Implementing an anti-smoking program in rural-remote communities: challenges and strategies.

INTRODUCTION: Rural-remote communities report higher smoking rates and poorer health outcomes than that of metropolitan areas. While anti-smoking programs are an important measure for addressing smoking and improving health, little is known of the challenges faced by primary healthcare staff implementing those programs in the rural-remote setting. The aim of this study was to explore the challenges and strategies of implementing an anti-smoking program by primary healthcare staff in rural-remote Australia. METHODS: Guided by a phenomenological approach, semi-structured interviews and focus groups were conducted with health service managers, case managers and general practitioners involved in program implementation in Australian rural-remote communities between 2008 and 2010. RESULTS: Program implementation was reported to be challenged by limited primary and mental healthcare resources and client access to services; limited collaboration between health services; the difficulty of accessing staff training; high levels of community distress and disadvantage; the normalisation of smoking and its deleterious impact on smoking abstinence among program clients; and low morale among health staff. Strategies identified to overcome challenges included appointing tobacco-dedicated staff; improving health service collaboration, access and flexibility; providing subsidised pharmacotherapies and boosting staff morale. CONCLUSIONS: Findings may assist health services to better tailor anti-smoking programs for the rural-remote setting, where smoking rates are particularly high. Catering for the unique challenges of the rural-remote setting is necessary if anti-smoking programs are to be efficacious, cost-effective and capable of improving rural-remote health outcomes.

To Be or Not: A Brief History of the Health Humanities Consortium.

The Health Humanities Consortium (HHC) was established in 2015 to "promote health humanities scholarship, education, and practice through transdisciplinary methods and theories that focus on the intersection of the arts and humanities, health, illness, and healthcare." As the founding co-chairs of the HHC, we provide a history of the founding of this organization in this article, describing the journey of its creation, the choices and challenges it faced as a new organization, and our hopes for a rich future.

Bless me reader for I have sinned: physicians and confessional writing.

From the poetry of William Carlos Williams, the novels of Walker Percy, and the short stories of Anton Chekov to the contemporary essays of Atul Gawande, physicians' contributions to literary genres have been significant. This article explores the specific form of confessional writing offered by physicians during the past half century, writing that often exposes medical error or negative feelings towards patients. A history of confessional practices as a legal tool, as religious practice, and as literary genre is offered, followed by analyses of selected confessional writings by physicians, many of them found in clinical journals such as Journal of the American Medical Association, Annals of Internal Medicine, and the Lancet. The authors of the narratives described here are engaged in several or all elements of the confessional sequence, which may offer them some resolution through the exposure and acknowledgment of their shared humanity with their patients and their expression of regret for any harm done.

The effect of a soap promotion and hygiene education campaign on handwashing behaviour in rural India: a cluster randomised trial.

OBJECTIVE: To investigate the effectiveness of a hygiene promotion intervention based on germ awareness in increasing handwashing with soap on key occasions (after faecal contact and before eating) in rural Indian households. METHODS: Cluster randomised trial of a hygiene promotion intervention in five intervention and five control villages. Handwashing was assessed through structured observation in a random sample of 30 households per village. Additionally, soap use was monitored in a sub-sample of 10 households per village using electronic motion detectors embedded in soap bars. RESULTS: The intervention reached 40% of the target population. Germ awareness increased as well as reported handwashing (a possible indicator of perceived social norms). Observed handwashing with soap on key occasions was rare (6%), especially after faecal contact (2%). Observed handwashing with soap on key occasions did not change 4 weeks after the intervention in either the intervention arm (-1%, 95% CI -2%/+0.3%), or the control arm (+0.4%, 95% CI -1%/+2%). Data from motion detectors indicated a significant but small increase in overall soap use in the intervention arm. We cannot confidently identify the nature of this increase except to say that there was no change in a key measure of handwashing after defecation. CONCLUSION: The intervention proved scalable and effective in raising hygiene awareness. There was some evidence of an impact on soap use but not on the primary outcome of handwashing at key times. However, the results do not exclude that changes in knowledge and social norms may lay the foundations for behaviour change in the longer term.

The Donor Letter Project: Learning Professionalism and Fostering Empathy in an Anatomy Curriculum.

While cadaver dissection remains an unmatched learning tool for structural anatomy, recent shifts in medical culture and pedagogy indicate that developing humanistic practices and fostering empathic responses are crucial components of early medical education. The Donor Letter Project (DLP) was designed to accompany a traditional dissection curriculum, and the pilot, described here, tested its quality and efficacy. In 2017, family members of recently deceased donors to the Colorado State Anatomical Board were invited to submit letters about their loved ones, and forty-seven first-year medical students at the University of Colorado School of Medicine volunteered to read the letters after their human anatomy course. The students then completed a survey about their experience. Because student and donor family responses to the DLP were overwhelmingly positive, the DLP will be repeated with incoming medical school classes, and an addendum to the State Anatomical Board donation application will invite donors to submit letters along with their enrollment materials that may be read by students at the time of donation.

Influencing population health performance: feedback from managers, population health staff and clinicians on the NSW Population Health Standards for Area Health Services.

The NSW Population Health Standards for Area Health Services have recently been introduced in NSW to assist area health services assess and improve performance in population health. Greater Western Area Health Service was the pilot site for trialling the Standards as a self-assessment tool. Following self-assessment, managers, population health staff and clinicians were asked for feedback. Staff were either interviewed or participated in a group discussion. Consulting with staff who would be required to use the Standards in the long term was seen as important for facilitating implementation across the area health service. The Standards were seen as credible and potentially beneficial, especially in raising the profile of population health work and encouraging population-based and integrated approaches.

Influencing population health performance: introduction of standards for area health services in New South Wales.

Standards are a yardstick against which performance can be assessed and improved. Standards are well established in healthcare settings; however, population health standards have only recently been developed for area health services in NSW. This paper describes international and Australian population health standards, and presents the results of a pilot evaluation of the NSW Population Health Standards for Area Health Services against the Greater Western Area Health Service performance requirements. The findings revealed that the standards relating to the work of specialist population health staff feature in performance requirements; however the standards requiring the contribution of other health service staff do not. Population health standards have the potential to guide the health system towards population health goals.

The Almost Right Word: The Move From Medical to Health Humanities.

Since the emergence of the field in the 1970s, several trends have begun to challenge the original assumptions, claims, and practices of what became known as the medical humanities. In this article, the authors make the case for the health humanities as a more encompassing label because it captures recent theoretical and pedagogical developments in higher education such as the shift from rigid disciplinary boundaries to multi- and interdisciplinary inquiry, which has transformed humanities curricula in health professions. Calling the area of study health humanities also underscores the crucial distinction between medicine and health. Following a brief history of the field and the rationales that brought humanities disciplines to medical education in the first place-the "why" of the medical humanities-the authors turn to the "why" of the health humanities, using disability studies to illuminate those methodologies and materials that represent the distinction between the two. In addition, the authors make note of how humanities inquiry has now expanded across the landscape of other health professions curricula; how there is both awareness and evidence that medicine is only a minor determinant of health in human populations alongside social and cultural factors; and finally, how the current movement in health professions education is towards interdisciplinary and interprofessional learning experiences for students.

On Becoming a Humanities Curriculum: the Center for Medical Humanities and Ethics at the University of Texas Health Science Center at San Antonio.

The authors describe the development and implementation of a new longitudinal and integrated humanities curriculum in the School of Medicine at the University of Texas Health Science Center at San Antonio. Included are a history of ethics and humanities education in the medical school leading to the creation of the Center for Medical Humanities and Ethics in July 2002; an articulation of the Center's basic principles; a curricular blueprint outlining the core objectives and methodologies, such as a narrative approach of this required, four-year humanities curriculum for undergraduate medical students; and an overview of course materials and activities.

Reflection in/and writing: pedagogy and practice in medical education.

During the past decade, "reflection" and "reflective writing" have become familiar terms and practices in medical education. The authors of this article argue that the use of the terms requires more thoughtfulness and precision, particularly because medical educators ask students to do so much reflection and reflective writing. First, the authors discuss John Dewey's thoughts on the elements of reflection. Then the authors turn the discussion to composition studies in an effort to form a more robust conception of reflective writing. In particular, they examine what the discipline of composition studies refers to as the writing process. Next, they offer two approaches to teaching composition: the expressivist orientation and the critical/cultural studies orientation. The authors examine the vigorous debate over how to respond to reflective writing, and, finally, they offer a set of recommendations for incorporating reflection and reflective writing into the medical curriculum.

Ross River virus disease in inland NSW: higher than average notifications in 2007-08.

This study showed that Ross River virus notifications in the Greater Western Area Health Service of NSW were higher in 2007-08 than any other financial year for the 1997-2009 period. The study also examined the epidemiology of those notifications. Notification and population data were retrieved from the NSW Health Notifiable Diseases Database and HOIST Populations Library respectively. Age-standardised notification rates were highest in Bogan, Bourke, Brewarrina, Gilgandra, Narromine, Walgett and Warren. Notifications peaked for the 35-39-year age group and were evenly distributed between the sexes. Notifications peaked in February. Aboriginal status was under-reported.

Quantitative assessment of pleasant touch.

The hedonic attributes of tactile stimulation are important to one's quality of life, yet they have rarely been studied scientifically. The earliest experimental investigations suggested soft and smooth materials as pleasant, those that were stiff, rough, or coarse as unpleasant. More recent studies conducted by the authors and described herein obtained ratings of pleasantness of different textured materials stroked across the skin of multiple body sites at controlled velocities and forces of application. Statistically significant interactions between materials, sites, velocities, forces and subject sex attest to the complexity of the percept. Less pleasant percepts arose from stimuli that were rougher. However, the difficulty in making further general statements regarding hedonic touch raises questions as to whether the body surface can be mapped affectively in a meaningful manner with a single stimulus and indeed whether pleasantness-to-touch can be viewed as a unidimensional construct.