Extension, austerity, and emergence: Themes identified from a global scoping review of non-urban occupational therapy services

INTRODUCTION

Rural communities contribute to national wellbeing, identities, economies, and social fabrics yet experience increased risk of mortality, morbidity, and disability, coupled with lower levels of income, formal education, and employment than urban citizens. Despite higher need, occupational therapy services are maldistributed to urban locations. Publications about non-urban services discuss predominantly outreach-based, individualist, rehabilitation for specified diagnoses/age groups. However, given this population level inequity, it is unclear why individualist focussed services are more commonly discussed. Understanding intentions expressed in publications about non-urban service design may identify assumptions/limitations to current approaches and contribute to improved future services.

METHODS

Each of 117 publications identified in a scoping review was read by two reviewers to independently identify themes. Provisional themes were discussed and modified in an iterative process to develop final themes/subthemes. The first author reinterrogated the publications and coded data to identify relevant examples to support the identified themes.

RESULTS

Three key themes and nine subthemes were identified. Hegemonic perspectives were found in the themes (i) Extension of urban practice and (ii) Austerity, particularly in the Global North. Non-urban services were typically extended to non-urban contexts underpinned by austerity and neoliberal values such that non-urban persons and their context were problematised rather than service or funding design. A counter-hegemonic perspective was found in the theme (iii) Responses to situational realities more commonly in Global South publications, which valued non-urban contexts, and focussed on developing non-urban communities and promoting justice.

CONCLUSION

The hegemonic paradigm links occupational therapy services with neoliberal notions of individualism, private provision of care, and efficiency/market value, rather than the occupational therapy values for justice. The profession must consider our role in perpetuating injustice for non-urban people and consider if and how more contextually tailored counter hegemonic place-based paradigms can be developed from and with regional, rural, and remote practice.

Epidemiology of Neuromelioidosis in Asia-Pacific: A Systematic Review

Introduction: Neuromelioidosis is a rare complication of melioidosis caused by Burkholderia pseudomallei, a Gram-negative bacterium commonly found in soil and surface water. Although cerebral involvement of melioidosis comprises only 4% of total complications, it significantly impacts mortality and morbidity. This study aims to perform a systematic review on various neurological complications of melioidosis in the Asia-Pacific region within the previous 5 years. Method: Systematic search was performed in PubMed, Web of Science databases and Google Scholar on neuromelioidosis complications published from 2015-2019. Results: Central nervous system (CNS) complications comprise 5% of all cases of melioidosis. 16 selected articles were analysed based on its risk factors like diabetes mellitus, chronic renal and lung disease, alcohol abuse, and immunosuppression. Neuromelioidosis is detected 6-14 days after the first presentation and confirmed by detailed investigations. Radioimaging helps to differentiate neuromelioidosis from other diagnoses such as meningitis or brain abscess. The majority of literature recommended 2-week intensive Ceftazidime or Meropenem therapy, followed by 3–6 months Trimethoprim and Sulfamethoxazole oral eradication therapy. Conclusion: Neuromelioidosis is rare, with relatively nonspecific CNS clinical features. Patients or travelers from endemic areas with risk factors should be treated cautiously. Radioimaging modalities aid early microbiological sampling and appropriate antibiotic therapy.