Volume ten, Issue 4

This Editorial coincides with the recent launch of the WHO guidelines "Increasing access to health workers in remote and rural areas through improved retention: Global policy recommendations". The Editorial and a linked review of the Guidelines (which includes the WHO URL for free Guidelines download) will be of interest to all who are concerned with improving the recruitment and retention of health workers in underserved areas.

This Editorial invites Rural and Remote Health readers to participate in a return to traditional values in healthcare delivery, by promoting compassionate rural health care.

Rural health research is continually needed to demonstrate the links between place and health. This article, focusing on older rural women and breast cancer, provides information about these links and also some surprising information about support and breast cancer treatment.

From the analysis of data input to the national health information system, the Papua New Guinea government monitors the performance of its health system. In an era when anything IT is seen as the ultimate authority, this cautionary article is a reminder to information custodians not to lose sight of the reality of local (rural) service level when looking at the Big Picture.

Sometimes we would like to show differences in interventions that lead to better care or more rural workforce, but studies often fail to have proper controls or use arbitrary definitions. Similar problems often involve studies of origins and admission, or outcome and studies of healthcare quality. This study examined out-of-pocket healthcare costs. It included controls for healthcare insurance coverage, healthcare utilization, and patient income. These are factors known to be different for rural populations. Are out-of-pocket costs different relative to rurality - or are other factors at play here?

This article offers information about three specific chronic diseases including their incidence and management among the rural population. The investigation is a welcome addition for those keen for greater precision regarding rural health status.

Clincial educators are challenged to prepare students not only for practice, but also for the larger environmental context within whcih they work. This article focuses on preparing nursing students for rural environments, specifically their sense of belonging during a rural hospital preceptorship.

Enduring natural disasters can undermine the wellbeing of those effected, with responses ranging from feelings of loss of control to helplessness and fear. The stress of prolonged drought, floods and other recent pressures on Australian farmers has increased their vulnerability to mental health issues and psychiatric morbidity. In response, the 2007 pilot 'Mental Health First Aid' training was offered to a range of non-health rural workers Queensland, such as landcare officers, financial counsellors and farm inspection officers, with the aim of early recognition of symptoms, referral and support for the farmers encountered in their daily work. This study re-visits the training offered in this unique program, and evaluates its impact on participants.

The debate about loan repayments and other incentives continues. Do they result in more primary care? Do they result in more basic health access in locations short of physicians? Do they result in changes in physician locations to the most needed locations? What does a loan repayment really accomplish that is above what the recipient would have done anyway? How much do short term obligations accomplish in the context of 30 or more years in the career of a physician? While the questions will continue, this study provides some answers.

The Australian Government encourages the regional resettlement of refugees. However, for people used to urban living or those with a background of disruption, torture and trauma, relocation to a rural area requires sensitive, appropriate support. This article describes the development of a basic manual and additional support materials for the use of volunteers and caseworkers in regional Australia.

When patient needs require rural generalists to venture into specialist areas, professional and ethical issues are raised. This thought-provoking study from Queensland, Australia, reports on a survey of rural physiotherapists who have also provided patient care in the specialist field of paediatrics. The findings raise important questions about the nature of rural and remote practice and its impact on the confidence of generalist health professionals, and also rural patients requiring specialist care.

Women with gestational diabetes (GDM) have an increased risk of developing type 2 diabetes mellitus, although this risk can be reduced by behavioural changes. The group of rural women with GDM studied by these authors showed one intriguing difference from urban women. The authors' skilful application of the Stages of Change Model also focused issues in the promotion of the lifestyle behaviour changes that are so important for the long-term health of this special group of women.

The retention of GPs in remote parts of Australia is an urgent workforce issue, and the Northern Territory is a case in point: it has the highest GP turnover and few 'home grown' practitioners; the sense of adventure that promotes NT recruitment works against retention. In the context of too many short-stay GPs, these authors applied the theory of 'place attachment' to the highly mobile NT medical workforce. Although their sample was small, this article offers a fresh look at a constant issue - and provides an intriguing model for remote area retention that could apply across disciplines.

Does eating shellfish live protect against the transmission of pathogens? How is Ash Monday related to an epidemic of gastroenteritis? The answers to these and other questions are provided in this report of a recent public health outbreak investigation on the remote Greek island, Agios Efstratios. The authors describe epidemiological methods that would be useful in any remote setting where the source of an epidemic must be tracked despite limited or absent laboratory support.

What are GPs' community management issues for chronic heart failure patients in rural and remote Scotland? And has the recent community based nurse-led heart failure service improved care, as intended? These questions and the views of the first Highlands CHF specialist nurses are explored in this postal survey of all Highlands GPs.

What do adolescents eat? This detailed study of the diet of 100 rural Greek adolescents has some interesting findings to add to the developing knowledge base of the lifestyle and health-risk profile of the most recent Mediterranean generation.

In common with other countries, the recruitment, retention and training of rural mental health workers is a major concern in Australia. What are the views and perspectives of their managers? The information provided by this research complements studies of the clinicians themselves, and so offers a unique contribution to achieving a sustainable and effective rural mental health workforce.

What factors influence patients' choice of primary care facility for an episode of care? This question was asked in a bid to understand - and ease - the pressure on primary care in many parts of Canada. In a microcosm of the larger picture, the researchers analysed the pattern of medical visits to 6 primary care facilities in rural Quebec. The results provide a first insight into the influence of patients' location, sex and age.

This study of 388 rural South Australian high-school students used a multidimensional process model - encompassing individual, family and community factors - to investigate the determinants of mental health problems. The researchers' comprehensive approach makes a substantial contribution to the scant existing database on the mental health of rural adolescents in South Australia - an important but currently under-researched population.

How do rural undergraduate students get their health information? This US study from the time of the 2009 influenza A (H1N1) pandemic offers useful information for health educators as well as those responsible for emergency preparedness plans.

Mental health services are limited in rural areas. Are computer-based programs that address mental health a possible solution? This article focuses on rural womens' experiences of depression and examines their use of an on-line social support program.

Are there differences in early childhood caries (ECC) among religious agricultural groups? This report is the first study to examine ECC among Hutterite children in Manitoba.

It started when the Warlpiri Aboriginal community in Central Australia wanted to bring their old people home from distant nursing homes. The subsequent development of the Yuendumu Old Peoples Programme and its Family Model of Care shows how this was achieved - and so much more. When government and community worked together respectfully, the power of the traditional system of care based on Law, kinship and 'country' transformed the everyday setting of community based Indigenous aged care - and the final years of many older people.

Are rural health workers at a disadvantage in regard to injury and disability? This comprehensive review provides insight about rural-urban differnces on this topic and offers recommendations for future research.

Addressing the epidemic of type 2 diabetes among First Nations peoples is an ongoing challenge. These authors reflect on their clinical practice and research endeavors, providing useful insights that health workers can use to engage with First Nations communities in these efforts.

In developing countries where TB is endemic and co-infection with HIV is rising, disfiguring cutaneous TB is a re-emerging pathology, due in part to the treatment access barriers of rural and remote patients. This case report gives some practical advice for health personnel in district health posts where effective diagnostic tests may not be available.

Secondhand smoke and its health impacts on children is an issue of great importance in public health. What do we know about SHS exposure and rurality in Alaskan children? This population-based survey adds to our knowledge.

How do we prepare health care professionals for geriatric practice in rural areas? We can all learn from this project report which provides details and examples from the author's experiences in New York State.

This Letter to the Editor reports a unique clinical opportunity to identify a rural African population LESS likely to suffer from sickle cell disease - with consequent implications for the preservation of scarce laboratory resources.

Parental attitudes have been found to inhibit childhood vaccination in some world regions. This brief letter from Uganda suggests this may not be the main different barrier to achieving high levels of child immunisation in developing rural communities.

Much has been written internationally about the access of rural populations to health care; however, until now there has been no information from Hungary. This letter informs readers of a landmark survey in the year 2000, which established the difference between the rural and urban populations' health care in Hungary.

This is a Comment on the recently published Commentary, "Attracting and retaining doctors in rural Nepal". The Commentary author's Reply will be published shortly.