A Randomized Placebo-Controlled Study of a Transcranial Photobiomodulation Helmet in Parkinson's Disease: Post-Hoc Analysis of Motor Outcomes.

Emerging evidence is increasingly supporting the use of transcranial photobiomodulation (tPBM) to improve symptoms of neurodegenerative diseases, including Parkinson's disease (PD). The objective of this study was to analyse the safety and efficacy of tPBM for PD motor symptoms. The study was a triple blind, randomized placebo-controlled trial with 40 idiopathic PD patients receiving either active tPBM (635 nm plus 810 nm LEDs) or sham tPBM for 24 min per day (56.88J), six days per week, for 12 weeks. The primary outcome measures were treatment safety and a 37-item MDS-UPDRS-III (motor domain) assessed at baseline and 12 weeks. Individual MDS-UPDRS-III items were clustered into sub-score domains (facial, upper-limb, lower-limb, gait, and tremor). The treatment produced no safety concerns or adverse events, apart from occasional temporary and minor dizziness. There was no significant difference in total MDS-UPDRS-III scores between groups, presumably due to the placebo effect. Additional analyses demonstrated that facial and lower-limb sub-scores significantly improved with active treatment, while gait and lower-limb sub-scores significantly improved with sham treatment. Approximately 70% of participants responded to active treatment (≥5 decrease in MDS-UPDRS-III score) and improved in all sub-scores, while sham responders improved in lower-limb sub-scores only. tPBM appears to be a safe treatment and improved several PD motor symptoms in patients that responded to treatment. tPBM is proving to be increasingly attractive as a possible non-pharmaceutical adjunct therapy.

A Qualitative Study of Rural and Remote Australian General Practitioners' Involvement in High-Acuity Patients.

This study aimed to understand the experiences, barriers, and facilitators of rural general practitioners' involvement with high-acuity patients. Semi-structured interviews with rural general practitioners in South Australia who had experience delivering high-acuity care were audio-recorded, transcribed verbatim, and analyzed through content and thematic approaches incorporating Potter and Brough's capacity-building framework. Eighteen interviews were conducted. Barriers identified include the inability to avoid high-acuity work in rural and remote areas, pressure to handle complex presentations, lack of appropriate resources, lack of mental health support for clinicians, and impacts on social life. Enablers included a commitment to community, comradery in rural medicine, training, and experience. We concluded that general practitioners are a vital pillar of rural health service delivery and are inevitably involved in disaster and emergency response. While the involvement of rural general practitioners with high-acuity patients is complex, this study suggested that with the appropriate system, structure and role supports, rural general practitioners could be better empowered to manage high-acuity caseloads locally.

Impact of the COVID-19 pandemic on student experiences during rural placements in Australia: findings from a national multi-centre survey.

BACKGROUND: The aim of this national study was to explore the learning experiences of Australia's medical students who trained rurally during the COVID-19 pandemic in 2020. METHODS: A cross-sectional, national multi-centre survey was conducted in 2020, through the Federation of Rural Australian Medical Educators (FRAME). Participants were medical students who had completed an extended Rural Clinical School (RCS) training placement (≥ 12 months). A bespoke set of COVID-19 impact questions were incorporated into the annual FRAME survey, to capture COVID-19-related student experiences in 2020. Pre-pandemic (2019 FRAME survey data) comparisons were also explored. RESULTS: FRAME survey data were obtained from 464 students in 2020 (51.7% response rate), compared with available data from 668 students in 2019 (75.6% response rate). Most students expressed concern regarding the pandemic's impact on the quality of their learning (80%) or missed clinical learning (58%); however, students reported being well-supported by the various learning and support strategies implemented by the RCSs across Australia. Notably, comparisons to pre-pandemic (2019) participants of the general RCS experience found higher levels of student support (strongly agree 58.9% vs 42.4%, p < 0.001) and wellbeing (strongly agree 49.6% vs 42.4%, p = 0.008) amongst the 2020 participants. Students with more than one year of RCS experience compared to one RCS year felt better supported with clinical skills learning opportunities (p = 0.015) and less affected by COVID-19 in their exam performance (p = 0.009). CONCLUSIONS: This study has provided evidence of both the level of concern relating to learning quality as well as the positive impact of the various learning and support strategies implemented by the RCSs during the pandemic in 2020. RCSs should further evaluate the strategies implemented to identify those that are worth sustaining into the post-pandemic period.

Associations of the Initial COVID-19 Lockdown on Self-Reported Happiness and Worry about Developing Loneliness: A Cross-Sectional Analysis of Rural, Regional, and Urban Australian Communities.

Australia adopted hard lockdown measures to eliminate community transmission of COVID-19. Lockdown imposes periods of social isolation that contributes to increased levels of stress, anxiety, depression, loneliness, and worry. We examined whether lockdowns have similar psychosocial associations across rural and urban areas and whether associations existed between happiness and worry of loneliness in the initial wave of the COVID-19 pandemic in Australia. Data were collected using the "COVID-19 Living Survey" between 13 and 20 May 2020 by BehaviourWorks Australia at the Monash Sustainable Development Institute. The mean self-reported feeling of happiness and anxiousness (N = 1593), on a 10-point Likert scale with 0 being least happy or highly anxious, was 6.5 (SD = 2.4) and 3.9 (2.9), respectively. Factors associated with happiness were older age and having a postgraduate education. Participants worried about becoming lonely also exhibited reduced happiness (estimate = -1.58, 95%CI = -1.84--1.32) and higher anxiousness (2.22, 1.93-2.51) scores, and these conditions remained associated after adjusting for demographics. Interestingly, worry about loneliness was greater in rural areas than in urban communities. The negative impact of the COVID-19 lockdown on rural youth and those less-educated was evident. Participants in rural Australia who were worried about becoming lonely were reportedly less happy than participants in major cities. This dataset provides a better understanding of factors that influence psychological well-being and quality of life in the Australian population and helps to determine whether happiness may be an associative factor that could mitigate self-feelings of anxiety and worry about loneliness.