Sarah Larkins

Telemedicine for rural cancer care in North Queensland: Bringing cancer care home

OBJECTIVE To describe the use of telemedicine in cancer care (teleoncology model of care) for rural patients in North Queensland. DESIGN This is a descriptive study. Data on demographical and clinical factors were retrieved from the teleoncology database of Townsville Hospital and review of medical records for the period between May 2007 and May 2011. SETTING AND PARTICIPANTS The medical oncologists at the Townsville Cancer Centre, a regional cancer centre in North Queensland, have been providing their services to rural hospitals in Townsville and Mt Isa districts via videoconferencing since 2007. INTERVENTION   Cancer care delivery to rural sites via Townsville teleoncology model. MAIN OUTCOME MEASURES The ability of the teleoncology model to provide the following services to rural towns: (i) specialist consultations; (ii) urgent specialist medical care; (iii) care for Indigenous patients; and (iv) remote supervision of chemotherapy administration. RESULTS Between May 2007 and May 2011, 158 patients from 18 rural towns received a total of 745 consultations. Ten of these patients were consulted urgently and treatment plans initiated locally, avoiding interhospital transfers. Eighteen Indigenous patients received consultative services, being accompanied by more than four to six family members. Eighty-three patients received a range of intravenous and oral chemotherapy regimens in Mt Isa and oral agents in other towns through remote supervision by medical oncologists from Townsville. CONCLUSION Teleoncology model of care allows rural and Indigenous cancer patients to receive specialist consultations and chemotherapy treatments closer to home, thus minimising the access difficulties faced by the rural sector.

Localisation of calcitonin gene-related peptide immunoreactivity within the spinal nucleus of the genitofemoral nerve

Because transection of the genitofemoral nerve (GFN) prevents inguino-scrotal testicular descent, we postulated that a neuro-transmitted may act as a “second messenger” for androgen to cause gubernacular migration. Immunohistochemistry for various neuropeptides was performed on frozen serial sections of upper lumbar spinal cord and pelvis from immature male and female rats and immature male, female, and testicular feminisation syndrome (TFM) mice. Calcitonin gene-related peptide (CGRP) immunoreactivity was present in significant amounts in the soma of motor neurons in the 1st and 2nd lumbar segments. Vasoactive intestinal peptide, 5-hydroxytryptamine, somatostatin 8, met-enkephalin, substance P, thyrotrophin releasing hormone, and neuropeptide Y were not present above background levels in upper lumbar motor neurons. Colocalisation studies, combining fluorescent retrograde labelling of the GFN with immunohistochemistry for CGRP, showed that the CGRP staining was localized within the motor nucleus of the GFN. Quantification in mice of cells within this nucleus that contained CGRP immunoreactivity showed that the nucleus of the GFN contained more numerous and larger cells in male mice than in TFM or female mice. The proportion of cells that were positive for CGRP immunoreactivity was greatest in males, suggesting that sexual dimorphism of CGRP may be important in gubernacular migration and inguino-scrotal testicular descent.

Risk factors for preterm, low birth weight and small for gestational age birth in urban Aboriginal and Torres Strait Islander women in Townsville

Objectives: To assess the characteristics of Indigenous births and to examine the risk factors for preterm (<37 weeks), low birth weight (<2,500 g) and small for gestational age (SGA) births in a remote urban setting.

Community participation in rural primary health care: intervention or approach?

Community participation is considered important in primary health care development and there is some evidence to suggest it results in positive health outcomes. Through a process of synthesising existing evidence for the effectiveness of community participation in terms of health outcomes we identified several conceptual areas of confusion. This paper builds on earlier work to disentangle the conceptual gaps in this area, and clarify our common understanding of community participation. We conducted a research synthesis of 689 empirical studies in the literature linking rural community participation and health outcomes. The 37 final papers were grouped and analysed according to: contextual factors; the conceptual approach to community participation (using a modification of an existing typology); community participation process; level of evidence; and outcomes reported. Although there is some evidence of benefit of community participation in terms of health outcomes, we found only a few studies demonstrating higher levels of evidence. However, it is clear that absence of evidence of effect is not necessarily the same as absence of an effect. We focus on areas of debate and lack of clarity in the literature. Improving our understanding of community participation and its role in rural primary health care service design and delivery will increase the likelihood of genuine community-health sector partnerships and more responsive health services for rural communities.

Measuring social accountability in health professional education: Development and international pilot testing of an evaluation framework

Background: Health professional schools are responsible for producing graduates with competencies and attitudes to address health inequities and respond to priority health needs. Health professional schools striving towards social accountability founded the Training for Health Equity Network (THEnet). Aim: This article describes the development of THEnet evaluation framework for socially accountable health professional education, presents the framework to be used as a tool by other schools and discusses the findings of pilot implementation at five schools. Methods: The framework was designed collaboratively and built on Boelen and Woollards conceptualization, production and usability model. It includes key components, linked to aspirational statements, indicators and suggested measurement tools. Five schools completed pilot implementation, involving workshops, document/data review and focus group discussions with faculty, students and community members. Results: Three sections of the framework consider: How does our school work?; What do we do? and What difference do we make? Pilot testing proved that the evaluation framework was acceptable and feasible across contexts and produced findings useful at school level and to compare schools. The framework is designed as a formative exercise to help schools take a critical look at their performance and progress towards social accountability. Initiatives to implement the framework more widely are underway. The framework effectively aids in identifying strengths, weaknesses and gaps, with a view to schools striving for continuous self-improvement. Conclusion: THEnet evaluation framework is applicable and useful across contexts. It is possible and desirable to assess progress towards social accountability in health professional schools and this is an important step in producing health professionals with knowledge, attitudes, and skills to meet the challenges of priority health needs of underserved populations.

Prevalence of sexually transmitted infections in pregnant urban Aboriginal and Torres Strait Islander women in northern Australia

Objective:  To assess the prevalence of sexually transmitted infections (STI) in a cohort of pregnant urban Indigenous women and association of STI with preterm birth, low birthweight birth and perinatal mortality.

Fluorescent anterograde labelling of the genitofemoral nerve shows that it supplies the scrotal region before migration of the gubernaculum

The genitofemoral nerve (GFN) contains a sexually dimorphic neuropeptide transmitter, calcitonin generelated peptide (CGRP). It has been proposed that release of CGRP from the nerve may mediate testicular descent. The aim of this study was to determine the course of the GFN in order to see if CGRP-containing fibres reached the future scrotum before gubernacular migration occurs, since this arrangement would be expected if the nerve controls gubernacular migration by CGRP release. Fluorescent anterograde labelling of the cut GFN in young rats using diamidinophenyl indole (DAPI) or Fast Blue was performed to determine the distal course of the nerve. On frozen serial sections, the nerve was found running posterolateral to the developing spermatic cord in the inguinal canal, then distally on the surface of the cremaster muscle. It then turned cranially to enter the gubernaculum from its distal attachment while some branches continued past the gubernaculum to end in the skin of the future scrotum. Immunoperoxidase staining for CGRP showed labelling in all GFN fibre bundles, including those reaching the scrotum. The course of the nerve with its sexually dimorphic neurotransmitter, CGRP, suggests that the nerve may influence the direction of gubernacular migration from the groin into the scrotum.

Impact of selection strategies on representation of underserved populations and intention to practise: international findings

Socially accountable medical schools aim to reduce health inequalities by training workforces responsive to the priority health needs of underserved communities. One key strategy involves recruiting students from underserved and unequally represented communities on the basis that they may be more likely to return and address local health priorities. This study describes the impacts of different selection strategies of medical schools that aspire to social accountability on the presence of students from underserved communities in their medical education programmes and on student practice intentions.

Medical schools as agents of change: socially accountable medical education

Medical education reform can make an important contribution to the future health care of populations. Social accountability in medical education was defined by the World Health Organization in 1995, and an international movement for change is gathering momentum. Priority community needs are generally not well reflected in existing medical curricula. Medical schools have often been concerned more with prestige, research competitiveness and training doctors for narrow specialist careers in urban areas. Orthodoxies in medical education have been challenged where the gap between a communitys health care needs and the availability of doctors has been greatest — notably in rural areas and, in Australia, in Aboriginal communities. At a time of growing crisis in health care systems, the need to focus on addressing health inequalities and delivering effective, affordable, people‐centred health care is more important than ever. While change can be enabled with policy levers, such as funding tied to achieving equity outcomes and systems of accreditation, medical schools and students themselves can lead the transformation agenda. An international movement for change and coalitions of medical schools with an interest in socially accountable medical education provide a “community of practice” that can drive change from within.

Factors to consider in smoking interventions for Indigenous women

More than 18,000 Australians die annually from diseases caused by tobacco. Indigenous Australians suffer a greater smoking-related disease burden than the remainder of the general public and have a higher prevalence of tobacco use than other Australians. The overall decline in smoking rates is slowest in women of low educational status between the ages of 25 -44. This is of particular concern as these young women may be pregnant or raising young children. During pregnancy, the effects on the foetus from cigarette smoke include respiratory illness, low birthweight and Sudden Infant Death Syndrome. However, if the mother is able to give up smoking by her fourth month of pregnancy, her risk of delivering a low birthweight baby decreases to nearly that of a non-smoker. As part of the planning to develop an effective smoking cessation program for young Indigenous pregnant women, the Townsville Aboriginal and Islanders Health Services (TAIHS) surveyed a group of women to assess smoking habits, attitudes to smoking, nicotine dependence and readiness for change. This paper reports on this survey and the results found can be used to develop a tailored, smoking cessation program for Indigenous women.