Physician retention and migration in rural clinics designated for areas without physicians in Japan: descriptive epidemiological study using the national physicians' survey.

BACKGROUND: In Japan, local governments have rural clinics designated for areas without physicians (RCDA) to secure physicians for rural medical care. Moreover, a medical policy of dispatching physicians between the RCDA and core hospitals for rural areas (CHRA) exists. This study aimed to assess the actual situation of physician migration from RCDAs and those who migrated, and examine the factors associated with their migration. METHODS: This retrospective cohort study used biennial national physicians' survey data from 2012 to 2018. It targeted physicians who worked at RCDAs in 2012 and participated in all four surveys (n = 510). The physicians were divided into two groups. One group consisted of physicians who worked continuously at the RCDA over the four study periods (retained physicians, n = 278), and the other included physicians who migrated to other institutions midway through the study period (migrated physicians, n = 232). We tracked the types of facilities where RCDA physicians worked from 2012 to 2018, also examined the factors associated with their migration. RESULTS: Among physicians from RCDAs who migrated to other institutions (n = 151) between 2012 and 2014, many migrated to hospitals (n = 87/151, 57.6%), and some migrated to CHRA (n = 35/87, 40.2%). Physicians in their 40s (Hazard ratio 0.32 [95% CI 0.19-0.55]), 50s (0.20 [0.11-0.35]), and over 60 years (0.33 [0.20-0.56]) were more likely to remain at RCDAs. Changes in their area of practice (1.82 [1.34-2.45]) and an increase in the number of board certifications held by physicians between 2012 and 2018 (1.50 [1.09-2.06]) were associated with migration. CONCLUSIONS: Many migrating physicians choose to work at hospitals after migrating from RCDAs. It was seemed that the physician dispatch system between RCDA and CHRA has been a measure to secure physicians in rural areas. Young age, obtaining board certification, and changes in areas of practice were associated with physician migration from RCDAs.

Examining workplace safety for remote area nurses in Australia: a cross-sectional descriptive study.

INTRODUCTION: Australia's remote health sector has chronic understaffing issues and serves an isolated, culturally diverse population with a high burden of disease. Workplace health and safety (WHS) impacts the wellbeing and sustainability of the remote health workforce. Additionally, poor WHS contributes to burnout, high turnover of staff and reduced quality of care. The issue of poor WHS in Australian very remote primary health clinics was highlighted by the murder of remote area nurse (RAN) Gayle Woodford in 2016. Following her death, a national call for change led by peak bodies and Gayle's family resulted in the development of many WHS recommendations and strategies for the remote health sector. However, it is unclear whether they have been implemented. The aim of this study is to identify which WHS recommendations have been implemented, from the perspective of RANs. METHODS: A cross-sectional online survey of 173 RANs was conducted during December 2020 and January 2021. The survey was open to all RANs who had worked in a very remote (MM 7 of the Modified Monash (MM) Model) primary health clinic in Australia more recently than January 2019. A convenience sampling approach was used. The survey tool was developed by the project team using a combination of validated tools and remote-specific workplace safety recommendations. Broad recommendations, such as having a safe clinic building, safe staff accommodation, local orientation, and 'never alone' policy, were broken down into specific safety criteria. These criteria were used to generate workplace safety scores to quantify how well each recommendation had been met, and clustered into the following domains: preparation of staff, safe work environment and safe work practices. Descriptive statistics were used and the safety scores between different states and territories were also compared. RESULTS: Overall, the average national workplace safety score was 53% (standard deviation (SD) 19.8%) of recommendations met in participants' most recent workplace, with median 38.5% (interquartile range (IQR) 15.4-61.5%) of staff preparation recommendations, median 59.4% (IQR 43.8-78.1%) of safe work environment recommendations, and median 50.0% (IQR 30.0-66.7%) of safe work practices recommendations met. Within domains, some recommendations had greater uptake than others, and the safety scores of different states/territories also varied. Significant variation was found between the Northern Territory (57.5%, SD 18.7%) and Queensland (41.7%, SD 16.7%) (p<0.01), and between South Australia (74.5%, IQR 35.9%) and Queensland (p<0.05). Last, many RANs were still expected to attend after-hours call-outs on their own, with only 64.1% (n=107/167) of participants reporting a 'never alone' policy or process in their workplace. CONCLUSION: The evidence from this study revealed that some recommended safety strategies had been implemented, but significant gaps remained around staff preparation, fatigue management and infrastructure safety. Ongoing poor WHS likely contributes to the persistently high turnover of RANs, negatively affecting the quality and continuity of health care in remote communities. Variation in safety scores between regions warns of a fragmentation of approaches to WHS within the remote health sector, despite the almost identical WHS legislation in different states/territories. These gaps highlight the need to establish and enforce a national minimum standard of workplace safety in the remote health sector.

Invasive group A streptococcal infection can be fatal to pregnant women in restricted medical resources remote areas-Emergent alert after COVID-19 pandemic.

Invasive group A streptococcal (iGAS) infection is a leading cause of maternal death. The increase in the number of patients with iGAS in Japan is markedly greater than before the coronavirus pandemic. We encountered a case of iGAS infection, on a remote island with restricted medical resources, in a third-trimester pregnant woman, resulting in both maternal and fetal death. A 34-year-old woman was admitted via a local general hospital with a high fever. Intrauterine fetal death disseminated intravascular coagulation, and septic shock were confirmed. Broad-spectrum antibiotics were started, and the patient was returned to the local general hospital. Eight hours after arrival, the patient died of circulatory and respiratory dysfunction complications. iGAS infections in remote areas may directly lead to life-threatening conditions and should be treated as an emergency, comparable to the serious conditions of placental abruption or placenta previa.

Satisfaction with Teleophthalmology Services: Insights from Remote Areas of Taiwan.

During and after the COVID-19 pandemic, teleophthalmology provided access to eye care for rural populations. This study aimed to assess the efficacy of and satisfaction with an integrated real-time videoconferencing module. This project incorporated ophthalmic instruments and telecommunication devices and provided on-site consultations via videoconferencing. Both patients and healthcare providers completed satisfaction questionnaires. From May 2020 to May 2021, this project provided eye care services to 395 patients (aged 6-90 years). The most frequent eye condition was chronic conjunctivitis (n = 197), followed by senile cataract (n = 163), dry eye (n = 103), and refractive error (n = 95). Among them, 40 (10.1%) patients were referred to secondary or tertiary hospitals for further evaluation or treatment. In total, 181 recruited respondents provided good satisfaction scores in all dimensions, including quality of medical care (4.50 of 5.00), financial aspects of care (4.48), supportive attitude toward the project (4.47), quality of service (4.40), and quality of telecommunication (4.40). Women had a substantially more supportive attitude toward the project, and 25 healthcare providers provided low ratings in areas representing the quality of telecommunication (4.04) and user-friendliness of the instrument (4.00). This teleophthalmology system provided efficient and satisfactory eye care to participants in remote communities. However, better internet access and training in instrument use can reduce obstacles to the future implementation of the project.

Challenges, practices, and impact of COVID-19 among mothers of children with autism spectrum disorder in cities and remote areas in Saudi Arabia.

BACKGROUND: Mothers of children with autism spectrum disorder (ASD) across Saudi Arabia have experienced tremendous challenges during the COVID-19 pandemic. However, the challenges may be different for mothers living in a city compared to those living more remotely. AIMS: We investigated challenges and practices related to COVID-19 and their impact among Saudi mothers of children with ASD in cities and remote areas during the pandemic. METHODS: A sample of 99 mothers (60 in cities and 39 remote) who had a child with ASD was surveyed using an electronic questionnaire. RESULTS: Mothers who lived in remote areas reported more challenges, while mothers in cities reported adopting more new practices with children than remote mothers. Regression analyses revealed that place of residence and age of the child were significant predictors of the challenges experienced by mothers of children with ASD. RECOMMENDATIONS: Intervention services, community-based education programs, and electronic media are recommended for use with mothers in Saudi Arabia to increase awareness of COVID-19, improve practices, and minimize challenges in protecting their children with ASD.

Remote area nurses' experiences of workplace safety in very remote primary health clinics: A qualitative study.

AIM: To explore Remote Area Nurses' experiences of the implementation of workplace health and safety policies and risk mitigation strategies in Australian very remote primary health clinics. DESIGN: This qualitative study used online semi-structured interviews, with participants purposively sampled to maximize variation in work location and service type. Data were analysed using a reflexive thematic analysis approach. Coding was carried out inductively, with NVivo 12 aiding data management. SETTING: The interviews were conducted from 24 Februrary 2021 to 06 March 2021 with Remote Area Nurses from very remote primary health clinics in Australia. PARTICIPANTS: Fifteen Remote Area Nurses participated in the study. RESULTS: Thematic analysis revealed varied approaches to workplace safety among the different health services and regions. While the spread of 'never alone' policies in many clinics addressed one of the significant risks faced by Remote Area Nurses, gaps remained even for hazards specifically highlighted in existing work health and safety legislation. Meaningful collaboration with staff and the community, local orientation, preparation for the role and providing quality care were protective factors for staff safety. Understaffing, unsafe infrastructure and inadequate equipment were common concerns among Remote Area Nurses. CONCLUSION: Health services need to prioritize workplace safety and take a continuous quality improvement approach to its implementation. This will include ensuring safety strategies are appropriate for the local context, improving infrastructure maintenance, and establishing sustainable second responder systems such as a pool of drivers with local knowledge. IMPLICATIONS FOR THE PROFESSION: Poor personal safety contributes to burnout and high turnover of staff. Nurses' insights into the barriers and enablers of current workplace safety strategies will aid policymakers and employers in future improvements. REPORTING METHOD: COREQ reporting guidelines were followed. PIPE STATEMENT: A panel of six Remote Area Nurses collaborated in the development of this project.

Conducting an Ebola vaccine trial in a remote area of the Democratic Republic of the Congo: Challenges, mitigations, and lessons learned.

Conducting a vaccine trial in a low- and middle-income country (LMIC) can present unique challenges and lessons learned. This Ebola vaccine trial, enrolling 699 healthcare providers and frontliners and jointly set up by the University of Antwerp (Sponsor) and the University of Kinshasa (Principal Investigator (PI)), was conducted in Boende, a remote city in the Democratic Republic of the Congo (DRC), between December 2019 and October 2022 (ClinicalTrials.gov: NCT04186000). While being bound by strict ICH-GCP and international funder regulations, this trial, exemplary for being a public-private partnership, required collaboration between several international stakeholders (e.g., two universities, a pharmaceutical company, and a clinical research organization), local communities and government agencies. Here we address several logistical and administrative challenges, cultural differences, language barriers and regulatory, political, and ethical considerations over the trial's 2.5-year duration, while tailoring and adapting the study to the specific local context. Lessons learned include the importance of clear communication with participants in all phases of the study, but also within the study team and among different stakeholders. Challenges, mitigations, and lessons learned are presented in nine categories (e.g., safety management; trial documentation, tools, and materials; communication, staff training and community engagement/sensitization; financial and administrative hurdles; and more). Ultimately, to reach the successful end of the vaccine trial in this remote Ebola endemic area in the DRC, careful planning, collaboration, and great flexibility and adaptability was often required from all involved partners. Despite the encountered challenges, the vaccine trial discussed in this paper was able to obtain high participant retention rates (i.e., 92% of participants completed the study). We hope that other international teams aspiring to conduct similar trials in remote areas of LMICs can learn from the way our challenges were addressed, mitigations developed, and lessons were learned.

Impact of Interprofessional Student Teams at a Remote Area Medical Event in Rural Appalachia.

Introduction: Education in interprofessional collaboration is vital to expand healthcare access, especially in areas of higher disparity. To address this need, interprofessional faculty collaborators incorporated undergraduate and graduate health profession students into teams at an annual Remote Area Medical event in rural Appalachia between 2017 and 2020. Purpose: This article evaluates the impact of an interprofessional student teams model on both patient care experience and students' interprofessional collaboration attitudes and behaviors. Methods: Student volunteers completed pre- and post-event surveys containing questions about demographics, open-ended questions, and questions from two instruments: the Student Perceptions of Interprofessional Clinical Education-Revised Instrument, Version 2 (SPICE-R2) and the Interprofessional Collaborative Competency Attainment Scale-Revised (ICCAS-R). Quantitative data were analyzed statistically; qualitative data thematically. Tally forms collected patient care interventions that were compared to regional health disparities. Two years of survey data and four years of intervention data were analyzed. Results: There was an increase (p < 0.001) in the post-event survey SPICE-R2 factors (teamwork, healthcare outcomes, and roles and responsibilities) in 2020 but not in 2019. ICCAS-R mean post-event composite scores increased (p < 0.05) in both 2019 and 2020. Qualitative coding of open-ended responses revealed interprofessional competency themes and provided event feedback. Over 5,900 health-disparity-focused interventions were completed between 2017 and 2020. Implications: Students participating in interprofessional teams demonstrate changes in attitudes towards the interprofessional approach to care, an improved ability to collaborate interprofessionally, and a positive impact on patient care interventions. The findings allow educators to understand how experiential interprofessional education influences students' interprofessional attitudes and beliefs while benefitting patient care.

The Attributes of Physicians Assigned to Rural Clinics Designated for Areas without Physicians in Japan.

In Japan, there are rural clinics designated for areas without physicians to ensure the availability of medical care for rural area residents. The purpose of this study was to clarify the attributes of physicians working in the rural clinics. Using the 2018 Ministry of Health, Labour and Welfare data in Japan, we compared the attributes and board certifications of physicians in rural clinics with those of physicians in other clinics. The age group with the highest percentage of physicians was the over 70 group (16%) and the early 30s group (15%) at rural clinics; however, the highest percentage of physicians at other clinics was the 70 over group (20%) and the early 60s group (16%). The number of physicians working in the internal medicine field at rural clinics was 550 (89%). There were 147 (27%) board-certified physicians in that field. Among them, the number of board certifications in internal medicine, surgery, and other than internal medicine or surgery were 79 (54%), 17 (12%), and 51 (35%), respectively. The proportion of board-certified surgery physicians within the internal medicine field in rural clinics was significantly higher than in other clinics (5%). In rural clinics, the age distribution of physicians was different from that in other clinics, and many of the physicians worked in the internal medicine field, but some of them seemed to have a mismatch between their board-certifications and their fields of practice. Further studies are necessary to clarify what the mismatches mean in rural practice.

Understanding allochthonous marine litter in a Protected Area in the Amazon Coast.

Studies on international waste on the Amazon coast are lacking, leaving a substantial knowledge gap concerning the socioeconomic, cultural, and environmental repercussion of this issue. In this context, the objective of this study is to comprehensively characterize and trace the origins of allochthonous litter discovered on a beach situated within a Protected Area. Given this, the hypothesis of this study is that the international litters comes from vessels operating in the region. A total of 384 containers were collected, originating from 36 countries, with those located in Asia and Africa showing the highest prevalence. Among the bottles with identified expiration dates, 76 % are newly arrived, confirming our hypothesis. The presence of older waste may result from a combination of the absence of beach cleaning public services and local dynamic processes. While international engagement is necessary, local communities, along with the scientific community, have taken proactive measures to address the problem.

What are tutors' perceptions of an online tutoring project-Digital Learning Companion-During the COVID-19 pandemic? A case study in Taiwan.

The COVID-19 outbreak has had serious impact on remote education and service-learning implementation in Taiwan. To alleviate these impacts, the Digital Learning Companion, an online tutoring project, was proposed to bridge the digital divide and learning gap among remote children, while offering university students an online service-learning environment. This project recruited international students as tutors for local children. To explore tutors' perceptions of this project during the COVID-19 pandemic, qualitative research, particularly a case study, was conducted. Adopting purposive sampling, 15 participants were chosen for interviews at the end of the project, and 10 reflective videos were used to reveal further information to supplement the interview results. Content analysis was employed to analyse the data. The findings implied that using JoinNet and tutoring journals significantly facilitated the tutoring process, which led to tutors' remarkable development in skills, social relationships, multicultural experience, altruism, social responsibility, self-efficacy, and affective values. However, they encountered some challenges, such as technical problems, communication barrier, lack of tutee information, and short tutoring duration. The solutions to these challenges and insightful suggestions for the project development are pointed out. The results of this study contribute to tutors' cognitive, social, and motivational development, and support the online service-learning-integrated curriculum, which can become a reference for further studies regarding online service-learning implementation to bridge the research gap.

Standing alone on the frontline. The meaning of being a nurse in the archipelago-A phenomenological hermeneutical study.

AIM: The aim of this study was to illuminate the meaning of being a nurse in the archipelago. METHODOLOGICAL DESIGN AND JUSTIFICATION: A phenomenological hermeneutical design was applied, as there is a need to understand the lifeworld and the meaning of being a nurse in the archipelago. ETHICAL ISSUES AND APPROVAL: Approval was granted by the Regional Ethical Committee and local management team. All participants provided consent to participate. RESEARCH METHOD: Individual interviews were conducted with 11 nurses (Registered Nurses or primary health nurses). The interviews were transcribed, and the text was analysed by means of phenomenological hermeneutical method. RESULTS: The analyses ended in one main theme: Standing alone on the frontline, and three themes: 1. Combating sea, weather and the clock with the sub-themes: Fighting to give care to patients despite harsh conditions and Fighting against time; 2. Standing firm but wavering with the sub-themes: Embracing the unexpected and Calling out for support; and 3. Being a lifeline throughout the entire lifespan with the sub-themes: Having responsibility for the islanders and Having an intertwined private and work life. STUDY LIMITATIONS: The interviews may be considered few, but the textual data were rich and assessed suitable for the analysis. The text may be interpreted differently, but we deemed our interpretation as more probable than others. CONCLUSION: Being a nurse in the archipelago means standing alone on the frontline. Nurses, other health professionals and managers need knowledge and insight about working alone and the moral responsibilities thereof. There is a need to support the nurses in their lonely work. Traditional means of consultations and support could preferably be supplemented by modern digital technology.

Mental Health of Primary and Secondary School Teachers in the Remote Mountain Areas.

Background and objective: Teaching is widely recognized as a highly stressful profession. Job stress leads to emotional exhaustion, which in turn triggers teacher attrition. The cost is estimated as USD 2.2 billion annually for teacher dropouts. It is therefore important to understand the mental state of teachers and the factors that may influence it in order to provide the appropriate early intervention. In the past, more attention has been paid to the mental status of teachers in economically developed cities, but less research has been conducted in remote cities. In this study, we selected primary and secondary school teachers in a typical area to assess their mental health, thereby contributing to the development of effective mental health education programs for teachers in primary and secondary schools. Materials and methods: In this study, 1102 teachers from a typical city in Ningxia Province, characterized by remote mountain areas, minority communities, and a low economic level, participated. The mental status of the teachers was assessed by a Symptom Checklist-90 (SCL-90). The effects of gender, age, level of education, place of work, and marital status on the total SCL-90 score were recorded and compared. The subscale scores of the SCL-90 and the differences among the respondents with various characteristics were analyzed. Results: In total, 1025 data were valid and used for statistical analysis. The effective rate of this study was 93.01%. The analysis showed that 25.17% of the subjects had possible mental problems. There were significant differences in age and marital status (p < 0.001). The score of teachers less than 30 years old was lower than that of other teachers (p = 0.001 vs. 30-39; p < 0.001 vs. 40-49; p < 0.001 vs. ≥50). The no-marriage teachers had the lowest score than the married group or others (p < 0.001 vs. married; p < 0.05 vs. others). Compared to the norm, teachers' mental status was poor, especially in somatization (p < 0.001), obsessive-compulsive symptoms (p < 0.001), depression (p < 0.001), anxiety (p < 0.001), hostility (p < 0.001), phobic anxiety (p < 0.001), and psychosis (p < 0.001). There were gender differences in obsessive-compulsive symptoms (p < 0.05) and depression (p < 0.05). Conclusions: These data indicate that the mental status of these teachers is not optimistic, and married female teachers aged 40-55 years need to be given more attention. Mental health examinations can be incorporated into daily physical examination items to facilitate the timely detection and early intervention of negative emotions.

Augmented reality training in basic life support with the help of smart glasses. A pilot study.

Introduction: Laypeople should be trained in basic life support and traditional and innovative methodologies may help to obtain this goal. However, there is a knowledge gap about the ideal basic life support training methods. Smart glasses could have a role facilitating laypeople learning of basic life support. Aim: To analyze the potential impact on basic life support learning of a very brief training supported by smart glasses video communication. Methods: Twelve laypeople were basic life support tele-trained by means of smart glasses by an instructor in this pilot study. During training (assisted trough smart glasses) and after the training (unassisted) participants' performance and quality of basic life support and automated external defibrillation procedure were assessed on a standardized simulated scenario. Results: After the training all participants were able to deliver good quality basic life support, with results comparable to those obtained when real time remotely guided by the instructor through the smart glasses. Mean chest compression rate was significantly higher when not guided (113 /min vs. 103 /min, p = 0.001). When not assisted, the participants spent less time delivering the sequential basic life support steps than when assisted while training. Conclusions: A very brief remote training supported by instructor and smart glasses seems to be an effective educational method that could facilitate basic life support learning by laypeople. This technology could be considered in cases where instructors are not locally available or in general in remote areas, providing basic internet connection is available. Smart glasses could also be useful for laypeople rolling-refreshers.

Feelings toward medicine in remote areas among medical students aiming to become generalists : A comparison with other specialists.

Geographic maldistribution of physicians is a serious problem in Japan, resulting in a few physicians in remote areas. We distributed questionnaires to 396 medical students at Tokushima University from 2013 to 2016. We examined the intensity of medical students toward medicine in remote areas by using a visual analog scale and investigated what medical specialty they chose after two years of clinical training. The intensity of interest in medicine and the intensity of willingness to contribute to it in remote areas were statistically higher among medical students who intended to choose general medicine. After graduation, only five participants chose to specialize in general medicine. Of the 14 medical students who originally chose general medicine, six chose internal medicine, three chose general medicine, and the others chose surgery, neurosurgery, anesthesiology, orthopedics, or emergency medicine. This study demonstrated that medical students who intend to choose general medicine have a higher intensity of willingness to contribute to medicine in remote areas, indicating that the support program for these students to become general practitioners after graduation increases the number of physicians in remote areas. J. Med. Invest. 70 : 129-134, February, 2023.

Homogenization of microplastics in alpine rivers: Analysis of microplastic abundance and characteristics in rivers of Qilian Mountain, China.

Microplastics in remote areas has received increasing concern in recent years. However, studies on microplastics in alpine rivers and their affecting factors are still limited. In this study, we investigate the abundance and characteristics of microplastic in the surface water of five alpine rivers in Qilian Mountain, China. Utilizing sieve collection, digestion and density separation, along with microscopy and Raman spectroscopy analyses, microplastics were observed in all the water samples and the average abundance of microplastics was 0.48 ± 0.28 items/L, which was lower than in other freshwaters. Transparent (37.3%) and fibrous (72.1%) microplastics were predominant. Polypropylene (53.8%) was the most frequently identified polymer type. Analysis of similarities (ANOSIM) and linear discriminant analysis (LDA) based on microplastic shape, color, and polymer type showed that there was no significant difference in the microplastic characteristics among rivers of Qilian Mountain. The distance decay models revealed that the similarity in microplastics characteristics was not affected by changes in watershed characteristics, such as geographical distance, elevation, water quality, and land use. This finding suggests that the primary source of microplastics in Qilian Mountain rivers could be from dispersed origins. The results of this study indicated that despite remote alpine rivers suffering limited anthropogenic impacts, they were not immune to microplastics. However, in watersheds with lower intensity of human activity, the abundance and characteristics of microplastics in water bodies may be more uniformly distributed and controlled by diffusion conditions such as atmospheric transport or riverine transport. Our investigation unveils novel understanding of microplastic dispersion in secluded alpine territories, emphasizing the crucial need for managing atmospheric transport of microplastics within conservation areas.

Transcriptome Profile Reveals Differences between Remote and Ischemic Myocardium after Acute Myocardial Infarction in a Swine Model.

Acute myocardial infarction (AMI) is the consequence of an acute interruption of myocardial blood flow delimiting an area with ischemic necrosis. The loss of cardiomyocytes initiates cardiac remodeling in the myocardium, leading to molecular changes in an attempt to recover myocardial function. The purpose of this study was to unravel the differences in the molecular profile between ischemic and remote myocardium after AMI in an experimental model. To mimic human myocardial infarction, healthy pigs were subjected to occlusion of the mid-left anterior descending coronary artery, and myocardial tissue was collected from ischemic and remote zones for omics techniques. Comparative transcriptome analysis of both areas was accurately validated by proteomic analysis, resulting in mitochondrion-related biological processes being the most impaired mechanisms in the infarcted area. Moreover, Immune system process-related genes were up-regulated in the remote tissue, mainly due to the increase of neutrophil migration in this area. These results provide valuable information regarding differentially expressed genes and their biological functions between ischemic and remote myocardium after AMI, which could be useful for establishing therapeutic targets for the development of new treatments.

Microplastics in plateau agricultural areas: Spatial changes reveal their source and distribution characteristics.

The Huangshui catchment on the northeastern Qinghai-Tibet Plateau (QTP) was selected as the study area to investigate the abundance, distribution characteristics, and influencing factors of microplastics (MPs) in surface agricultural soils (0-20 cm). The MP levels ranged from 6 to 444 items/kg, with an average of 86 items/kg. The relative abundance of small-sized MPs (<2 mm) was higher than that of large-sized MPs (2-5 mm). Polyethylene was the most common, and residual mulching film in farmland was the main source of MPs. The spatial distribution characteristics of MPs were analyzed through inverse distance weight interpolation, and MP abundance in agricultural soils in neighboring urban areas was significantly higher than that in other areas. Further analysis found that population density was significantly positively correlated with MP abundance (R2 = 0.9090, p < 0.01), indicating that human activities play a key role in MP pollution even in remote areas. In addition, the effects of irrigation, land use type, and soil physicochemical properties on the abundance of MPs were analyzed. Atmospheric transport and irrigation with surface water contribute to soil MP pollution. The direct effects of soil properties on MP abundance are still largely unclear, requiring further studies.

A case of disseminated intravascular coagulation of sepsis that caused extreme-thrombocytopenia treated at a remote-island-hospital.

Sepsis is a critical syndrome and DIC often develops in severe septicemia. However, cares for severe patients are limited in remote hospitals. In addition, bad weather often makes medical evacuation difficult in such areas. A 66-year-old man had urinary tract infection by Escherichia coli, followed by septic shock and DIC rapidly just 2 days after the onset. He recovered in 3 weeks without any massive bleeding. Immediate insertion of the central venous catheter to maintain stable hemodynamics and Gram-staining for selecting antibiotics were considered essential techniques for the survival of sepsis patients even in remote hospitals.

Health literacy of critical care patients in a remote area health service: A cross-sectional survey.

BACKGROUND: Lower life expectancy, higher rates of chronic disease, and poorer uptake of health services are common in remote patient populations. Patients with poor health literacy (HL) are less likely to attend appointments, adhere to medications, and have higher rates of chronic illness. Evidence underpinning the relationship between HL and inequity in remote critical care populations is sparse. OBJECTIVES: The primary study aim was to explore a multidimensional HL profile of patients requiring critical care in a remote area health service. Secondary aims were to explore HL in subgroups of the sample and to explore associations between HL and emergency department representation and discharge against medical advice. METHODS: This was a cross-sectional study of consecutive eligible patients admitted to the Mount Isa hospital intensive care unit. The Health Literacy Questionnaire was administered in a semistructured interview. RESULTS: In a 5-month period, there were 141 patient admissions to the five-bed intensive care unit, 67 patients (47.5%) met inclusion criteria and were not discharged prior to recruitment, and 37 (26.2%) agreed to participate. Participants felt understood and supported by healthcare providers, had sufficient information to manage their health, proactively engaged with healthcare providers, and had strong social supports. More challenging was their capacity to advocate on their own behalf, to explore and appraise information and to navigate healthcare systems. Patients who represented to the emergency department (n = 8, 21.6%) felt more empowered to seek healthcare advice. Of the 11 patients that discharged against medical advice, only one participated in the study. CONCLUSION: Trends in the data showed that Aboriginal and Torres Strait Islander participants were marginally less likely to be information explorers and to understand all written information. Findings provide guidance for the development of interventions to progress a reduction in health disparities experienced by this population.