Volume twenty-three, Issue 1

Every year, an estimated 15 million infants are born preterm worldwide. Women residing in rural and remote areas of Australia experience increased rates of adverse perinatal outcomes and are at almost twice the risk of having a preterm infant than women residing in major cities. Mortality and morbidity rates are higher for preterm infants born in non-tertiary centres, thus women are generally transferred to metropolitan tertiary centres to give birth. This study investigates the experiences of women from rural areas who have had a preterm infant admitted to a neonatal intensive care unit.

Although the output from health training institutions is increasing in most low-resource settings, the rural workforce availability remains low and suffers frequent rural–urban attrition. Improved retention – having healthcare workers stay longer in the post – is likely to alleviate the crisis. We interviewed healthcare workers and policymakers in Malawi and Tanzania to explore their perspectives on factors affecting retention. While policymakers’ views centred around the national-level retention policies, health workers considered the welfare of families and the immediate community more important in deciding to stay or relocate from a post. This article highlights the need to align retention policies with healthcare workers’ expectations.

Chagas disease (CD), a devastating infectious disease caused by the protozoan parasite Trypanosoma cruzi, affects 6 to 7 million people worldwide, with 30,000 new cases reported each year. CD is endemic to 21 Latin American countries, but has spread more widely in recent decades. In Latin America, CD is spread most often via the feces of the 'kissing bug', which can infest housing, particularly in poorer rural areas. Prevention programs therefore often focus on the interruption of household transmission. This study evaluates current knowledge of CD among youth in the three communities of southern Ecuador.

Universal access to health services and universal health coverage are needed to achieve good health for all, yet rural communities face a variety of access barriers. As part of an effort to 'rural proof' health systems, it is therefore imperative to identify and act on the factors limiting access to health services by rural and Indigenous communities. This article provides a comprehensive overview of the wide range of access barriers faced by rural and remote communities and discusses the potential for barrier assessments to contribute evidence for rural proofing of national health policies, strategies, plans and programs.

Various reactions of the body are activated during stress, including activation of the hypothalamo-pituitary-adrenal endocrine axis and the autonomous nervous system. This activity can be assessed by the measurement of biological stress marker molecules – salivary α-amylase and cortisol – as well as heart rate, and blood pressure monitoring. This article reports on the stress levels produced by the daily professional routines of rural general practitioners in Bulgaria.

The general principles of healthcare quality are well articulated internationally, but less has been written about applying these principles to rural contexts. Research exploring patient and provider views of healthcare quality in rural communities is limited. This study investigated what was important in healthcare quality, particularly for hospital-level care, for rural New Zealand communities.

The supply of new general practitioners (GPs) sufficient to meet the population’s health needs, particularly in rural and remote areas, continues to be a major global workforce distribution challenge. In Australia, despite substantial investment in rural workforce support, insufficient medical graduates are choosing a general/rural practice career. Medical training at postgraduate level remains strongly reliant on hospital experience in larger hospitals, potentially diverting interest away from general/rural practice. The Rural Junior Doctor Training Innovation Fund (RJDTIF) program offered junior hospital doctors (interns) 10 weeks in a rural general practice, aiming to increase their consideration of general/rural practice careers. This study evaluates the educational and potential workforce impact of the RJDTIF program.

In Papua New Guinea (PNG), tuberculosis (TB) is the leading cause of death from an infectious agent and many cases are multidrug-resistant. Optimising models of care for TB patients living in the Torres Strait/PNG international border region has been particularly difficult; geographical, geopolitical and socioeconomic challenges in the region have created healthcare disparities that affect diagnosis, referral pathways, treatment and management of TB patients. Delays between symptom onset and commencement of effective treatment contribute to ongoing TB transmission. This study assessed improvements in time to commencement of effective treatment in patients diagnosed with drug-resistant TB in the Torres Strait/Papua New Guinea cross-border region.

Bootheel Counties (Dunklin, Mississippi, New Madrid, and Pemiscot) experience some of the worst health outcomes in Missouri. In this study, a collaborative team of academics, practice partners and community health workers were engaged in a participatory strategy development process to identify social and organizational determinants of accessing health care in the Bootheel counties and to collectively prioritize identified issues and develop strategies for change. Participants identified several individual, social, community, and organization-level barriers to accessing health care, including cost, lack of transportation, lack of information about services, lack of coordinated care, lack of trust, and racism and classism in local healthcare systems.

People do not receive regular dental care for several reasons. This may result in tooth loss and other health effects. Dental care may be a bigger challenge in rural settings, where there are several barriers to care. This study used Behavioral Risk Factor Surveillance System (BRFSS) data and examined dental visits and tooth loss for US Indigenous American Indian/Alaska Native (AI/AN) adults in rural vs. urban settings. In adjusted analyses, AI/AN adults in rural vs. urban settings had a similar frequency of dental visits in 2020 with 33% higher odds of having missing teeth. The author recommends interventions to maintain teeth in AI/AN adults in rural settings.

Debriefing following a critical incident is utilised across many different fields, including the military, aviation and health care, and is associated with clear benefits for team performance. Healthcare professionals working in rural and remote areas face a variety of unique barriers that may make debriefing challenging. This Commentary presents an example that illustrates the complexities of a critical incident in a remote service and outlines evidence-based strategies to support team members in rural and remote areas to debrief effectively, including the use of technology, formal teaching in university curriculums and regular practice via simulation.

This conference declaration, the Limerick Declaration on Rural Health Care, an outcome of the 19th World Rural Health Conference in Limerick, Ireland in 2022, is designed to inform rural communities, academics and policymakers how to achieve the goal of delivering high quality health care in rural and remote areas most effectively, with a particular focus on the Irish healthcare system. Congruent with current evidence and best international practice, the participants of the conference endorsed a series of recommendations for the creation of high quality, sustainable and cost-effective healthcare delivery for rural communities in Ireland and globally.

Despite the availability of preventive medication, tuberculosis (TB) kills millions of people every year. People in vulnerable populations (eg people with HIV/AIDS, health professionals, and those living in poverty) in low and middle-income countries are at particularly high risk. Practical public health strategies are required to effectively reduce the global TB burden. TB infection control measures emerged as a potential preventive public health strategy to prevent TB transmission in a health setting and spreading into the community. This review examined the current evidence for tuberculosis infection control measures, including administrative, environmental, and respiratory controls, in reducing TB transmission and explored the barriers and enablers of these measures in resource-constrained primary healthcare settings.

Poor mental health is under-recognised in rural locations. Although the prevalence of mental disorders is similar in rural and urban areas, suicide rates are 40% higher in rural communities. The level of readiness and engagement of rural communities to adapt to, or even acknowledge, poor mental health can impact effective interventions. This Review examines how community engagement, participation and empowerment were used in the development and implementation of interventions aimed at improving mental health of adults residing in rural communities of the USA, UK and Guatemala.

Despite policies aimed at universal health coverage by ensuring availability and accessibility of general practitioners (GPs), medically underserved areas (or ‘medical deserts’) are still present in Europe. This systematic review summarizes and compares literature on interventions and their potential effectiveness in GP recruitment and retention in these underserved areas.

Rural generalist anaesthetists (RGAs) are central to the delivery of elective and emergency anaesthesia and the acute care of critically unwell patients in much of rural and remote Australia. Without a well-trained RGA workforce of sufficient numbers, Australia would struggle to provide anaesthetic services outside of urban locations or make viable other crucial healthcare services that are reliant on anaesthetic support such as obstetrics, surgery, emergency medicine and critical care. This paper details a systematic review of the literature specifically asking the question: ‘What is the current evidence of the ‘safety’ of anaesthesia delivered by RGAs?’

This research reports on patient and community physician satisfaction with a teleneurology program that provided consultations to 14,241 patients at 12 community-based hospitals between 2014 and 2021. Results show high levels of satisfaction with using tablet technology for teleneurology consultation.

Significant policy initiatives have been implemented in Australia to ensure people in rural and remote areas have appropriate access to health services, with increasing interest in allied health. The allied health focus has been centred on pharmacy and physiotherapy so far, and there is limited evidence about the role osteopathy plays in rural and remote populations. In Australia, osteopaths are university-trained and government-registered allied health professionals who manage predominantly musculoskeletal complaints using manual therapy, exercise and patient education. This Short Communication reports on the demographic, practice, and clinical management characteristics of Australian osteopaths in rural and remote settings.

Access to ultrasound imaging services is limited in rural areas and point-of-care ultrasound (POCUS) has the potential to reduce this gap. This exploratory study assessed how POCUS is utilised by doctors in contemporary Australian rural general practice. Doctors reported limited confidence for certain scans and used POCUS predominantly for obstetric indications. Attention to the barriers to POCUS utilisation is needed to realise the potential benefits for the health of rural communities.

Australians living in regional and remote communities face several barriers when accessing health care. Voluntary assisted dying (VAD), presents a new challenge for these communities. Western Australia is the second Australian state to implement VAD laws and, to date, is the jurisdiction with the greatest need to address such inequities due to its vast geography. This article identifies and explores initiatives introduced during the law-making and implementation stages of the law reform to address regional and remote access inequities.

Remote delivery of assessment, consultation, and therapy via digital communication technologies in mental health services is important in rural locations, and has rapidly increased due to the COVID-19 pandemic. This study investigated the factors that should be considered in the development and evaluation of digitally-mediated service provision for children and young people with social, emotional, and mental health (SEMH) needs.

In this Letter to the Editor, which responds to an article recently published in Rural and Remote Health titled ‘The impact of politics, religion, and rurality on COVID-19 vaccine hesitancy in Oregon: a cross-sectional study'(https://doi.org/10.22605/RRH7140), the authors further consider the influence of politics, race, education, social network and religion on individual views on COVID-19 and vaccination and the role of doctors and medical scientists in this new paradigm.