Prevention of water borne diseases in the tsunami affected Thotagamuwa-Hikkaduwa area of southern Sri Lanka

Thotagamuwa, Hikkaduwa in the southern coast of Sri Lanka was devastated by the Indian Ocean tsunami of December 26, 2004 leaving the affected population with poor sanitation conditions and at risk to water borne diseases and vector borne diseases. The Thotagamuwa Tsunami Relief Environmental Health Program(THOTEN) is serving a community of four thousand households towards improving the quality of drinking water through chlorination and providing for hand washing with soap-the Safe Water System(SWS).The first monitoring and evaluation survey conducted after three months of interventions are revealing that the population is beginning to use the SWS introduced under the THOTEN program. It also revealed that numbers have increased in awareness of appropriate use of soap to wash hands. The paper describes the overall approach and methodology used and the preliminary results

Epidemiology of melanoma in rural southern Queensland

Objective: The objective of this study is to define the epidemiology of melanoma in rural communities in southern Queensland. Design: The design used was a 6‐year clinical record audit of melanoma cases identified by billing records and electronic clinical records, confirmed and typed with histology. Setting and Participants: This study was based on seven agricultural communities on the Darling Downs with patients presenting to local primary care clinics. Main outcome measures: Outcomes measured were confirmed type, depth and anatomic distribution of melanoma identified at these practices during the study period. Results: The results from 317 cases of melanoma found anatomic distribution was significantly different (χ2 = 9.6, P < 0.05) to that reported previously from the Queensland Cancer Registry. A high proportion (87%) of melanoma diagnosed by these general practitioners were 1 mm or less when treated. Conclusions: Conclusions drawn from these findings are that melanoma risk is not so much lesser in rural, inland communities compared with coastal and metropolitan regions, but different. Differences may relate to comprehensive data capture available in rural community studies and to different sun exposure and protection behaviours. The higher proportion of melanoma identified at early stages suggests rural primary care is an effective method of secondary prevention

Self-efficacy and planning strategies can improve physical activity levels in women with a recent history of gestational diabetes mellitus

Introduction: Regular physical activity can reduce the risk of developing diabetes in high risk populations including in women with gestational diabetes mellitus (GDM). This study applied the Health Action Process Approach (HAPA) to determine the motivational and volitional factors important in increasing physical activity among women with previous GDM. Methods: Women with GDM receiving obstetric care at a teaching hospital in Sri Lanka were invited to participate in a survey 6–36 months post-delivery. At baseline and 8 weeks later, 152 women completed postal and telephone surveys that collected socio-cognitive and physical activity data. The study hypotheses were tested using structural equation modelling. Results: The modified model fit the data well (CFI = .95, TLI = .94,RMSEA = .057) and explained 11% of the variance in behaviour. Action self-efficacy was the only important predictor of intention to be physically active. Intention as well as maintenance self-efficacy predicted planning, which, in turn, predicted physical activity. Planning mediated the effect of intention and self-efficacy (maintenance and recovery) on physical activity. Conclusion: This study has identified predictors of physical activity among women with previous GDM that can inform intervention studies. Interventions targeting this population need to include planning strategies and enhance self-efficacy

Chronic disease and health risk behaviors among rural agricultural workforce in Queensland

Introduction: Little is known of the lifestyle behaviors and prevalence of chronic disease in the Australian agricultural workforce. This study aimed to assess behavioral risk factors and the prevalence of chronic disease among attendees of agricultural events in rural Queensland. Methods: Data on lifestyle risk factors and prevalence of diabetes and cardiovascular diseases were collected from participants in four separate cross-sectional studies in rural southern Queensland. Anthropometric measures, blood pressure, serum cholesterol, and glucose levels of consenting participants were assessed by trained medical students under the supervision of rural clinicians. Data were analyzed using SPSS 22 statistical software package and t-tests and chisquare tests were used to compare differences between groups. Results: A total of 702 attendees participated; the majority were agricultural workers (n = 393). Greater psychological distress was reported among participants from these rural communities (42%) than in the Australian population (31%); however, levels of psychological distress was similar between agricultural workers and others in the sample. Fewer people in these agricultural communities reported smoking (10%), and they reported being more active (86%) than the average Australian, but a greater proportion reported high-risk alcohol consumption (53%) and were found to be hypertensive (31%). These findings were accentuated among agricultural workers. Conclusion: This method of investigation both raises awareness in the community and identifies health risks for further management in a group that has otherwise been poorly defined. Resident agricultural workers have different health risks and behaviors, though psychological distress appears to be borne across these communities

Sociocognitive determinants of lifestyle behaviours of Sri Lankan women with a recent history of gestational diabetes mellitus

Gestational Diabetes Mellitus (GDM) is a common complication of pregnancy that increases the future risk for type 2 diabetes. Lifestyle changes, comprising regular physical activity and healthy eating have been proven to reduce the risk of developing diabetes in high risk groups. This thesis sought to provide a better understanding of the theoretical and contextual factors that influence physical activity and dietary behaviour of Sri Lankan women with a history of GDM. In the first study, semi-structured interviews were conducted to explore women’s experiences in relation to lifestyle changes following a GDM pregnancy. Thirty women who had GDM 6-36 months previously and received obstetric care from the Gampaha Health Service District participated in the interviews. Excessive family demands, low perceived risk, perception of good health, and social norms were identified as barriers to lifestyle change. In the second study, postal and telephone follow-up surveys were conducted from November 2012 to March 2013 to collect information on sociocognitive measures affecting physical activity and diet based on the Health Action Process Approach (HAPA). Study participants were women diagnosed with GDM 6-36 months previously and attended the Colombo North Teaching Hospital for obstetric care. The research hypotheses were tested using structural equation modelling. The hypothesised models explained 11% and 14% of the variance in physical activity and dietary behaviour, respectively. Action self-efficacy was the most important predictor of behavioural intention. Outcome expectancies were important for dietary intention but not for physical activity. Of the post-intentional variables, action and coping planning were important for both physical activity and diet. Though volitional self-efficacy was not a direct predictor of behaviour, women with high self-efficacy were more likely to execute their behaviours through planning. Higher intentions did not directly predict behaviour but the intention-behaviour relationship was mediated by planning. Of the additional variables tested, spousal support was associated with intention formation for both behaviours of interest but was positively associated only with physical activity. This thesis makes a theoretical contribution in this understudied South Asian population in the use of sociocognitive models to develop behavioural interventions. The use of strategies to improve planning and volitional self-efficacy were identified to be helpful to close the intention-behaviour gap. In addition, the importance of spousal support in both the preliminary qualitative work and HAPA modelling may be used to inform future intervention studies among this group

Recruiting students to rural longitudinal integrated clerkships: a qualitative study of medical educationists’ experiences across continents

Abstract Introduction Many health systems struggle in the provision of a sustainable and an efficient rural health workforce. There is evidence to suggest that Longitudinal Integrated Clerkships (LIC) placing student learners in rural community settings have positively impacted the provision of rural health care services The recruitment and engagement of students in rural LIC have significant challenges. This study explored best practice methods of recruiting and supporting the transition of medical students into rural LIC. Methods The study took place during the 2021 Consortium of Longitudinal Integrated Clerkships Conference, a virtual event hosted by Stellenbosch University, South Africa. Participants consisted of delegates attending the Personally Arranged Learning Session (PeArLS) themed ‘Secrets to success’. The session was recorded with the participants’ consent and the recordings were transcribed verbatim. Data was uploaded to NVivo software and coded and analyzed using constant comparative analysis. Salient themes and patterns were identified. Results Thirteen attendees participated in the PeArLS representing a range of countries and institutions. Strategically marketing the LIC brand, improving the LIC program profile within institutions by bridging logistics, and the need to scaffold the transition to the rural LIC learning environment emerged as key themes for success. The attendees highlighted their experiences of using peer groups, early exposure to rural LIC sites, and student allocation strategies for promotion. Unique learning styles adopted in LIC models, student anxiety and the importance of fostering supportive relationships with stakeholders to support students in their transition to the LIC environment were discussed. Discussion This PeArLS highlighted successful systems and processes implemented in rural settings across different countries to recruit and manage the transition of medical students to rural LIC. The process proved to be a quick and efficient way to elicit rich information and may be of benefit to educationists seeking to establish similar programs or improve existing rural LIC

Analysis of agriculture-related life-threatening injuries presenting to emergency departments of rural generalist hospitals in Southern Queensland

Objective: Agricultural industries are among the most dangerous in Australia posing significant public health risks.This study analyses the nature and management of agriculture-related injuries presenting to EDs in selected hospitals in Southern Queensland. Methods: Data on agricultural injury presentations over a 6 month period was collected at four rural hospitals by a dedicated onsite hospital data coordinator. Additionally, in two of the participating hospitals all injury presentations over the same 6 month period were recorded. A pre-tested survey instrument, modified for rural settings and designed and developed to export the abstracted data using an iPad application was used as the survey tool. Results: The incidence of agriculture related injuries was 11% of all injuries, most were males (73%), averaging 40 years. On presentation, 66.5% (n = 234) were categorised as imminently or potentially life threatening with 44% of those patients presenting to hospital ED >3 h after the injury. Large animals were more commonly reported as involved in the aetiology of the presenting injury, particularly using horses and handling cattle. Conclusions: Agricultural injuries are a significant group of primary care presentations to rural hospitals and training and resourcing for rural hospitals should reflect this. A better understanding of common injury types can lead to efficient allocation of available resources in rural hospitals and potentially improve ED practices. The delay in presentation must be considered in response planning both by farmers and hospital EDs

Exploring recent trends (2014–21) in preferencing and accepting Queensland medical internships in rural hospitals

Abstract Background Medical internship is a key transition point in medical training from student to independent (junior) doctor. The national Regional Training Hubs (RTH) policy began across Australia in late 2017, which aims to build medical training pathways for junior doctors within a rural region and guide students, interns and trainees towards these. This study aims to explore preferencing and acceptance trends for rural medical internship positions in Queensland. Moreover, it focuses on internship preference and acceptance outcomes prior to and following the establishment of RTHs, and their association with key covariates such as rural training immersions offered by medical schools. Methods Data from all applicants to Queensland Health intern positions between 2014–2021 were available, notably their preference order and location of accepted internship position, classified as rural or metropolitan. Matched data from Queensland’s medical schools were added for rural training time and other key demographics. Analyses explored the statistical associations between these factors and preferencing or accepting rural internships, comparing pre-RTH and post-RTH cohorts. Results Domestic Queensland-trained graduates first preferencing rural intern positions increased significantly (pre-RTH 21.1% vs post-RTH 24.0%, p = 0.017), reinforced by a non-significant increase in rural acceptances (27.3% vs 29.7%, p = 0.070). Rural interns were more likely to have previously spent ≥ 11-weeks training in rural locations within medical school, be rurally based in the year applying for internship, or enrolled in the rural generalist pathway. Conclusions The introduction of the RTH was associated with a moderate increase of graduates both preferencing and accepting a rural internship, though a richer understanding of the dominant reasons for and against this remain less clear. An expansion of graduates who undertook longer periods of undergraduate rural training in the same period did not diminish the proportion choosing a rural internship, suggesting there remains an appetite for these opportunities. Overall, domestic graduates are identified as a reliable source of intern recruitment and retention to rural hospitals across Queensland, with entry to the rural generalist pathway and extended rural placement experiences enhancing uptake of rural practice