Geographic Disparities in Domestic Pig Population Exposure to Ebola Viruses, Guinea, 2017-2019.

Although pigs are naturally susceptible to Reston virus and experimentally to Ebola virus (EBOV), their role in Orthoebolavirus ecology remains unknown. We tested 888 serum samples collected from pigs in Guinea during 2017-2019 (between the 2013-16 epidemic and its resurgence in 2021) by indirect ELISA against the EBOV nucleoprotein. We identified 2 hotspots of possible pig exposure by IgG titer levels: the northern coast had 48.7% of positive serum samples (37/76), and Forest Guinea, bordering Sierra Leone and Liberia, where the virus emerged and reemerged, had 50% of positive serum samples (98/196). The multitarget Luminex approach confirms ELISA results against Ebola nucleoprotein and highlights cross-reactivities to glycoprotein of EBOV, Reston virus, and Bundibugyo virus. Those results are consistent with previous observations of the circulation of Orthoebolavirus species in pig farming regions in Sierra Leone and Ghana, suggesting potential risk for Ebola virus disease in humans, especially in Forest Guinea.

Seroprevalence of brucellosis, Q fever and Rift Valley fever in domestic ruminants in Guinea in 2017-2019.

BACKGROUND: Brucellosis, Q fever and Rift Valley fever are considered as Neglected Zoonotic Diseases (NZDs) leading to socioeconomic losses in livestock globally, and particularly in developing countries of Africa where they are under-reported. In this study, we evaluated the seroprevalence of these 3 zoonotic diseases in domestic ruminants in Guinea from 2017 to 2019. A total of 1357 sera, sampled from 463 cattle, 408 goats and 486 sheep, were collected in 17 Guinean prefectures and analyzed by enzyme-linked immunosorbent assay (ELISA). RESULTS: Cattle was the species with highest seroprevalence (5 to 20-fold higher than in small ruminants) for the three diseases. The seroprevalence of brucellosis, mostly focused in Western Guinea, was 11.0% (51 of 463) in cattle, 0.4% (2 in 486) in sheep while no specific antibodies were found in goats. Q fever, widespread across the country, was the most frequently detected zoonosis with a mean seroprevalence of 20.5% (95 in 463), 4.4% (18 in 408) and 2.3% (11 in 486) in cattle, goats and sheep, respectively. The mean seroprevalence of RVF was 16.4% (76 in 463) in cattle, 1.0% (4 in 408) in goats and 1.0% (5 in 486) in sheep. Among the samples 19.3% were seropositive for at least one of the three NZDs, 2.5% showed specific antibodies against at least two pathogens and 4 cattle (0.8%) were seropositive for all three pathogens. In cattle, adults over 3-years old and females presented a higher antibody seroprevalence for the three diseases, in congruence with putative exposure risk. CONCLUSIONS: This study confirms the circulation of these three zoonotic pathogens in Guinea and highlights the need for implementing a syndromic surveillance of ruminant abortions by the Guinean veterinary authorities as well as for the screening of the human population at risk (veterinarians, breeders, slaughterers) in a One Health perspective.

SARS-CoV-2 Circulation, Guinea, March 2020-July 2021.

This overview of severe acute respiratory syndrome coronavirus 2 circulation over 1.5 years in Guinea demonstrates that virus clades and variants of interest and concern were progressively introduced, mostly by travellers through Conakry, before spreading through the country. Sequencing is key to following virus evolution and establishing efficient control strategies.

Making a case for telehealth: measuring the carbon cost of health-related travel.

BACKGROUND: Telehealth services are promoted to reduce the cost of travel for people living in rural areas. The previous Australian Government, through the national Digital Economy Strategy, invested heavily in telehealth service development, at the same time introducing a carbon pricing mechanism. In planning a range of new telehealth services to a rural community the authors sought to quantify the travel conducted by people from one rural area in Australia to access health care, and to calculate the associated carbon emissions. METHODS: A population survey was conducted over a 1-week period of health-related travel events for the year 1 July 2011 to 30 June 2012 of all households on King Island, a community situated between the Australian mainland state of Victoria and the state of Tasmania. Validated emissions calculators were sourced from the Carbon Neutral website, including the vehicle and fuel use calculator and air travel carbon calculator, to calculate the total emissions associated with the fuel burned in tonnes of carbon dioxide equivalent (tCO2e). RESULTS: Thirty nine percent of the population (625 participants) reported a total of 511 healthcare-related travel events. Participants travelled a total of 346 573 km and generated 0.22 tCO2e per capita. Participants paid the cost of their own travel more than 70% of the time. CONCLUSIONS: Dependence on fossil fuels for transport in a carbon economy has a significant impact on total healthcare carbon emissions. Alternative models of care, such as telehealth, need be developed for an environmentally sustainable healthcare system for rural and remote areas.

The current state of Indigenous and Aboriginal women with diabetes in pregnancy: a systematic review.

UNLABELLED: To undertake a systematic review of diabetes in pregnancy (DIP), determining prevalence and impact on maternal and child health outcomes for Indigenous and Aboriginal women. METHOD: Electronic searches of MEDLINE, Embase, CINAHL, ERIC, DARE, CDSR, PsycINFO, Austhealth and HealthInfoNet were undertaken. Changes in diagnostic criteria for DIP and variability in methodology meant a qualitative synthesis of the data was undertaken. RESULTS: From the 142 potential studies, 42 peer reviewed journal articles met the inclusion criteria. GDM prevalence in 65% of studies was greater for Indigenous and Aboriginal women than the comparison groups; Pacific Islander 8.1%, Canadian Aboriginal 11.5%, American Indian 7.9%, Australian Aboriginal 8.4% compared with 2-5% worldwide. Of studies reporting high birth weight (>4000 g) and DIP, 75% had a higher than expected prevalence, 86% had higher macrosomia prevalence and 63% had higher stillbirth rates. Studies with Alaskan, Australian Aboriginal and Pacific Islander women had GDM prevalence both greater and less than comparison groups. CONCLUSION: Correcting the health disparity for Indigenous and Aboriginal women with DIP is a health priority. DIP prevalence is not the same for all Indigenous and Aboriginal women. Inconsistent study design without robust data is interfering with accurate prevalence of DIP. New international consensus guidelines provide opportunities for high quality studies of DIP for Indigenous and Aboriginal women.

The Cradle Coast personally controlled electronic health record evaluation research.

In 2010 the Federal Government announced funding over two years to create a Personally Controlled Electronic Health Record (PCEHR) for Australians. One of the wave 2 implementation sites is the Cradle Coast in Tasmania. A PCEHR Program Benefits and Evaluation Partner (BEP) has been appointed to undertake evaluation activities with the e-health lead implementation sites. In addition to this implementation a comprehensive research plan has been developed and commenced through the Rural Clinical School at the University of Tasmania. The overarching aim of the research agenda is to evaluate the outcomes of various elements of the 4C project as it evolves and is implemented, from multiple perspectives. The research agenda is important as it expands upon the NEHTA mandated evaluation and provides an holistic overview of the PCEHR implementation process and outcomes for clinicians, patients and family members. This paper will detail the planned evaluation and its progress to date.

Improving the skills of rural and remote generalists to manage mental health emergencies.

CONTEXT: People living in rural and remote areas have been found to suffer higher rates of mental illness and psychological distress than their urban counterparts. However, rural and remote Australians also suffer from a lack of specialist mental health services. Mental health consumers are concerned about the lack of access to specialist mental health care and report poor service quality and stigmatizing staff attitudes when presenting with mental health emergencies at acute care facilities. Standards for the Mental Health Workforce released in 2002 promote respect for the individual, their family and carers; best practice in the assessment, early detection and management of acute illness; promotion of mental health and safety; and the prevention of relapse. These standards are for generalists providing care to mentally ill patients; their family and carers in the acute care setting; as well as specialist mental health professionals. Up-skilling generalists in rural and remote areas to respectfully and effectively manage mental health emergency care is a priority. ISSUES: A short course, 'Managing Mental Health Emergencies' was developed by the Australian Rural Nurses and Midwives in 2002. Almost 750 participants had completed the course at the time of the evaluation. The objectives of the course were to: develop an increased knowledge of mental health presentations and gain confidence in managing and assessing mental health clients; gain an understanding of the referral processes in the local environment; gain an insight into the impact of mental health emergencies on individuals, their family and carers; and identify strategies to minimise the impact of managing mental health emergencies on the healthcare team. The model of training matched what is known to be best practice in rural and remote health practitioner development in emergency care, being local, interdisciplinary, and engaging local expert service providers while being overseen by a national steering committee. The evaluation consisted of a pre- (n=456) and post-course (n=163) survey, and follow-up interviews with participants between 3 and 6 months post-course (n=44). LESSONS LEARNED: The pre- and post-survey identified that, as a result of the course, participants had improved confidence in seeking information about suicide ideation, were significantly more able to differentiate between substance intoxication and psychosis (χ(2)[df=1, n=619] =140.9, p<.000); and between dementia and delirium (χ(2)[df=3, n=619] =126.5, p<.000). The follow-up interview notes were analysed using thematic analysis. Three themes were used: changing attitudes; changing clinical practice; and communication. Participants had reflected on their attitudes following the course and recognized how these had been stigmatizing. Many participants reported putting their new skills into practice and reported better recognition of non-verbal cues and better information seeking from family members, past history and police. The Managing Mental Health Emergencies course is a valuable addition to the emergency courses available to rural and remote healthcare providers.

Sun-protective behaviours of beach goers in the North-West.

ISSUE ADDRESSED: The study investigates the sun-protective behaviours of beach goers in the north-west of Western Australia as the basis for a new health promotion intervention to be implemented in the area. METHODS: A cross-sectional, observational survey of 1,498 beach goers in 25 beach locations across northwest Western Australia. Details of sun-protective clothing (none, hat with no shirt, shirt with no hat and full coverage) were recorded, as was time on beach, age and gender. Environmental audits were also completed to characterise the effects of the natural and built environments on sun-protective behaviours. RESULTS: Both females and children had the lowest rates of sun protection - 33.7% of females were found to wear shirts with no hats, compared to 29.0% of males, and they were less likely to be fully covered than males (30.3% compared to 41.5%). Children were more likely to wear shirts with no hats (43.1%) compared to adults (28.2%). CONCLUSIONS: Female and child beach goers represent two groups that are at a higher risk of developing skin cancer and, therefore, should become targets for a sustainable, effective and multi-component health promotion program.

The clinical champion role in the development of a successful telehealth wound care project for remote Australia.

The role of a clinical champion in a wound care project was examined in terms of an emancipatory processes framework. During the project the role changed significantly, as the needs of the project changed. In the early phase of the project, the clinical champion's role was that of team leader. During the middle phase of the project, the clinical champion's role changed to health services advocate and coach. During the final phase of the project, the clinical champion's role changed again, to that of salesperson and academic. Experience with the clinical issue being addressed by the new service, and clear motivation to complete the project, thereby seeing the new service established, allowed the clinical champion to motivate the team to overcome the difficulties in the change process.

From workshop to work practice: An exploration of context and facilitation in the development of evidence-based practice.

BACKGROUND: This article examines the process of translating evidence into practice using a facilitation model developed by the Western Australian Centre for Evidence Based Nursing and Midwifery. AIMS: Using the conceptual framework Promoting Action on Research Implementation in Health Services (PARIHS), the aims of the study were (1) to explore the relative and combined importance of context and facilitation in the successful implementation of a new evidence-based clinical practice protocol and (2) to examine the establishment of more lasting change to individuals and organizations that resulted in greater incorporation of the principles of evidence-based practice (EBP). METHODS: A pre-workshop, semi-structured telephone survey with 16 nurse managers in six rural hospitals; a summative evaluation immediately post-workshop with 54 participants; and follow-up, semi-structured interviews with 23 workshop participants. FINDINGS: The contexts in each of the participating hospitals were very different; of the six hospitals, only one had not implemented the new protocol. Five had reviewed their practices and brought them in line with the protocol developed at the workshop. The rate of adoption varied considerably from 2 weeks to months. The participants reported being better informed about EBP in general and were positive about their ability to improve their practice and search more efficiently for best practice information. Underlying motivations for protocol development should be included in the PARIHS framework. IMPLICATIONS FOR EDUCATION: Good facilitation appears to be more influential than context in overcoming the barriers to the uptake of EBP.

Is telehealth the right tool for remote communities? Improving health status in rural Australia.

The health status of people in rural and remote areas, particularly of Indigenous Australians, has been widely reported to be poorer than their urban counterparts. Health care in rural and remote Australia has relied on the work of nurses, often in the absence of medical or allied health personnel other than via telecommunication. Over the last 5 years telehealth has been heavily promoted as an innovative and effective way of improving the health status of people in rural and remote areas by providing improved access to specialist care. Through national infrastructure development and funding for a vast array of pilot projects, telehealth provision has been promoted as progressive, effective, and modern. This Editorial reviews the literature and highlights a need for additional research around telehealth-mediated patient practitioner relationships.