What is a reasonable length of employment for health workers in Australian rural and remote primary healthcare services?

Background: Optimising retention of rural and remote primary healthcare (PHC) workers requires workforce planners to understand what constitutes a reasonable length of employment and how this varies. Currently, knowledge of retention patterns is limited and there is an absence of PHC workforce benchmarks that take account of differences in geographic context and profession.

Methods: Three broad strategies were employed for proposing benchmarks for reasonable length of stay.

Intimate partner violence, depressive symptoms, and immigration status: does existing advocacy intervention work on abused immigrant women in the Chinese community?

Advocacy intervention has been shown to be efficacious at reducing depressive symptoms in women who suffer from intimate partner violence (IPV). However, the intervention effect among abused immigrant women has not been well studied. This study compares the demographic and psychosocial characteristics between abused immigrant and nonimmigrant women, and evaluates the impact of immigration status on the efficacy of an advocacy intervention in reducing depressive symptoms and improving perceived social support.

The effect of target postgrazing height on sward clover content, herbage yield, and dairy production from grass-white clover pasture.

White clover (Trifolium repens) is an important legume for grazed grassland that can increase the profitability and environmental sustainability of milk production. Previous experiments on mown grass-clover plots suggest that low postgrazing heights (PGH) can increase sward clover content and herbage production. However, this has not been tested in actual strip or rotational grazing systems with dairy cows.

Postpublication validation of the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis: where do we stand?

Purpose Of Review: To summarise the results of the validation studies testing the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria for rheumatoid arthritis (RA) to date and highlight the areas for future research.

Recent Findings: The 2010 ACR/EULAR classification criteria for RA were developed aiming to identify patients early in the natural history of the disease. Validation studies conducted since their publication have demonstrated that, compared with the 1987 ACR criteria for RA, the 2010 criteria identify more patients earlier in the disease course.

The carbon footprint of pasture-based milk production: can white clover make a difference?

Carbon footprint (CF) calculated by life cycle assessment (LCA) was used to compare greenhouse gas emissions from pasture-based milk production relying mainly on (1) fertilizer N (FN), or (2) white clover (WC). Data were sourced from studies conducted at Solohead Research Farm in Ireland between 2001 and 2006. Ten FN pastures stocked between 2.

Understanding drivers of rural and remote health outcomes: a conceptual framework in action.

Objective: To demonstrate the usefulness of a conceptual framework to increase the understanding of rural and remote health by applying it to specific rural and remote health scenarios.

Design: A conceptual framework was applied to two case studies illustrative of key issues in rural health to reflect different contexts, issues and responses.

Results: Application of the framework to both case studies highlighted that changes in rural and remote health are diverse.

Working memory performance of older adults with insomnia.

Older individuals suffering insomnia typically report declines in their cognitive performance beyond what they consider to be normal changes due to the aging process. Recent neuro-imaging studies have demonstrated frontal lobe hypo-activation among insomniac populations when compared with healthy, good sleepers. However, research is yet to confirm whether frontal lobe hypo-activation translates into objective declines when performing tasks hypothesized to draw upon this brain region.

In vitro investigations into the roles of drug transporters and metabolizing enzymes in the disposition and drug interactions of dolutegravir, a HIV integrase inhibitor.

Dolutegravir (DTG; S/GSK1349572) is a potent HIV-1 integrase inhibitor with a distinct resistance profile and a once-daily dose regimen that does not require pharmacokinetic boosting. This work investigated the in vitro drug transport and metabolism of DTG and assessed the potential for clinical drug-drug interactions. DTG is a substrate for the efflux transporters P-glycoprotein (Pgp) and human breast cancer resistance protein (BCRP).

International medical graduates mandated to practise in rural Australia are highly unsatisfied: results from a national survey of doctors.

Objectives: Rural communities worldwide are increasingly reliant on international medical graduates (IMGs) to provide health care access, with many countries utilising health policies which mandate IMGs to practise only in rural designated areas of (medical) workforce shortage for many years. The objective of this study is to analyse the satisfaction of IMGs in their current work location, particularly in relation to the effect of mandating IMGs to small rural communities.

Methods: We used data of 3502 general practitioners (GPs) from Wave 2 of the Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal study of Australian doctors.

How do rural GPs' workloads and work activities differ with community size compared with metropolitan practice?

Rural communities continue to experience shortages of doctors, placing increased work demands on the existing rural medical workforce. This paper investigates patterns of geographical variation in the workload and work activities of GPs by community size. Our data comes from wave 1 of the Medicine in Australia: Balancing Employment and Life longitudinal study, a national study of Australian doctors.

Sleep patterns in children with ADHD: a population-based cohort study from birth to 11 years.

Associations between sleep duration and disturbance in infancy and early childhood and attention deficit hyperactivity disorder diagnoses were investigated. Data from the Avon Longitudinal Study of Parents and Children, a population-based prospective longitudinal birth-cohort study of children born in 1991-1992 in South-West England, were employed. Eight thousand, one hundred and ninety-five children were assessed using the Development and Well-Being Assessment.

A national study of workplace aggression in Australian clinical medical practice.

Objective: To describe the 12-month prevalence of verbal or written and physical aggression from patients, patients' relatives or carers, coworkers and others in Australian clinical medical practice.

Design, Setting And Participants: An exploratory, descriptive study of cross-sectional survey design in the third wave (March 2010 to June 2011) of the Medicine in Australia: Balancing Employment and Life longitudinal survey.

Main Outcome Measures: Proportions of clinicians reporting verbal or written and physical aggression from each aggression source and the significance of differences reported by doctor type, sex, international medical graduate status, age and postgraduate experience.

Dopamine exerts activation-dependent modulation of spinal locomotor circuits in the neonatal mouse.

Monoamines can modulate the output of a variety of invertebrate and vertebrate networks, including the spinal cord networks that control walking. Here we examined the multiple changes in the output of locomotor networks induced by dopamine (DA). We found that DA can depress the activation of locomotor networks in the neonatal mouse spinal cord following ventral root stimulation.

What factors contribute most to the retention of general practitioners in rural and remote areas?

The objectives of this study were to measure the relative strength, significance and contribution of factors associated with rural and remote medical workforce retention. Length of stay data from two Australian GP workforce datasets, the 2008 National Minimum Data Set (4223 GPs) and a subset of the 2008 Medicine in Australia: Balancing Employment and Life dataset (1189 GPs), were separately analysed using multiple linear regression models and the results compared. Length of employment in their current practice location was the outcome measure.

The incidence of rheumatoid arthritis in the UK: comparisons using the 2010 ACR/EULAR classification criteria and the 1987 ACR classification criteria. Results from the Norfolk Arthritis Register.

Objectives: The development of new classification criteria for rheumatoid arthritis (RA) calls for a re-estimation of RA incidence rates. The objectives of this study were to estimate the age and sex-specific incidence rates (IR) of RA in Norfolk, England using the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism criteria, and to compare those with IRs estimated using the 1987 ACR criteria.

Setting: The Norfolk Arthritis Register (NOAR), a large primary care inception cohort of patients with inflammatory oligo- and polyarthritis (IP) aged ≥ 16.

Junior doctors' preferences for specialty choice.

A number of studies suggest that there is an over-supply of specialists and an under-supply of general practitioners in many developed countries. Previous econometric studies of specialty choice from the US suggest that although income plays a role, other non-pecuniary factors may be important. This paper presents a novel application of a choice experiment to identify the effects of expected future earnings and other attributes on specialty choice.

How best to measure health workforce turnover and retention: five key metrics.

Objective: This article identifies, critically appraises and illustrates the use of five key workforce turnover and retention metrics that are well suited for use by Australian rural health workforce planners. These are crude turnover (separation) rates, stability rates, survival probabilities, median survival and Cox proportional hazard ratios. Examples of their calculation are presented using actual data obtained from payroll records in Australian rural and remote health services.

Assessment of the drug interaction risk for remogliflozin etabonate, a sodium-dependent glucose cotransporter-2 inhibitor: evidence from in vitro, human mass balance, and ketoconazole interaction studies.

Remogliflozin etabonate is the ester prodrug of remogliflozin, a selective sodium-dependent glucose cotransporter-2 inhibitor. This work investigated the absorption, metabolism, and excretion of [(14)C]remogliflozin etabonate in humans, as well as the influence of P-glycoprotein (Pgp) and cytochrome P450 (P450) enzymes on the disposition of remogliflozin etabonate and its metabolites to understand the risks for drug interactions. After a single oral 402 ± 1.

N leaching to groundwater from dairy production involving grazing over the winter on a clay-loam soil.

This study investigated concentrations of various N species in shallow groundwater (<2.2m below ground level) and N losses from dairy production involving grazing over the winter period on a clay loam soil with a high natural attenuation capacity in southern Ireland (52°51'N, 08°21'W) over a 2-year period. A dense network of shallow groundwater piezometers was installed to determine groundwater flow direction and N spatial and temporal variation.

[Types and severity of partner violence against women living in the community in Cali, Colombia].

Objective: Identifying the incidence and severity of types of intimate partner violence against women exposed to this in their communities and the pertinent socio-demographic characteristics.

Methodology: This was a cross-sectional descriptive study of 150 women suffering intimate partner violence. The Severity of Violence Against Women Scale was used to explore demographic variables, e.

Celebrating another decade of progress in rural health: what is the current state of play?

The Australian Journal of Rural Health is currently celebrating its 20th anniversary. Following a review of the first decade of rural health published by the authors in 2002, this article outlines and reviews the range of policies that have impacted upon rural health in Australia since then. During the past decade there has been a raft of new policies and programs designed to bring about improved rural health outcomes, and some progress has been made.

A collaborative project to improve identification and management of patients with chronic kidney disease in a primary care setting in Greater Manchester.

Problem: Research has demonstrated a knowledge and practice gap in the identification and management of chronic kidney disease (CKD). In 2009, published data showed that general practices in Greater Manchester had a low detection rate for CKD.

Design: A 12-month improvement collaborative, supported by an evidence-informed implementation framework and financial incentives.

Association of morbid obesity with disability in early inflammatory polyarthritis: results from the Norfolk Arthritis Register.

Objective: Obesity has been associated with disease outcomes in inflammatory arthritis. This study aimed to investigate cross-sectionally the relationship between body mass index (BMI) and functional disability in a large inception cohort of patients with early inflammatory polyarthritis (IP).

Methods: Patients age ≥16 years with ≥2 swollen joints for ≥4 weeks were recruited into the Norfolk Arthritis Register.