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Koukalova L, Chmelova M, Amlerova Z, Vargova L. Out of the core: the impact of focal ischemia in regions beyond the penumbra. Front Cell Neurosci 2024; 18:1336886. [PMID: 38504666 PMCID: PMC10948541 DOI: 10.3389/fncel.2024.1336886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/08/2024] [Indexed: 03/21/2024] Open
Abstract
The changes in the necrotic core and the penumbra following induction of focal ischemia have been the focus of attention for some time. However, evidence shows, that ischemic injury is not confined to the primarily affected structures and may influence the remote areas as well. Yet many studies fail to probe into the structures beyond the penumbra, and possibly do not even find any significant results due to their short-term design, as secondary damage occurs later. This slower reaction can be perceived as a therapeutic opportunity, in contrast to the ischemic core defined as irreversibly damaged tissue, where the window for salvation is comparatively short. The pathologies in remote structures occur relatively frequently and are clearly linked to the post-stroke neurological outcome. In order to develop efficient therapies, a deeper understanding of what exactly happens in the exo-focal regions is necessary. The mechanisms of glia contribution to the ischemic damage in core/penumbra are relatively well described and include impaired ion homeostasis, excessive cell swelling, glutamate excitotoxic mechanism, release of pro-inflammatory cytokines and phagocytosis or damage propagation via astrocytic syncytia. However, little is known about glia involvement in post-ischemic processes in remote areas. In this literature review, we discuss the definitions of the terms "ischemic core", "penumbra" and "remote areas." Furthermore, we present evidence showing the array of structural and functional changes in the more remote regions from the primary site of focal ischemia, with a special focus on glia and the extracellular matrix. The collected information is compared with the processes commonly occurring in the ischemic core or in the penumbra. Moreover, the possible causes of this phenomenon and the approaches for investigation are described, and finally, we evaluate the efficacy of therapies, which have been studied for their anti-ischemic effect in remote areas in recent years.
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Affiliation(s)
- Ludmila Koukalova
- Department of Neuroscience, Second Faculty of Medicine, Charles University, Prague, Czechia
| | - Martina Chmelova
- Department of Neuroscience, Second Faculty of Medicine, Charles University, Prague, Czechia
- Department of Cellular Neurophysiology, Institute of Experimental Medicine of the Czech Academy of Sciences, Prague, Czechia
| | - Zuzana Amlerova
- Department of Neuroscience, Second Faculty of Medicine, Charles University, Prague, Czechia
| | - Lydia Vargova
- Department of Neuroscience, Second Faculty of Medicine, Charles University, Prague, Czechia
- Department of Cellular Neurophysiology, Institute of Experimental Medicine of the Czech Academy of Sciences, Prague, Czechia
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Di Prima S, Nguyen Dinh D, Reurings DD, Wright EP, Essink D, Broerse JEW. Home-Grown School Feeding: Implementation Lessons From a Pilot in a Poor Ethnic Minority Community in Vietnam. Food Nutr Bull 2022; 43:271-302. [PMID: 35470722 PMCID: PMC9403386 DOI: 10.1177/03795721221088962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: Undernutrition threatens the health and future of preschool children in
disadvantaged remote communities. Home-grown school feeding (HGSF) in
nursery schools could positively impact children’s nutrition while creating
multiple benefits for the whole community. However, evidence is lacking on
implementation of HGSF within multi-sectoral programs in remote areas. Objective: This study assessed an HGSF pilot intervention, part of a nutrition-sensitive
agriculture (NSA) program, in a mountain ethnic minority community in
Vietnam. It aimed to identify the changes brought about by the intervention,
in particular diversity of children’s food, food sources, barriers and
facilitators to change, and future challenges and strategies. Methods: Mixed-methods assessment covered school meal diversity, cost, and food
sources but the key focus was on observed changes resulting from the HGSF
intervention and perceived barriers and facilitators to its implementation.
Data were collected mainly through semi-structured interviews (n = 30) and
seven focus group discussions (n = 76). Results: School meals contributed to increasing diversity of food consumed by
children. Above 30% of foods used were home-grown. Respondents reported
increased school attendance; children’s food preferences and hygiene
practices improved as did parents’ caring and feeding practices. Local food
systems became less cash-crop-oriented and more self-reliant, contributing
to household food security and income generation. Social capital increased.
Positive changes were attributed to HGSF and synergy among NSA program
components. Poverty and limited resilience to external shocks threatened
sustainability. Conclusions: Implementing HGSF within an NSA program in a mountainous ethnic minority area
with a high prevalence of undernutrition benefitted children and their
communities.
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Affiliation(s)
- Sabina Di Prima
- Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Sabina Di Prima and Dai Nguyen Dinh contributed equally to this work and qualify as first authors for this publication
| | - Dai Nguyen Dinh
- Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Sabina Di Prima and Dai Nguyen Dinh contributed equally to this work and qualify as first authors for this publication
| | | | - E Pamela Wright
- Guelph International Health Consulting, Amsterdam, the Netherlands
| | - Dirk Essink
- Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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3
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Mahdi SS, Allana R, Battineni G, Khalid T, Agha D, Khawaja M, Amenta F. The promise of telemedicine in Pakistan: A systematic review. Health Sci Rep 2022; 5:e438. [PMID: 35028430 PMCID: PMC8738974 DOI: 10.1002/hsr2.438] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/14/2021] [Accepted: 09/27/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Telemedicine offers the possibility of provision of medical assistance to remote patients, and it has great potential in developing countries like Pakistan. Telemedicine solves logistical barriers, gives support to weak health systems, and helps to establish worldwide networks of healthcare professionals. Because of the high implementation costs, it is not possible yet to adopt telehealth systems for low- and middle-income nations. OBJECTIVE To present a revision of region-based telemedical services in Pakistan. METHODS Libraries such as PubMed (Medline), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Scopus (EMBASE), and Google Scholar were used for document search. Newcastle-Ottawa Scale (NOS) was adopted to conduct study quality. Many of the studies (n-8) included in the review were of high quality as assessed through the Newcastle-Ottawa scale. Selected study characteristics were further analyzed based on different parameters such as publication year, sample size, study design, methods, motivation, and outcomes. RESULTS Search produced 955 articles and 11 items were ultimately selected to conduct the review. These studies were further characterized as region-based telemedicine implementation. Out of 11, eight studies were conducted in the urban region and three studies were conducted in the rural areas of Pakistan. Many studies produced evidence on telehealth interventions by smartphone services such as SMS, apps, and web-based telemedicine. CONCLUSIONS Telehealth interventions such as mHealth, eHealth, telemedicine, and telepharmacy in Pakistan were introduced starting from the last two decades. For obtaining the full benefits of these technologies, it is necessary that they but certainly need to become an integral part of Pakistan's current health infrastructure.
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Affiliation(s)
- Syed Sarosh Mahdi
- Department of Community DentistryJinnah Medical and Dental College, Sohail UniversityKarachiPakistan
- Athena Center for Advanced Research in HealthcareCamerinoItaly
- Center of Clinical Research, Telemedicine & Telepharmacy DepartmentSchool of Medicinal and Health products Sciences, University of CamerinoMacerataItaly
| | - Raheel Allana
- Department of Pediatrics & Child HealthAga Khan University HospitalKarachiPakistan
| | - Gopi Battineni
- Center of Clinical Research, Telemedicine & Telepharmacy DepartmentSchool of Medicinal and Health products Sciences, University of CamerinoMacerataItaly
| | - Tamsal Khalid
- Department of Community DentistryJinnah Medical and Dental College, Sohail UniversityKarachiPakistan
| | - Daniyal Agha
- Department of Community DentistryJinnah Medical and Dental College, Sohail UniversityKarachiPakistan
| | - Mariam Khawaja
- Department of Community DentistryJinnah Medical and Dental College, Sohail UniversityKarachiPakistan
| | - Francesco Amenta
- Center of Clinical Research, Telemedicine & Telepharmacy DepartmentSchool of Medicinal and Health products Sciences, University of CamerinoMacerataItaly
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Lykomitrou A, Stylianidis S, Geitona M, Pantelidou S, Souliotis K. Assessment of the Mobile Mental Health Units' effectiveness in Cyclades islands. Psychiatriki 2021; 32:199-207. [PMID: 34390558 DOI: 10.22365/jpsych.2021.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
In Greece, the provision of mental health shows inefficiencies in remote and inaccessible areas due to the lack of appropriate structures and access to healthcare. The purpose of this study was to assess the effectiveness of the Mobile Mental Health Units (MMHUs) in Cyclades with and without MMHUs' operation based on Real-World Evidence (RWE). The study population consisted of 724 people who visited the MMHUs of the western and northeastern Cyclades in 2015. The data derived from the patients' medical records of EPAPSY classified by International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) and the Global Assessment of Functioning (GAF) scale. The analysis revealed that 60.9% of the participants were women and the average age was 50.1. 50.4% of the people who visited MMHUs without referral from primary health care professionals and 18.8% with referral. The calculation of effectiveness was based on DALYs (Disability-Adjusted Life Years) and was performed according to the World Health Organization methodology. In the specific population, there are no recorded deaths caused by mental disorders and thus DALYs are equal to Years Lost due to Disability (YLDs) with MMHUs' operation. 18% of the population was diagnosed with mood disorders (F30-F39) and morbidity burden 9.49 (YLDs), while 17.5% of the patients were diagnosed with neurotic, stress-related and somatoform disorders (F40-F48) and corresponding morbidity burden 4.53 (YLDs). Our results revealed that the effectiveness of MMHUs corresponds to 17.98 Disability-Adjusted Life Years (DALYs) averted in 2015. The mood disorders and the neurotic, stress-related disorders have shown a high morbidity burden. Advanced age, non-permanent employment, existence of psychopathology in the family and referral on patients' own will were found to significantly affect the mental health status of the participants. The implementation and expansion of flexible and alternative community-based interventions, such as MMHUs, constitute a best practice both for obtaining higher clinical outcomes and for facing regional inefficiencies related to population's access to healthcare.
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Affiliation(s)
- Aikaterini Lykomitrou
- Department of Social and Educational Policy, School of Social Sciences, University of Peloponnese, Corinth, Greece
| | - Stelios Stylianidis
- Department of Psychology, Panteion University of Social and Political Sciences, Athens, Greece
| | - Mary Geitona
- Department of Social and Educational Policy, School of Social Sciences, University of Peloponnese, Corinth, Greece
| | - Stella Pantelidou
- Scientific Association for the Regional Development and Mental Health (EPAPSY)
| | - Kyriakos Souliotis
- Department of Social and Educational Policy, School of Social Sciences, University of Peloponnese, Corinth, Greece
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He K, Weng D, Ji S, Wang Z, Chen W, Lu Y, Nie Z. Improving the Performance of Time-Relative GNSS Precise Positioning in Remote Areas. Sensors (Basel) 2021; 21:E292. [PMID: 33406691 DOI: 10.3390/s21010292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 11/24/2022]
Abstract
Global navigation satellite systems (GNSS) can attain centimeter level positioning accuracy, which is conventionally provided by real-time precise point positioning (PPP) and real-time kinematic (RTK) techniques. Corrections from the data center or the reference stations are required in these techniques to reduce various GNSS errors. The time-relative positioning approach differs from the traditional PPP and RTK in the sense that it does not require external real-time corrections. It computes the differences in positions of a single receiver at different epochs using phase observations. As the code observations are not used in this approach, its performance is not affected by the noise and multipath of code observations. High reliability is another advantage of time-relative precise positioning because the ambiguity resolution is not needed in this approach. Since the data link is not required in the method, this approach has been widely used in remote areas where wireless data link is not available. The main limitation of time-relative positioning is that its accuracy degrades over time between epochs because of the temporal variation of various errors. The application of the approach is usually limited to be within a time interval of less than 20 min. The purpose of this study was to increase the time interval of time-relative positioning and to extend the use of this method to applications with a longer time requirement, especially in remote areas without wireless communication. In this paper, the main error sources of the time-relative method are first analyzed in detail, and then the approach to improve the accumulated time relative positioning method is proposed. The performance of the proposed method is assessed using both static and dynamic observations with a duration as long as several hours. The experiments presented in this paper show that, among the four scenarios tested (i.e., GPS, GPS/Galileo, GPS/Galileo/BeiDou, and GPS/Galileo/BeiDou/GLONASS), GPS/Galileo/BeiDou performed best and GPS/Galileo/BeiDou/GLONASS performed worst. The maximum positioning errors were mostly within 0.5 m in the horizontal direction, even after three hours with GPS/Galileo/BeiDou. It is expected that the method could be used for positioning and navigation for as long as several hours with decimeter level horizontal accuracy in remote areas without wireless communication.
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Kealoha MK. Aholoa Lāna'i! Asian Pac Isl Nurs J 2020; 5:185-187. [PMID: 33324739 PMCID: PMC7733635 DOI: 10.31372/20200503.1093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Truchado DA, Llanos-Garrido A, Oropesa-Olmedo DA, Cerrada B, Cea P, Moens MAJ, Gomez-Lucia E, Doménech A, Milá B, Pérez-Tris J, Cadar D, Benítez L. Comparative Metagenomics of Palearctic and Neotropical Avian Cloacal Viromes Reveal Geographic Bias in Virus Discovery. Microorganisms 2020; 8:E1869. [PMID: 33256173 DOI: 10.3390/microorganisms8121869] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 01/11/2023] Open
Abstract
Our understanding about viruses carried by wild animals is still scarce. The viral diversity of wildlife may be best described with discovery-driven approaches to the study of viral diversity that broaden research efforts towards non-canonical hosts and remote geographic regions. Birds have been key organisms in the transmission of viruses causing important diseases, and wild birds are threatened by viral spillovers associated with human activities. However, our knowledge of the avian virome may be biased towards poultry and highly pathogenic diseases. We describe and compare the fecal virome of two passerine-dominated bird assemblages sampled in a remote Neotropical rainforest in French Guiana (Nouragues Natural Reserve) and a Mediterranean forest in central Spain (La Herrería). We used metagenomic data to quantify the degree of functional and genetic novelty of viruses recovered by examining if the similarity of the contigs we obtained to reference sequences differed between both locations. In general, contigs from Nouragues were significantly less similar to viruses in databases than contigs from La Herrería using Blastn but not for Blastx, suggesting that pristine regions harbor a yet unknown viral diversity with genetically more singular viruses than more studied areas. Additionally, we describe putative novel viruses of the families Picornaviridae, Reoviridae and Hepeviridae. These results highlight the importance of wild animals and remote regions as sources of novel viruses that substantially broaden the current knowledge of the global diversity of viruses.
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8
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Antonietti L, Ortiz Z, Esandi ME, Duré I, Cho M. [Health working conditions and environment: conceptual model for remote and rural areas]. Rev Panam Salud Publica 2020; 44:e111. [PMID: 32994789 PMCID: PMC7518646 DOI: 10.26633/rpsp.2020.111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 07/02/2020] [Indexed: 11/24/2022] Open
Abstract
This report proposes a conceptual model on workplace environment and working conditions that integrates the available evidence to facilitate the design and evaluation of interventions aimed at improving the attraction, recruitment and retention of health personnel at the first level of care in rural and remote areas. Theoretical, empirical and testimonial evidence was consulted to support the model, and 15 frameworks disseminated in the last 20 years were synthesized. The article shows the diversity of perspectives and the complexity involved in establishing the dimensions to be considered in a proposal that is useful to apply to human resources for health policies.The proposed model includes four categories of components: factors of the external context, organizational factors, employment and work conditions, and individual factors. The boundaries between the components -as well as the weight and influence of each one- vary according to the interrelationship among them and the interaction with the environment, and thus its interpretation must be adapted to the context in which it is intended to be applied.Based on this conceptual model, the design and evaluation of interventions aimed at increasing the availability of health personnel -particularly at the primary care level in rural and remote areas of the Region of the Americas- should emerge from an interaction between health and employment policies, and the realities and expectations of workers and the communities.
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Affiliation(s)
- Laura Antonietti
- Academia Nacional de MedicinaBuenos AiresArgentinaAcademia Nacional de Medicina, Buenos Aires, Argentina.
| | - Zulma Ortiz
- Academia Nacional de MedicinaBuenos AiresArgentinaAcademia Nacional de Medicina, Buenos Aires, Argentina.
| | - María Eugenia Esandi
- Academia Nacional de MedicinaBuenos AiresArgentinaAcademia Nacional de Medicina, Buenos Aires, Argentina.
| | - Isabel Duré
- Ministerio de Salud de la NaciónBuenos AiresArgentinaMinisterio de Salud de la Nación, Buenos Aires, Argentina
| | - Malhi Cho
- Organización Panamericana de la SaludWashington DCEstados Unidos de AméricaOrganización Panamericana de la Salud, Washington, DC, Estados Unidos de América
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Esandi ME, Antonietti L, Ortiz Z, Cho M, Duré I, Reveiz L, Menezes F. [Factors and interventions that affect working conditions and environment to increase the attraction, recruitment and retention of human resources for health at the primary care level in rural, remote or underserved areas]. Rev Panam Salud Publica 2020; 44:e112. [PMID: 32952534 PMCID: PMC7491859 DOI: 10.26633/rpsp.2020.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/29/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To identify and systematize available empirical evidence on factors and interventions that affect working conditions and environment in order to increase the attraction, recruitment and retention of human resources for health at the primary care level in rural, remote or underserved areas. METHODS Rapid review of reviews selected according to relevance, eligibility and inclusion criteria. The search was conducted on electronic and manual databases, including grey literature. AMSTAR I was used to assess the quality of systematic reviews and a thematic analysis for synthesis of the results. RESULTS Sixteen reviews were included, one of which contained 14 reviews. Of the total, 20 reviews analyzed factors and 9 evaluated the effectiveness of interventions. The evidence on factors is abundant, but of limited quality. Individual, family and "previous exposure to a rural setting" factors were associated with higher recruitment; organizational and external context factors were important for human resource retention. Networking and professional support influenced recruitment and retention. Evidence on the effectiveness of interventions was limited, both in quantity and quality. The most frequently used intervention was incentives. CONCLUSIONS Evidence on factors that are positively related to recruitment and retention of workers at the first level of care in rural, remote or underserved areas is sufficient and should be taken into account when designing interventions. Quality evidence on the effectiveness of interventions is scarce. More controlled studies with methodological rigor are needed, particularly in the Americas.
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Affiliation(s)
- María Eugenia Esandi
- Academia Nacional de MedicinaBuenos AiresArgentinaAcademia Nacional de Medicina, Buenos Aires, Argentina
| | - Laura Antonietti
- Academia Nacional de MedicinaBuenos AiresArgentinaAcademia Nacional de Medicina, Buenos Aires, Argentina
| | - Zulma Ortiz
- Academia Nacional de MedicinaBuenos AiresArgentinaAcademia Nacional de Medicina, Buenos Aires, Argentina
| | - Malhi Cho
- Organización Panamericana de la SaludWashington, DCEstados Unidos de AméricaOrganización Panamericana de la Salud, Washington, DC, Estados Unidos de América
| | - Isabel Duré
- Ministerio de Salud de la NaciónBuenos AiresArgentinaMinisterio de Salud de la Nación, Buenos Aires, Argentina
| | - Ludovic Reveiz
- Organización Panamericana de la SaludWashington, DCEstados Unidos de AméricaOrganización Panamericana de la Salud, Washington, DC, Estados Unidos de América
| | - Fernando Menezes
- Organización Panamericana de la SaludWashington, DCEstados Unidos de AméricaOrganización Panamericana de la Salud, Washington, DC, Estados Unidos de América
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Chen SCI, Liu C, Wang Z, McAdam R, Brennan M, Davey S, Cheng TY. How Geographical Isolation and Aging in Place Can Be Accommodated Through Connected Health Stakeholder Management: Qualitative Study With Focus Groups. J Med Internet Res 2020; 22:e15976. [PMID: 32459181 PMCID: PMC7287745 DOI: 10.2196/15976] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/27/2019] [Accepted: 04/10/2020] [Indexed: 01/09/2023] Open
Abstract
Background In remote areas, connected health (CH) is needed, but as local resources are often scarce and the purchasing power of residents is usually poor, it is a challenge to apply CH in these settings. In this study, CH is defended as a technological solution for reshaping the direction of health care to be more proactive, preventive, and precisely targeted—and thus, more effective. Objective The objective of this study was to explore the identity of CH stakeholders in remote areas of Taiwan and their interests and power in order to determine ideal strategies for applying CH. We aimed to explore the respective unknowns and discover insights for those facing similar issues. Methods Qualitative research was conducted to investigate and interpret the phenomena of the aging population in a remote setting. An exploratory approach was employed involving semistructured interviews with 22 participants from 8 remote allied case studies. The interviews explored perspectives on stakeholder arrangements, including the power and interests of stakeholders and the needs of all the parties in the ecosystem. Results Results were obtained from in-depth interviews and focus groups that included identifying the stakeholders of remote health and determining how they influence its practice, as well as how associated agreements bring competitive advantages. Stakeholders included people in government sectors, industrial players, academic researchers, end users, and their associates who described their perspectives on their power and interests in remote health service delivery. Specific facilitators of and barriers to effective delivery were identified. A number of themes, such as government interests and power of decision making, were corroborated across rural and remote services. These themes were broadly grouped into the disclosure of conflicts of interest, asymmetry in decision making, and data development for risk assessment. Conclusions This study contributes to current knowledge by exploring the features of CH in remote areas and investigating its implementation from the perspectives of stakeholder management. It offers insights into managing remote health through a CH platform, which can be used for preliminary quantitative research. Consequently, these findings could help to more effectively facilitate diverse stakeholder engagement for health information sharing and social interaction.
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Affiliation(s)
| | - Chenglian Liu
- School of Computing, Neusoft Institute of Guangdong, Foshan, China
| | - Zhenyuan Wang
- Faculty of Economics and Management, East China Normal University, Shanghai, China.,Antai College of Economics and Management, Shanghai Jiao Tong University, Shanghai, China
| | - Rodney McAdam
- Ulster Business School, Ulster University, Newtownabbey, United Kingdom
| | - Michael Brennan
- Ulster Business School, Ulster University, Newtownabbey, United Kingdom
| | - Shirley Davey
- Ulster Business School, Ulster University, Newtownabbey, United Kingdom
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11
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Wong HY, Marcu LG, Bezak E, Parange NA. Review of Health Economics of Point-of-Care Testing Worldwide and Its Efficacy of Implementation in the Primary Health Care Setting in Remote Australia. Risk Manag Healthc Policy 2020; 13:379-386. [PMID: 32440241 PMCID: PMC7212773 DOI: 10.2147/rmhp.s247774] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/20/2020] [Indexed: 11/30/2022] Open
Abstract
There are important differences concerning health outcomes between the Australian population living in rural/remote regions and the urban population. Health care provision in remote areas, particularly in regions with a low number of inhabitants, is not without challenges. Aboriginal, rural and remote communities are therefore affected, as they face various obstacles in accessing health services, owing to geographical settings, difficulties in transportation to nearby hospitals, limited or inexistent local qualified personnel. The implementation of point-of-care testing could be a plausible solution to these challenges, as various point-of-care services that have been successfully put into action worldwide indicate towards positive clinical outcomes. Point-of-care units have a real potential in reducing morbidity and mortality in all population groups. This article aims to review the published literature on point-of-care testing around the world, with a focus on health economics and the feasibility of its implementation in Australian rural and remote regions.
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Affiliation(s)
- Hoi Yan Wong
- Division of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Loredana G Marcu
- Faculty of Informatics & Science, University of Oradea, Oradea 410087, Romania.,Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia
| | - Eva Bezak
- Division of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia.,Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.,Department of Physics, University of Adelaide, Adelaide, SA 5005, Australia
| | - Nayana Anupam Parange
- Division of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia.,Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia
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12
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Wong A, Chow YT. Solar-Supplied Satellite Internet Access Point for the Internet of Things in Remote Areas. Sensors (Basel) 2020; 20:s20051409. [PMID: 32143462 PMCID: PMC7085503 DOI: 10.3390/s20051409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 06/10/2023]
Abstract
As satellite communications provide ubiquitous coverage, they play a key role in providing Internet connectivity in remote or marginalized areas, so as to enable the vision of a truly global connectivity of the Internet of Things (IoT). However, these areas often lack reliable electricity supply. Thus, this paper proposes a satellite internet access point powered by solar energy, so that a stable Internet connection can be provided. The access point provides Wi-Fi coverage so that sensors, IoT, and devices can connect to the access point using the Wi-Fi, a common wireless technology. Our design took some cost-saving measures to make it affordable and selected the components that require minimal maintenance operations. The satellite access point costs about USD $500, and can provide four days of Internet connectivity without solar energy.
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Affiliation(s)
- Angus Wong
- Department of Technology, School of Science and Technology, The Open University of Hong Kong, Hong Kong SAR, China
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13
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Chen SCI, Liu C. Factors Influencing the Application of Connected Health in Remote Areas, Taiwan: A Qualitative Pilot Study. Int J Environ Res Public Health 2020; 17:E1282. [PMID: 32079241 PMCID: PMC7068356 DOI: 10.3390/ijerph17041282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/10/2020] [Accepted: 02/12/2020] [Indexed: 11/16/2022]
Abstract
This pilot study investigated factors influencing the application of connected health (CH) in Taiwanese remote areas. These factors cover issues of cost, infrastructure, technology, business sustainability, business model, collaboration, and communication. It aimed to explore the significance and to assess the feasibility of researching CH in Taiwan. A qualitative exploratory study was conducted by interviewing relevant stakeholders (n = 18). The majority were healthcare providers as most of them are the CH end users. Their feedback was essential in reflecting the effectiveness of CH products and services. Therefore, understanding their views is significant in the design of a successful and user-friendly interactive system. A theoretical framework on the introduction of innovations in healthcare was employed to guide data collection and thematic analysis. Additionally, stakeholders proposed strategies for enhancing the implementation of CH in remote areas. This pilot study also contributed to identifying future directions and information for conducting the multi-stage interviews for collecting the data more effectively. Although the results reveal that the study of CH is meaningful, there is an issue of business sustainability which is obscured by some barriers that need to be addressed. These barriers will be further investigated in the first-stage interview and second-stage interview in future research. The research findings also suggest that strategies and sustainability for CH implementation should be included from the planning phase to benefit all the stakeholders in the CH ecosystem.
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Affiliation(s)
- Sonia Chien-I. Chen
- School of Economics and Finance, Huaqiao University, Quanzhou 362021, China;
| | - Chenglian Liu
- School of Computing, Neusoft Institute of Guangdong, Foshan 528225, China
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Abstract
INTRODUCTION For the past 10 years, skin cancer has been the most frequent malignant neoplasm in Brazil and worldwide. Each year, there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon. There were an estimated 188 000 new cases of skin cancer in Brazil in 2016. The prevention department of Barretos Cancer Hospital (BCH) runs some prevention programs for cancer such as breast, prostate, cervical, oral, colon and skin cancers. The skin cancer prevention program comprises educational activities and medical assistance conducted at the hospital and at a mobile unit (MU). The objective of this study is to evaluate the use of the MU as part of a skin cancer prevention program, 10 years after the implementation of this prevention program, using an MU in remote areas of Brazil. METHODS The database of the BCH was used. These data refer to data collected by the BCH Prevention MU. A total of 45 872 patients with suspected skin cancer were evaluated at the MU from 2004 to 2013. Of these, 8954 surgical procedures (excisions and/or biopsy) were performed. RESULTS This study demonstrated a significant number of skin cancer cases diagnosed and treated by the MU. CONCLUSIONS This study showed that the MU positively contributes to the early diagnosis and treatment of skin cancer among populations residing in remote areas of Brazil.
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Affiliation(s)
| | - Edmundo C Mauad
- Barretos Cancer Hospital, Rua Antenor Duarte 1331, Barretos, SP, Brazil
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Augustussen M, Pedersen M, Hounsgaard L, Timm H, Sjøgren P. Development of health-related quality of life and symptoms in patients with advanced cancer in Greenland. Eur J Cancer Care (Engl) 2018; 27:e12843. [PMID: 29578252 PMCID: PMC6001430 DOI: 10.1111/ecc.12843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2018] [Indexed: 12/28/2022]
Abstract
A prospective national cohort study assessed the development of health-related quality of life (HRQoL) and symptoms in adult patients undergoing treatment and care for advanced cancer in Greenland. HRQol was examined by EORTC QLQ-C30 version 3.0 questionnaire monthly for 4 months. Changes over time and between-group comparisons were examined. Of 58 patients included in the study, 47% completed the questionnaire four times. Functioning was generally high, and improved social functioning was observed after 1 and 2 months. The highest symptom score was for fatigue followed by pain and nausea/vomiting. A high score for financial problems remained unchanged during the entire period. Patients with higher income had reduced pain intensity (p = .03) and diarrhoea (p = .05) than patients with income below the poverty line. After 1 month, reduction in pain intensity was observed for Nuuk citizens compared with non-Nuuk citizens (p = .05). After 2 months, non-Nuuk citizens reported improved social functioning compared with Nuuk citizens (p = .05). After 3 months, Global Health in Nuuk citizens was improved compared with non-Nuuk citizens (p = .05). An important clinical finding was that patients' needs for support are related to social status, and geographical factors should be taken into account when planning palliative care.
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Affiliation(s)
- M. Augustussen
- Institute of Nursing and Health ScienceIlisimatusarfikUniversity of GreenlandNuukGreenland
| | - M.L. Pedersen
- Greenland Center for Health ResearchInstitute of Nursing and Health ScienceUniversity of GreenlandNuukGreenland
| | - L. Hounsgaard
- Institute of Nursing and Health ScienceIlisimatusarfikUniversity of GreenlandNuukGreenland
- Greenland Center for Health ResearchInstitute of Nursing and Health ScienceUniversity of GreenlandNuukGreenland
- Department of Clinical ResearchOPENUniversity of Southern DenmarkOdenseDenmark
| | - H. Timm
- REHPA, Danish Knowledge Centre for Rehabilitation and Palliative CareNyborgDenmark
| | - P. Sjøgren
- Palliative Research GroupDepartment of OncologyRigshospitaletCopenhagenDenmark
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Abstract
BACKGROUND The medical internship as a way of exposing young doctors to training in a rural context is regarded as a useful tool to recruit and retain doctors in rural areas. Norwegian health authorities tested an arrangement of early sign-up for medical internships in the Finnmark County in Norway. OBJECTIVE To report on the effects of the early sign-up for medical internship. DESIGN This study compares the choice of workplace after internship among physicians who signed up early with those candidates assigned to the raffle model of internship in the study area, and in a comparison area experiencing similar recruitment and retention problems. RESULTS The proportion of interns who signed up early that still worked as physicians in the study area by April 2014 (29%) was twice as high as among the regular interns (15%) and interns in the comparison area (14%). Among the 59 interns who signed up early still working in the study area in April 2014, 33% had grown up in this area. However, the greatest benefits were for the most densely populated municipalities in the study area. CONCLUSIONS The early sign-up model had a net contribution of proving additional physicians in the study area.
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Affiliation(s)
- Margrete Gaski
- a National Centre of Rural Medicine , UiT The Arctic University of Norway , Tromsø , Norway
| | - Birgit Abelsen
- a National Centre of Rural Medicine , UiT The Arctic University of Norway , Tromsø , Norway
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Abstract
Papua New Guinea is one of the 14 highest-burden countries for tuberculosis (TB) infection, but few community-based studies exist. We evaluated a low-cost method of active community case finding in Kabwum and Wasu in Morobe Province, Papua New Guinea. Over 3 months we visited 26 villages and screened adults and children for symptoms and signs of TB. Sputum samples were examined using smear microscopy. A total of 1700 people had chronic symptoms, of which 267 were suspicious for TB on further examination. Sputum from 230 symptomatic adults yielded 97 samples that were positive for acid-fast bacilli. In addition, 15 cases of extrapulmonary TB in adults and 17 cases of TB in children were identified. One hundred and thirty people were identified with active TB disease among the source population of approximately 17 000, giving an estimated prevalence of 765 per 100 000. One hundred and six (82%) cases were not previously diagnosed. The cost per case identified was US$146. It is feasible to conduct active community-based case finding and treatment initiation for TB with limited resources and in remote areas, and in Papua New Guinea the yield was high. Active case finding and follow-up of treatment in villages is needed to address the hidden burden of TB in Papua New Guinea and other high-burden Asia Pacific countries.
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Affiliation(s)
- Bindu Karki
- 1 Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Guenter Kittel
- 2 Lutheran Health Service, Etep, Morobe, Papua New Guinea
| | | | - Trevor Duke
- 3 University of Melbourne, Melbourne, Victoria, Australia.,4 University of Papua New Guinea, Port Moresby, Papua New Guinea
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Jadoon WA, Sakugawa H. Concentrations of polycyclic aromatic hydrocarbons: Their potential health risks and sources at three non-urban sites in Japan. J Environ Sci Health A Tox Hazard Subst Environ Eng 2016; 51:884-899. [PMID: 27314274 DOI: 10.1080/10934529.2016.1191300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This investigation was undertaken to monitor particulate polycyclic aromatic hydrocarbons (PAHs) concentrations in order to determine their emission sources and potential human health risks in remote and rural areas of Japan. Seventeen PAHs in aerosol samples collected in remote (Kamihaya), coastal (Hiki) and inland (Higashi-Hiroshima) areas of Japan during 2013-2014 were analyzed using gas chromatography/mass spectrometry. Total PAH (Σ17PAH) concentrations in aerosol samples were in the range of 0.08-6.51 ng m(-3), 0.09-4.74 ng m(-3), and 0.21-6.53 ng m(-3) at Kamihaya, Hiki, and Higashi-Hiroshima sites, with mean concentrations of 1.63, 1.18, and 2.43 ng m(-3), respectively. Significant seasonal variation in concentrations occurred at Hiki and Higashi-Hiroshima, while no significant variation occurred at Kamihaya. Ambient air temperature greatly affected PAH concentrations in Higashi-Hiroshima, but had only moderate effects in Kamihaya and Hiki. Wind direction also influenced the concentrations of PAHs. Vehicle exhaust, industrial emissions, biomass combustion, and domestic heating and cooking were identified as the main PAH emission sources using principal component analysis. Backward trajectory calculations showed that domestically generated PAHs were significant in Kamihaya and Hiki, while in Higashi-Hiroshima concentrations were mainly influenced by long-range transport. The incremental lifetime lung cancer risk had values of 3.38 × 10(-5) and 1.84 × 10(-5) at Higashi-Hiroshima and Hiki, which are greater than the US EPA acceptable level (10(-6)). Typically, 5-6-ring PAHs contributed 95% to this overall health risk, of which benzo(a)pyrene was the largest contributor, followed by dibenz(a,h)anthracene at both residential sites. Clearly, stricter guidelines for PAHs need to be implemented at these sites to protect the population.
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Affiliation(s)
- Waqar A Jadoon
- a Graduate School of Biosphere Science , Hiroshima University , Higashi Hiroshima , Japan
| | - Hiroshi Sakugawa
- a Graduate School of Biosphere Science , Hiroshima University , Higashi Hiroshima , Japan
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Abstract
RemoDem aimed to develop, test and evaluate services for people with dementia in remote areas of the Faroe Islands, Greenland, Sweden and Scotland. Formative and summative evaluation used a flexible research design including collection of baseline data, interviews and focus groups with key informants and data relating to service users, i.e. people with dementia and their carers. Challenges for service providers included organisational difficulties, lack of clear information about their populations with dementia and lack of knowledge in local communities. Test sites which developed services building on their particular local starting points adopted both specialist and 'off the shelf' technologies and found that these were generally helpful for people with significant support needs. The flexible research design was found to be essential in the real world conditions of the service development and evaluation. Services were more successful where more mature and less experimental technologies were used. The new services promised to address effectively challenges of remoteness including distance, communication and workforce deployment issues.
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Affiliation(s)
- Alison Bowes
- Faculty of Social Sciences, University of Stirling, Scotland
| | - Alison Dawson
- Faculty of Social Sciences, University of Stirling, Scotland
| | - Louise McCabe
- Faculty of Social Sciences, University of Stirling, Scotland
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Diouara AA, Ndiaye HD, Guindo I, Bangoura N, Cissé M, Edmond T, Bougoudogo F, Mboup S, Peeters M, Ayouba A, Kane NC. Antiretroviral treatment outcome in HIV-1-infected patients routinely followed up in capital cities and remote areas of Senegal, Mali and Guinea-Conakry. J Int AIDS Soc 2014; 17:19315. [PMID: 25527333 DOI: 10.7448/IAS.17.1.19315] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 11/02/2014] [Accepted: 11/03/2014] [Indexed: 11/23/2022] Open
Abstract
Introduction Access to antiretroviral treatment (ART) becomes more and more effective in resource-limited settings (RLS). However, this global effort would be even more profitable if the access to laboratory services especially in decentralized settings was strengthened. We report the virological outcome and HIV-1 drug resistance in three West African countries using dried blood spots (DBS) samples.
Methods We included HIV-1-infected adults on ART ≥6 months and followed up in capital cities and decentralized sites in Senegal, Mali and Guinea-Conakry. Patients were consecutively enrolled and DBS were collected in field conditions and kept at ambient temperature before transfer to the reference laboratory. Viral load (VL) was quantified using the NucliSENS EasyQ HIV-1 v1.2. Genotyping of HIV-1 pol gene was performed using in-house protocol. Results Of the 407 participants, 119, 152 and 136 were from Senegal, Mali and Guinea-Conakry, respectively. The median treatment duration was 36 months [IQR: 6–136]. Virological failure (VF) (VL≥3log10 copies/mL) was observed in 26% (95% confidence interval (CI), 18–35; n=31), 11% (95% CI, 6–17; n=16) and 24% (95% CI, 17–32; n=33) of patients in Senegal, Mali and Guinea-Conakry, respectively (p=0.001). Of samples presenting VL≥3log10 copies/mL (n=80), 70 were successfully genotyped. At least one drug resistance mutation (DRM) was detected in the following proportions: 70% (95% CI, 50–86; n=19), 93% (95% CI, 68–100; n=14) and 68% (95% CI, 48–84; n=19) in Senegal, Mali and Guinea-Conakry, respectively (p=0.22). Twenty-six per cent (26%; 95% CI, 16–38; n=18) of patients in VF harboured wild-type viruses, which is likely indicative of weak adherence. Phylogenetic analysis showed the predominance of CRF02_AG subtype (73%; 95% CI, 61–83; n=51). Conclusions We describe the ART outcome in capital and rural settings of Senegal, Mali and Guinea-Conakry. Our results in all of the three countries highlight the need to reinforce the ART adherence in order to minimize the occurrence of drug resistance. In addition, these findings provide additional evidence that the use of DBS as a sampling support could assist virological monitoring of patients on ART in remote areas.
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Abstract
This article analyses (1) how financial incentives (salary top-ups) and non-financial incentives (housing and education) affect nurses' willingness to work in remote areas of Tanzania and (2) how the magnitude of the incentives needed to attract health workers varies with the nurses' geographic origin and their intrinsic motivation. A contingent valuation method was used to elicit the location preferences of 362 nursing students. Without any interventions, 19% of the nurses were willing to work in remote places. With the provision of free housing, this share increased by 15 percentage points. Better education opportunities increased the share by 28 percentage points from the baseline. For a salary top-up to have the same effect as provision of free housing, the top-up needs to be between 80 and 100% of the base salary. Similarly, for salary top-ups to have the same effect as provision of better education opportunities, the top-up should be between 120 and 140%. Our study confirms results from previous research, that those with a strong intrinsic motivation to provide health care are more motivated to work in a remote location. A more surprising finding is that students of older age are more prepared to take a job in remote areas. Several studies have found that individuals who grew up in a remote area are more willing to work in such locations. A novel finding of our analysis is that only nursing students with a 'very' remote origin (i.e. those who grew up farther from a district centre than the suggested remote working place) express a higher willingness to take the remote job. Although we do control for nursing school effects, our results could be biased due to omitted variables capturing individual characteristics.
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Affiliation(s)
- Michael A Munga
- Health systems and Policy Reserach/Monitoring and Evaluation Departments, National Institute for Medical Research, P.O BOX 9653, DAR ES SALAAM 999, United Republic of Tanzania.
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