Volume twenty-four, Issue 2

Rural populations face inequitable access to primary healthcare services and are increasingly challenged to sustain a sufficient healthcare workforce. In addition, in the USA, the rural physician workforce is expected to decrease by 23% by 2030. Despite this, there are encouraging trends in the rapidly increasing numbers of nurse practitioner (NP) graduates. NPs have advanced clinical education, are qualified to provide primary care services, and are more likely to practice in rural communities than their physician colleagues. This Integrative Review synthesizes the scholarly literature about the early career experiences of NPs in rural health care and identifies the gaps in the literature for future research.

Salmonella spp. is one of the most commonly reported causal agents of bacterial gastroenteritis and a leading cause of foodborne outbreaks globally. It has been estimated that 94% of salmonellosis is transmitted via contaminated food of animal origin, such as poultry and pig meat, eggs and milk. Salmonella  enterica subsp. enterica serovar Give is one of the less frequently isolated serotypes in humans. Between 2007 and 2021, there have been 1874 Salmonella ser. Give cases in European Union and European Economic Area countries. This Original Research study investigates an outbreak of Salmonella ser. Give linked to consumption of a local traditional roast pork recipe in September 2022 in southern Greece.

Agricultural workers around the world face unique stressors, including many factors beyond their control (e.g. weather, predators, markets), and experience higher rates than the general population of mental ill-health, depression and risk of death by suicide. There is also evidence that exposure to pesticides can produce adverse effects on mental health, such as anxiety and depression. This Systematic Review examines the association between pesticide exposure and the incidence of suicide in agricultural workers.

Los trabajadores agrícolas de todo el mundo enfrentan factores estresantes únicos, incluidos varios que escapan a su control (por ejemplo, el clima, los depredadores, los mercados), y experimentan tasas más altas que la población general de problemas de salud mental, depresión y riesgo de muerte por suicidio. También hay evidencia de que la exposición a pesticidas puede producir efectos adversos en la salud mental, como ansiedad y depresión. Esta revisión sistemática examina la asociación entre la exposición a pesticidas y la incidencia de suicidio en trabajadores agrícolas.

Os trabalhadores agrícolas em todo o mundo enfrentam fatores de estresse únicos, incluindo aqueles fora do seu controle (por exemplo, clima, predadores, mercados), e experimentam taxas mais elevadas de problemas de saúde mental, depressão e risco de morte por suicídio do que a população em geral. Há também evidências de que a exposição a pesticidas pode produzir efeitos adversos na saúde mental, como ansiedade e depressão. Esta revisão sistemática examina a associação entre a exposição a pesticidas e a incidência de suicídio em trabalhadores agrícolas.

Globally, rural and remote areas are impacted by limited access to highly skilled physicians. Addressing these shortages requires concerted efforts by medical schools to place medical students on rotation within these communities and for medical students to have a positive experience. Positive experiences within rural rotations has previously been found to be an important factor in medical students’ career intentions. This Original Research study, set in Northern Ontario, Canada, explores what rural preceptors believe contributes to positive rural placements for medical students.

Injury from trauma is the leading cause of death in Australia for people aged 1–44 years. In Queensland, Australia, approximately 40% of residents live in rural and remote areas and face higher rates of morbidity and mortality from trauma than residents in urban settings because of the greater time, distance and resource constraints in accessing emergency care. Each of the 16 hospitals and health services in Queensland are responsible for developing and delivering their own trauma resources. Limited communication and collaboration across the vast service areas often results in inconsistencies in the content, processes, volume and regularity of trauma education provided across facilities. The Queensland Trauma Education (QTE) program was created in 2021 to complement available trauma courses and resources. This article reviews the QTE program and assesses the benefits to clinicians in both the delivery of education and the provision of trauma care.

In Queensland, Australia, people residing in rural and remote locations have poorer access to health care than urban people and nurses working in these settings play a crucial role, often being the first point of contact for people needing care. Although inadequacies in access to, and choice of, maternity care for women living in rural and remote communities have been highlighted in the past, 43% of rural maternity services have closed over the past two and half decades, and remote area nurses (RANs) have been increasingly relied on to provide care to pregnant and labouring women. This Original Research study provides an in-depth description of the lived experience of RANs who care for pregnant women in their role.

Machado-Joseph Disease (MJD) is the most common spinocerebellar ataxia worldwide and has the highest estimated prevalence in affected Aboriginal communities of the Top End of Australia. MJD, or spinocerebellar ataxia 3 (SCA3), is a genetic disease that leads to loss of coordination of all motor functions, for which there is no cure. Within 5 to 10 years of symptoms first emerging, individuals typically become wheelchair dependent and require full assistance for all activities of daily living and have a mean life expectancy of 20 years from symptom onset. Physical activity programs responsive to the culture and lifestyle of families with MJD, and those with degenerative ataxias more broadly, are scarce in Australia and internationally, despite calls for person-centred rehabilitation programs. For Aboriginal people, and other first Nations people internationally, programs are found to fail when views, lifestyle and concepts of cultural and traditional practices are not taken into account. The ‘Staying Strong Toolbox’ is a physical activity and lifestyle program co-designed by Aboriginal families living in Groote Eylandt and Ngukurr, the MJD Foundation and university researchers. This Original Research article presents the results of a mixed-method multiple case study design to determine the feasibility and impact of the ‘Staying Strong Toolbox’ program on walking and moving around for Aboriginal families with MJD in the Top End of Australia.

Cultural disruption appears to be particularly important in determining refugee health outcomes. Given that culture can influence pain experience and expression, Western pain management programs may not be meeting the needs of migrant peoples. Nepali-speaking Bhutanese (Lhotshampa) refugees have a multigenerational history of displacement from their homeland and subsequent countries, separation from their families, persecution and torture, malnutrition and poor health. This accumulation of trauma places Nepali-speaking Bhutanese refugees at significant risk of mental and physical ill-health and it is estimated that up to 56% of Nepali-speaking Bhutanese refugees experience chronic pain. This Original Research article reports the results of a qualitative study exploring conceptualisations and beliefs about pain held by the Nepali-speaking Bhutanese community in rural and regional Australia.

Rural and remote health services face challenges recruiting and retaining allied health (AH) professionals, despite increasing demand for AH services with the expansion of disability and aged care services, increasingly complex health needs and ageing populations. Postgraduate training is one strategy that can be used to develop skills relevant to rural AH roles. The Allied Health Rural Generalist Pathway (AHRGP) is a postgraduate program that includes coursework and work-based projects throughout a program of study with the aim of growing and sustaining the rural and remote AH workforce. Regional Local Health Networks in South Australia introduced the AHRGP in 2019 as a workforce strategy. This Original Research article presents the first evaluation of the resources and outcomes of the AHRGP using a cost consequence analysis approach.

Breast cancer is the most common cause of cancer-related deaths worldwide. Regular screening and early diagnosis are vital for reducing breast cancer deaths but, in Turkey, despite a screening program that includes mammography every 2 years for women aged 40–69, 75% of women are unaware of the need for mammography. International studies have found that health literacy is a crucial component in predicting knowledge, awareness and decision-making for breast cancer screening, but there is little knowledge of this issue in rural Turkey, where there are particularly low rates of health service access. This Original Research study uses a survey and face-to-face interviews to investigate health literacy levels and breast cancer screening behaviors in a rural area of Turkey.

Despite its high-achieving health system, universal health coverage and having the world’s highest life expectancy, Japan faces challenges in providing equitable health care to rural and remote populations. Approximately 10% of Japan's population of over 100 million people live in rural and remote areas (mountains, small islands and peninsulas) and its healthcare system is experiencing increasing healthcare costs, physician maldistribution and an entrenched workforce and training culture in which primary care has lacked formal recognition (until recently) as a specialty medical workforce. The Rural Generalist Program Japan (RGPJ) was established in 2017 to support medical training in rural and remote areas. The program is certified by the Australian College of Rural and Remote Medicine (ACRRM) and registrars who complete training and assessment are awarded the Certificate of Completion of Training jointly by ACRRM and RGPJ. This Original Research article presents the views of RGPJ participants, academics and government officials on the future role of rural generalist medicine in contributing to solutions for rural and island health in Japan.

Inequitable distribution of allied health professionals (AHPs) affects the delivery of rural healthcare services and the retention of rural healthcare professionals. Models of future supply and demand for rural and urban allied healthcare services predict continued widening of the gap between the number of available AHPs and healthcare needs in the USA. This Review article identifies literature related to the rural AHP workforce, specifically that assessing demographics and predicted trends, the person factors (cognitive, physical, and psychosocial), and recruitment and retention.

Approximately 97% of Indigenous peoples live in low- and middle-income countries (LMICs) and, owing to the ongoing effects of colonialism, experience high levels of poverty, discrimination and marginalization, and have poorer access to health care, are more likely to live in ill health and have lower life expectancies at birth than non-Indigenous peoples. This is compounded by a lack of data on Indigenous peoples’ health and needs. Indigenous women in LMICs can experience many barriers to access to maternal health services (antenatal care, postnatal care and childbirth), including the ‘top-down nature’ of interventions, a lack of cultural awareness from providers, language barriers, cost, poor awareness of services, and geographical barriers such as distance and transport. This Integrative Review explores the extent of the published literature on Indigenous women’s access to maternal health services in LMICs from 2018 to 2023. The results update a previous review, and allow the authors to comment on how barriers might have changed, new barriers that have been identified and the WHO’s aim of achieving Universal Health Coverage by 2030.

Farming is physically demanding and may be associated with a higher risk of joint diseases including osteoarthritis. However, there is sparse literature on the association of farming and risk of osteoarthritis. In this Original Research study, Rahmanzadeh Koucheh and colleagues examined administrative databases in Alberta, Canada, to evaluate the association between farming and osteoarthritis. They followed over 350,000 adults over a 20-year period and observed a higher risk of osteoarthritis in farm and non-farm rural residents compared with urban residents. Additional work is required to examine factors associated with the higher risk and interventions that may reduce this risk.

In South Africa, around 40% of the population lives in rural areas. The responsibility for rehabilitation services in rural and underserved areas frequently rests on a group of novice practitioners completing a year of compulsory Community Service after graduation. Many of these therapists are placed in settings where services are underdeveloped or where they are the only occupational therapist. Previous studies have reported that they are often provided inadequate management, support, and supervision, and experience increased vulnerability to burnout. One area of practice that these novice therapists have reported as being challenging is hand therapy, of which there is substantial demand because of high levels of hand trauma largely resulting from interpersonal violence, road accidents, and work-related injuries. This Original Research article reports on participants’ experience of a virtual Community of Practice (CoP) for providing support and sustained learning partnerships for novice, generalist occupational therapists delivering hand therapy services in rural and underserved areas.

Health status between urban and rural areas is particularly important in the context of regional equity. Owing to factors like inequitable distribution of healthcare providers, the distance to access healthcare services and socioeconomic factors, people living in rural and remote areas are often at a disadvantage relative to people in urban areas for access to health resources and health outcomes. Understanding the healthcare and financial burden of death and how this differs in rural and urban areas is an important, but understudied, part of the equity equation. The cost of health care for people before they die depends on factors including the type of treatment, geographic location, and socioeconomic status of the individual. Catastrophic health expenditure (CHE), calculated as the ratio of out-of-pocket expenditure to the household's ability to pay, is a useful indicator of household financial burden. This study examines ability to pay and equity of CHE between households of deceased members in urban and rural areas of South Korea.

Podcasting has grown dramatically over the last two decades. Health-related podcasts provide a way of making health information available to a wide audience at low or no cost. They often facilitate discussions from medical professionals and have been used to increase health literacy and deliver educational resources to a range of clinical and non-clinical populations. A wide variety of mental-health-related podcasts are available to the public. Recent research has demonstrated that people who listen to mental-health-themed podcasts hold fewer stigmatizing attitudes than the general population, but little is known about listeners’ experiences. This Original Research study sheds light on the motivations, listening habits and outcomes for mental health-related podcast listeners.

The Barkly, in the Northern Territory, Australia, is a highly creative region, with seven art centres and a range of creative practices across its multicultural population. Alongside the Barkly’s cultural and artistic strengths, there exists extreme socio-economic disadvantage, with indicators of homelessness, domestic violence, unemployment, poverty and ill health at much higher than national Australian averages. The region is very remote - extreme weather conditions are experienced for long consecutive periods and distances between communities are many hundreds of kilometres on roads of very poor condition. Discussions of health and wellbeing are prefaced with First Nations’ conceptions of health due to the authors' positionality and the significant proportion of the Barkly Region’s population who are First Nations’ peoples. This Original Research paper offers a snapshot of the overall arts-health ecology in the Barkly in order to advance our understanding of how the arts can be inextricably intertwined with social, cultural, political and place-based health determinants in remote contexts. These insights are illuminating for health policies and practices in remote regions more broadly.

Māori, the Indigenous Peoples of Aotearoa New Zealand, are disproportionately represented in cardiovascular disease (CVD) prevalence, morbidity and mortality rates, and are less likely to receive evidence-based CVD treatments than non-Māori New Zealanders. Rural Māori experience additional barriers to treatment access, poorer health outcomes, and a greater burden of CVD risk factors, compared to Non-Māori and Māori living in urban areas. Inequities in CVD outcomes and access to CVD healthcare for rural Māori are similar to those experienced by rural Indigenous Peoples internationally. Despite these inequities, literature exploring access to CVD healthcare for rural Indigenous Peoples is limited. This Scoping Review identifies and summarises literature that explores the barriers and facilitators influencing access to CVD healthcare for rural Indigenous Peoples. This review offers a novel approach to summarising literature by situating the findings within an equity-and-Indigenous-rights based framework.

Skin and soft tissue infections (SSTIs; e.g. cellulitis, wound infections, boils and abscesses) present a substantial financial burden on Australia’s health system. A single episode of hospitalisation for SSTIs costs at least AU$670 per day and individuals living in rural and remote Australia often require aeromedical retrieval service to access emergency department and inpatient care, which also represents a sizeable financial cost. The Torres and Cape Hospital and Health Service (TCHHS) is the main, publicly funded health service in the Torres Strait, a body of water bounded by mainland Papua New Guinea to the north and Cape York, Queensland, to the south that includes 18 inhabited islands. Approximately 64% of the population of 4500 people serviced by the TCHHS identify as Aboriginal and/or Torres Strait Islander. This Short Communication defines the health service utilisation and health system costs associated with SSTIs in the Torres Strait in order to identify ways of improving the quality of regional healthcare delivery. 

Survey tools are commonly used to collect patient experience data to monitor, evaluate and improve health services and health outcomes, but the quality of data collected can be compromised in contexts where languages and cultures are different to those in which the surveys were developed. Health service improvement is imperative to address persistent disparities in health outcomes between First Nations and other Australians. Best-practice models emphasize both the time required for adapting surveys and the need for co-design through shared expertise in language, culture and context. This collaborative qualitative study explored the acceptability, relevance and translatability of two patient-experience survey tools intended for use with speakers of First Nations languages in the Northern Territory, Australia, where more than 100 First Nations languages and dialects are spoken, and the majority of First Nations residents speak one or more of these languages at home.