Volume twelve, Issue 3

For an essential guide to reporting rural and remote health research, the Journal offers a new, informative editorial from the pens of the Editor in Chief and two of our Regional Editors.

Few periods of time strain health care delivery to the limit as much as an epidemic. Did rural emergency rooms in Ontario measure up to the stress of H1N1?

Access to care is difficult for rural populations that are often remote with low resources and barriers to transportation, but access can be even more challenging for children and for children with special needs. Then there is the challenge of such children in need of dental care, perhaps their most prevalent health care need. These needs represent a great challenge facing Appalachian parents and caregivers.

Community assessment is an unfamiliar road that must be traveled, with cultural perceptions, barriers to care, and coping strategies represent the roadmap to improved health for rural communities.

In rural Tanzania where the majority of the population resides, improvements in maternal and neonatal health are hampered by high health worker shortages and care is mainly provided by lower-level cadres of staff. These researchers used in-depth interviews to focus on the job satisfaction of existing primary care staff and their motivation to perform their roles. While this is local research, the findings may assist those seeking to improve primary care performance in settings with similar health disadvantages.

Throughout the developed world, an ageing population is increasing governmental health expenditure, especially on institutional care. This is so for Japan where the rural population is ageing most rapidly. In a shifting public-policy environment, these authors investigated whether providing home-care support for disabled elderly people is a cost-effective option.

Much attention has been paid to patient aspects of care, but this is often focused on cost savings or marketing services. It is refreshing to see a study that interviews the patients and populations in most need of care - migratory agricultural workforces. More studies focused on better understanding and improved awareness just might improve access, improve quality, and decrease costs.

Neonates in rural South Australia with the birth defect developmental dysplasia of the hip, are increasingly at risk of late diagnosis with routine screening by physical examination. This pilot study suggests that ultrasound is a feasible rural diagnostic option to greatly reduce late detection.

Is there a gender difference in the mental health of rural adolescents? This study into the interplay of depression, gender and rural residency for Australian youth will be essential reading for mental health clinicians and service planners.

In the Solomon Islands where a relatively small population is spread across 1000 islands, the cost of medical transport to a central referral hospital has been inflated by inappropriate referrals. This unusual study analysed patient transport data to discover where improvements to inter-island referral could strengthen the quality of health care.

Missed handoffs are a problem when diabetic patients depart the hospital in need of follow-up care. Is the lack of follow up a function of rural location or other factors unique to patients? To prevent fumbles, more practice is needed - and more research.

The most recent medical schools added in the United States have been a disappointment for primary care and for rural outcomes but there are some exceptions. One newer school has started well in the primary care and family practice areas most needed as indicators of future rural workforce. Students were surveyed regarding their intent for rural practice and this was compared to characteristics such as origin of student and spouse and Myers-Briggs Personality Type.

Food security has increasingly been an issue in rural and remote communities. This study provides convincing evidence for the support of a school snack program in a remote community in northern Ontario, Canada.

Rural suicide rates are of global concern. Is low service access a contributing factor? This forensic record review from Scotland assessed hospital, mental health or general practice contact in the month before death by suicide for Highland residents. The contribution of location is discussed with implications for rural services.

This Indian-Swedish study shows that with planning and collaborative organisation, improvements can be made to a range of health and mortality indicators in maternal and child populations - even in the most remote and economically disadvantaged rural communities.

Ghana has one of the highest physician emigration rates in the world, and its rural citizens are doubly disadvantaged by remaining physicians' preferences for urban posts. To find a solution, these researchers surveyed a country-wide, entire-year cohort of medical students, focussing on specific lifecourse factors that may predispose to rural practice.

If pregnancy affects a woman's oral health and her oral health affects the foetus (and, subsequently, the child), accessible oral health care is an essential element of rural maternal and child health services. This comprehensive study from Sri Lanka compared rural with urban pregnant women on a range of oral health indicators, including their beliefs about the safety of dental care during pregnancy.

For subsistence farmers whose work is manual, repetition strain injury leading to low back pain (LBP) is an occupational risk that can have devastating social and economic effects. In the South-south region of Nigeria, where farmlands are cleared from dense rain forest, the physical demands of farming are great. These authors sought to determine the prevalence and predisposing factors of LBP among this unstudied group with the aim of reducing their occupational risk.

Backyard poultry raising risks human infection with avian influenza but it is an essential source of food and income for women and subsistence farmers throughout the rural, developing world. This qualitative, observational study reports some alarming poultry-keeping practices, but also provides evidence, in the participants' own words, that established public health control strategies need creative reinvention.

In the context of the rapid disappearance of small rural maternity units in rural Australia, is what rural women want sustainable and safe? Tasmanian maternity health providers discuss a different model of care.

An audit of one rural procedural GP's 3000 serial colonoscopies suggests that GPs can provide rural Australians with safe and high quality access to colonoscopy.

Motivated by a mix of social, community and governmental accountability, many medical schools involve rural community members in the undergraduate student selection process. These Flinders University researchers investigated the motivation and more of a sample of South Australian community members who make this pro bono contribution.

With cancer mortality higher for Indigenous Australians in Queensland, these authors mapped relevant support services and assessed access barriers for (mostly) rural Indigenous clients. Location was just one factor identified.

Action learning: learning by sharing real problems with real people. Can rural health managers in your region replicate the positive experience of these African participants?

Best practices for employment and services for those with serious mental illness in rural locations is the focus of this article. It reports on a qualitative study that identifies the most important factors to help ensure that people with serious mental illness have an opportunity to participate in a full life, including work.

Social determinant studies usually involve large populations being left behind. Sometimes it is important to understand how factors such as lack of income, social distance, and geographic distance interact with disease to result in poor health. A single case can illustrate social exclusion.

When disaster strikes, the integrity of the water supply paramount. This short report on the 2010 floods emergency in rural northern Pakistan concerns the experience of assessing damaged community water systems. The discussion of treatment for microbiologically contaminated potable water will be relevant in any context.

Despite legislation, unqualified private rural health providers dominate rural health delivery in Haryana, India. While this study identified some alarming practices and deficiencies in their work, it also suggests a potential to use their efforts constructively.

This project report from in fragile, post-conflict Timor-Leste's shows what can be done with dedication, careful management and the partnership of government with NGOs to improve rural residents' access to vital eye care services.

This landmark conference highlighted research and on-the-ground action to improve long-term health outcomes for Indigenous Australians.

Postpartum haemorrhage can be life threatening in rural maternity clinics without the resources of a major hospital. This letter describes two relatively simple intrauterine tamponade techniques which may be life-saving in resource low environments.