Volume twenty-one, Issue 2

Responding in the Scottish Outer Hebrides presents a number of challenges above and beyond standard prehospital work owing to its remoteness and the limited resources available on the island. As a prehospital physician, it is important to have an excellent working relationship with all local emergency services and with the wider community. One’s emotional resilience will be tested when responding and living in a rural setting, when you are far less removed from the tragedies you encounter.

This study evaluated pilot community paramedicine (CP) programs from the perspectives of paramedics to gain program recommendations related to both rural and urban settings. Researchers distributed an online questionnaire to paramedics with and without CP experience employed at eight emergency medical services providers in northern Ontario. Results demonstrate the value of CP and indicate areas for CP program inprovement.

Type 2 diabetes mellitus (T2DM) and social disadvantage are related. In Australia, this association is most pronounced amongst Indigenous people. Indigenous Australians are among the most socially disadvantaged in the country, with the worst social determinants of health (SDoH). This study combines the perspectives of Indigenous Australians with T2DM and Indigenous health workers to explore the SDoH-related barriers and facilitators to self-managing T2DM, and how SDoH could be incorporated into usual clinical care for Indigenous Australians with T2DM.

Distance learning methods have long been an integral part of medical education in rural and remote settings, but the global coronavirus crisis has stimulated a rapid shift in medical education everywhere from predominantly face to face to being delivered online. As thinking and practice in distance learning have developed, the idea of distance learning (in which the central institution delivers teaching and learning resources to remote learners) is changing to distributed learning (where the institution itself distributes its functions to be near those students). This Commentary examines the design and management of distributed learning.

A 5-year-old girl presented to the coronavirus assessment centre on a remote Scottish island with symptoms consistent with COVID-19, including an irregular pulse. To minimise potential spread of coronavirus in the healthcare setting, a portable ECG device was immediately delivered to the patient with the ECG tracing being sent electronically to the cardiologist, who was then able to communicate a diagnosis to the parents within 2 hours of the initial contact.

Rural physicians face many challenges with providing rural health care, which often leads to innovative solutions. Despite this, there is a lack of support for rural health research – an area of health care where research makes great impacts on small communities. This article describes the rural research capacity building (RRCB) ecosystem and explains how the 6for6 and Rural360 programs at Memorial University of Newfoundland address the need for RRCB.

Chronic medical workforce shortage and maldistribution continues to be a significant challenge in rural Australia. The Rural Clinical Schools (RCSs) program helps to alleviate this problem with evidence of increased rural location in graduates of rural training programs. However, rural work intent may change during the years after completing a rural placement. This qualitative study investigated the factors involved in the change of career intention from rural to urban work location among the Australian National University Medical School Rural Stream alumni.

This mixed methods study sought to explore the use of dating apps amoung men who have sex with men (MSM) in rural areas of the southern United States, and the potential to use dating apps to deliver HIV prevention information. Dating app use was found to be high amongst rural MSM, with individuals using dating apps more likely to be interested in pre-exposure HIV prophylaxis (PrEP).

Access to health care in developing countries is scarce. One solution to this problem has been for doctors from the USA to provide single-visit care through short-term medical service trips. There is interest in using ultrasound imaging as a portable diagnostic tool; however, data describing its usefulness are scarce. This study determined the usefulness of portable ultrasound imaging during a medical service trip to rural Guatemala.

O acesso aos cuidados de saúde nos países em desenvolvimento é escasso. Uma solução para esse problema tem sido os médicos dos EUA fornecerem atendimento em uma única consulta por meio de viagens de serviço médico de curto prazo. Há interesse em usar a imagem de ultrassom como ferramenta de diagnóstico portátil; no entanto, os dados que descrevem sua utilidade são escassos. Este estudo determinou a utilidade da imagem de ultrassom portátil durante uma viagem de serviço médico à zona rural da Guatemala.

International electives and exchange programs for medical students have sometimes been criticized as providing little benefit for host institutions. This personal view is offered as an example of how international electives may contribute a helpful comparative perspective on a local healthcare systems, in this case, primary care.

Slaughterhouse workers are at high risk of accidents and pathogen contamination. Although cattle production is a big industry in Brazil, there are illegal operators in the countryside outside several Brazilian cities. This illegal activity represents severe risks to the health of consumers and slaughterhouse workers. This article reports on the first study to analyze the health of illegal slaughterhouse workers in rural Brazil.

Trabalhadores em matadouros apresentam alto risco de acidentes e contaminação por patógenos. Embora a pecuária seja uma grande indústria no Brasil, existem operadores ilegais no campo fora de várias cidades brasileiras. Essa atividade ilegal representa graves riscos à saúde dos consumidores e trabalhadores dos frigoríficos. Este artigo relata o primeiro estudo para analisar a saúde de trabalhadores clandestinos de frigoríficos no interior do Brasil.

Having a stoma after bowel surgery is associated with inferior quality of life (QoL). Care of patients with stoma-related problems is usually reliant on hospital-based stoma nurses and surgeons. This study reports on the impact of distance to nearest hospital on the QoL of rectal cancer patients who receive a stoma at index surgery.

This qualitative study explores barriers to accessing contraceptives in a rural, culturally conservative area in the USA. The authors reflect on how a Federally Qualified Health Center adapted to their cultural setting, by integrating contraceptive services into their primary care model. This ensured that every woman seeking primary care was screened for contraceptive need, offered contraceptive counselling and comprehensive contraceptive methods. Recommendations to further strengthen the responsiveness of services are provided.

Women in the climacteric period present a wide variety of symptoms that can affect their daily life. Latin American women tend to report more severe climacteric symptoms compared with other parts of the world. In Peru, the severity of symptoms might be intrinsic to the community in which the women live, such as altitude or lifestyle. Understanding the variation of climacteric symptoms among geographically distinct communities could contribute to improving women’s quality of life. This study evaluated the severity of climacteric symptoms among two Peruvian communities.

Las mujeres en su climaterio presentan una gran variedad de síntomas que pueden afectar su vida diaria. Las mujeres latinoamericanas tienden a reportar síntomas climatéricos más severos que en otras partes del mundo. En Perú la severidad puede ser intrínseca de la comunidad donde las mujeres viven y sus condiciones como altitud o estilos de vida. La comprensión de la variabilidad de estos síntomas entre comunidades geográficamente distintas podría contribuir a mejorar la calidad de vida de las mujeres. Este estudio evalúa la severidad de síntomas climatéricos entre dos comunidades peruanas.

Occupations are the everyday activities that people choose to engage in individually or as groups that bring meaning and purpose to their lives. This study explored the occupations of school-going adolescents of Pitseng, Lesotho, to gain insight into adolescent behaviour, and the strategies needed to develop sustainable health promotion programmes for adolescents in this area.

This paper considers the role of governance in Indigenous medical education research through the lens of an Australian Aboriginal research project titled Healing Conversations. The Healing Conversations Project is developing and testing a targeted educational framework for improved clinical communication between healthcare practitioners and Australian Aboriginal peoples in regional and urban locations.

The oral health of Indigenous children in Canada and globally is a major public health issue, with 80% of First Nations children and 71% of Inuit children between the ages of six and eleven having experienced early childhood caries. This focused ethnographic study used participatory research principles to explore oral health experiences and understandings of children and youths in two Anishnabeg communities in Quebec, Canada.

This Research Letter reports that health professionals in rural areas of Japan support interprofessional collaboration and education, and this may contribute to retaining health professionals in rural clinical settings.

Chronic respiratory disorders are highly prevalent among Australian Aboriginal people living in the Top End Health Service region, Northern Territory of Australia. Bronchiectasis is a heterogeneous disease that features among these chronic respiratory conditions in this population. This retrospective study compares the demographics, clinical characteristics and relevant laboratory parameters among adult Aboriginal and non-Aboriginal patients diagnosed with bronchiectasis between 2012 and 2017.

In long-term care, effective communication among healthcare professionals is vital to reduce inappropriate emergency transfer and eventual death in hospitals. As nursing homes lack adequate healthcare resources in rural areas, information and communication technology (ICT) can reduce the burden on professionals. This study investigated whether the application of ICT-based communication can reduce the number of emergency transportations to, and death in, hospitals in rural facilities.

Turkey, which suffers from both undersupply of physicians, nurses and midwives and inequitable distribution of healthcare personnel, has been developing and implementing various policies to solve this problem. This study takes a closer look at the impact of policies implemented to reduce the imbalance in the distribution of human resources for health for the last fifteen years in Turkey.

This study examined healthcare utilization and access to care for rural adults with Inflammatory Bowel Disease (IBD). This manuscript reports on the qualitative findings of a larger mixed-methods study that involved patient and family advisors as active and equal team members in decision-making throughout the project. Findings suggest several methods for improving access to care in rural areas that can increase disease remission, decrease direct and indirect care costs, and promote quality of life in individuals with IBD.

As a result of the COVID-19 outbreak in Tasmania, Australia, two hospitals were closed, all patients discharged or moved and the entire staff furloughed for 14 days. During the furlough period, a decommissioning, terminal clean and recommissioning process was undertaken. This paper describes the process undertaken from the perspective of a small management group to close, clean and reopen the hospital, providing a foundation for site-specific adaptation to include in pandemic escalation plans in other regional and rural settings.

According to global estimates, 39 million people suffer from blindness and 285 million are at risk of severe vision loss, with a significant portion of this burden in Sub-Saharan Africa. Some African nations like The Gambia are beginning to tackle vision impairment by addressing the problem through a health system lens. This study reports on the use of a health system framework, focusing on system areas of leadership and governance, resources for vision care and vision care access, to understand and analyze how The Gambia has increased access to vision care using a public–private pilot partnership.