Volume eighteen, Issue 3

This Editorial celebrates the contribution of rural programs to the longitudinal integrated clerkship (LIC) movement by examining the contributions of articles published online in Rural and Remote Health to the LIC discourse.

A uniform certified basic training program for interns started in Japan in 2004. Following this change, more interns chose to train in community settings, including in rural areas. This article reports on geographic and demographic variations in attitudes towards interns from this new training system.

Rural emergency departments (EDs) and urgent care centres (UCCs) are often the first point of care for consumers experiencing acute mental health issues. Rural nurses working in EDs and UCCs require a diverse clinical skill set to manage complex presentations, often with limited support and resources. This study found that although rural generalist nurses are the frontline providers of care for mental health consumers in rural EDs and UCCs, they feel ill-equipped for assessing and managing mental health presentations.

In Mongolian provinces affected by the dzud, a winter disaster that occurs in Mongolia following drought in dryland areas and results in the death of a large number of livestock, children under 5 years suffer increased mortality rates. This study evaluated the health risks for children during the dzud.

To address the lack of Australian data examining mental health in same-sex-attracted rural adolescents, this study examined experiences of stressors, symptoms of depression and suicidality, and perceptions of barriers to seeking mental health support, comparing same-sex-attracted adolescents with heterosexual adolescents living in rural Australia.

Managing outpatients with chronic diseases like hypertension in resource-poor settings is challenging. This study determined the factors associated with where and how people obtain their anti-hypertensive medicines in rural villages in Indonesia.

Tuberculosis (TB) remains a major public health problem in many countries. Health services can be TB ‘hot spots’ and, in the absence of good TB infection control (TBIC), a clinical service may actually promote the spread of TB, rather than contain it. This research explores rural health workers’ perspectives of barriers and facilitators to effective TBIC practices in rural health facilities in Madang Province, PNG.

Twenty public health nurses who worked during the flood season in the years 2014 and 2015 in a rural area in southern Brazil were interviewed to identify primary health care nurses’ competencies when responding to flood disasters in rural areas.

Shortages and maldistribution of dermatology services have negative impacts on the quality of care for patients with skin problems. The study examined the urban–rural distribution of dermatologists and office-based dermatology services in Taiwan.

Rural health workforce shortages are a global phenomenon. Some of Australia’s most severe rural workforce shortages, particularly among early-career health professionals, are in public sector community mental health. This study investigated how employment and rural-living factors impacted the turnover intention of early-career, rural-based community mental health professionals in their first few years of working.

In Canada, rural-based family medicine residency programs were established largely in response to a shortage of rural physicians and the perception that urban-based training programs were not meeting the needs of rural populations. Examinations of practice patterns of physicians trained in rural and urban programs are lacking. This study compared the scope of practice of family medicine graduates who completed a rural versus an urban residency program as assessed by practice location.

This study identifies geographic differences in HIV-related stigma experiences among women in the Canadian HIV Women's Sexual & Reproductive Health Cohort Study. Region-specific strategies to reduce stigma, and to support those impacted by it, are recommended, particularly for those living in geographically isolated areas.

Rural children with a disability seldom participate in the recommended 60 minutes of moderate-to-vigorous physical activity per day. This investigation of parents’ perceptions indicates that this population faces multiple barriers to participation, including access, ability and isolation, and suggests that support structures aimed at promoting physical activity should be enhanced.

This article examines Employment Related Mobility (ERM) and its impact on families, particularly new mothers. This research carries implications for nurses and other healthcare providers who have the opportunity to interact with or provide support to families experiencing ERM.

Research on wellness in rural older people is scarce. This study tests an ecological model of wellness that includes intrapersonal factors, interpersonal processes, institutional factors, community factors and public policy.

Sensory impairment and associated disability is a significant global health concern. This study evaluated the effect of a brief educational intervention for rural community nurses to enhance their knowledge, skills and attitudes about sensory impairment and subsequent impact on referral practices.

Remotely Supported Prehospital Ultrasound (RSPU) is a process in which an ultrasound operator performs a scan and sends images to a remote expert for interpretation. As part of an investigation assessing the capability of RSPU to improve patient outcomes and standard of prehospital care in the Highlands of Scotland, this study explores the views of emergency medicine consultants and paramedics.

Rural healthcare resource limitations can affect the choices people make and their quality of life during the end stages. In rural Australia, district nurses working in generalist community roles provide access to care by visiting people in their homes. This survey tested how district nurses advocate successfully for the end-of-life goals of rural Australians.

This qualitative study explores rural adolescents perceptions of health issues and health needs. Findings identify issues beyond difficulty accessing health care, and highlight these adolescents desire for health promoting role-models within their social sphere.

Farmers are a high-risk group for carcinogen exposure. However many studies investigating the risk of cancer in farmers focus on pesticide exposure alone. This study determined to which carcinogens Australian farmers are exposed, the prevalence and circumstances of those exposures and the use of protective equipment. 

This narrative review of paramedic models of service delivery focuses on models that have the potential to improve the health and well-being of frontier and remote populations. The authors conclude that a change in orientation from an emergency response system to a health service providing clinical care, will require paramedic services and paramedics to take a more patient-centered approach to service delivery and strengthen their community engagement activities.

Rural clinicians in small communities face the situation of always being “on-duty” as well as the challenges of increased social proximity. Conducting insider research in these communities involves similar issues. This commentary describes the challenges and management of insider-research in small rural communities.

Given the new Commonwealth and State interest in encouraging rural training pathways after graduation in Australia, it is important to gauge pre-graduate students’ level of interest in rural options. This study asked pre-graduating Western Australian medical students about levels of interest, and factors associated with interest in a full time rural internship.

Patients in rural China have long had inadequate access to quality medical services because of a concentration of medical resources in major hospitals in cities. This article reports on the Medical Service Unity approach, trialed in Funan county to tackle these issues by taking into account considers funding, patient and resource flow.

Small rural hospitals face challenges in attracting and retaining physicians. Over time, many have moved towards a hospitalist model of staffing. This project report describes an alternative model that has been successfully implemented for several years in a ten-bed rural hospital in Washington State. The author identifies increased physician satisfaction and potential cost savings associated with adoption of the model.

In the last 5 years, there has been a rapid rise in numbers of overseas trained medical graduates returning to country to work as interns across the Western Pacific. The varied level of clinical knowledge and skill of these graduates led to the development of workshops to equip clinical staff with the education and supervision skills to optimise teaching and learning opportunities in clinical settings for these new graduates of foreign medical programs.

This personal view article provides critical commentary on the current state of end-of-life care for First Nations persons living on reserve. They identify a need to raise awareness regarding culturally sensitive care for this population.

Telepsychiatry has become an important component of rural health care, but cultural factors influence how comfortable patients are with telepsychiatric services. Considering cultural factors when planning and implementing telepsychiatric services may contribute to the success of these services and increase their use in rural and remote populations.

A review of Appalachian Health and Well-Being, edited by Robert L. Ludke and Phillip J. Obermiller.

This study highlights the fact that those GPs and specialists  who choose inland and coastal regional centres may have different location drivers. Environmental attributes such as the beach, in addition to  professional factors like work variety and work place culture, have high rankings for GPs and specialists resident in coastal locations. In contrast, their inland counterparts have significantly lower values for locational factors but share high values for professional factors. Recruiting for inland locations should consider concentrating on factors promoting professional satisfaction because this may be the most potent issue for these clinicians.