Volume twenty-two, Issue 1

Over the course of the COVID-19 pandemic, Australian general practices have rapidly pivoted to telephone and video call consultations for infection control and prevention. Initially, these telehealth consultations were required to be bulk billed (doctors could only charge fees equivalent to the national Medicare Benefits Schedule). There was concern that bulk billing only policies could have a broader impact on rural practices, which may rely on mixed or private billing for viability in small communities where complex care is often needed. This study explores the patterns of bulk billing nationally and describes the characteristics of practices more or less likely to bulk bill patients, to identify the potential impact of a rapid shift to bulk billing only policies.

Stunting is still a prominent health problem in Indonesia, particularly in children from poor families or living in rural areas. This study examines the factors associated with stunting by socioeconomic status and area of residence in Indonesia.

Although sedentary behaviour and low levels of physical activity are two of the main risk factors for non-communicable diseases, little research has been conducted to compare these behaviours in rural and urban settings, especially in low- and middle- income countries. This could be because of the misleading notion that rural people are less sedentary than urban people. This study compares differences in physical activity indicators and TV-viewing according to area of residence and sociodemographic variables in Brazil.

The current SARS-CoV-2 coronavirus epidemic (COVID-19) and the confinement strategies that have been implemented to stop the spread of the virus are wreaking havoc on physical activity, mental health, diet and economy at the global level. The catastrophic effects on employment, working hours and incomes that COVID-19 has had throughout the world are repeated in Latin America. This study determines the relationships between symptoms of anxiety and anhedonia and diet quality during confinement due to COVID-19 in rural populations of 11 Latin American countries.

Brazil is rapidly becoming an aged country, with 30 million of the 213 million inhabitants aged 60 years or over. Nearly 4.5 million (15%) Brazilian older adults live in rural areas. Despite the advances in primary health care coverage in Brazilian rural areas, provision of adequate health services for rural populations is particularly challenging. This study presents the methods used to design a prospective cohort study with older adults from a rural area in the far south of Brazil (EpiRural Cohort Study) and also describes the cohort profile.

Emergency Department (ED) utilisation continues to increase, particularly for primary care presentations that do not require high level ED services. The reasons for this are complex and research has focused on patient perspectives in choosing where to seek care rather than those of ED and general practice (GP) providers. This study addresses this gap by exploring the views of ED and GP providers regarding ED utilisation for primary care type health conditions in a small, remote city in Queensland, Australia.

Achieving high immunisation rates is a priority for public health units in Australia. Aspiring to 95% coverage rates for all children, regardless of financial or geographic barriers, is a national strategic aim. While immunisation is well supported in Australia, and most children are fully immunised for their age, pockets of low coverage exist. This study presents a deeper understanding of the reasons for low coverage.

Seasonal influxes of influenza patients result in an increased demand for hospital beds. During peak periods, it is common for rural hospitals to experience bed block and increased risk of spreading hospital-acquired respiratory illnesses to patients and staff across the hospital, further exacerbating the bed block and placing additional strain on a system already worn thin by existing workforce shortages and limited resources. This study examines rural hospital bed management practices with a focus on the transfer of patients who are actively diagnosed with influenza and investigates the association of increased bed movement with the rate of nosocomial transmission and staff workload.

In countries such as New Zealand, where there has been little community spread of COVID-19, psychological distress has been experienced by the population and by health workers. COVID-19 has caused changes in the model of care that is delivered in New Zealand general practice. This study explores whether these changes have resulted in different levels of strain between rural and urban general practices.

Women and children in Uganda and other low- and middle-income countries are exposed to disproportionately high levels of household air pollution from biomass smoke generated by smoke-producing cookstoves, especially in rural areas. This population is therefore particularly vulnerable to the negative health effects caused by household air pollution, including negative pregnancy outcomes and other health issues throughout life. This study reports on the perspectives of midwives, Village Health Team members and mothers on the long-term impact of an education programme on lung health implemented by The Midwife Project, a collaboration between research and health teams in the UK and Uganda.

Children with deep-partial or full-thickness burns often require complicated post-surgical care and rehabilitation, including specialist occupational therapy (OT) intervention, to achieve optimal outcomes. Those from rural and remote areas rarely have access to these services and must travel to a tertiary referral hospital to access follow-up, placing them at higher risk of complications and poorer outcomes. The OT-led Paediatric Burn Telehealth Review (OTPB) Clinic, based at Townsville University Hospital in northern Queensland, Australia, was set up to address this inequity. This study investigates the experiences of family members and clinicians in using the OTPB Clinic.

Historically, some approaches to Aboriginal and Torres Strait Islander health research have been unethical. Greater accountability in the research process, transparency in reporting, and use of culturally appropriate research methodologies are key recommendations to improving the ethical integrity of research. This Project Report uses the CONSIDER statement (CONSolIDated critERia for strengthening the reporting of health research involving Indigenous peoples) to critically reflect on participatory research undertaken in partnership with an Aboriginal Community Controlled Health Organisation in the rural context and to identify lessons of value for future research.

The podiatry needs of rural populations are poorly addressed, partly because of workforce maldistribution. Encouraging emerging podiatrists to work in rural areas is a key solution. This study explores recently graduated podiatrists’ perceptions regarding working rurally and broader industry views of the factors likely to be successful for rural recruitment and retention.

Recruiting and retaining qualified rural health workforce is of global significance. This study used a novel method, machine learning, to examine predictors of rural practice in the state of Utah in the USA. Income emerged as the most important factor associated with rural practice, followed by rural upbringing, updating earlier research and providing new insights into the literature.

Rural generalist (RG) doctors are broadly skilled to provide comprehensive primary care, emergency and other specialist services in small, distributed communities where access is otherwise limited because of distance, transport and cost limitations. In Victoria, Australia, the Victorian Rural Generalist Pathway (VRGP) represents a significant state-wide investment in training and growing the next generation of RGs. The first step of the VRGP is well established through the Rural Community Internship Training program; however, the second step (RG2) requires expansion by growing supervised learning in small rural communities where RGs will eventually work. This study examines enablers and barriers to the supervision of RG2 learners across a core generalist curriculum in distributed towns in three rural Victorian regions.

Primary health care, the cornerstone of health systems, has an important role in infectious disease control. The SARS-CoV-2 (COVID-19) pandemic has put a burden on health systems worldwide and especially on healthcare workers in remote areas of Greece. This study investigates preparedness and awareness level of primary healthcare workers and their risk perception in managing the pandemic during its initial phase.

Rural populations have disproportionately higher injury hospitalisation rates, higher morbidity and mortality rates and higher costs than patients injured in major cities. Poorer outcomes arise from inefficiencies in one or more potentially modifiable factors in the chain of survival. This Commentary discusses the burden of injury in Australia, presents a brief history of retrieval services in Queensland and discusses how remoteness requires a different kind of service delivery from point-of-injury to definitive care.

Gastroschisis, a birth defect of the abdominal wall in which the baby's intestines are found outside of the baby's body, is one of the most common congenital abdominal wall defects. Although a survival rate of up to 90% is now achievable in many settings, management remains a challenge in Papua New Guinea, where there are only 0.7 doctors and 5 nurses per 10,000 people. This Clinical Case Report describes the care of a preterm male baby born with gastroschisis in Papua New Guinea.

A clinical case report published in Rural and Remote Health in 2020 reported introducing an oral, centrally acting, alpha agonist sedative to the prescribed secondary prophylaxis (SP) regimen of IM penicillin for each of three Aboriginal children previously diagnosed with acute rheumatic fever (ARF). The living environments of the three children increased their risk for repeat group A Streptococcus infections and subsequent recurrences of ARF. The authors of this Comment find the clinical case report perpetuates a troubling tone about this singular priority for SP and present alternative perspectives and initiatives for consideration.

Lack of awareness about diabetes has been linked with a high prevalence of undiagnosed diabetes and previous research has identified poor awareness of diabetes in several low and middle-income countries. India has the second highest prevalence of diabetes globally. This study reports on awareness of type 2 diabetes and how sociodemographic factors influence diabetes knowledge in a rural population of Tamil Nadu, India.

Indigenous cultural identity has been suppressed by the conventions of academic publishing. This sees author and subject credibility resting on Western views of provenance, including institutional affiliation, college membership, educational qualifications and disciplinary background. This research colonialism reflects a power imbalance that must end. In this Editorial, three rural health research journals jointly announce their commitment to 'nothing about Indigenous Peoples, without Indigenous Peoples'. Articles submitted about any Indigenous community must have an Indigenous author or provide evidence of participatory engagement with the Indigenous communities.

Within an Australian health context, the fundamental diagnostic tool used by medical staff is the biomedical interview or history taking, which is based on a battery of direct questions. Similarly, many health professionals rely on patient questions to prompt the sharing of information, or to make them aware of gaps in communication. This is problematic for many First Nations peoples, including Yolηu (First Nations people of North-East Arnhem Land), who are culturally less inclined to use direct questioning as it is deemed impolite within their cultural context. This study addresses an important research gap by exploring the experiences and perspectives related to the use of questions in clinical interactions with one cultural group, speakers of Yolηu languages from East Arnhem Land. Potential strategies to overcome any identified communication barriers that questions pose are also explored.

Low- and middle-income countries often face the issue of unequal distribution of healthcare services and human resources between rural and urban areas. Globally, there are many factors that negatively affect the willingness of physicians to work in remote and rural areas, including low wages, poor living conditions, poorer and sicker patients, suboptimal equipment and supplies, and a lack of quality infrastructure and transportation. This study explores the perceptions of barriers and facilitators of medical entrepreneurship and the impact of medical entrepreneurship on the served communities among the owners of private medical practices in rural and semirural areas of Armenia.

Training healthcare workers is essential for Vanuatu, a Western Pacific Island nation, where the current ratio of healthcare workers is well below the WHO recommendations. In addition, the preparation of a highly skilled workforce has been shown to be essential to high quality patient care. Research evidence has consistently shown that nurses educated by bachelor degree improve patient health outcomes and reduce hospital length of stay. This Project Report describes the development and implementation of a new Bachelor of Nursing degree to provide a skilled, safe nursing workforce for the provision of health care to the people of Vanuatu.

For rural and remote clinicians, quality education is often difficult to access owing to geographic isolation, travel, time, expense constraints and lack of an onsite educator. This integrative review investigates the telehealth education available to rural practitioners, evaluates current telehealth education models, establishes the quality of education provided through telehealth and presents recommendations for supporting and developing an education model for rural and remote health practitioners through telehealth.

This Project Report describes the creation of pilot program aimed at creating culturally responsive end-of-life (EOL) planning in American Indian and Alaska Native communities and offers suggestions for the development of toolkits on EOL planning with Indigenous communities.

Evidence suggests people living with Parkinson disease benefit from coordinated health care provided by a team of specialists. People who live in rural areas face additional challenges in accessing this care. This study tested the feasibility of providing a coordinated, multidisciplinary telehealth program to people with Parkinson disease living in rural areas of the USA.

Chronic non-communicable diseases are one of the biggest public health problems worldwide. In Brazil, the population is aging and these diseases are prevalent in 70% of elderly people. Many diseases that affect the osteoarticular system cause chronic pain. This study reports on the prevalence and associated factors of self-reported chronic lower back pain in elderly people living in rural riverside areas in the Amazon.

What is known about Primary Health Care (PHC) in the Amazon? Health studies in the Amazon often focus on diseases and infections in the region, with few studies addressing health organisations and services. This scoping review explored the PHC implementations and their results in areas outside the urban centres in the nine Amazonian countries.