Physical and mental health perspectives of first year undergraduate rural university students

Background: University students are often perceived to have a privileged position in society and considered immune to ill-health and disability. There is growing evidence that a sizeable proportion experience poor physical health, and that the prevalence of psychological disorders is higher in university students than their community peers. This study examined the physical and mental health issues for first year Australian rural university students and their perception of access to available health and support services. Methods. Cross-sectional study design using an online survey form based on the Adolescent Screening Questionnaire modeled on the internationally recognised HEADSS survey tool. The target audience was all first-year undergraduate students enrolled in an on-campus degree program. The response rate was 41% comprising 355 students (244 females, 111 males). Data was analysed using standard statistical techniques including descriptive and inferential statistics; and thematic analysis of the open-ended responses. Results: The mean age of the respondents was 20.2 years (SD 4.8). The majority of the students lived in on-campus residential college style accommodation, and a third combined part-time paid work with full-time study. Most students reported being in good physical health. However, on average two health conditions were reported over the past six months, with the most common being fatigue (56%), frequent headaches (26%) and allergies (24%). Mental health problems included anxiety (25%), coping difficulties (19.7%) and diagnosed depression (8%). Most respondents reported adequate access to medical doctors and support services for themselves (82%) and friends (78%). However the qualitative comments highlighted concerns about stigma, privacy and anonymity in seeking counselling. Conclusions: The present study adds to the limited literature of physical and mental health issues as well as barriers to service utilization by rural university students. It provides useful baseline data for the development of customised support programs at rural campuses. Future research using a longitudinal research design and multi-site studies are recommended to facilitate a deeper understanding of health issues affecting rural university student

Habitat selection under the risk of infectious disease

ABSTRACT Question: How does the risk of infectious disease transmission affect individual habitat selection decisions and the resulting spatial distributions of populations? Mathematical method: We use a differential equation model to describe disease dynamics in two habitats coupled by natal dispersal and use an evolutionary game theoretical approach to calculate the evolutionarily stable strategy for habitat choice. Key assumptions: Natal dispersal by offspring with ideal knowledge of habitats. Habitats differ only in resource quality. Fecundity is proportional to intake rate, which decreases with density. We assume density-dependent disease transmission, with infection reducing fecundity or lifespan. Disease may be present in both habitats or the high-quality habitat only. Conclusions: In the absence of disease, our model predicts input matching (i.e. the distribution of individuals matches the distribution of resource inputs). The negative fitness consequences of infection can result in undermatching (underuse of the high-quality habitat compared with input matching), but stable overmatching (overuse of the high-quality habitat) is never predicted. Increasing the risk of transmission increases the degree of observed undermatching when only the high-quality habitat is infected but reduces undermatching when both habitats present a risk of disease. Increasing the cost of infection by reducing fecundity reduces use of the high-quality habitat (undermatching) in both cases. Increasing the cost of infection by increasing mortality rates also reduces the use of the high-quality habitat when both habitats are infected; if only the high-quality habitat is infected, undermatching may initially increase with mortality but eventually decreases

Self-care self-efficacy, religious participation and depression as predictors of poststroke self-care among underserved ethnic minorities

Underserved ethnic minorities have multiple chronic disease risk factors, including tobacco, alcohol and substance use, which contribute to increased incidence of stroke. Self-efficacy (self-care self-efficacy), religious participation and depression may directly and indirectly influence engagement in post stroke self-care behaviors. The primary aim of the present study was to investigate the effects of self-care self-efficacy, religious participation and depression, on tobacco, alcohol and substance use in a sample of largely ethnic minority, underserved stroke survivors (n=52). Participants previously recruited for a culturally tailored secondary stroke prevention self-care intervention were included. The treatment group received three stroke self-care sessions. The usual care group completed assessments only. Both groups were included in these analyses. Main outcome measures included tobacco, alcohol and substance use. Self-care self-efficacy, religious participation and depression were also assessed. Logistic regression analyses, using self-efficacy, religious practice and depression as the referents, were used to predict binary outcomes of tobacco, alcohol and substance use at 4-weeks post-stroke. Higher depression and self-care self-efficacy were associated with reduced odds of smoking and substance use. Greater participation in religious activities was associated with lower odds of alcohol use. We can conclude that incorporating depression treatment and techniques to increase self-care self-efficacy, and encouraging religious participation may help to improve stroke self-care behaviors for underserved and low socioeconomic status individuals. Results are discussed in the context of stroke self-management

Primary care services co-located with Emergency Departments across a UK region: early views on their development

Background Co-location of primary care services with Emergency Departments (ED) is one initiative aiming to reduce the burden on EDs of patients attending with non-urgent problems. However, the extent to which these services are operating within or alongside EDs is not currently known. This study aimed to create a typology of co-located primary care services in operation across Yorkshire and Humber (Y&H) as well as identify early barriers and facilitators to their implementation and sustainability. Methods A self-report survey was sent to the lead consultant or other key contact at 17 EDs in the Y&H region to establish the extent and configuration of co-located primary care services. Semi-structured interviews were then conducted with urgent and unscheduled care stakeholders across five hospital sites to explore the barriers and facilitators to the formation and sustainability of these services. Results Thirteen EDs completed the survey and interviews were carried out with four ED consultants, one ED nurse and three general practitioners (GPs). Three distinct models were identified: ‘Primary Care Services Embedded within the ED’ (seven sites), ‘Co-located Urgent Care Centre’ (two sites) and ‘GP out-of-hours’ (nine sites). Qualitative data were analysed using framework analysis. Four interview themes emerged (justification for the service, level of integration, referral processes and sustainability) highlighting some of the challenges in implementing these co-located primary care services. Conclusion Creating a service within or alongside the ED in which GPs can use their distinct skills and therefore add value to the existing skill mix of ED staff is an important consideration when setting up these systems. Effective triage arrangements should also be established to ensure appropriate patients are referred to GPs. Further research is required to identify the full range of models nationally and to carry out a rigorous assessment of their impact

Priority Medicines for Maternal and Child Health: A Global Survey of National Essential Medicines Lists

BACKGROUND: In April 2011, the World Health Organization (WHO) published a list of "priority medicines" for maternal and child health based on 1) the global burden of disease and 2) evidence of efficacy and safety. The objective of this study was to examine the occurrence of these priority medicines on national essential medicines lists. METHODS AND FINDINGS: All essential medicines lists published since 1999 were selected from the WHO website collection. The most-up-to date list for each country was then selected, resulting in 89 unique country lists. Each list was evaluated for inclusion of medicines (chemical entity, concentration, and dosage form) on the Priority Medicines List. There was global variation in the listing of the Priority Medicines. The most frequently listed medicine was paracetamol, on 94% (84/89) of lists. Sodium chloride, gentamicin and oral rehydration solution were on 93% (83/89) of lists. The least frequently listed medicine was the children's antimalarial rectal artesunate, on 8% of lists (7/89); artesunate injection was on 16% (14/89) of lists. Pediatric artemisinin combination therapy, as dispersible tablets or flexible oral solid dosage form, appeared on 36% (32/89) of lists. Procaine benzylpenicillin, for treatment of pediatric pneumonia and neonatal sepsis, was on 50% (45/89) of the lists. Zinc, for treatment of diarrhoea in children, was included on only 15% (13/89) of lists. For prevention and treatment of postpartum hemorrhage in women, oxytocin was more prevalent on the lists than misoprostol; they were included on 55 (62%) and 31 (35%) of lists, respectively. Cefixime, for treatment of uncomplicated anogenital gonococcal infection in woman was on 26% (23/89) of lists. Magnesium sulfate injection for treatment of severe pre-eclampsia and eclampsia was on 50% (45/89) of the lists. CONCLUSIONS: The findings suggest that countries need to urgently amend their lists to provide all priority medicines as part of the efforts to improve maternal and child health

Towards Space-like Photometric Precision from the Ground with Beam-Shaping Diffusers

We demonstrate a path to hitherto unachievable differential photometric precisions from the ground, both in the optical and near-infrared (NIR), using custom-fabricated beam-shaping diffusers produced using specialized nanofabrication techniques. Such diffusers mold the focal plane image of a star into a broad and stable top-hat shape, minimizing photometric errors due to non-uniform pixel response, atmospheric seeing effects, imperfect guiding, and telescope-induced variable aberrations seen in defocusing. This PSF reshaping significantly increases the achievable dynamic range of our observations, increasing our observing efficiency and thus better averages over scintillation. Diffusers work in both collimated and converging beams. We present diffuser-assisted optical observations demonstrating $62^{+26}_{-16}$ppm precision in 30 minute bins on a nearby bright star 16-Cygni A (V=5.95) using the ARC 3.5m telescope---within a factor of $\sim$2 of Kepler's photometric precision on the same star. We also show a transit of WASP-85-Ab (V=11.2) and TRES-3b (V=12.4), where the residuals bin down to $180^{+66}_{-41}$ppm in 30 minute bins for WASP-85-Ab---a factor of $\sim$4 of the precision achieved by the K2 mission on this target---and to 101ppm for TRES-3b. In the NIR, where diffusers may provide even more significant improvements over the current state of the art, our preliminary tests have demonstrated $137^{+64}_{-36}$ppm precision for a $K_S =10.8$ star on the 200" Hale Telescope. These photometric precisions match or surpass the expected photometric precisions of TESS for the same magnitude range. This technology is inexpensive, scalable, easily adaptable, and can have an important and immediate impact on the observations of transits and secondary eclipses of exoplanets.Comment: Accepted for publication in ApJ. 30 pages, 20 figure

Behavioral health coaching for rural-living older adults with diabetes and depression: an open pilot of the HOPE Study

BACKGROUND: Patients with diabetes are at increased risk for depression, compounding the burden of disease. When comorbid with diabetes, depression leads to poorer health outcomes and often complicates diabetes self-management. Unfortunately, treatment options for these complex patients are limited and comprehensive services are rarely available for patients in rural settings. METHODS: A small open trial was conducted to test the acceptability, feasibility and preliminary outcomes of a telephone-delivered coaching intervention for rural-dwelling older adults with uncontrolled diabetes and comorbid, clinically significant depressive symptoms. A total of eight older adults were enrolled in Healthy Outcomes through Patient Empowerment (HOPE), a 10-session (12-week), telephone-based coaching intervention. Primary study constructs included measures of diabetes control (Hemoglobin [Hb] A1c), depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]), and diabetes-related distress (Problem Areas in Diabetes Scale [PAID]). Assessments were conducted at baseline, post-intervention, and 6-month follow-up. Acceptability and feasibility were evaluated using patient surveys, focused exit interviews, and session attendance data. RESULTS: Clinically significant improvements were realized post-intervention and at 6-month follow-up for outcomes related to diabetes and depression. Effect sizes using Cohen's d were determined post-intervention and at 6-month follow-up, respectively, for HbA1c (d=0.36; d=0.28), PHQ-9 (d=1.48; d=1.67, and PAID (d=1.50; d=1.06) scores. Among study participants, HbA1c improved from baseline by a mean (M) of 1.13 (SD=1.70) post-intervention and M=0.84 (SD=1.62) at 6 months. Depression scores, measured by the PHQ-9, improved from baseline by M=5.14 (SD=2.27) post-intervention and M=7.03 (SD=4.43) at 6-month follow-up. PAID scores also improved by M=17.68 (SD=10.7) post-intervention and M=20.42 (SD=20.66) from baseline to 6-month follow-up. Case examples are provided for additional context and to more fully articulate salient intervention concepts. CONCLUSION: Although preliminary, data from this small open trial suggest that HOPE holds the potential to improve both physical (diabetes) and emotional (diabetes distress, depression) health outcomes and that changes can be maintained over a 6-month time period. As envisioned by the authors, HOPE may function as an extension of traditional primary care for rural-dwelling older adults with multiple comorbidities. A future randomized clinical trial will test HOPE’s broader effectiveness with rural-dwelling older adults. TRIAL REGISTRATION: NCT0127471

Parasite detection in food:Current status and future needs for validation

Background Many parasites (protozoa and helminths) can be transmitted through food and lead to infections with high morbidity, as well as disease outbreaks. Although the importance of foodborne parasites (FBP) is recognised by many sectors of the food industry, standardized analytical methods and validation procedures for testing food for FBP are lacking. Scope and approach:Current methods for detection of FBP, and their validation, are critically reviewed, focusing on priority FBP in Europe: the helminths Echinococcus multilocularis, Echinococcus granulosus, Taenia saginata, Trichinella spp., and Anisakidae, and the protozoa Toxoplasma gondii, Cryptosporidium spp., and Giardia duodenalis. Key findings and conclusions:Standard methods exist for detection of T. saginata in beef, and Trichinella spp. in meat (and are mandatory at meat inspection in Europe), Anisakidae in fish, and Cryptosporidium spp. and G. duodenalis in leafy green vegetables and berry fruits. For other FBP or foods, methods used in sample surveys have been described, but validation data are generally absent; limits of detection are not provided, ring trials have rarely been performed, and for most FBP quality control materials, proficiency schemes, and reference standards are lacking. The use of surrogate particles or organisms for method development or validation purposes needs to be carefully considered. Documented procedures for validation, such as ISO17468 and ISO16140-2:2016 that were established for bacteria, are mostly inappropriate for FBP. The development and application of standardized and validated detection methods would enhance understanding of the foodborne route of transmission, improve risk assessments, and help identify and verify critical control points.Peer Reviewe

Urban-Rural Disparities in Chronic Obstructive Pulmonary Disease Management and Access in Uganda.

Introduction: Almost 90% of chronic obstructive pulmonary disease (COPD) deaths occur in low- and middle-income countries (LMICs), where there are large rural populations and access to health care for COPD is poor. The purpose of this study was to compare urban-rural provider experiences regarding systemic facilitators and barriers to COPD management and treatment access. Methods: We conducted a qualitative study using direct observations and in-depth semi-structured interviews with 16 and 10 health care providers in urban Kampala and rural Nakaseke, Uganda, respectively. We analyzed interviews by performing inductive coding using generated topical codes. Results: In both urban and rural districts, exposure to evidence-based practices for COPD diagnosis and treatment was limited. The biomedical definition of COPD is not well distinguished in rural communities and was commonly confused with asthma and other respiratory diseases. Urban and rural participants alike described low availability of medications, limited access to diagnostic tools, poor awareness of the disease, and lack of financial means for medical care as common barriers to seeking and receiving care for COPD. While there was greater access to COPD treatment in urban areas, rural populations faced more pronounced barriers in access to diagnostic equipment, following standard treatment guidelines, and training medical personnel in non-communicable disease (NCD) management and treatment. Conclusion: Our results suggest that health system challenges for the treatment of COPD may disproportionately affect rural areas in Uganda. Implementation of diagnostic and treatment guidelines and training health professionals in COPD, with a special emphasis on rural communities, will assist in addressing these barriers