Volume twelve, Issue 4

In this new editorial, RRH offers an essential guide to rural primary care research. The European Regional Editor and his co-author look at the issue with both a wide lens and also in helpful detail, giving readers the benefit of their combined wisdom and experience.

Eight women die every hour in India due to complications of pregnancy and child birth. This study reports on data from Andhra Pradesh as part of a longitudinal study on childhood poverty, and examined the effect of factors such as caste, education and prenatal care on the women's use of skilled institutional obstetric care.

Much has been published about access to rural palliative care (PC) in the developed world. This unusual qualitative study considered the experience of a small number of specialist healthcare participants who provide community PC in remote, isolated areas of rural South Africa, where a patient's prognosis and even diagnosis may not be known, and people follow traditional ways of caring.

Much has been written and published globally about recruiting rural medical workforce to underserved rural locations. This latest contribution from Turkey surveyed an entire year cohort of graduating physicians to define their views on working in underdeveloped areas, opinions of recent policy initiatives, and to identify incentives and disincentives to working away from major hospitals and cities.

How do farmers manage stress - and is their way of coping unique? This complex study surveyed South Australian farm men and women of all ages at a time of severe drought to provide a glimpse into psychological distress and coping within the Australian farming community.

This description and discussion of a pilot, remote Aboriginal community care service model will inspire others to address the integrated delivery of aged, disability and mental health services in similar contexts - in a culturally appropriate way.

Telehealth is an increasing part of healthcare delivery in remote and rural settings but to date evaluation is limited. This article reports an evaluation of the ethical competencies of behavioral health providers, offering suggestions for continuing education to improve telehealth services.

Access to health care is vital for every migrant's health and wellbeing. With interracial marriages increasing in rural and urban Australia, this study looked at factors affecting healthcare access for intermarried Filipino women in rural Tasmania.

The United States has increased the number and distribution of Federally Qualified Health Centers. Studies such as these are needed to help understand rural populations and insured and uninsured population differences so that interventions can be more efficient and more effective.

There are great changes and challenges in the American nation's pharmacies. This article moves beyond simplistic newspaper headlines to the challenges facing the pharmaceutical component of rural community health care. It is also a model article for those planning to address various abuses at the local and individual level, rather than waiting for government assistance.

Australian rural GPs often provide emergency and inpatient services. Whether accredited GP-Anaesthetists or 'occasional intubators' for emergency patients, most can expect to encounter 'difficult airways' that require specific equipment and procedures. As a first of its kind, this recent online survey sought to understand rural preparedness for such a clinical situation, including access to equipment and training, and awareness of the guidance available in established algorithms and local protocols.

In Australia, live kidney donation is a critical source of organs for transplant. While nephrectomy is now a common procedure with low morbidity, what is the financial cost of this altruistic act to non-metropolitan donors?

Mental health assessment and mental health care for the elderly remain challenging in many rural areas. Much must be understood to move the people in a community towards better mental health. This article is a good primer for community based interventions that help people in areas such as properly identifying mental health issues and separating mental health changes from aging changes.

With Greece currently striving to limit its health expenditure, what is the role of rural primary health care, and how can the effectiveness and efficiency of PHC services be improved? This study sought the opinions of the PHC providers in the regions of Epirus and Crete.

Despite evidence that the debilitating Parkinson's disease may be more prevalent in rural communities, little is known about the life quality of those affected. This Australian study compared the impact of the disease on a rural population with those affected in an urban location.

This research from the University of Western Sydney adds to the medical education evidence for long-term rural placements. The authors place their own results in the context of recent, similar Australian studies.

Mental health professional deficits are common across the United States, but what about rural areas or more isolated rural areas? Studies of mental health workforce must include consideration of rural access, rather than just focusing on psychiatry. In this study hospital leaders were surveyed for information about local healthcare workforce.

Generations of Australian Aboriginal people have been exposed to traumatic events with devastating psychosocial and health consequences, including psychiatric morbidity and mortality, and medical complications. This study suggests that a high prevalence of undiagnosed posttraumatic stress disorder (PTSD) in this population group leads to misinterpretation of symptoms - with tragic consequences.

To resolve shortages of workforce at the local level, evaluation and planning is needed that is specific to the local level and integrated at higher levels, along with training capabilities. The CHC Community Apgar Questionnaire is just such a tool to help with evaluation and planning.

Healthy People 2020 sets important goals in areas such as oral health, but to reach these goals the United States will need to do much better in areas such as oral cancer screening. Deficits in dental care, decreased access to health insurance coverage, and personal habits represent a challenge. A study of oral cancer screening of Appalachian women in Ohio can help guide those who are attempting to move less healthy populations toward Healthy People in 2020.

Healthcare policies impact rural America through increasing barriers to health access, insufficient health workforce, increased patient waiting times, and decreased time with patients. Studies demonstrate the consequences for elderly rural Americans in need of better care, especially in mental health care. Is anyone listening?

Dementia care has been described as a journey through which the care providers move. This article reports on original research that documents this journey in relation to the type of information needed by care partners in rural settings.

Globesity studies continue with more populations and age groups indicated. A rural serving university offers the opportunity to explore obesity relationships and stressful obesogenic environments past, present, and future for an entire region - especially a border region with substantial Hispanic population.

The enormous impact of suicide on families and the wider rural community calls for urgent attention and action. A starting place is in seeking to understand key associated factors - in this case, those established by Northern Territory coroners in Australia.

Australia's largely privately financed dental services mean reduced access for many in need. Using hospitalisation for surgical removal of impacted teeth as an indicator of service access, this study identified disadvantaged groups nation-wide as a guide to the allocation of resources and services.

Palliative care in remote areas is often beset with difficulties, resulting in suboptimal symptom control. These authors studied 24 home palliative-care patients on an island in south-eastern Japan and demonstrate the effectiveness of using a clinical pathway in palliation in a remote setting.

At a time period where rural workforce shortages continue worldwide, new sources of information and analysis are needed. Studies that interview the rural origin health professional students can make valuable contributions. Does training offer an escape or do students see training as an opportunity to serve their families, neighbors, and communities of origin?

In regional areas, where patients are ageing, specialists scarce and GPs often generalists, this study suggests a novel way increase the knowledge and confidence of GPs, while decreasing their professional isolation.

This commentary by a well-known Australian rural medical educator puts the case for extending the successful medical Remote Vocational Training Scheme supervision model to all health professions.

Extensive dental decay impacts a child's nutrition, health and wellbeing. Amid indications that the oral health of Australian Aboriginal children is worsening, this important review collates the evidence, comparing Aboriginal with non-Aboriginal children, by state, rural/urban location and over time. The evidence speaks for itself.

Dilated cardiomyopathy is a significant health problem in rural Africa. This case report alerts clinicains in rural areas to an uncommon presentation.

Over half a decade since the introduction of Accredited Social Health Activist (ASHA) workers in rural India, how can a knowledge-practice gap in village-level child health be improved?

Ever wondered about nursing in remote Greenland? This short report on Greenland's nurses' scope of practice and self-perceived competency over a range of patient encounters was part of a countrywide audit.

Do specific factors increase the risk of symptomatic gallstone disease during polar residence? This short report of four cases among a year-long Indian Antarctic expedition provides some clues.

The challenge of childhood obesity increases even as malnutrition continues. Rural situations may offer some unique insights as to the contributions of physical activity, culture, eating habits, and social determinant factors that can shape dietary disturbances.

This project report from the Solomon Islands concerns the cooperative investigation of local and visiting researchers into the late or non-presentation of islanders with TB. As well as identifying local answers to a global question, the authors have show how a small project can inform the development of large service changes.

Rural vocational experiences commonly involve generalist rotations, but rural specialists are also needed. The typical pattern of packing specialty and sub-specialty training into a few most concentrated locations will not assist physician distribution. Studies such as this one are needed to help understand the impact of rural experiences on various types of specialties.

The abuse of oxycodine has reached epidemic levels in some remote communities in Canada. To address this addiction, a withdrawal support service was developed and is described here in the hope it will help other communities struggling with similar issues.

Rural health practitioners are, by necessity, experts in improvisation using materials to hand. The innovative device reported by these Nigerian authors can be adapted to any oral health clinic, remote or rural, in developed or developing context, to improve preventive dental care and general health outcomes.

For rural health clinicians to participate in continuing professional development it is necessary to transcend conventional educational methods - or so say these authors. They present a different approach to interprofessional learning that is both flexible and adaptable.

Is the 'fly in/fly out' (FIFO) model used successfully in industry the answer to Australia's crisis in sustaining medical services for its rural, remote and Indigenous populations? This personal perspective adds an authentic voice to the debate.

Abstracts now available at Rural and Remote Health from the 2012 MICRRH (Mount Isa, Queensland) conference "Are You Remotely Interested... in Prevention? Building a Culture of Safety".