A qualitative study of rural and remote Australian general practitioners' involvement in high-acuity patients

This study aimed to understand the experiences, barriers, and facilitators of rural general practitioners’ involvement with high-acuity patients. Semi-structured interviews with rural general practitioners in South Australia who had experience delivering high-acuity care were audio-recorded, transcribed verbatim, and analyzed through content and thematic approaches incorporating Potter and Brough’s capacity-building framework. Eighteen interviews were conducted. Barriers identified include the inability to avoid high-acuity work in rural and remote areas, pressure to handle complex presentations, lack of appropriate resources, lack of mental health support for clinicians, and impacts on social life. Enablers included a commitment to community, comradery in rural medicine, training, and experience. We concluded that general practitioners are a vital pillar of rural health service delivery and are inevitably involved in disaster and emergency response. While the involvement of rural general practitioners with high-acuity patients is complex, this study suggested that with the appropriate system, structure and role supports, rural general practitioners could be better empowered to manage high-acuity caseloads locally

Financial sustainability of mini-grid electricity distribution companies in Uganda

This study investigated the financial sustainability of electricity Mini-grids in Uganda. The challenges of sustainability of Mini-grids were recognised by Tenenbaum Bernard, Greacen Chris, Siyambalapitiya Tilak (2014) as well as Payen, Bordeleau and Young (2016), with a focus on developing countries, particularly in Asia. There is, however, no literature that was found on similar challenges in Uganda. The specific objectives of this study were to examine the profitability, liquidity, efficiency and operational sustainability of Mini-grids in Uganda. The study focused on four Mini-grids as case studies: Ferdsult Engineering Services Limited (FESL), Bundibugyo Energy Cooperative Society (BECS), Kilembe Investments Limited (KIL) and West Nile Rural Electrification Company (WENRECO). The research objective was addressed by analysing audited financial reports for the respective Mini-grids from 2010 to 2015 and other operational information published by the electricity regulator. The study established that Mini-grids in Uganda were not financially sustainable despite having steady growth in sales revenue and customer numbers. The main factors that affected the sustainability of Mini-grids include a higher growth rate in operational and maintenance costs compared to the sales revenue. In addition, operational efficiency challenges were observed, including energy losses, imprudent financial management practices and poor liquidity. These shortfalls consequently showed that the Mini-grids are not financially sustainable. Despite the fact that Mini-grids are not financially sustainable in Uganda, their benefits go beyond electricity provision. The other benefits of Mini-grids are socio-economic in nature, including support for health services and enhancement of economic activities and the livelihoods of the poor. The socio-economic benefits from access to electricity in these rural areas may far outweigh the financial limitations observed. It is therefore important that Mini-grids continue to get the necessary support until such a time as they become sustainable. It is recommended that the Government of Uganda should provide financial and operational support through subsidies or other support systems to ensure continuity of the Mini-grids and, ultimately, their financial sustainability in the medium term in order to enhance access to electricity and the knock- on benefits that come with this access. In this regard, governance and technical skills enhancement remain key in order for these -grids to move forward. Further research should establish the optimal size and internal operational parameters that will ensure the sustainability of the Mini-grids, the amount of government subsidy required and the time it would prudently take to attain sustainability

The outcomes of a person-centered, non-pharmacological intervention in reducing agitation in residents with dementia in Australian rural nursing homes

Background: There is limited best- practice evidence to address behavioral and psychiatric symptoms for those with dementia in Australian rural nursing homes. This study aims to evaluate the outcomes of a person-centered, non-pharmacological dementia care model, ‘Harmony in the Bush’, based on the Progressively Lowered Stress Threshold principles and person-centered music in rural Australia. Methods: A quasi-experimental (nonrandomized, pre-post) intervention study was conducted in five rural nursing homes in Queensland and South Australia. Seventy-four residents with dementia participated in this intervention study, which yielded a sample power of 80%. Eighty-seven staff completed the Caregiver Stress Inventory at pre-post four-weeks of intervention. Staff training workshops focused on the theory of the Progressively Lowered Stress Threshold principles and delivery of person-centered care plan with integrated music intervention. We used reported changes in agitation of the residents, measured using Cohen- Mansfield Agitation Inventory, and staff’s caregiving stress, using Caregivers Stress Inventory. This study adheres to the CONSORT guidelines. Results: Mean age of residents with dementia was 82.4 (7.7) years and 69% were females. The mean age of admission was 80.1(8.4) years. Baseline measures indicated that 32.7% had mild- severe pain and 30.5% reported mild-severe sadness. The results showed statistically significant decline in aggressive behaviors, physically non-aggressive behaviors, verbally agitated behavior and hiding and hoarding. There was similar reduction in staff stress in the domains of aggressive behaviors, inappropriate behaviors, resident safety, and resource deficiency. Conclusions: The Harmony in the Bush model is effective in reducing agitation among dementia residents with significant reduction in staff stress levels in nursing homes in rural Australia. Trial registration: Australian and New Zealand Clinical Trials Registry (ANZCTR) on 20/2/2018 (Registration No: ACTRN12618000263291p). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374458

Towards personalized care: Factors associated with the quality of life of residents with dementia in Australian rural aged care homes

Quality of dementia care improves with a personalized approach to aged care, and knowledge of the disease process and unique care needs of residents with dementia. A personalized model of care can have a significant impact on the overall organizational culture in aged care homes. However, the dimensions of personalized aged care relating to dementia often remain under-managed. We aim to explore the factors that shape the dimensions of personalized dementia care in rural nursing homes using qualitative data of a mixed-method ‘Harmony in the Bush’ dementia study. The study participants included clinical managers, registered nurses, enrolled nurses and care workers from five rural aged care homes in Queensland and South Australia. One hundred and four staff participated in 65 semi-structured interviews and 20 focus groups at three phases: post-intervention, one-month follow-up and three-months follow-up. A multidimensional model of nursing home care quality developed by Rantz et al. (1998) was used in data coding and analysis of the factors. Three key themes including seven dimensions emerged from the findings: resident and family [resident and family centeredness, and assessment and care planning]; staff [staff education and training, staff-resident interaction and work-life balance]; and organization [leadership and organizational culture, and physical environment and safety]. A lack of consideration of family members views by management and staff, together with poorly integrated, holistic care plan, limited resources and absence of ongoing education for staff, resulted in an ineffective implementation of personalized dementia care. Understanding the dimensions and associated factors may assist in interpreting the multidimensional aspects of personalized approach in dementia care. Staff training on person-centered approach, assessment and plan, and building relationships among and between staff and residents are essential to improve the quality of care residents receive

The Extent of History Lecturers’ Use of Virtual Libraries for Teaching and Research

Virtual libraries are essential sources of information in universities teaching and research among lecturers. For the aims of imparting knowledge to students and self-development, history lecturers require various information resources for teaching and research. The purpose of the research was to ascertain the extent that history lecturers use virtual libraries for teaching and research in Nigerian universities. One hundred and five (105) history lecturers were the respondents for this study. The study data were collected using a questionnaire. The study data were analyzed using descriptive statistics and t-test. The results revealed a moderate extent of use of virtual libraries among history lecturers for teaching and research. The results also showed that there is no significant difference between the male and female history lecturers\u27 use of virtual libraries for teaching and research. It is recommended that university libraries assist these lecturers in learning more about virtual libraries and the required skills for practical use in teaching and research

Associations of the initial Covid-19 lockdown on self-reported happiness and worry about developing loneliness : a cross-sectional analysis of rural, regional, and urban Australian communities

Australia adopted hard lockdown measures to eliminate community transmission of COVID-19. Lockdown imposes periods of social isolation that contributes to increased levels of stress, anxiety, depression, loneliness, and worry. We examined whether lockdowns have similar psychosocial associations across rural and urban areas and whether associations existed between happiness and worry of loneliness in the initial wave of the COVID-19 pandemic in Australia. Data were collected using the “COVID-19 Living Survey” between 13 and 20 May 2020 by BehaviourWorks Australia at the Monash Sustainable Development Institute. The mean self-reported feeling of happiness and anxiousness (N = 1593), on a 10-point Likert scale with 0 being least happy or highly anxious, was 6.5 (SD = 2.4) and 3.9 (2.9), respectively. Factors associated with happiness were older age and having a postgraduate education. Participants worried about becoming lonely also exhibited reduced happiness (estimate = −1.58, 95%CI = −1.84–−1.32) and higher anxiousness (2.22, 1.93–2.51) scores, and these conditions remained associated after adjusting for demographics. Interestingly, worry about loneliness was greater in rural areas than in urban communities. The negative impact of the COVID-19 lockdown on rural youth and those less-educated was evident. Participants in rural Australia who were worried about becoming lonely were reportedly less happy than participants in major cities. This dataset provides a better understanding of factors that influence psychological well-being and quality of life in the Australian population and helps to determine whether happiness may be an associative factor that could mitigate self-feelings of anxiety and worry about loneliness. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Adverse Associations between Visceral Adiposity, Brain Structure, and Cognitive Performance in Healthy Elderly

The link between central adiposity and cognition has been established by indirect measures such as body mass index (BMI) or waist–hip ratio. Magnetic resonance imaging (MRI) quantification of central abdominal fat has been linked to elevated risk of cardiovascular and cerebro-vascular disease. However it is not known how quantification of visceral fat correlates with cognitive performance and measures of brain structure. We filled this gap by characterizing the relationships between MRI measures of abdominal adiposity, brain morphometry, and cognition, in healthy elderly. Methods: A total of 184 healthy community dwelling elderly subjects without cognitive impairment participated in this study. Anthropometric and biochemical markers of cardiovascular risk, neuropsychological measurements as well as MRI of the brain and abdomen fat were obtained. Abdominal images were segmented into subcutaneous adipose tissue and visceral adipose tissue (VAT) adipose tissue compartments. Brain MRI measures were analyzed quantitatively to determine total brain volume, hippocampal volume, ventricular volume, and cortical thickness. Results: VAT showed negative association with verbal memory (r = 0.21, p = 0.005) and attention (r = 0.18, p = 0.01). Higher VAT was associated with lower hippocampal volume (F = 5.39, p = 0.02) and larger ventricular volume (F = 6.07, p = 0.02). The participants in the upper quartile of VAT had the lowest hippocampal volume even after adjusting for age, gender, hypertension, and BMI (b = −0.28, p = 0.005). There was a significant age by VAT interaction for cortical thickness in the left prefrontal region. Conclusion: In healthy older adults, elevated VAT is associated with negative effects on cognition, and brain morphometry

Hypertension Status and Associations with Self-Rated Health and General Practitioner Health Seeking in a Rural Australian Cohort

© 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).Hypertension is the most frequently managed condition by Australian general practitioners (GP). Knowledge of hypertension and blood pressure (BP) values may motivate individuals to seek GP management. Our study aims to determine the associations of knowledge of BP values, BP perception, GP health seeking, and self-rated health (SRH) in a rural population. Two-hundred and seventy-eight (278) residents responded to the health survey on socio-demographic profile, medical history, BP knowledge and perception, SRH, and GP visit frequency. Associations were evaluated using Chi-squared test and multivariate logistic regression. Cohort mean age was 63.6 (12.4) years with 63.3% females. Hypertension (37.8%) was the most common condition. GP visits were made at least once every month (19.1%), every 2–6 months (35.6%), >6 months (11.5%), or only when needed (29.5%). Univariate analyses showed age, education, alcohol consumption, comorbidities, hypertension status, and SRH were significantly associated with visit frequency. After adjustments, hypertension status (OR = 3.6, 95% CI [1.7, 7.9]) and poor SRH (OR = 3.1, 95% CI [1.4, 7.0]) were significantly associated with frequent monthly visits. Our cohort demonstrated that having hypertension and poor self-rated health were associated with frequent monthly GP visits. The perception of high blood pressure does not drive seeking additional GP input

Self-efficacy reduces the impact of social isolation on medical student’s rural career intent

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: Social isolation in medical students is a subjective experience that may influence medical career decision making. Rural self-efficacy has been shown to influence rural career intentions following a rural clinical placement, however its impact on social isolation during a rural clinical placement has not been previously modeled. The objective of this study is to explore whether self-perception of social isolation is associated with rural career intent in rural medical students. Secondly, to determine whether self-efficacy influences the association between social isolation and rural career intent. Methods: 2015 data, from a cross-sectional survey of the National Federation of Rural Australian Medical Educators (FRAME) study. Among 619 medical students attending rural clinical schools (RCS), rural career intent was assessed. This included intended rural location for either postgraduate medical specialist or generalist training or completion of that training. Self-efficacy beliefs in rural medical practice were based on a validated scale consisting of six questions. Social isolation was measured asking students whether they felt socially isolated during their RCS placement. Results: 31.3% of surveyed students self-reported feeling socially isolated during their rural placement. Social isolation was associated with reduced rural career intent after controlling for gender, rural background, RCS preference, RCS support and wellbeing. In step-wise logistic regression the association between social isolation and rural intent disappeared with the inclusion of rural self-efficacy. Conclusions: Social isolation during a rural clinical placement is commonly reported and is shown to reduce rural career intent. High levels of rural clinical self-efficacy reduce the effects of social isolation on future rural workforce intentions.

The Impact of Human Resource Management Practices on Labour Turnover in Ghana

The human resources of every organization are considered as the most vital resource required for her growth. Consequently, most organizations have adopted Human Resource Management (HRM) practices and policies to ensure quality human resources are attracted, engaged and retained. Labour turnover on the other hand refers to the movement of individuals in and out of jobs over a particular period. The HRM practices adopted in an organization can go a long way to influence the rate of labour turn over and subsequently affect productivity and growth of the organization. The study therefore assessed the impact of the HRM practices and labour turnover at Cocoa Research Institute of Ghana (GRIG).  Both primary and secondary data were collected for the study. Questionnaires were administered and semi-structured interviews conducted to collect data from management and staff of CRIG. The data collected was presented and analysed using frequency tables and graphs. The study revealed a labour turnover rate of 11.9% of which only 0.43% left voluntarily over the five-year period under study. Sixty four percent (64%) of respondents rated their level of satisfaction with the HRM practice as good which confirms why about 29% percent of the workforce have been working with the institution for twenty years and above. To assess whether employees would opt for other organisations aside of CRIG or other divisions inside of CRIG, some of the employees sampled responded positively with the comment that workers of the research divisions are treated better than those of the other units. It is therefore recommended that all employees are treated fairly no matter the division or unit. Notwithstanding the low turnover rate and the desire of majority of employees to remain with the institute until retirement, there is the need for some level of labour turnover to allow new ideas, technology and changes to be introduced into the organisation to help bring dynamism into the operations of the organisation.