow up of patients in non-metropolitan areas particularly during the early time period post diagnosis. Periods of resource constraint and travel restrictions as is faced currently may accentuate these disparities. In addition, the nature of myeloma therapy is evolving with addition of treatments requiring expertise to deliver, such as monoclonal antibodies and chimeric antigen receptor T cells. As these therapies become commercial further studies are needed to assess adequacy of access for patients from non-metropolitan centres. Disclosures Leahy: Pfizer: Membership on an entity's Board of Directors or advisory committees. Sidiqi:Celgene: Honoraria, Other: Travel grant; Amgen: Honoraria; Janssen: Honoraria.

"To be there for my family" and "Keep my independence": Metropolitan and Non-Metropolitan Cancer Survivors' Health Behaviour Motives.

Cancer survivors are at risk of comorbidities and mortality, and those living outside of metropolitan areas are particularly susceptible given poorer socioeconomic, health and support resources. As engagement in health behaviours is affected by participants' autonomous motives, investigation of the motives of cancer survivors in metropolitan and non-metropolitan areas could elucidate the values and reasons for practising health behaviours, allowing programs to be tailored to these motives. Metropolitan (n = 103) and non-metropolitan (n = 80) Australian cancer survivors completed a survey item by describing their motives for physical activity and healthy diet change. Inductive thematic analysis of responses was performed to establish themes across health behaviour motives. Analyses revealed four themes: to be able to, longevity, psychological health and appearance. Survivors primarily referred to being able to enjoy family, leisure activities, travel and staying independent, with these motives often linked to longevity. Motives were similar across locations; however, those in non-metropolitan locations reported continuation of work and pain relief more frequently. Female survivors more often reported weight loss. A predominant motive for health behaviour change in cancer survivors across geographical location was the ability to enjoy family and engage in leisure and work activities. Programs aiming to promote health behaviours in cancer survivors might consider framing interventions accordingly by emphasizing benefits of longevity and maintaining independence.

Prevalence of Oral Human Papillomavirus Infection Among Australian Indigenous Adults

Human papillomavirus (HPV) infection is associated with oropharyngeal squamous cell carcinoma. International estimates suggest overall oral HPV prevalence is 7.5%, with prevalence of oral HPV types 16 and 18 being 1.6%; prior Australian estimates suggest oral HPV prevalence is 2.3%, with HPV-16 and HPV-18 being 1.3%. To estimate the prevalence of oral HPV infection among Indigenous Australians and to report the prevalence of factors associated with high-risk HPV types (ie, HPV-16 and HPV-18) and HPV types linked with Heck disease (ie, HPV-13 and HPV-32). This cross-sectional study analyzed HPV screening results from saliva samples collected from 1011 Indigenous Australians between February 2018 and January 2019. Data were analyzed from May 2018 to May 2019. Recruitment occurred through Aboriginal Community Controlled Health Organisations in South Australia. Eligibility included identifying as Indigenous, residing in South Australia, and being aged 18 years or older. Saliva samples were collected, with microbial DNA for genotyping extracted. Sociodemographic parameters, health-related behaviors, and sexual history data were collected. Analyses were stratified by sex as well as by HPV types 13 and 32 (Heck disease) and 16 and 18 (high risk of oropharyngeal squamous cell carcinoma). Multivariable analyses were conducted to obtain adjusted odds ratios (ORs). Data were obtained for 910 participants (median [interquartile range] age, 37 [27-51] years); 595 participants (65%) were female and 572 (63%) resided in nonmetropolitan locations. In all, 321 saliva samples (35.3%; 95% CI, 32.2%-38.4%) were positive for oral HPV (106 [33.7%] men; 215 [36.1%] women). The highest prevalence was found for HPV types 13 and 32 (207 [22.7%] total; 60 [19.0%] men; 147 [24.7%] women) followed by HPV types 16 and 18 (30 [3.3%] total; 9 [2.9%] men; 21 [3.5%] women). After multivariable analysis, risk factors associated with HPV types 13 and 32 included nonmetropolitan residential status (OR, 2.06; 95% CI, 1.10-3.88) and not having had a tonsillectomy (OR, 2.74; 95% CI, 1.05-7.16). Among women, having obtained a high school education or less was associated with lower odds of HPV-16 and HPV-18 infection (OR, 0.16; 95% CI, 0.03-0.97). Prevalence of oral HPV infection in a large sample of Indigenous Australians was high, with one-third testing positive. The most prevalent HPV types were those associated with Heck disease. The prevalence of HPV types associated with oropharyngeal squamous cell carcinoma exceeded both Australian and international population-level estimates.

Towards an integrated theoretical framework for understanding women, work and violence in non-metropolitan contexts

Abstract This paper proposes an integrated theoretical framework for understanding women, work and violence in non-metropolitan contexts. Despite the fact that the relationship between domestic and family violence (DFV) and the workplace is a growing focus of academic research, there remain certain lacunae within the literature. In particular, research that examines DFV and work in tandem is incredibly urban-centric, but also quite descriptive and a-theoretical, as well as quantitative in its methodological approaches. The lack of non-metropolitan research at the nexus of DFV and work is puzzling, given that established scholarship tells us firstly that DFV is more potent and complicated outside of big cities, and secondly that work is also harder to obtain and more complicated. In light of these issues, the current paper serves three distinct functions. Firstly, it operates as a call for the generation of new research that addresses limitations within the academic conversation. Secondly, it argues for the significance of research that illuminates the relationship between work and DFV in non-metropolitan locations; not only to address the existing knowledge gap, but also because the findings generated in these more ‘extreme’ scenarios may assist us in effectively addressing the DFV–work nexus more broadly. And thirdly, to facilitate the production of rigorous and holistic knowledge at the intersection of work, DFV and non-metropolitan experience, the paper proposes an integrated theoretical framework for understanding women, work and violence in non-metropolitan contexts. Overall, it argues that such an integrated framework would necessarily need to account for the contextual factors of space and place, as well as feminist theory on work, and existing knowledge on both violence against women and the complexities of work in non-metropolitan contexts.

Effectiveness of strategies for reducing risky alcohol consumption among youth living in rural or remote areas: a systematic review protocol.

The aim of this review is to evaluate the effectiveness of strategies for reducing risky alcohol consumption among youth living in rural and remote areas. Youth living in rural and remote areas are more likely to drink alcohol and are at higher risk of experiencing alcohol-related harm than youth living in urban locations. However, a review has not yet been conducted evaluating the effectiveness of strategies for reducing young people's risky alcohol consumption in rural and remote locations. This systematic review will consider papers that include youth (aged 12 to 24 years) who are identified as living in rural, remote, regional, non-urban or non-metropolitan locations. Any intervention or strategy with the purpose of reducing or preventing alcohol consumption or alcohol-related harms among this population will be considered. The primary outcome is frequency of short-term risky alcohol consumption, as measured by self-reported incidents of drinking five or more standard drinks. Secondary outcomes will also be included. Sources of published studies, unpublished studies and gray literature will be searched. Only studies in English published from 1999 will be included. Titles and abstracts of all search results will be screened. The full text of potentially relevant studies will then be assessed in detail. Studies will be stratified by methodological quality. The data extracted will include specific details about the populations, study methods, interventions and outcomes. Studies will be pooled in statistical meta-analysis, where possible, and where statistical pooling is not possible, the findings will be presented in narrative form.

Follow-up of Intervention to Prevent Dental Caries Among Indigenous Children in Australia

For an intervention delivered in early childhood to have meaningful translational effect, long-term follow-up is necessary, especially among underserved indigenous children among whom preventable dental disease is common. To test the long-term effectiveness of an early-childhood dental intervention through a follow-up at age 5 years among Aboriginal children in Australia. This secondary analysis of a randomized clinical trial followed up on participants of the Baby Teeth Talk Study, a 2-group parallel, outcome assessor-blinded, randomized clinical trial conducted among Aboriginal children in South Australia, Australia. Participants included 448 mother or caregiver-child dyads who were enrolled in the Baby Teeth Talk trial between February 2010 and May 2011 and were randomized in the present trial to the immediate intervention group or the delayed intervention group. Intention-to-treat principles were used for all data analyses to estimate the effect of the intervention on dental caries experience. Data analysis was performed from April 10 to May 27, 2019. The intervention comprised 4 services to participants: (1) dental care to mothers during pregnancy, (2) application of fluoride varnish to children's teeth, (3) anticipatory guidance in the form of oral health educational packages, and (4) motivational interviewing for pregnant mothers and children at ages 6, 12, and 18 months in the immediate intervention group and at ages 24, 30, and 36 months in the delayed intervention group. The primary outcome was the mean number, in the primary dentition, of decayed, missing, or filled teeth (dmft) at age 5 years. Individual components of the dmft index were examined, as was the prevalence of dmft greater than 0. Of the 449 Aboriginal mothers and children recruited, 223 (49.7%) were randomized to the immediate intervention group and 225 (50.1%) to the delayed intervention group. The mean dmft at age 5 years was 2.10 (95% CI, 2.04 to 2.16) for children in the immediate intervention group and 2.91 (95% CI, 2.83 to 3.00) for children in the delayed intervention group (adjusted mean difference, -1.02; 95% CI, -1.81 to -0.22). When considering children in nonmetropolitan locations, the differences were stark; the mean dmft was 2.46 (95% CI, 2.38-2.54) for children in the immediate intervention group and 3.65 (95% CI, 3.53 to 3.78) for children in the delayed intervention group, with an adjusted mean difference of -1.52 (95% CI, -2.61 to -0.43). Most of this difference was accounted for by missing teeth, with the mean number of missing teeth of children in the immediate intervention group living in nonmetropolitan locations being 0.29 (95% CI, 0.27 to 0.31) compared with 1.02 (95% CI, 0.96 to 1.07) for their counterparts in the delayed intervention group. A 3-fold difference was observed in the percentage of missing teeth greater than 0 between children in the immediate intervention group and those in the delayed intervention group (10.8 [95% CI, 10.2 to 11.4] vs 31.0 [95% CI, 30.1 to 31.8]). This trial found that a multifaceted initiative to reduce early-childhood caries continued to be efficacious in participating indigenous children aged 5 years, especially those residing in nonmetropolitan locations and with teeth missing because of dental disease. anzctr.org.au Identifier: ACTRN12611000111976.

General practitioners' perceptions of best practice care at the end of life: a qualitative study.

BackgroundGPs can play a central role in palliative care delivery. However, little is known about their views on what constitutes best practice care at the end of life.AimTo explore, in a sample of Australian GPs, their perceptions of best practice palliative care and their ideal role in its delivery.Design & settingA qualitative interview study of 25 GPs practising in metropolitan and non-metropolitan locations in New South Wales, Australia.MethodSemi-structured telephone interviews were conducted. Data were analysed using qualitative content analysis.ResultsParticipants had a mean age of 51 years, and had practised between 3 and 38 years (mean 19 years). Best practice palliative care was perceived to be proactive and responsive to a wide range of patient and family needs. Many participants indicated a need for relational continuity, which involves GPs establishing a care pathway from diagnosis to palliation, coordinating care across the pathway, and collaborating with other healthcare providers. A number of participants perceived palliative care as a natural extension of primary care and indicated that best practice palliative care mainly requires experiential knowledge and good communication skills, rather than specialised medical knowledge. Participants listed a number of communication strategies to offer patients and their families choice and ongoing negotiation about the recommended treatments.ConclusionThis study provides novel in-depth insights into GPs’ perceptions of best practice palliative care. Future research should further investigate the identified features of care, and whether they can maximise the outcomes of patients and their families.

Using Google Street View to examine associations between built environment characteristics and U.S. health outcomes.

Neighborhood attributes have been shown to influence health, but advances in neighborhood research has been constrained by the lack of neighborhood data for many geographical areas and few neighborhood studies examine features of nonmetropolitan locations. We leveraged a massive source of Google Street View (GSV) images and computer vision to automatically characterize national neighborhood built environments. Using road network data and Google Street View API, from December 15, 2017-May 14, 2018 we retrieved over 16 million GSV images of street intersections across the United States. Computer vision was applied to label each image. We implemented regression models to estimate associations between built environments and county health outcomes, controlling for county-level demographics, economics, and population density. At the county level, greater presence of highways was related to lower chronic diseases and premature mortality. Areas characterized by street view images as ‘rural’ (having limited infrastructure) had higher obesity, diabetes, fair/poor self-rated health, premature mortality, physical distress, physical inactivity and teen birth rates but lower rates of excessive drinking. Analyses at the census tract level for 500 cities revealed similar adverse associations as was seen at the county level for neighborhood indicators of less urban development. Possible mechanisms include the greater abundance of services and facilities found in more developed areas with roads, enabling access to places and resources for promoting health. GSV images represents an underutilized resource for building national data on neighborhoods and examining the influence of built environments on community health outcomes across the United States.

Participation and achievement in technology education: the impact of school location and socioeconomic status on senior secondary technology studies

The rise of STEM education, and the twenty first century skills movement, and the increasingly technologically driven nature of our world, has pushed technology education to the fore in recent times. Technology education faces a range of equity issues and there has been a particular focus on gender issues. This study considers two less explored equity issues: school location and socioeconomic status (SES). Using data routinely collected in Victoria, Australia by the Department of Education and Training, senior school technology subject provision, enrolment and achievement patterns were examined by location and SES. Though little difference was found in the academic performance of students from metropolitan or non-metropolitan locations in technology subjects, there were notable differences in participation. Non-metropolitan students were more likely to enrol in design technology and engineering subjects than students attending metropolitan schools. However, while nonmetropolitan student’s enrolled in the digital technology subjects at a similar rate to metropolitan students, nonmetropolitan students were less likely to have access to these subjects. Students from lower SES schools tended to perform more poorly in technology subjects than students from high SES backgrounds. Further, the lowest SES schools were the least likely to offer technology subjects. This skewed access to, and performance in, technology subjects by SES and location, highlights significant equity issues in technology education that have attracted only limited attention in the literature.

Possibilities of transformation: Women's Studies in Tier II cities in Tamil Nadu, India

ABSTRACTExisting scholarship on knowledge mobilities tends to focus on the largest metropolitan centres as loci of education and employment and as desirable destinations for knowledge migrants. This paper draws attention to the ways in which the spaces of learning in non-metropolitan locations intersect with circulations of disciplinary knowledge and aspiration to generate opportunities for social and spatial mobility. It is premised on the idea that the experiences and situated knowledge of those engaged in women’s studies in Tier II cities are apposite starting points for a critical reflection on non-metropolitan locations as brokers of student mobilities. Focusing on two government-funded Women’s Studies Centres in universities in the state of Tamil Nadu, India, I explore the transformations catalysed by these mobilities and discuss the politics of the personal – by rethinking the notions of home and alienation, and reflecting on the re-imagination of futures that Women's Studies (WS) has permitted.