Stuart Wark

University of New England | UNE · School of Rural Medicine

Background The constraints imposed by the COVID-19 pandemic has led to the rapid development and implementation of digital methods for teaching clinical skills in medical education. This systematic review presents both the benefits, challenges, and effectiveness of this transition. Methods A systematic search of six electronic databases (SCOPUS, M...

People living in rural areas of Australia are significantly disadvantaged, compared to metropolitan dwelling peers, in accessing basic support services. Australians with intellectual disabilities living in rural areas are at specific risk of further disadvantage. This article examines the findings and recommendations of the Disability Royal Commiss...

Fundamental health knowledge has expanded substantially in the past century, necessitating future health professionals to both learn effectively and adapt to unpredicted situations. Simultaneously, university student demographics are changing dramatically. Consequently, academic teaching needs to facilitate students in developing lifelong learning...

Background Healthcare access and equity are human rights. Worldwide conflicts, violence, and persecution have increased the number of people from refugee or refugee-like backgrounds. Because urban areas are already densely populated, governments have aimed to increase refugee resettlement in rural and/or regional areas. Because of the complex healt...

The life expectancy of persons with intellectual disability is increasing, and this is often occurring concurrently with the aging of their long-term parental carers. Research in both Australia and around the world indicates that proactive post-parental care planning is not widely implemented, and transitions primarily happen suddenly following a p...

Background: Historically the voices of people with intellectual disability have been occluded by barriers imposed by research practice. More recently, adaptive research approaches have been proposed to enhance the inclusion of people with intellectual disability in qualitative research. Method: This article presents an adaptive interviewing approa...

Background Since its emergence, the COVID-19 pandemic has compromised the food security both directly by impacting food supply chain and indirectly by overwhelming the individual health and/or personal financial situation. The overarching aim of the current study is to assess aspects of the food security crisis that have arisen due to COVID-19 and...

Background Hospital pharmacists can assist patients with medication adherence in a hospital setting. No studies have explored the views of hospital pharmacists on medication adherence. Objectives The study aimed to explore Ethiopian clinical pharmacists’ understanding of and experience with medication adherence, and identify strategies for medicat...

BACKGROUND Healthcare access and equity are human rights. Worldwide conflicts, violence, and persecution have increased the number of refugees and/or asylum seekers. Because urban areas are already densely populated, governments have aimed to increase refugee resettlement in rural and/or regional areas. Because of the complex healthcare needs of re...

Background There is little research comparatively assessing prevalence of pain between older people either with or without intellectual disability. This paper explores health and social factors associated with chronic pain in these two groups. Method A cross-sectional survey was undertaken in New South Wales and Queensland, Australia. Inclusion cr...

Objectives: The aim of this study was to assess the frequency of indirect positive health outcomes as a result of the COVID-19 pandemic. Study design: This was a systematic review. Methods: Articles were identified from four online databases (Web of Science, Scopus, PubMed and Google Scholar) using predetermined search terms. After studies wer...

Abstract : People with intellectual disability are a diverse population with varied experiences and support needs for activities of daily living. Contemporary knowledge about intellectual disability care has been produced primarily through an urban-centric lens with a small body of rural research focused on care at the interface of ageing and intel...

Background The emergence of COVID-19 has resulted in health, socio-economic, and political crises. The overall health impact of this disease can be measured by disability-adjusted life years (DALYs) which is the sum of the life years lost due to disability (YLDs) and the years life lost due to premature death (YLLs). The overarching objective of th...

Background Australian research indicates that post-parental care transitions are rarely planned and primarily occur following a crisis for a primary carer. This paper examines disability staff perceptions of transitions for people with intellectual disability and their ageing carers in rural South Australia. Method A focus group interview model wa...

Background and Objective Several medication adherence patient-reported outcome measures (MA-PROMs) are available for use in patients with cardiovascular disease (CVD); however, little evidence is available on the most suitable MA-PROM to measure medication adherence in patients with CVD. The aim of this systematic review is to synthesise the measur...

Background COVID-19 is a highly contagious infectious disease that emerged in 2019. This disease is causing devastating health, socio-economic, and economic crises. More specifically COVID-19 is affecting both the quality and length of human life. The overall health impact of this disease is measured by the disability-adjusted life years which is t...

Background Food security is substantially affected directly by COVID-19 and/or indirectly by the measures adopted for the prevention of COVID-19 transmission. The aim of this systematic review is to summarize the impact of COVID-19 on food security and identify the most compromised food security dimension to ease the food security regulators and ac...

Public Health: Local and Global Perspectives presents a comprehensive introduction to public health issues and concepts in the Australian and international contexts. It provides students with fundamental knowledge of the public health field, including frameworks, theories, key organisations and contemporary issues. The third edition features a new...

Changing disease patterns and improved life expectancy have resulted in a growing cohort of older Australians with an intellectual disability, with the provision of end-of-life care to this group only recently emerging as a priority area. Particularly in rural settings, where the availability of both specialist and general local services may be lim...

Data specifically comparing outcomes for people with and without intellectual disability is limited. This paper reports perceived health and wellbeing of older Australians resident in metropolitan and rural locations in New South Wales and Queensland. Respondents were community-residing individuals with intellectual disability and mainstream age pe...

Individuals who experience a traumatic injury or an acute illness are often reliant on initial healthcare assessment and support from a pre‐hospital emergency medical service (EMS). These community‐based support models perform a vital role in the provision of life‐saving support, but research indicates that the availability, accessibility and resou...

Objective The need for residential care services will grow significantly over the coming years as the general population in Australia continues to age. The aim of this study was to assess the adequacy of residential care services across New South Wales (NSW), Australia, in relation to the current and predicted future aging population.Method This st...

OBJECTIVE: Pre-hospital emergency medical services (EMS) are a vital component of health management, however there are disparities in the provision of EMS between rural and urban locations. While rural people experience lower levels of pre-hospital care, there has been little examination of the reasons underpinning these differences through discus...

Background There is a disparity in outcomes between rural and urban emergency medical services (EMS) around the world. However, there is a scarcity of research that directly asks EMS staff in both rural and urban areas how service delivery could be improved. The aim of the present study is to gain insights from frontline workers regarding organisat...

Background Although a ‘person-centred focus’ is a legislated objective for both aged-care and disability services sectors in Australia, evidence suggests limited translation into systems and practices due to entrenched silos. This paper proposes a Best Practice Framework to mitigate these silos. Methods Mixed-methods research comprising key inform...

Background The progressive increase in life expectancy of people with intellectual disability (ID) has resulted in enhanced survival into old age and has also seen a growth in research on both lifelong and emerging ageing‐related health issues. Health issues amongst provider‐supported adults have been previously studied, but these studies have not...

Background: There is a disparity in outcomes between rural and urban emergency medical services (EMS) in both developed and developing countries. However, there is a scarcity of research that directly asks EMS staff in both rural and urban areas of developing countries how service delivery could be improved. The aim of the present study is to gain...

Background Research has identified that rurally located persons face health inequities when compared to their urban peers. While health policies and practice frameworks to address the needs of rural people are largely developed on the principles of evidence-based medicine, it is not clear whether this evidence base appropriately considers geographi...

Individuals with intellectual and developmental disabilities (IDD) are known to be at high risk of developing a comorbid mental or behavioural disorder. However, there has only recently been an increased focus on the epidemiology of such disorders in the older population of people with IDD. Attempting to precisely quantify the prevalence and incide...

Background: Callouts resulting in patient nontransportation can impact the overall quality of prehospital Emergency Medical Service (EMS), as resources in health care are finite. While some studies have investigated the causes of nontransportation, few have examined whether there are differences between urban and rural patients. Similarly, there ha...

Background: There is limited research outside the USA, Europe, or Australia on the capacity, efficiency, and development of prehospital emergency medicine services (EMS) between urban and rural areas. This study aimed to examine the usage of prehospital EMS across rural and urban areas in Riyadh region in the Kingdom of Saudi Arabia. Methods: A ran...

Abstract Living ‘rurally’ remains one of the most significant barriers to accessing necessary supports. People with intellectual disabilities in a rural location are disadvantaged with respect to quality of life measures, and in being able to make meaningful decisions about their life. This article briefly reviews key background knowledge, and summ...

Background Response impacts on treatment outcomes, particularly for time-sensitive illnesses, including trauma. This study compares key outcome measures for emergency medical services (EMS) operating in urban versus rural areas in the Riyadh region of Saudi Arabia. Methods A cross-sectional study of EMS users was conducted using a random sampling...

Accessible Summary • In the past 30 years, many people with (intellectual) learning disabilities have been moved out of large “institutions” and into their own home in their local community • These people are now often between 30 and 50 years old • We asked people with learning disabilities aged between 30 and 50 and who are living in their local...

Background There is paucity of research from Australia about comorbidity in older people with intellectual disability (PwID). This paper examines the burden of chronic diseases and associated sociodemographic correlates in a cohort of PwID aged 60+. Methods A cross‐sectional survey was used with community‐dwelling older PwID in urban/rural regions...

Objectives Little is known about the vulnerabilities faced by human immunodeficiency virus [HIV] positive parents living with their children in Bangladesh. Methods A qualitative research design was used to examine parental experiences of living with HIV in the Bangladeshi family context, with data collected through in-depth interviews with 19 indi...

Objective: The aim of this review is to identify high-quality self-reported medication adherence tools for adults with cardiovascular disease to improve health outcomes. Introduction: Medication adherence is a complex concept affected by multiple factors and positively associated with clinical outcomes. Poor adherence to cardiovascular medicatio...

This chapter provides readers with an introduction to planning and evaluation with respect to public health promotions and interventions. Entire text books have been written on health-care planning and evaluation (e.g. Issel & Wells, 2017), so this chapter will focus primarily on key over-arching concepts. It identifies a simple six stage public he...

The goal of this systematic review was to examine the existing literature base regarding the factors impacting patient outcomes associated with use of emergency medical services (EMS) operating in urban versus rural areas. A specific subfocus on low and lower-middle-income countries was planned but acknowledged in advance as being potentially limit...

Background Life expectancy for persons with intellectual disability has increased dramatically over the past decade, which has seen an associated rise in the need for end-of-life care. However, little is known regarding how end-of-life affects the individual’s personal relationships with family, friends and staff. Methods Focus group interviews...

Australia has one of the world’s highest life expectancy rates, and there is a rapidly growing need for informal caregivers to support individuals who are ageing, have chronic illness or a lifelong disability. These informal carers themselves face numerous physical and psychological stressors in attempting to balance the provision of care with thei...

Background: This descriptive single-case study reports upon a four-decade history of health care and support provided to one male with life-long intellectual disability and significant comorbidities. Methods: All available paper and electronic documentation from the past 40 years was reviewed, with relevant health and medication information collate...

The Emergency Medical Services (EMS) is an important system ensuring an effective, timely, and well-coordinated delivery of health and safety services to the people affected by sudden illness or injuries. From studies conducted in many developed and developing countries, it is evident that there exist discrepancies between rural and urban health pa...

Background: Individuals with intellectual disability (ID) have a higher likelihood of exposure to identified risk factors for suicide when compared with the general community and have been recognised as being both capable of forming intent for suicide and acting on this intent. However, in spite of research outlining these concerns from the 1970s,...

Background: It is known that rurally-residing individuals are often at a significant health disadvantage when compared to urban peers. Improving the health of rural residents has been directly identified as a key priority across the world; however, as models of healthcare are primarily derived from evidence-based research, any failure by the resear...

Background: Increasing life expectancy for people with intellectual disability is resulting in greater need for end-of-life care services. However, limited knowledge is available regarding what barriers to accessing end-of-life care support are evident, particularly comparatively across rural and metropolitan locations. Methods: Focus group inte...

Aims: Life expectancy for both sexes in Australia exceeds 80 years, with individuals with intellectual disability also increasingly living into older age. This research aimed to comparatively examine perceptions of staff supporting either older adults or age peers with lifelong intellectual disability. Methods: This project asked 420 medical, healt...

The preliminary findings from an ongoing large-scale Australian study assessing health, well-being and health service use for older people with intellectual disability (PwID), compared to their normative age-peers, have revealed the nature of the burden of chronic disease experienced by PwID aged ≥60 years (n=356). Preliminary results confirm a sig...

Background Residing in a rural location is associated with socioeconomic disadvantage and reduced access to essential services such as housing, education, transport and healthcare. However, it is not clear whether researchers consistently consider geographic impact for people with intellectual disability. Method All research articles since January...

Precision medicine approaches to depression argue for the assessment of individual client profiles of the two major diagnostic criteria of depressed mood and anhedonia. To explore this suggestion, 1,513 males and 1,348 females aged between 55 and 87 years from Newcastle, Australia, completed the Center for Epidemiological Studies-Depression Scale (...

Objective To report on self-reported physical and mental health of informal carers in rural regions of New South Wales, Australia. Methods A cross-sectional community-based sample (n=222) of carers completed a questionnaire incorporating self-reported measures of health from validated international instruments including Medical Outcomes Study Scal...

Research is limited on whether differing methodologies for facilitating personal contributions from individuals aging with intellectual disability produce equivalent knowledge outcomes. Two matched purposedeveloped tools examined five qualityoflife domains. Results showed substantial variance between qualitative interview responses and Likertscale...

Objective The aim of the present study was to explore the use of complementary consent methodologies to support a potentially vulnerable group of people, namely those aging with intellectual disability, to provide personal input. It was premised on the view that processes to determine capacity for consent, appropriately modified to account for indi...

Objective: Investigations around ageing with an intellectual disability have increased substantially in the past three decades. A research gap continued to exist regarding the detection of ageing issues in this cohort of people, particularly in rural areas where access to specialist support continued to be limited. The purpose of this study was to...

Accessible summary This paper is about older people with learning disabilities who live in the country in Australia. We talked to both individuals and their carers to find out what things helped them they got older, and what things made it harder. These people said that they were well supported by the local community and particularly their doctors....

-Social support is proposed as a coping mechanism against anxiety and depression amongst older persons, but few data have examined how this occurs. This study assessed the contributions of two sub-components of social support as mediators against psychological distress-broadly defined as anxiety and depression. 1,560 men and 1,758 women from the Hu...

Purpose While ageing with an intellectual (learning) disability has been subject to increased research in recent years, there remains little knowledge regarding the daily practice issues that disability workers struggle most to support in this cohort. The goal of this project was to gain feedback directly from staff regarding the problems they expe...

Language framed as derogatory names and symbols can have implications for people and their life experiences. Within a Saussurian-inspired frame, and looking at ideas of stigma and social inclusion, this paper examines the use of language as a weapon within a social context of (changing) intent and meaning. Three examples of language use in mainstre...

Language framed as derogatory names and symbols can have implications for people and their life experiences. Within a Saussurian-inspired frame, and looking at ideas of stigma and social inclusion, this paper examines the use of language as a weapon within a social context of (changing) intent and meaning. Three examples of language use in mainstre...

Purpose: The attitudes of support staff towards people with intellectual disability can greatly impact upon an individual’s quality of life and level of social inclusion. However, there are few studies that examine how perceptions and beliefs have changed within one organisation over the past few decades; a period during which there have been major...

The author of this conceptual article was awarded a Churchill Fellowship to travel to the United States, Ireland, and United Kingdom to meet with researchers, practitioners, and community agencies and review how support for people with intellectual disability is provided. A specific focus was upon provision of care for individuals who were either a...

The past century has seen a dramatic improvement in the life expectancy of people with Down syndrome. However, research has shown that individuals with Down syndrome now have an increased likelihood of early onset dementia. They are more likely than their mainstream peers to experience other significant co-morbidities including mental health issues...

The emerging phenomenon of ageing with an intellectual disability has become subject to an increasing research focus in recent years. However, there remains little knowledge regarding the specific impediments that community workers face in supporting this cohort. The aims of the current study were to identify the major factors that, direct care sta...

The issue of ageing within the cohort of people with intellectual disabilities has been an increasing focus for research. However, the training needs of the staff who support them has not been subject of extensive examination. A multiround Delphi project was conducted focusing upon the impact ageing issues have on the support provided by disability...

Background: Dramatic improvements in life expectancy have led to a large cohort of people with intellectual disabilities (ID) who are ageing. To date, there is limited comparative research across metropolitan and rural regions with respect to understanding issues faced by ageing individuals with disabilities and their carers. Method: The purpose o...

In the past 100 years, the life expectancy for individuals with an intellectual disability has increased dramatically. This improvement is due to an improvement in a variety of social and structural support systems; however, a major knowledge gap has emerged in how to most effectively assist this cohort of people to age successfully. In particular,...

In recent years, a combination of factors has seen life expectancies for people with intellectual disabilities increase dramatically. The majority of research so far has focused upon metropolitan areas, but little information is available regarding the impact of this relatively new phenomenon within rural localities. The authors examine the issues...

This article uses a descriptive case study design to examine the potential of narrative therapy as a direct intervention for adults with moderate to severe intellectual disabilities, autism and/or severe communication limitations. Archival clinical data on four individuals who received a form of social constructionist narrative therapy are examined...

Aim: In recent years, a combination of factors have seen life expectancies for people with intellectual disabilities increase dramatically. While this improvement is naturally a very desirable outcome, there are limited policy frameworks and little information regarding the impact of rurality on this relatively new phenomenon. The purpose of this s...

The release of the 1983 Inquiry into Health Services for the Psychiatrically Ill and the Developmentally Disabled report, commonly known as the Richmond Report, provided an impetus to improve services to people with disabilities, to modify the way services were provided to people with disabilities, and to enhance the wider community's understanding...