An integrative review of the impact of allied health student placements on current staff's knowledge and procedural skills in acute and primary care settings.

BACKGROUND: Staff shortages limit access to health services. The bidirectional benefits of allied health clinical placements are understood in the domains of student learning, health service delivery, and future workforce development. Still, the benefits to current workforce outcomes remain unknown. This review provides insights into the effects of allied health student placements in acute and primary care settings, particularly on healthcare staff's knowledge and procedural skills. METHODS: This search was based on the integrative review process established by Whittemore and Knafl in 2005. In October 2023, the first author (MH) searched five major electronic databases: Medline-EBSCO, PubMed, CINAHL, Embase, and Scopus. The CLUSTER model was used to track additional references. The first three authors (MH, SM, and SC) were involved in screening, quality appraisal, and synthesis of the studies. Data were thematically synthesised and analysed. RESULTS: MeSH headings and keywords were used in key search areas: health education, health professional training, clinical placements, and allied health professions. The systematic search yielded 12 papers on allied health student placements across various healthcare settings in rural and metropolitan areas, with no high-quality methodologies measuring student placements' impact on staff knowledge and skills. Four main themes were identified from the analysis: meaningful student integration in service delivery, targeted educational support to healthcare staff, development of staff procedural skills and confidence, and the mechanisms of why student placements work in this aspect. CONCLUSIONS: This review suggests that offering allied health student placement could be a promising approach to supporting rural healthcare staff in performing patient assessments and treatments proficiently and collaboratively. However, this requires further investigation to confirm.

"When I suffer from fever, I eat mangos." Determinants of health-seeking beliefs and behaviors of rural older women in Sylhet, Bangladesh.

Poverty, poor living conditions, religious values and norms, lack of education, and gender discrimination influence the beliefs and behaviors of rural older women in many low-income countries. This paper aims to report the socio-ecological determinants of health-seeking beliefs and behaviors of rural older women in North-eastern Bangladesh and how these behaviors impact their recognition within the setting. It involved semi-structured interviews with 25 older women and 11 healthcare professionals. The findings revealed various determinants at the personal level (awareness of illness, mistrust toward medical treatment, self-treatment, and religious values and norms), the interpersonal level (isolation in family and communication with clinicians), community level (community perception of aging, neighboring and community organizations), and in the sphere of human rights (care affordability, social safety-net coverage and national policy). Four core determinants (poverty, education, gender and religiosity) were intertwined in shaping beliefs and behaviors.

A Scoping Review of Changes to Patient-Doctor Communication During COVID-19.

Effective communication between patients and doctors is fundamental to high-quality healthcare, patient safety, and overall satisfaction. However, the onset of COVID-19 has prompted significant shifts in communication from in-room and face-to-face interactions to virtual consults. The impact of this pandemic-related change on patient-doctor communication goals, processes, attributes, and environment remains unclear. We undertook a scoping review involving the systematic search of seven academic databases for relevant articles published up to and including June 2021. In total, 47 articles were identified that met the inclusion criteria. We applied the patient-doctor communication framework to guide our deductive thematic analysis of articles included, sorting results from reported studies and position papers into themes and sub-themes. The theme of communication goals highlighted sub-themes related to patient safety, convenience, affordability, and satisfaction; preparation included sub-themes on technology interventions, workforce training, and digital literacy; participant attributes included compassion for doctors and rebuilding trust among patients; and communication process included issues related to telemedicine or video conferencing, challenges with diminished patient privacy, and distractions in the patient's home setting. Finally, the environment theme included insights into doctors' workload, isolation, and anxiety and how changes requiring increases in virtual consults iteratively altered confidence in care provision and communication with patients. Results of the scoping review provide important insights for strengthening virtual patient-doctor interactions, including target areas for training and professional development during and beyond the current pandemic.

Aging, care and dependency in multimorbidity: how do relationships affect older Bangladeshi women's use of homecare and health services?

Gender issues can create major barriers to healthcare utilization for older women with multimorbidity, especially in developing countries like Bangladesh. Elderly rural women in Bangladesh, are the poorest of the poor, and the women with multimorbidity live in a regulated family atmosphere. This study explored the relationship dimensions of older women with multimorbidity in homecare and their utilization of health services. To gain a deeper understanding of these complex issues, a qualitative case study was conducted. Semi-structured, in-depth interviews were conducted with 11 health staff and 22 older women with multimorbidity, living in three residential communities of the Sylhet District, Bangladesh. Our analysis used critical thematic discourse, a technique developed from Axel Honneth's recognition-and-misrecognition theory. Seven relationship dimensions have been identified, and grouped under three major themes: intimate affairs [marital marginalization and parent-children-in law dynamics]; alienation in community relationships [patriarchal sibling relationships, neighborhood challenges, and gender inequality in interactions]; and legal disconnections [ignorance of rights and missed communication]. Our findings revealed a lack of understanding of the women's multimorbid care needs and patriarchal marginalization in family. This lack of understanding together with poor peer-supports in healthcare is perpetuated by misrecognition of needs from service providers, resulting in a lack of quality and poor utilization of homecare and health services. Understanding the high needs of multimorbidity and complexities of older women's relationships can assist in policy decisions. This study deepens our understanding of the ways gender inequality intersects with cultural devaluation to reduce the well-being of older women in developing countries.

Health Services Utilization Barriers for Rural Elderly Women in Bangladesh: Narratives of Clinicians, Pharmacists and Public Health Assistants.

Bangladesh has the third largest population of poor older adults in the world and 73% of them live in rural areas. Disparity in the country's health services is evident that creates a substantial pressure, especially on rural elderly women who live in a compromised socio-cultural atmosphere. This is true that we know about rural elderly women's self-reported health and service use barriers, but no studies captured the views of health staff. This study presents a qualitative exploration of the views held by rural health staff whose role is to provide care to local elderly women. We conducted 11 interviews with clinicians, pharmacists and public health assistants in Sylhet district, Bangladesh. A critical thematic discourse analysis, using the critical social constructs of Habermas and Honneth, of the data informed the women's inadequate healthcare access and associated barriers that were complex and overlapping but had explicit institutional, subjective and material consequences. Five major themes emerged including: unequal distribution of health services; marginalization in patient-staff relationships; living with poverty; social relegation; and mistrust of clinical treatment. Rural areas were viewed with inequitably distributed health services and traditionally a large proportion of elderly women living in poverty who lacked social support and demonstrated a mistrust towards healthcare system. No recognition of the women and power differences were underpinned by economic factors and cultural societal values. The findings suggest a need for health policy solutions and education of healthcare staff and elderly women regarding accessing healthcare.

Health and Social Care Outcomes in the Community: Review of Religious Considerations in Interventions with Muslim-Minorities in Australia, Canada, UK, and the USA.

The aims of this integrative review included examining the intervention characteristics, religious tailoring, and behavioural outcomes of health and social care interventions with Muslim-minorities in Australia, Canada, UK, and the USA. Nineteen articles were included, and each showed some level of improved health and social care outcomes associated with interventions that were religiously tailored to Islamic teachings, and when notions of health were extended to physical, psychological, spiritual and social domains. Future studies should measure levels of religiosity to understand whether religiously tailored interventions produce a significant intervention effect when compared to non-religiously tailored interventions with Muslims.

Person-centered, non-pharmacological intervention in reducing psychotropic medications use among residents with dementia in Australian rural aged care homes.

BACKGROUND: High rates of psychotropic medications are prescribed in aged care homes despite their limited effectiveness and associated adverse effects. We aim to evaluate the changes in prescription patterns for elderly residents with dementia in the 'Harmony in the Bush Dementia Study'. Harmony in the Bush is a person-centered model of dementia care in nursing homes, based on the principles of Progressively Lowered Stress Threshold and person-centered music intervention. METHODS: Our larger study (12 weeks period) was a quasi-experimental design conducted in five rural nursing homes in Australia. Medication charts (n = 31) were collected retrospectively from three rural aged care facilities. Medication data for each resident was collected from a three-month medication charts, pre-intervention, and post-intervention. Fifty-three staff participated in 31 semi-structured interviews and 8 focus groups at post-intervention, and at 1-month and 3-months follow up. RESULTS: The median age of the participants was 83 years, and 68% of them were female. Polypharmacy was measured in 87% (n = 27) of the participants. Hypertension, hyperlipidemia, diabetes, and the Alzheimer's disease were the major comorbidities identified in residents. None of the residents received more than the maximum dose of psychotropic medications recommended by the guidelines. There was a reduction of 22.4% (77.4% vs 55%) in the use of at least any psychotropic medications, 19.6% (39% vs, 19.4%) reduction in antipsychotics and benzodiazepines (39% vs 19.4%), and 6.5% (42% vs 35.5%) reduction in antidepressants prescription medicines, when comparing residents' medication charts data covering 3-months pre- and post-intervention, however, these changes were not statistically significant. Additionally, there was a decreasing trend in the use of inappropriate medications. Psychotropic medications were prescribed in up to 43% and anti-dementia medications in 44% of participants for more than 6 months. Three themes extracted from qualitative data include decrease behavioral and psychiatric symptoms of dementia due to medication weaning or dose tapering, other strategies to reduce medication use, and environmental or noise control. CONCLUSIONS: Our findings indicate that the Harmony in the Bush model as a non-pharmacological approach reduces the prescription of psychotropic medications in rural nursing homes as supported by findings from both quantitative and qualitative data. TRIAL REGISTRATION: ANZCTR, ACTRN12618000263291 . Registered on 20th February 2018.

The outcomes of a person-centered, non-pharmacological intervention in reducing agitation in residents with dementia in Australian rural nursing homes.

BACKGROUND: There is limited best- practice evidence to address behavioral and psychiatric symptoms for those with dementia in Australian rural nursing homes. This study aims to evaluate the outcomes of a person-centered, non-pharmacological dementia care model, 'Harmony in the Bush', based on the Progressively Lowered Stress Threshold principles and person-centered music in rural Australia. METHODS: A quasi-experimental (nonrandomized, pre-post) intervention study was conducted in five rural nursing homes in Queensland and South Australia. Seventy-four residents with dementia participated in this intervention study, which yielded a sample power of 80%. Eighty-seven staff completed the Caregiver Stress Inventory at pre-post four-weeks of intervention. Staff training workshops focused on the theory of the Progressively Lowered Stress Threshold principles and delivery of person-centered care plan with integrated music intervention. We used reported changes in agitation of the residents, measured using Cohen- Mansfield Agitation Inventory, and staff's caregiving stress, using Caregivers Stress Inventory. This study adheres to the CONSORT guidelines. RESULTS: Mean age of residents with dementia was 82.4 (7.7) years and 69% were females. The mean age of admission was 80.1(8.4) years. Baseline measures indicated that 32.7% had mild- severe pain and 30.5% reported mild-severe sadness. The results showed statistically significant decline in aggressive behaviors, physically non-aggressive behaviors, verbally agitated behavior and hiding and hoarding. There was similar reduction in staff stress in the domains of aggressive behaviors, inappropriate behaviors, resident safety, and resource deficiency. CONCLUSIONS: The Harmony in the Bush model is effective in reducing agitation among dementia residents with significant reduction in staff stress levels in nursing homes in rural Australia. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry (ANZCTR) on 20/2/2018 (Registration No: ACTRN12618000263291p). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374458.

Frailty indexed classification of Bangladeshi older adults' physio-psychosocial health and associated risk factors- a cross-sectional survey study.

BACKGROUND: Frailty is associated with healthy ageing, and it has been identified as a means of measuring older adults' physio-psychosocial health. We know about the ageing trends and common diseases of older adults living in South Asia, but literature to date does not widely feature their health status based on frailty, especially in Bangladesh. This study aims to understand the prevalence of frailty in Bangladeshi older adults; classify their health status; and investigate associated risk factors. METHODS: A cross-sectional study was conducted in the north-eastern region (i.e. Sylhet City Corporation) of Bangladesh. Four hundred participants aged 55 years and above were randomly selected, attended a health assessment session and completed a multi-indicator survey questionnaire. We developed a 30-indicator Frailty Index (FI30) to assess the participant's health status and categorized: good health (no-frailty/Fit); slightly poor health (mild frailty); poor health (moderate frailty); and very poor health (severe frailty). Pearson chi-square test and binary logistic regression analysis were conducted. RESULTS: The participants' mean age was 63.6 years, and 61.6% of them were assessed in poor to very poor health (moderate frailty/36.3% - severe frailty/25.3%). The eldest, female and participants from lower family income were found more frailty than their counterparts. Participants aged 70 years and above were more likely (adjusted OR: 4.23, 95% CI: 2.26-7.92, p < 0.0001) to experience frailty (medical conditions) than the pre-elderly age group (55-59 years). Female participants were more vulnerable (adjusted OR = 1.487, 95% CI: 0.84-2.64, p < 0.0174) to frailty (medical conditions) than male. Also, older adults who had higher family income (Income>$473.3) found a lower risk (adjusted OR: 0.294, 95% CI: 0.11-0.76, p < 0.011) of frailty (poor health). CONCLUSION: Our study results confirm the prevalence of frailty-related disorders in Bangladeshi older adults and highlight the importance of targeted clinical and community-led preventive care programs.

Rural disability workforce perspective on effective inter-disciplinary training-A qualitative pilot study.

OBJECTIVE: Inter-professional education is a growing area of importance that enables training of health care professionals and students to develop skills in collaborative clinical practice, a critical aspect of disability care. However, research is limited on appropriate on-site inter-professional training for the rural and remote disability workforce. This paper aims to explore the features of an effective inter-professional training approach for rural disability workforce. SETTING: Riverland, South Australia. PARTICIPANTS: Clinical educators, allied health professionals, health and service providers and students. DESIGN: A qualitative-explorative research design, involving focus group discussion and a thematic analysis method were employed in this study. Participants of the focus group discussion completed a capacity building training program centred on inter-professional education, cultural-safety and the National Disability Insurance Scheme. National Disability Services Social Impact Measurement Tool was used to evaluate and explore the features of effective inter-professional training program for existing and emerging disability workforce in rural regions. RESULTS: Four themes emerged from data analysis: inter-professional education focus; structured inter-professional training; building collaborative learning environment; and culturally appropriate care practice. Inter-professional supervision was identified as a key enabler for capacity building in an area with limited health workforce. Inter-agency collaboration and professional network were identified as important elements to support disability health workforce retention and the transition from novice to practitioner. Prior knowledge about the needs of persons with disability and empathetic relationships influenced the quality of practice. CONCLUSION: In situ training programs, which provide real-life rural practice context and harness inter-agency collaboration, improve effectiveness of rural disability workforce readiness for practice.

The World Is Not Mine - Barriers to Healthcare Access for Bangladeshi Rural Elderly Women.

Social determinants of health is a core cross-cutting approach of the World Health Organization to reduce health inequalities, and places an emphasis on aged care planning in rural areas of low- and lower-middle income countries including Bangladesh. The complex correlated health and social factors in Bangladesh interplay to shape the healthcare access of rural people. This impact is significant for rural elderly women in particular who have been shown to access healthcare in ways that are described as 'socially determined'. This study aimed to explore how this cohort related their healthcare access to their living circumstances and provided insight into how their healthcare access needs can be addressed. This study was a critical social theoretical exploration from conversational interviews held over three months with 25 elderly women in rural Bangladesh. Two critical social constructs, 'emancipation' of Habermas and 'recognition' of Honneth, were used in the exploration and explanation of the influence of personal circumstances, society and system on rural elderly women's healthcare access. The concept of 'social determinants of healthcare access' is defined from the physical, emotive, symbolic and imaginative experiences of these women. Interviewing the women provided information for exploration of the determinants that characterized their experiences into an overall construct of 'The World is Not Mine'. This construct represented four themes focusing on the exclusion from healthcare, oppressive socioeconomic condition, marginalization in social relationships and personal characteristics that led the women to avoid or delay access to modern healthcare. This study confirms that the rural elderly women require adequate policy responses from the government, and also need multiple support systems to secure adequate access to healthcare. As healthcare services are often a reflection of community values and human rights concerns for the elderly, there is a need of recognition and respect of their voice by the family members, society and the healthcare system in planning and implementation of a prudent aged care policy for rural elderly women in Bangladesh.

Self-reported Seasonal Symptoms and Diseases and Primary Healthcare Utilization Among Rural Elderly Women in Sylhet District, Bangladesh.

The physical health and conditions of elderly people are challenged by the adverse effects of seasonal variations in sub-tropical countries, including Bangladesh. Research to date does not feature the risk of seasonal changes for primary healthcare infrastructures and practices in supporting elderly women's care, especially in rural areas. This study aims to identify the health effects of seasonal variations that place increased risk of symptoms and diseases on rural elderly women, and to explore the determinants associated with the women's use of healthcare locally. Using a mixed-methods approach, audio-recorded semi-structured interviews including a short survey with sixty-five rural elderly women and eleven healthcare professionals were conducted. Quantitative data were analyzed in SPSS, and a thematic analysis of the qualitative data was facilitated by NVivo. Self-reported health history by rural elderly women identified the prevalence of three major seasonal symptoms: headache (28/43.1%), digestive disorder (27/41.5%), and physical pain (27/41.5%). The prevalence of three symptoms such as nausea, headache and digestive disorder varied significantly (p < 0.05) across the study villages. Of the women, the age group (60-70 years) recorded the highest number of cases (20), followed by age group (71-80 years/15), where the number of cases significantly varied across three seasons (p = 0.021). While 78.5% and 55.4% reported one and two symptoms/diseases respectively, the community clinic visits differed significantly (p = 0.011) among the seasons. The utilization of primary healthcare was low, and marginalization in using healthcare was underpinned by the health system, the poor living conditions of the women, and their reluctance to seek treatment. The findings suggest a need for policy solutions in promoting preventive measures and treatments by strengthening local clinics and on-going health education and training of staff and elderly women.

Exploring Aboriginal aged care residents' cultural and spiritual needs in South Australia.

BACKGROUND: Attention to culture and its impact on health care can improve the quality of care given, add to our understanding of health care among culturally diverse populations, and encourage a more holistic approach to health care within general care. Connection to culture is important to Aboriginal peoples, and integrating Aboriginal culture into general care in residential aged care facilities may contribute to improving care delivery and outcomes for residents. The literature to date revealed a lack of understanding of the capacity of residential aged care and the health practices of carers in relation to providing cultural care for Aboriginal people. This study aimed to explore how cultural care needs are maintained for Aboriginal residents from their own and their carers' perspectives. METHODS: Applying an Aboriginal centered research method, an Interpretive Descriptive Approach was used as a theoretical framework to explore data in this study. Semi structured audio-recorded interviews were conducted. An additional file provides a complete description of the interview questions used as a guide for the study [see Additional file 1]. Three Residential Aged Care Centres, in South Australia were used i.e., two rural from centres and one urban metropolitan centre. Seven Aboriginal residents and 19 carers participated in interviews. Data was transcribed and an interpretive analysis was employed to code the transcribed data for themes and sub-themes. The study was guided by an Aboriginal community advisory group with an aim to work under the principle of reciprocity; giving back to the communities, participants and those where the research results may have been relevant. RESULTS: Three themes emerged from the views of the residents and carers: (i) lack of resources and funding; (ii) care practice; and (iii) marginalisation of Aboriginal culture within aged care facilities. CONCLUSION: The findings suggest that carers and residents believe cultural inclusion in general care practices may enrich Aboriginal residents' daily life, health and well-being in residential aged care facilities. This study may provide carers, aged care centre managers and policy makers with information on the need of resources, funding, organised care plan and management, and cultural competency of carers to be considered to improve Aboriginal aged care protocols for integrating cultural care into practice.

Older women's experience with COVID-19 pandemic: A study of risk perception and coping among culturally and linguistically diverse population in South Australia.

BACKGROUND: A global catastrophe-the COVID-19 pandemic-appears to have two-dimensional health consequences for older adults: high risk of being infected and psychological distress. There is limited evidence on how the pandemic has impacted the life and coping of older adults who are culturally and linguistically diverse (CALD), women in particular. This study explored the COVID-19 risk perception and coping strategies of older CALD women in South Australia. METHODS: A mixed-methods research design was employed, involving a 31-items coping and emergency preparation scale for survey and semi-structured interviews with participants. The older CALD women were approached through 11 multicultural NGOs. One hundred and nine women participants from 28 CALD communities completed the online surveys; 25 of them agreed to a telephone interview and provided their contact details. 15 older CALD women ultimately participated in interviews. RESULTS: Mean sum-score of dread risk, unknown risk, and fear (M: 43.5; SD: 4.9) indicated that the participants were somewhat anxious and worried. Mean sum-score of coping (M: 79.8; SD: 9.3) reported their compliance with expert advice and disinfection practices but accessing health information (M: 2.8; SD 1.4) and tendency to minimize anxiety (M: 2.1; SD: 1.2) were below neutral. Significant variations were found in coping in terms of age, meaning that the women aged 75 years and older were less likely to cope with the pandemic (P = 0.01). Emergency preparation differed based on the participants' residence and occupation status. The deductive-inductive thematic analysis of interview data was framed around three priori themes: risks of being affected, emotional and behavioral coping, and emergency preparation and access to services. CONCLUSIONS: Evidence shows a fear among the older CALD women with an endeavor to cope and prepare for emergency situations. This suggests the requirements for interventions that improve coping and reduce the risk of stress among them.

Social Support Postpartum: Bengali Women from India on Their Coping Experiences following Childbirth.

Undertaken in Kolkata, India, our study aimed to explore the experiences of Bengali middle-class women on perceived stressful events, social support, and coping experiences following childbirth. Becoming a mother following childbirth is a shared phenomenon irrespective of culture, social strata, or country, while stress during the postpartum period or depression is not. Discrete medical intervention does not sufficiently address the complexities of postpartum experiences since influencing factors also include economic, political, cultural, and social backgrounds. Adopting a feminist and phenomenological approach, individual in-person interviews were conducted with twenty women recruited via snowball sampling. Our findings revealed that events experienced as stressful may lead to poor postpartum well-being. Underpinned by gendered discourse and biases, stressful events included familial imperatives for a male child, poor social and emotional support from the family, mostly partners and fathers, and systemic workplace barriers. The women in our study commonly resided with their mothers postpartum. They expressed feeling sheltered from these experiences, cared for, and supported. We discuss the women's experiences from a feminist pragmatic worldview, which advocates for a flexible feminism recognizant of the unique and nurturing relationship experiences between Bengali middle-class women and their mothers. In conclusion, we advocate for culturally sensitive, women-centered postpartum care practices that may entail the inclusion of intergenerational care during this critical phase of maternal well-being. These insights underscore the necessity of tailoring postpartum support systems to align with the cultural and familial contexts of the individuals they serve.

Skipping breakfast and its association with sociodemographic characteristics, night eating syndrome, and sleep quality among university students in Bangladesh.

INTRODUCTION: Skipping breakfast has become more common, and it can significantly affect a person's health, performance, mood, and other physiological and psychological factors. In Bangladesh, university students often encounter unhealthy dietary habits, which raises questions about why many university students choose to skip breakfast. The purpose of this study was to investigate the prevalence of skipping breakfast among university students in Bangladesh and explore the contributing factors. METHODS: Patuakhali Science and Technology University, Bangladesh was the location of this cross-sectional study. Breakfast consumption was measured with the single-question item, "How often do you eat breakfast?" (Almost every day, sometimes, rarely, or never). Skipping breakfast was classified as respondents selecting sometimes, rarely, or never having breakfast. Sociodemographic, behavioral, and sleep-related data were collected as key predictor variables. Multiple logistic regression models identified factors associated with skipping breakfast. RESULTS: The prevalence of skipping breakfast among study participants (N = 502, 51.6% female and mean age 21.31 years) was 63.5%. Female students were more likely to skip breakfast compared to male students (adjusted odds ratio, AOR = 1.65, 95% CI: 1.06-2.55). Smoker participants had a higher likelihood of skipping breakfast compared to non-smokers (AOR = 3.92, 95% CI: 1.57-9.78). Students with night eating syndrome had a higher likelihood of skipping breakfast compared to their counterparts (AOR = 1.84, 95% CI: 1.06-3.22). Students with poor sleep quality were three times more likely to skip breakfast than their counterparts (AOR = 2.95, 95% CI: 1.93-4.51). Overweight/obese students were less likely to skip breakfast compared to their counterparts (AOR = 0.40, 95% CI: 0.20-0.82). CONCLUSION: This study highlights a high prevalence of skipping breakfast among university students in Bangladesh. Specifically, students who are females, smokers, poor sleepers and who have night eating syndrome are more likely to skip breakfast compared to their counterparts. These findings underscore a need for targeted interventions and educational programs to promote healthy breakfast habits. Addressing these modifiable risk factors can have a positive impact on students' nutritional practices and their health and wellbeing.

Mindfulness meditation use in chronic pain treatment in rural Australia: Pitfalls and potential - A case report.

Mindfulness is a state of awareness characterized by open and non-judgmental recognition of thoughts and sensations and an ability to resist the usual wandering of an individual's attention. Usually achieved by meditation, mindfulness is recognized as a treatment for chronic pain. Evidence, thus far, has been characterized by poor quality trials and mixed results, but a growing body of research is further investigating its effectiveness. Despite inconclusive evidence, the inherent difficulties of mindfulness research, and problems of accessibility in rural settings, mindfulness meditation is an emerging treatment strategy for many chronic pain patients. This report presents the case of a patient admitted to a rural hospital in New South Wales, whose quality of life was severely impacted by chronic pain.

Person-Centred, Culturally Appropriate Music Intervention to Improve Psychological Wellbeing of Residents with Advanced Dementia Living in Australian Rural Residential Aged Care Homes.

This quasi-experimental, nonrandomized intervention study reports the effect of person-centred, culturally appropriate music on psychological wellbeing of residents with advanced dementia in five rural residential aged care homes in Australia. Seventy-four residents attended in person-centred music sessions and culturally appropriate group sessions. Interest, response, initiation, involvement, enjoyment, and general reactions of the residents were assessed using the Music in Dementia Assessment Scale (MiDAS), and interviews and focus groups were conducted with aged care staff and musicians. The overall effect of person-centred sessions at two-time points were: during the intervention-351.2 (SD 93.5); and two-hours post intervention-315.1 (SD 98.5). The residents presented a moderate to high level of interest, response, initiation, involvement, and enjoyment during the session and at post-intervention. However, the MiDAS sub-categories' mean scores differed between the time-points: interest (t59 = 2.8, p = 0.001); response (t59 = 2.9, p = 0.005); initiation (t59 = 2.4, p = 0.019); and involvement (t59 = 2.8, p = 0.007), indicating a significant decline in the effect of person-centred music over time. Interestingly, during the period of time, most of the residents were observed with no exhibitions of agitation (87.5%), low in mood (87.5%), and anxiousness (70.3%), and with a presentation of relaxation (75.5%), attentiveness (56.5%), and smiling (56.9%). Themes from qualitative data collected regarding culturally appropriate group music sessions were behavioural change, meaningful interaction, being initiative, increased participation, and contentment. The findings suggest that the integration of music into care plans may reduce the residents' agitation and improve their emotional wellbeing in rural aged care homes.

Virtual Dementia-Friendly Communities (Verily Connect) Stepped-Wedge Cluster-Randomised Controlled Trial: Improving Dementia Caregiver Wellbeing in Rural Australia.

Caring for people living with dementia often leads to social isolation and decreased support for caregivers. This study investigated the effect of a Virtual Dementia-Friendly Rural Communities (Verily Connect) model on social support and demand for caregivers of people living with dementia. The co-designed intervention entailed an integrated website and mobile application, peer-support videoconference, and technology learning hubs. This mixed-methods, stepped-wedge, cluster-randomised controlled trial was conducted with 113 participants from 12 rural communities in Australia. Caregiver data were collected using MOS-SSS and ZBI between 2018 and 2020. The relationship between post-intervention social support with age, years of caring, years since diagnosis, and duration of intervention were explored through correlation analysis and thin plate regression. Google Analytics were analysed for levels of engagement, and cost analysis was performed for implementation. Results showed that caregivers' perception of social support (MOS-SSS) increased over 32 weeks (p = 0.003) and there was a marginal trend of less care demand (ZBI) among caregivers. Better social support was observed with increasing caregiver age until 55 years. Younger caregivers (aged <55 years) experienced the greatest post-intervention improvement. The greatest engagement occurred early in the trial, declining sharply thereafter. The Verily Connect model improved caregivers' social support and appeared to ease caregiver demand.