Vitamin D deficiency and segregation status in prisoners

Purpose: The purpose of this paper is to investigate if any exposure to segregation minimal association in a single male prison population had any association with an increased risk of vitamin D deficiency. Design/methodology/approach: A retrospective case study was undertaken with all inmates who had a 25-hyrdoxy-vitamin D test taken during the study period deemed eligible. Hand searching of the medical records by an independent party identified eligible participants whose data were recorded for analysis. Findings: In total, 124 prisoners were deemed eligible for inclusion; 67 were vitamin D sufficient and 57 were vitamin D deficient by Australian standards. Time in segregation minimal association was shown not to be significant, however, smoking (OR 2.93, 95% CI 1.27-6.81, p=0.012) and having Asian ethnicity (OR 4.16, 95% CI 1.56-11.10, p=0.004) independently significantly increased the risk of vitamin D deficiency. Research limitations/implications: This research is limited by its study design, small sample size and single location. Originality/value: This paper presents the first published research into vitamin D levels in a prison population in Australia, and provides a basis for a larger prospective cohort study

What influences trainee decisions to practise in rural and regional Australia?

Although international medical graduates (IMGs) make up a substantial part of the Australian rural general practice workforce, most research on factors associated with rural practice has focused on Australian medical graduates (AMGs). This study aimed to determine whether there were differences between IMGs and AMGs in terms of these factors. Registrars in training and recent fellows (Fellowship of the Royal Australian College of General Practitioners/ Fellowship of the Australian College of Rural and Remote Medicine) who participated in training in rural and regional Australia were surveyed about practice models and rural practice. Almost two-thirds of participants were practicing or intending to practice in rural areas, with no difference between AMGs and IMGs. None of the variables associated with rural practice for AMGs was found to be associated with rural practice in IMGs in univariate binary regression analysis. Two key variables that are strongly associated with rural medical practice in the current literature, namely rural background and rural exposure, were not significant predictors of rural practice among IMGs. Due to the significant number of IMGs in regional training programs, any future incentives designed to improve rural recruitment and retention need to address factors relevant to IMGs

Accuracy of multiparametric magnetic resonance imaging to detect significant prostate cancer and index lesion location

Background: Multiparametric magnetic resonance imaging (mpMRI) of the prostate appears to improve prostate cancer detection, but studies comparing mpMRI to histopathology at the time of radical prostatectomy (RP) are lacking. This retrospective study determined the accuracy of mpMRI predicting Gleason score and index lesion location at the time of RP, the current gold standard for diagnosis. Methods: Between April 2013 and April 2016, a database of all men aged more than 40 years who underwent RP after positive transrectal ultrasound biopsy by an experienced urological surgeon was collated at a single regional centre. This was cross‐referenced with a database of all men who had mpMRIs performed at a single centre and reported according to Prostate Imaging Reporting and Data System (PI‐RADS version 1) during this period to generate a sample size of 64 men. A Spearman\u27s rho test was utilized to calculate correlation. Results: Median age of patients was 64 years, the median prostate‐specific antigen at RP was 6.22 ng/mL. mpMRI was positive (≥PI‐RADS 3) in 85.9% of patients who underwent RP. More than 92% of participants had Gleason ≥7 disease. A positive relationship between mpMRI prostate PI‐RADS score and RP cancer volume was demonstrated. An anatomical location correlation calculated in octants was found to be 89.1% accurate. Conclusion: mpMRI accurately detects prostate cancer location and severity when compared with gold standard histopathology at the time of RP. It thus has an important role in planning for future prostate biopsy and cancer treatment

The accuracy of self-perception of obesity in a rural Australian population: A cross-sectional study

Introduction: Obesity is a major public health concern. Accurate perception of body weight may be critical to the successful adoption of weight loss behavior. The aim of this study was to determine the accuracy of self-perception of BMI class. Methods: Patients admitted to the acute medical service in one regional hospital completed a questionnaire and classified their weight as: “underweight,” “normal,” “overweight,” or “obese.” Reponses were compared to clinically measured BMIs, based on the WHO Classification. Patients were also questioned about health-related behavior. Data were analyzed via Pearson’s Chi-squared test. Results: Almost 70% of the participating patient population (n = 90) incorrectly perceived their weight category, with 62% underestimating their weight. Only 34% of patients who were overweight and 14% of patients with obesity correctly identified their weight status. Two-thirds of patients who were overweight and one-fifth of patients with obesity considered themselves to be “normal” or “underweight.” Patients with obesity were 6.5-fold more likely to misperceive their weight status. Amongst patients with overweight/obesity, those who misperceived their weight were significantly less likely to have plans to lose weight. Almost 60% had not made any recent health behavior changes. This is one of the first regional Australian studies demonstrating that hospitalized patients significantly misperceive their weight. Conclusion: Patients with overweight/obesity had significantly higher rates of weight misperception and the majority had no intention to lose weight or to undertake any health behavior modification. Given the association between weight perception and weight reduction behavior, it introduces barriers to addressing weight loss and reducing the increasing prevalence of obesity in rural Australia. It highlights that doctors have an important role in addressing weight misperception

General practitioners or orthopaedic surgeons - who\u27s responsible for the gap in osteoporosis management?

No abstract

Giving birth in the Murrumbidgee region: A quantitative and qualitative approach to general practice obstetrics in a rural region

Objective: There is public concern regarding rural workforce shortages and closure of smaller obstetric centres. Aim: To identify whether safety is a concern for Murrumbidgee hospitals that fit primary medical care models and ascertain general practitioner (GP) obstetricians’ perspectives regarding the benefits and challenges to practising in the region. Design: Mixed-method retrospective analysis of selected outcomes in the NSW Mothers and Babies Reports 2012–2015 and semi-structured interviews with GP obstetricians. Setting: Murrumbidgee Local Health District. Main outcome measures: Evaluation of the safety of smaller hospitals (i.e. discharge status at birth, neonatal resuscitation and admission to intensive care); and iterative thematic analysis. Results: This study provides evidence that smaller hospitals are providing safe obstetric care. Fewer babies were transferred, with fewer stillbirths, at the smaller hospitals and no difference in newborn deaths. There were more normal vaginal births in the smaller hospitals (70.0%) than in Wagga Wagga Base Hospital (57.2%) or Griffith Base Hospital (58.6%). There were fewer neonatal resuscitations in the smaller hospitals than in Wagga Wagga Base Hospital or Griffith Base Hospital. More than one-quarter of babies were admitted into the special care/neonatal intensive care for both Wagga Wagga and Griffith Base Hospitals; however, the rate was \u3c3% in the smaller hospitals (p \u3c 0.001). GPs were overwhelmingly positive about the professional rewards of GP obstetric practice and the importance of continuity of care, despite barriers such as workforce shortages, loss of facilities and other staff (midwives and anaesthetists). Possible solutions included fostering support systems, proactive succession planning and improving training support. Conclusions: GP obstetricians are providing a valuable, safe service in MLHD with both personal and community benefits

Maintaining patient-centredness in Australian medical students: Culture, curriculum and selection criteria

Introduction: Previous studies have shown that patient-centredness may become eroded as students progress through medical training. The primary objective of this study was to explore the differences in patient-centred attitudes between first- and final-year students in the context of an Australian medical school. The secondary objective was to determine whether student factors such as age, gender, background (rural/urban), discipline of previous degree and specialty of interest were associated with patient-centred attitudes. Methods: This cross-sectional study surveyed 214 first-year and 141 final-year Australian medical students in 2016 and 2017 (total n = 355). Score on the Patient–Practitioner Orientation Scale (PPOS) was the main outcome measure. Results: Anonymous questionnaires were completed by 355 students (76.2%). Mean PPOS score was 4.51 (SD 0.46). Although there was no difference in mean PPOS between first-year and fourth-year students, female respondents were significantly more patient-centred than male respondents (4.58 vs 4.42, p = 0.002). Students with an interest in a surgical specialty had significantly lower patient-centredness than students with a non-surgical specialty of interest (4.36 vs 4.55, p = 0.002). Having general practice intentions was not associated with higher patient-centredness. Students with a previous humanities-based degree had higher patient-centredness than students with previous degrees in different areas (4.67 vs 4.49, p = 0.025). Conclusions: There appears to be no erosion of patient-centredness between first-year and fourth/final-year students. Medical student selection and university culture may have influenced this finding

The Australian Rural Clinical School (RCS) program supports rural medical workforce: evidence from a cross-sectional study of 12 RCSs

Introduction: Many strategies have been implemented to address the shortage of medical practitioners in rural areas. One such strategy, the Rural Clinical School Program supporting 18 rural clinical schools (RCSs), represents a substantial financial investment by the Australian Government. This is the first collaborative RCS study summarising the rural work outcomes of multiple RCSs. The aim of this study was to combine data from all RCSs\u27 2011 graduating classes to determine the association between rural location of practice in 2017 and (i) extended rural clinical placement during medical school (at least 12 months training in a rural area) and (ii) having a rural background. Methods: All medical schools funded under the RCS Program were contacted by email about participation in this study. De-identified data were supplied for domestic students about their gender, origin (rural background defined as having lived in an Australian Standard Geographic Classification-Remoteness Area (ASGC-RA) 2–5 area for at least 5 years since beginning primary school) and participation in extended rural clinical placement (attended an RCS for at least 1 year of their clinical training). The postcode of their practice location according to the publicly available Australian Health Practitioner Regulation Agency (AHPRA) register was collected (February to August 2017) and classified into rural and metropolitan areas using the ASGC 2006 and the more recent Modified Monash Model (MMM). The main outcome measure was whether graduates were working in a ‘rural’ area (ASGC categories RA2–5 or MMM categories 3–7) or ‘metropolitan’ area. Pearson’s χ2 test was used to detect differences in gender, rural background and extended placement at an RCS between rural and metropolitan practice locations. Binary logistic regression was used to determine odds of rural practice and 95% confidence intervals (CIs) were calculated. Results: Although data were received from 14 universities, two universities had not started collecting origin data at this point so were excluded from the analysis. The proportion of students with a rural background had a range of 12.3–76.6% and the proportion who had participated in extended RCS placement had a range of 13.7–74.6%. Almost 17% (16.6%) had a principal practice postcode in a rural area (according to ASGC), range 5.8–55.6%, and 8.3% had a principal practice postcode in rural areas (according to MMM 3–7), range 4.5–29.9%. After controlling for rural background, it was found that students who attended an RCS were 1.5 times more likely to be in rural practice (95%CI 1.2–2.1, p=0.004) using ASGC criteria. Using the MMM 3–7 criteria, students who participated in extended RCS placement were 2.6 times as likely to be practising in a rural location (95%CI 1.8–3.8, p\u3c0.001) after controlling for rural background. Regardless of geographic classification system (ASGC, MMM) used for location of practice and of student background (metropolitan or rural), those students with an extended RCS had an increased chance of working rurally. Conclusion: Based on the combined data from three-quarters (12/16) of the Australian medical schools who had a graduating class in 2011, this suggests that the RCS initiative as a whole is having a significant positive effect on the regional medical workforce at 5 years post-graduation