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Graham K, Fitzpatrick K, Agius J, Loughry C, Ong E, McMillan N, Gunn K, Fitridge R. A qualitative exploration of the experiences of Aboriginal and Torres Strait Islander people using a real-time video-based telehealth service for diabetes-related foot disease. Rural Remote Health 2024; 24:7970. [PMID: 38413381 DOI: 10.22605/rrh7970] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION Diabetes-related foot disease (DFD) is one of the most prevalent causes of global hospitalisation and morbidity, and it accounts for up to 75% of lower-extremity amputations globally. The 5-year mortality rate following any amputation ranges from 53% to 100%. Early identification of wounds and multidisciplinary management can reduce amputation rates by 39-56%. Rural and remote communities and Indigenous populations are disproportionately affected by DFD. This is reflected in amputation rates, which are much higher for Indigenous than for non-Indigenous Australians and for those in very remote areas than for those in major cities or inner regional areas. The large geographical spread of the population in Australia is a substantial barrier for those providing or accessing health services, particularly multidisciplinary and specialist services, which undoubtedly contributes to poorer DFD outcomes in rural and remote communities. METHODS A real-time, video-based telehealth service for DFD management was established at the Royal Adelaide Hospital Vascular Services clinic to improve access to specialist services for rural and remote Aboriginal and Torres Strait Islander communities. An exploratory qualitative study that utilised one-on-one, semi-structured interviews was conducted with 11 participants who identified as Aboriginal and who had participated in the telehealth foot service. Interviews were transcribed, de-identified and analysed using thematic analysis, using an inductive approach. RESULTS Four interrelated themes emerged. 'Practical benefits of staying home' describes the reduced burden of travel and advantages of having local healthcare providers and support people at consultations. 'Access to specialists and facilities' highlights how some participants felt that there was a lack of appropriate facilities in their area and appreciated the improved access telehealth provided. 'Feeling reassured that a specialist has seen their feet' reflects the positive impact on wellbeing that participants experienced when their feet were seen by specialist health staff. 'Facilitates communication' describes how participants felt included in consultations and how seeing a person on screen assisted conversation. CONCLUSION The advantages of real-time, video-based telehealth go beyond reduced travel burden and improved access to specialist care. This model of care may facilitate relationship-building, patient wellbeing, and feelings of trust and safety for Aboriginal and Torres Strait Islander DFD patients.
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Affiliation(s)
- Kristin Graham
- Allied Health and Human Performance, The University of South Australia, North Terrace, Adelaide, SA 5000, Australia
| | - Katrina Fitzpatrick
- Department of Podiatry, Central Adelaide Local Health Network, Adelaide, SA, Australia; and Watto Purrunna Aboriginal Health Service, Port Adelaide, SA, Australia
| | - Joseph Agius
- Department of Podiatry, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Cathy Loughry
- Allied Health and Human Performance, The University of South Australia, North Terrace, Adelaide, SA 5000, Australia; and Department of Podiatry, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Emilee Ong
- Allied Health and Human Performance, The University of South Australia, North Terrace, Adelaide, SA 5000, Australia
| | - Neil McMillan
- Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, SA, Australia; and Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Kate Gunn
- Allied Health and Human Performance, The University of South Australia, North Terrace, Adelaide, SA 5000, Australia
| | - Robert Fitridge
- Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, SA, Australia; and Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
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Birch GF, Lee JH, Tanner E, Fortune J, Munksgaard N, Whitehead J, Coughanowr C, Agius J, Chrispijn J, Taylor U, Wells F, Bellas J, Besada V, Viñas L, Soares-Gomes A, Cordeiro RC, Machado W, Santelli RE, Vaughan M, Cameron M, Brooks P, Crowe T, Ponti M, Airoldi L, Guerra R, Puente A, Gómez AG, Zhou GJ, Leung KMY, Steinberg P. Sediment metal enrichment and ecological risk assessment of ten ports and estuaries in the World Harbours Project. Mar Pollut Bull 2020; 155:111129. [PMID: 32469765 DOI: 10.1016/j.marpolbul.2020.111129] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 06/11/2023]
Abstract
Ten global harbours were assessed for sediment quality by quantifying the magnitude of anthropogenic change and ecological risk. Anthropogenic change (enrichment) was high for Derwent River and Sydney estuary, moderate for Santander Harbour, Rio de Janeiro and Dublin Port, slight for Hong Kong, minimal for Darwin. All 10 enrichment indices used showed similar results. Derwent River sediment was rated at high ecological risk, followed by Sydney and Santander estuaries with moderate risk. Auckland and Darwin sediments exhibited minimal ecological risk and sediment in the remaining harbours (Dublin, Hong Kong, Ravenna, Ria de Vigo and Rio de Janeiro) were assessed at slight ecological risk. The extraordinary variety of environments and types/quantities/qualities of data investigated resulted in as much a critique and development of methodology, as an assessment of human impact, including unique techniques for elemental normalisation and contaminant classification. Recommendations for an improved technical framework for sediment quality assessment are provided.
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Affiliation(s)
- G F Birch
- School of Geosciences, The University of Sydney, NSW, Australia.
| | - J-H Lee
- School of Geosciences, The University of Sydney, NSW, Australia; Lotsearch, 3/68 Alfred Street, Milsons Point, NSW, 2061, Australia
| | - E Tanner
- Sydney Institute of Marine Science, Mosman, NSW, Australia
| | - J Fortune
- Aquatic Health Unit, Department of Environment and Natural Resources, Northern Territory, Australia
| | - N Munksgaard
- Research Institute for the Environment and Livelihoods (RIEL), Charles Darwin University, Darwin, Northern Territory, Australia
| | - J Whitehead
- Derwent River Program, DPIPWE, Tasmania, Australia
| | - C Coughanowr
- Derwent River Program, DPIPWE, Tasmania, Australia
| | - J Agius
- Derwent River Program, DPIPWE, Tasmania, Australia
| | - J Chrispijn
- Derwent River Program, DPIPWE, Tasmania, Australia
| | - U Taylor
- Derwent River Program, DPIPWE, Tasmania, Australia
| | - F Wells
- Derwent River Program, DPIPWE, Tasmania, Australia
| | - J Bellas
- Centro Oceanográfico de Vigo, 36390, Vigo, Pontevedra, Spain
| | - V Besada
- Centro Oceanográfico de Vigo, 36390, Vigo, Pontevedra, Spain
| | - L Viñas
- Centro Oceanográfico de Vigo, 36390, Vigo, Pontevedra, Spain
| | - A Soares-Gomes
- Federal Fluminense University, Marine Biology Department, Valonguinho Campus, Niterói, RJ, Brazil
| | - R C Cordeiro
- Federal Fluminense University, Geochemistry Department, Valonguinho Campus, Niterói, RJ, Brazil
| | - W Machado
- Federal Fluminense University, Geochemistry Department, Valonguinho Campus, Niterói, RJ, Brazil
| | - R E Santelli
- Rio de Janeiro Federal University, Chemistry Institute, Rio de Janeiro, RJ, Brazil
| | - M Vaughan
- Research and evaluation unit, Auckland Council, New Zealand
| | - M Cameron
- Research and evaluation unit, Auckland Council, New Zealand
| | - P Brooks
- UCD Earth Institute and School of Biology and Environmental Science, University College Dublin, Dublin, Ireland
| | - T Crowe
- UCD Earth Institute and School of Biology and Environmental Science, University College Dublin, Dublin, Ireland
| | - M Ponti
- Department of Biological, Geological and Environmental Sciences and Interdepartmental Research Centre for Environmental Sciences, University of Bologna, 48123 Ravenna, Italy
| | - L Airoldi
- Department of Biological, Geological and Environmental Sciences and Interdepartmental Research Centre for Environmental Sciences, University of Bologna, 48123 Ravenna, Italy
| | - R Guerra
- Department of Physics and Astronomy and Interdepartmental Research Centre of Environmental Sciences, University of Bologna, 48123 Ravenna, Italy
| | - A Puente
- IHCantabria - Instituto de Hidráulica Ambiental de la Universidad de Cantabria Avda. Isabel Torres, 15, 39011, Santander, Spain
| | - A G Gómez
- IHCantabria - Instituto de Hidráulica Ambiental de la Universidad de Cantabria Avda. Isabel Torres, 15, 39011, Santander, Spain
| | - G J Zhou
- The Swire Institute of Marine Science and School of Biological Sciences, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - K M Y Leung
- The Swire Institute of Marine Science and School of Biological Sciences, The University of Hong Kong, Pokfulam, Hong Kong, China; State Key Laboratory of Marine Pollution, City University of Hong Kong, Kowloon, Hong Kong, China
| | - P Steinberg
- Sydney Institute of Marine Science, Mosman, NSW, Australia
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