Rural and Extreme Rural Settings: Reducing Distances and Managing Extreme Scenarios

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A number of children live today both in high- and low-income settings, in rural areas that still do not guarantee a prompt, affordable, and appropriate access to a health system. It means that medical conditions ranging from very mild ones up to major emergencies cannot be dealt with locally and require the transportation of the child to a far hospital, losing time and wasting resources. The application of telemedicine systems able to reduce or annihilate the distances among the user and the provider of the health service is affordable and sustainable over time. The same models applicable for rural and extreme rural settings can be applied for an emergency scenario, humanitarian crisis, and natural catastrophes – where children often are the most exposed – helping to optimize the resource and to control the intervention, also providing real-time support from experts that do not need to reach the place of the event anymore. This is supposed to reduce the wastes and to improve the logistic of the action. Future scenarios that would involve the delivery of health also for children in very inaccessible settings become paradigms of a model already implementable today, aimed to give children and families better care, in spite of the geographical locations they live in.

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In this paper we introduce five graphical statistical methods to compare countries level of development relative to other countries and across time. For this, we use seven panels of data on the Human Development Index and its components, containing information on more than 100 countries for more than 35 years. We create visual comparisons of the level of development of countries relative to each other, and across time, through five different visualization techniques: (i) Rankings (ii) Values (iii) Distributions (iv) visual metaphors (The Development Tree), and (v) networks, by introducing the concepts of Partial Ordering Networks (PON) and Development Reference Groups (DRG). The graphical exploration of both, values and distributions, show a saturation of both the education and life dimensions of the HDI, suggesting a need to extend the definitions of this components to include either more subcomponents, or completely new measures that could help differentiate between countries facing different development challenges. The Development Tree and the Partial Ordering Network, on the other hand, are used to create graphical narratives of countries and regions. The simplicity of the Development Tree makes it an ideal graphical metaphor for branding the HDI in a multilingual setting, whereas Partial Ordering Networks provide a more organic way to group countries according to their levels of development and connect countries to those with similar development challenges. We conclude by arguing that graphical statistical methods could be used to help communicate complex data and concepts through universal cognitive channels that are heretofore underused in the development literature.
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We carried out a prospective study of an Internet-based remote counselling service. A total of 15456 Internet users visited the Website over eight years. From these, 1500 users were randomly selected for analysis. Medical counselling had been granted to 901 of the people requesting it (60%). One hundred and sixty-four physicians formed project groups to process the requests and responded using email. The distribution of patients using the service was similar to the availability of the Internet: 78% were from the European Union, North America and Australia. Sixty-seven per cent of the patients lived in urban areas and the remainder were residents of remote rural areas with limited local medical coverage. Sixty-five per cent of the requests were about problems of internal medicine and 30% of the requests concerned surgical issues. The remaining 5% of the patients sought information about recent developments, such molecular medicine or aviation medicine. During the project, our portal became inaccessible five times, and counselling was not possible on 44 days. There was no hacking of the Website. Internet-based medical counselling is a helpful addition to conventional practice.
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Specialist outreach clinics in primary care and rural hospital settings. The Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD003798.pub2. DOI: 10.1002/14651858.CD003798.pub2.
Over a period of years (1970-1985), UNRISD carried out a programme of research on the measurement and analysis of socio-economic development. Some of the major results are summarized in this paper. A new analytic line between development variables was established which minimized the sum of absolute (simple) deviations from the line rather than the sum of the squares of deviations as in regression. This permitted the establishment of a "correspondence system' which showed what value of any given indicator tended to correspond with what values of all other selected indicators of development (19 selected indicators in toto). This in turn permitted establishment of a "correspondence grid' on which the values of any given country could be placed, resulting in a "development profile'. The profile served two purposes: as a basis of development measurement, showing amount of growth in different sectors of development as well as overall, and as a basis for studying possible causal relations. Thus it was found that the 10 fastest growing countries in GDP per capita generally had a relatively high level of education and a relatively low level of investment in 1970, while the slowest growing countries had low education and comparatively high investment in 1970. -from Author
Compositional changes in migration steams between non-metropolitan and metropolitan areas are examined in relation to the post-1970 migration 'turnaround'. Analysis focuses on changes between 1955 and 1975 in 1) the sex, age, educational, and occupational selectivity and interchange of migration; 2) the impact of migration on population composition. United States data from the 1960 and 1970 Public Use Samples and the 1975 Current Population Survey indicate that both streams since 1970 have become less selective of the young and high-SES groups. However, this decline is least prominent for the nonmetrapoliton to metrapoliton streams, thus accentuating the differential inability of non-metropolitan areas to retain these subgroups. -Author
This report focuses on one demographic trend: Age Distributions. The basic findings of this report are: 1) in all regions, the largest group is the adults (15-59 years old), 2) in Asia, Africa, and Latin America and the Caribbean, there are more children than there are seniors, while, recently, in Europe there are more seniors than children, and in Northern America there will soon be more seniors than children, 3) in almost all regions, the proportion of the population who are children is declining while the proportion who are seniors is increasing. Sub-Saharan Africa is an exception. There are almost as many children as there are seniors, and the proportions of the population who are seniors and children have not yet changed.Changes in age distributions have many implications for society. For example, a larger proportion of younger people means more people who have yet to attain adulthood and who can be expected to have more children, which means continued population growth. So, Sub-Saharan Africa, which has the highest proportion of children, also has the highest population growth rates (as seen in previous reports), and can be expected to continue to have the highest population growth rates. Similarly, Europe and North America, which have the lowest proportion of children, also have the lowest population growth rates, which can be expected to continue to be low. Also, since most regions have declining proportions of children, most regions have declining population growth rates and will likely continue to have declining population growth rates.
To compare the quality of care delivered to critically ill and injured children receiving telemedicine, telephone, or no consultation in rural emergency departments. Retrospective chart review with concurrent surveys. Three hundred twenty patients presenting in the highest triage category to five rural emergency departments with access to pediatric critical care consultations from an academic children's hospital. Quality of care was independently rated by two pediatric emergency medicine physicians applying a previously validated 7-point implicit quality review tool to the medical records. Quality was compared using multivariable linear regression adjusting for age, severity of illness, and temporal trend. Referring physicians were surveyed to evaluate consultation-related changes in their care. Parents were also surveyed to evaluate their satisfaction and perceived quality of care. In the multivariable analysis, with the no-consultation cohort as the reference, overall quality was highest among patients who received telemedicine consultations (n = 58; β = 0.50 [95% CI, 0.17-0.84]), intermediate among patients receiving telephone consultation (n = 63; β = 0.12 [95% CI, -0.14 to 0.39]), and lowest among patients receiving no consultation (n = 199). Referring emergency department physicians reported changing their diagnosis (47.8% vs 13.3%; p < 0.01) and therapeutic interventions (55.2% vs 7.1%; p < 0.01) more frequently when consultations were provided using telemedicine than telephone. Parent satisfaction and perceived quality were significantly higher when telemedicine was used, compared with telephone, for six of the seven measures. Physician-rated quality of care was higher for patients who received consultations with telemedicine than for patients who received either telephone or no consultation. Telemedicine consultations were associated with more frequent changes in diagnostic and therapeutic interventions, and higher parent satisfaction, than telephone consultations.
Compositional change in migration streams between nonmetropolitan and metropolitan areas are examined in relation to the post-1970 migration "turnaround." Analysis focuses on (1) changes in the sex, age, educational and occupational selectivity, and interchange of migration, and (2) the impact of migration on population composition. (Author)
This review examines the benefits and costs of outreach in a range of specialties and in a variety of settings. Simple 'shifted outpatients' styles of specialist outreach were shown to improve access, but there was no evidence of their impact on health outcomes. Outreach as part of more complex multifaceted interventions involving primary care collaborations, education and other services was associated with improved health outcomes, more efficient and guideline-consistent care, and less use of inpatient services. There is a need for better quality evidence evaluating specialist outreach in all settings, but especially in rural and disadvantaged populations.
The common features of remote environments are geographical separation, logistic problems with health care delivery and with patient retrieval, extreme natural conditions, artificial environment, or combination of all. The exposure can have adverse effects on patients' physiology, on care providers' performance and on hardware functionality. The time to definite treatment may vary between hours as in orbital space flight, days for remote exploratory camp, weeks for polar bases and months to years for interplanetary exploration. The generic system architecture, used in any telematic support, consists of data acquisition, data-processing and storage, telecommunications links, decision-making facilities and the means of command execution. At the present level of technology, a simple data transfer and two-way voice communication could be established from any place on the earth, but the current use of mobile communication technologies for telemedicine applications is still low, either for logistic, economic and political reasons, or because of limited knowledge about the available technology and procedures. Criteria for selection of portable telemedicine terminals in remote terrestrial places, characteristics of currently available mobile telecommunication systems, and the concept of integrated monitoring of physiological and environmental parameters are mentioned in the first section of this paper. The second part describes some aspects of emergency medical support in human orbital spaceflight, the limits of telemedicine support in near-Earth space environment and mentions some open issues related to long-term exploratory missions beyond the low Earth orbit.
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