Volume eleven, Issue 1

This is an era when medical educators and funders strive for quality clinical placements in expanded practice settings typified by rural and remote teaching sites. Could the proposed Australian 'meducation' card use existing infrastructure to facilitate the training of future medical practitioners?

Environmental degradation in the African Niger Delta has impoverished the rural population - how do they pay for urgent surgical treatment? This first study of its type in this geographic zone provides some answers.

In rural and remote New South Wales, Australia, selected GPs, registered nurses and physiotherapists may be trained and licensed to perform a limited range of X-ray examinations in the absence of a radiographer, providing a valuable service for local residents. The survey reported on in this publication provides background information on this special interprofessional group and also defines their need for educational and other support. The strategies suggested here may well be relevant to other health workforce areas where similar 'skills transfer' is required.

In this heartfelt Editorial, Professor Kazuo Inoue (Teikyo University School of Medicine, Tokyo) and the Rural and Remote Health Asian Regional Editor, Associate Professor Masatoshi Matsumoto (Faculty of Medicine, Hiroshima University) salute the Japanese rural health professionals who have stayed in their regions and are struggling to provide care and comfort to rural communities suffering the effects of earthquake, tsunami and radiation.

Highly centralized and subspecialized training is a prestigious line of work with a long and glorious tradition of failing to provide the workforce needed for rural areas worldwide. Common sense indicates that training specific to rural workforce would focus on training longitudinally in rural locations. Two of these models have captured rural medical student and rural clinician impressions for review.

Are there sociodemographic differences in high-risk behaviours for STIs and blood borne viruses among those in prison? This chart audit of 946 individuals imprisoned in metropolitan and regional Western Australia focussed on variables such as age, gender, racial group and location - and identified some distinct patterns.

North versus south can provide interesting contrasts as noted in Ontario. This descriptive study notes differences in physician gender, age, and specialty. Is it possible to have reasonable levels of physicians while still leaving certain populations behind with shortages?

The tyranny of distance and terrain is a significant barrier to health care for rural populations the world over. Three years after its inception, service users of the unique Canadian 'Connections' medical transportation customised bus service were surveyed to assess whether the service reached those in social and medical need.

Rural women are important 'gatekeepers' of health for rural families. Community factors such as access interact with health decisions and the health of the entire rural community. 'Rural Families Speak' and we would do well to listen to what rural women are saying in this multi-state study.

Studies of broad-scope generalist physicians indicate the influence of rural training upon rural practice location, but how does rural training impact on more specialized physicians? The authors review data from the Northeast Ontario Postgraduate Specialty program.

Faecal incontinence (FI) and associated constipation and chronic pelvic pain may cause embarrassment, loss of self-respect and possible withdrawal from normal daily activities. This study from an Australian regional centre reports on the use of biofeedback as a first-line therapy to improve patients' symptoms and quality of life. The comparison of outcomes for rural and regional participants offers new information for those involved in caring for rural FI patients.

A 'pig project', a library in a radio station, fun days for children... these are some of the stories told by participants about the most significant community change to come from a 2003 community radio development in Bali, Indonesia, which aimed to make an impact on the social and health needs of a village.

Superficial skin infections, eczema and infestations are all well-known conditions among school children. However, which socio-economic factors, if any, contribute to such transmissible and non-transmissible skin diseases in this age group? The authors of this comprehensive study from Saudi Arabia examined many factors, including rural residence.

Much has been published in our journal about national strategies to address the worldwide shortage of rural healthcare workers, especially the scarcity of rural physicians. This first report from Thailand reveals an array of (often successful) long-standing and responsive rural health workforce strategies.

The rurality of farm workers in any country limits their access to health care. However, this study from Sub-Saharan Africa highlights the extreme situation of Namibian farm workers and their families, who are greatly disadvantaged in access to even basic primary health care. The solutions suggested by the authors are both locally specific and also generalizable to other agricultural sectors, worldwide.

Rural populations represent a wide range of cultures and daily living patterns vary greatly. Measures of the activities of daily living need to be specific to culture and lifestyle. Pelvic organ prolapse is a significant problem for many rural females. Addressing the problem required a culturally specific assessment tool to facilitate the health care of rural women with pelvic organ prolapse in Guatemala.

Where mental health issues are concerned, a delay in seeking help can mean a poorer outcome. Many mental health problems first appear in adolescence; however, despite recent improvements to Australian youth mental health services, rural adolescents still face barriers to obtaining professional psychological help. This mixed methods Australian study adds to our knowledge of help-seeking among rural adolescents.

This letter highlights the rural-urban primary care gap in Greece.

Much has been written about the advantages of telemedicine for rural and remote patients - but what are the opinions of health practitioners who have used it in their work? In this report of one part of a larger Australian study, new information about telemed service barriers emerges that will have many nodding in agreement.

This study from Ogun State, Nigeria, touches on a number of familiar rural workforce themes - the 'brain drain' from developing countries; the depletion of remaining health workers in favour of urban positions; rural residents' access barriers despite a high burden of disease... The fresh approach of these authors, including a focus on those who chose to work rurally and those who were transferred, helps identify what attracts rural workers in this part of the world - and then what retains them.

What are the potential social determinants of health among African Americans in a rural Southern area of the United States? The authors of this community-based research study appplied ecological theory to find out. Their findings are tied to the pervasive rural disparities among this population, and demonstrate the value of this approach to conducting rural, community-based research.

What therapies do GPs favour when consulted by older adults with mild to moderate mental health issues? This broad question was tackled in the Scottish Highlands when the researchers investigated a low referral rate to the NHS Older Adults Clinical Psychology service. The results of this local survey will be of interest to those who provide primary care for what can be an underserviced patient group.

Is there a disparity in preventive counseling among rural women? This article explores this important issue within the Central Pennsylvania Women's Health Study.

When comparing rural versus urban, which is better: comparison at the town or at the county level? These authors analyzed previously collected town-level data on pediatric brain trauma to find out.

This study from Gippsland, Australia, sought the views of mental health service leaders about the global human resources isssue - recruiting and retaining rural mental health workers. The reflections and creative solutions reported, grounded as they are in day-to-day management work, bring a new voice to the literature of rural health human resources.

What do rural African mothers know about undernutrition in early childhood - and what determines their ability to nourish their children across varying and difficult circumstances? The grounded theory approach used in this small study offers a 'ground-up' perspective on an ancient problem. Does local wisdom suggest wider solutions?

Do multiple chronic health conditions affect colorectal cancer screening among vulnerable middle-aged and older US adults? In addition to the commonly expressed barriers to colonoscopy (unpleasant screening, no health insurance, shortage of gastroenterologists...), these authors found barriers specific to their Appalachian participants. Their thoughtful discussion of the barriers could be used to facilitate better care in many comparable rural areas.

As rural medical education becomes decentralised and dispersed to distant and sometimes remote sites, is the quality of learning being maintained? This article approaches the question by analysing performance data from multiple student cohorts across the multiple sites of a dispersed Australian clinical school.