ICIRAS: Research and reconciliation with indigenous peoples in rural health journals.

AIM: We aim to promote discussion about an Indigenous Cultural Identity of Research Authors Standard (ICIRAS) for academic journal publications. CONTEXT: This is based on a gap in research publishing practice where Indigenous peoples' identity is not systematically and rigorously flagged in rural health research publications. There are widespread reforms, in different research areas, to counter the reputation of scientific research as a vehicle of racism and discrimination against the world's Indigenous peoples. Reflecting on these broader movements, the editorial teams of three rural health journals-the Australian Journal of Rural Health, the Canadian Journal of Rural Medicine, and Rural and Remote Health-recognised that Indigenous peoples' identity could be embedded in authorship details. APPROACH: An environmental scan (through a cultural safety lens where Indigenous cultural authority is respected, valued, and empowered) of literature was undertaken to detect the signs of inclusion of Indigenous peoples in research. This revealed many ways in which editorial boards of Journals could systematically improve their process so that there is 'nothing about Indigenous people, without Indigenous people' in rural health research publications. CONCLUSION: Improving the health and wellbeing of Indigenous peoples worldwide requires high quality research evidence. The philosophy of cultural safety supports the purposeful positioning of Indigenous peoples within the kaleidoscope of cultural knowledges as identified contributors and authors of research evidence. The ICIRAS is a call-to-action for research journals and institutions to rigorously improve publication governance that signals "Editing with IndigenUs and for IndigenUs".

Indigenous Cultural Identity of Research Authors Standard: research and reconciliation with Indigenous Peoples in rural health journals.

The Indigenous Cultural Identity of Research Authors Standard (ICIRAS) is based on a gap in research publishing practice where Indigenous peoples' identity is not systematically and rigorously recognised in rural health research publications. There are widespread reforms, in different research areas, to counter the reputation of scientific research as a vehicle of racism and discrimination. Reflecting on these broader movements, the editorial teams of three rural health journals - Rural and Remote Health, the Australian Journal of Rural Health, and the Canadian Journal of Rural Medicine - adopted a policy of 'Nothing about Indigenous Peoples, without Indigenous Peoples'. This meant changing practices so that Indigenous Peoples' identity could be embedded in authorship credentials - such as in the byline. An environmental scan of literature about the inclusion of Indigenous Peoples in research revealed many ways in which editorial boards of journals could improve their process to signal to readers that Indigenous voices are included in rural health research publication governance. Improving the health and wellbeing of Indigenous peoples worldwide requires high-quality research evidence. This quality benchmark needs to explicitly signal the inclusion of Indigenous authors. The ICIRAS is a call to action for research journals and institutions to rigorously improve research governance and leadership to amplify the cultural identity of Indigenous peoples in rural health research.

Mental health and well-being impacts of COVID-19 on rural paramedics, police, community nurses and child protection workers.

OBJECTIVE: To investigate the impact of COVID-19 on the mental health and well-being of rural paramedics, police, community nursing and child protection staff. METHOD: An online survey was distributed to investigate the sources of stress and support across individual, task and organisational domains. SETTING AND PARTICIPANTS: The survey was completed by 1542 paramedics, police, community nurses and child protection workers from all states and territories of Australia. This study describes the data for the 632 rural participants. MAIN OUTCOME MEASURES: The main measures of well-being were the Public Health Questionnaire (PHQ9), the Generalised Anxiety Disorder (GAD7), the Maslach Burnout Inventory (MBI), workplace engagement, intention to quit and COVID-19-related stress. RESULTS: The mean depression and anxiety scores were 8.2 (PHQ9) and 6.8 (GAD7). This is 2-3 times that found in the general community. Over half (56.1%) of respondents showed high emotional exhaustion (burnout). The emotional exhaustion, depersonalisation and personal accomplishment mean scores were 28.5, 9.3 and 34.2, respectively. The strongest associations with burnout and psychological distress were workload, provision of practical support, training and organisational communication. A significant proportion of respondents were seriously considering quitting (27.4%) or looking for a new job with a different employer (28.5%) in the next 12 months. CONCLUSIONS: COVID-19 has increased the workload and stress on rural front-line community staff. The major sources of stress were related to organisations' responses to COVID-19 and not COVID-19 per se. The data suggest the most effective mental health interventions are practical and preventive, such as firstly ensuring fair and reasonable workloads.

An Organizational-Level Program of Intervention for AKI: A Pragmatic Stepped Wedge Cluster Randomized Trial.

BACKGROUND: Variable standards of care may contribute to poor outcomes associated with AKI. We evaluated whether a multifaceted intervention (AKI e-alerts, an AKI care bundle, and an education program) would improve delivery of care and patient outcomes at an organizational level. METHODS: A multicenter, pragmatic, stepped-wedge cluster randomized trial was performed in five UK hospitals, involving patients with AKI aged ≥18 years. The intervention was introduced sequentially across fixed three-month periods according to a randomly determined schedule until all hospitals were exposed. The primary outcome was 30-day mortality, with pre-specified secondary endpoints and a nested evaluation of care process delivery. The nature of the intervention precluded blinding, but data collection and analysis were independent of project delivery teams. RESULTS: We studied 24,059 AKI episodes, finding an overall 30-day mortality of 24.5%, with no difference between control and intervention periods. Hospital length of stay was reduced with the intervention (decreases of 0.7, 1.1, and 1.3 days at the 0.5, 0.6, and 0.7 quantiles, respectively). AKI incidence increased and was mirrored by an increase in the proportion of patients with a coded diagnosis of AKI. Our assessment of process measures in 1048 patients showed improvements in several metrics including AKI recognition, medication optimization, and fluid assessment. CONCLUSIONS: A complex, hospital-wide intervention to reduce harm associated with AKI did not reduce 30-day AKI mortality but did result in reductions in hospital length of stay, accompanied by improvements in in quality of care. An increase in AKI incidence likely reflected improved recognition.

Using digital and social media for health promotion: A social marketing approach for addressing co-morbid physical and mental health.

OBJECTIVE: This study examines consumer engagement with a social marketing digital media strategy designed to support the implementation of Equally Well-a program to improve the physical health of people living with mental illness. DESIGN: A four-stage strategic analysis and intervention mix were used as the theoretical framework to assess stakeholder needs and to evaluate the effectiveness of the intervention. SETTING: Online and digital media. PARTICIPANTS: Mental health consumers, carers, clinicians and service managers. INTERVENTIONS: A digital media, social marketing intervention to support those seeking to improve the physical health of people living with mental illness. The strategy was developed using a co-design methodology and provided links to self-care resources, access to service providers, clinical tools for health professionals and links to existing successful rural programs. MAIN OUTCOME MEASURES: The main outcome measures were the number of people from each category accessing the media, making connections and downloading resources. RESULTS: The program has resulted in more than 24 500 website hits per annum, 3500 tweets and 14.5 million Twitter impressions with good bounce and download rates. The analysis suggested the materials were mostly used by clinicians and service managers using desktop computers. CONCLUSIONS: Using a co-design approach, the study demonstrated the potential of a social marketing digital media strategy as a health promotion methodology. The paper has provided a framework for implementing and evaluating the effectiveness of digital social media campaigns that can help consumers, carers, clinicians and service planners address the challenges of rural health service delivery and the tyranny of distance.

Evaluating a low-intensity cognitive behavioural program for young people in regional Australia.

NewAccess is a low-intensity cognitive behavioural program which was recently trialled for the first time in Australia for clients aged under 18. Given that accessing support earlier tends to result in better outcomes for people with mild-to-moderate mental health issues, having NewAccess available for young people has the potential to reduce the likelihood of mild-to-moderate mental health concerns developing into more serious, or chronic mental illness over time for some clients, while also freeing up resources for those with more severe support needs. This mixed methods approach presents the findings of an independent evaluation of the program delivered out of two regional headspace centres in 2017-2019. From an initial sample of 165 young participants aged between 12 and 25, 109 completed the program. Of those who completed the program 60 were under the age of 18. The standardised assessment and outcome measures indicated a very good response to the program, with the majority showing significant improvements in their depression, anxiety and psychological distress scores. The overall 'reliable improvement' and 'recovery rates' were 64.2% and 72.3% respectively. Overall, the results indicated this program was an acceptable and efficacious intervention for young people in rural settings, when delivered in a 'youth-friendly' service environment.

Is rural mental health workforce a policy imperative?

An available and effective rural mental health workforce is critical to the provision of contemporary mental health care. During the last 5 years new mental health plans and strategies have been released every state and territory of Australia. This policy analysis examines the extent to which workforce, and particularly rural workforce issues are considered in these policies. The analysis revealed that rural workforce issues receive scant attention in state and territory mental health plans. Rural Australians comprise 28% of the total population, yet rural workforce issues are canvased, on average only 6% of the time general workforce issues are addressed. National mental health workforce plans do focus on the rural workforce, but these are not referenced in the state or territory strategies or workforce plans. Given the rural mental health workforce shortages, and consumer challenges in accessing rural mental health services, more planning and consideration to supporting and developing a rural workforce appears warranted.

Older people's mental health in rural areas: Converting policy into service development, service access and a sustainable workforce.

This paper describes the older people's mental health workforce development, policy development and implementation process and quantifies the rural service delivery and access impacts over a 15-year period in New South Wales. It highlights the factors that are considered to be critical to successful rural service development such as commitment to funding parity, investment in strong local service leadership, and development of innovative, locally adapted rural service models. Building on these foundations, the Older People's Mental Health Program in New South Wales was able to address key challenges relating to service access in rural health and develop new, sustainable specialist older people's mental health service networks. A sustained focus on policy and implementation which explicitly supports rural older people's mental health service enhancement, and development of evidence-based models of care, has significantly improved access to specialist mental health care for older people in rural areas. It has delivered 23 new rural older people's mental health community teams and a 440% increase in the number of people accessing these teams. It has also doubled the number of acute inpatient units and established new specialist mental health-residential aged care partnership services in rural New South Wales. It has resulted in increased access to services for the "older old," while not diminishing older people's rates of access to general adult mental health services. It has also supported innovative, sustainable rural service models such as "hub and spoke" models and step-up step-down inpatient services that build on existing health and hospital infrastructure and link geographically dispersed specialist clinicians and services together in rural service delivery.

Improving the physical health of people living with mental illness in Australia and New Zealand.

People diagnosed with mental illness have relatively poor physical health and die earlier than their counterparts in the general population. People living with mental illness in rural Australia have three times the risk of premature death than the total population. This article reviews recent international, Australian and New Zealand research, identifies the increased risk of early death of people living with mental health issues in rural settings and looks at the need for policy and practice responses. The 'Equally Well' national initiatives are described in Australia and New Zealand, which seek to systematically address this inequity as a matter of priority. Finally, it argues for co-design and consumer participation in policy development, program implementation and research. Improved understanding of the perspectives and priorities of people with experience of mental illness is vital if change is to be fully realised.

QuickTox™ Kit for QuickScan Aflatoxin FREE.

The QuickTox Kit for QuickScan Aflatoxin FREE uses competitive lateral flow technology and a reader based system for quantitative determination of total aflatoxins in varied matrixes. Aqueous based extraction protocols are used for corn and wheat, reducing use of solvents. Fifty percent ethanol (Reagent Alcohol) extraction is used for oats, sorghum, and barley. Eighty percent ethanol (Reagent Alcohol) extraction is used for whole peanut, peanut seed, and peanut hull samples. Matrix specific assay procedures and calibration curves are used to enable analyses across multiple sample types. The performance of this assay was examined using naturally contaminated aflatoxin corn samples and spiked samples of barley, oats, sorghum, wheat, whole peanut, peanut seed, and peanut hull samples. All data were judged against previously established acceptance criteria. Performance was evaluated in linearity, selectivity, matrix, lot consistency, and robustness experiments in the sponsor's laboratory. Results produced in all studies except robustness were within acceptable ranges. Out of range robustness study results reflected simultaneous deviation in sample volume and assay development time compared to the standard assay procedures. Aflatoxin B1, B2, and G1 were detected with approximately equal sensitivity; sensitivity for G2 was 64% that of B1. The presence of other common mycotoxins did not interfere with the assay. Matrix studies in an independent laboratory examined corn and barley to challenge both aqueous and ethanol based extraction procedures. All data points in these studies fell within the ranges defined in the acceptance criteria. The assay exhibited a linear dose response over the range tested, 0-100 ppb, with R(2) values exceeding 0.93 and RSDr values for results ranging from 2.27 to 23.84%.