Rural and Remote Health Rural and Remote Health is an open-access international academic journal serving rural and remote communities and publishing articles by rural health practitioners, educators, researchers and policy makers. en-gb Wed, 06 Dec 23 21:32:14 +0000 Papir Journal Platform (Melissa Storey) (Webmaster) Rural and Remote Health Evaluating maternal health capacity building in rural and underserved areas: a research protocol Maternal morbidity and mortality in the USA are higher than in other developed nations and continue to rise. Infant mortality, likewise, is higher in the USA than in other developed nations. Limited availability of maternal health services, particularly in rural areas, contributes to this crisis. This protocol describes the evaluation of a USA government-funded project that seeks to address the shortage of quality maternity care in rural and underserved areas by strengthening partnerships, enhancing maternal care training of Family Medicine residents and obstetrics fellows, and improving the transition from training to rural practice for residents and fellows. Tue, 05 Dec 23 00:00:00 +0000 Insights into rural generalist therapeutic reasoning using a simulated multi-patient emergency scenario Rural Generalists (RG) provide holistic and complex medical care in multiple settings (eg general practice and hospitals) across the lifespan in rural and remote areas of Australia. RGs are frequently faced with making clinical decisions about whether patients can be managed locally or need to be transferred. This Original Research study explores RG therapeutic reasoning approaches in a simulated emergency scenario in the rural and remote context. Sun, 03 Dec 23 00:00:00 +0000 The effectiveness of continuing education programmes for health workers in rural and remote areas: a systematic review and meta-analysis Health workers in rural and remote areas are called on to treat a large range of diseases, provide multiple health services, and perform a wide variety of procedures. All physicians undertake lifelong learning to maintain, develop or increase the knowledge, skills, professional performance and relationships used to provide services to patients, the public or the profession. Since the mid-1960s, many government and non-government organizations, including the World Health Organization, have conducted continuing education programs for rural health workers. This systematic review and meta-analysis examines the effectiveness of continuing education for health workers in rural and remote areas. Thu, 30 Nov 23 00:00:00 +0000 Joint exposure to urban-rural status and medically underserved area residence and risk of severe COVID-19 outcomes in 2020 Community-level factors, such as urban-rural status and pre-existing economic conditions, may increase risk for severe COVID-19 (defined as hospitalization, admission to the intensive care unit, intubation, mechanical ventilation, or death). Rural populations have a higher prevalence of comorbidities associated with severe COVID-19 (eg obesity, diabetes, and heart disease) and less access to adequate testing and healthcare facilities than urban populations. However, COVID-19 is more transmittable in densely populated areas.This Original Research article adds to the evidence base surrounding the incidence of severe COVID-19 outcomes in rural and urban USA. Data from over the course of 2020 are explored for medically underserviced areas (MUA) and non-MUA in Minnesota and Montana. Findings, including a shift in greater incidence from urban to rural over the year, may significantly inform future pandemic response planning.   Wed, 29 Nov 23 00:00:00 +0000 Defining quality of preventive oral health services in a northern First Nations community: a concept mapping study This article reports on a study conducted in partnership with a remote First Nation in northern Canada. The study utilised concept mapping to develop a framework for identifying gaps in oral health care for Indigenous youth. Findings of the concept mapping and framework development process can provide information on strategies to improve preventive oral health services for Indigenous youth living in rural and remote communities. Thu, 23 Nov 23 00:00:00 +0000 Distance as a barrier to HIV testing among sexual and gender minority populations in the rural southern US: a cross-sectional study The nature of the HIV epidemic in the United States and Canada has changed with a shift toward rural areas. Sexual and gender minority people who live in rural areas are less likely to have had an HIV test in the past 12 months compared with those who live in non-rural areas. Using data from 508 participants, this Original Research article assesses the independent contribution of distance and time required to travel to receive an HIV test on recent uptake of HIV testing. Tue, 21 Nov 23 00:00:00 +0000 Exploring the ideas of young healthcare professionals from selected countries regarding rural proofing Although most countries struggle to deliver adequate healthcare resources and services to rural communities, resulting in poorer health outcomes for rural-dwelling people, little attention has been paid to the need for policy to address inequities in rural and urban service delivery. Rural proofing, the systematic application of a rural lens across policies to ensure they adequately account for the needs, contexts, and opportunities of rural areas, provides a strategy to ensure rural contexts are fully considered when designing health programs and interventions. Young healthcare professionals (HCPs) will be called upon to advocate for and lead the implementation of rural proofing efforts, so their perceptions, ideas, and knowledge of rural proofing are integral to the future of rural health care. This Original Research article explores the knowledge and understanding of rural proofing among young rural HCPs from around the world.   Sat, 18 Nov 23 00:00:00 +0000 Prevalence of concomitant hypertension and diabetes among adults and elderly living in rural riverside areas in the Amazon Non-communicable chronic diseases are a major global public health concern, with impacts including premature death and disability as well as high costs for health systems and society. The burden of these diseases tends to fall disproportionately on populations with greater social vulnerability. Despite this, little is known about the prevalence of chronic diseases in rural riverside populations in the Amazon, where people live their daily lives with the dynamics of the rivers, making a living by fishing and plant extraction. People in these populations experience socioeconomic and health vulnerabilities and have limited regular access to health services. This study investigates the prevalence and risk factors of hypertension and diabetes in a rural riverside population of the Brazilian Amazon.  As doenças crônicas não transmissíveis são uma grande preocupação global de saúde pública, com impactos que incluem morte prematura e incapacidade, bem como altos custos para os sistemas de saúde e para a sociedade. A carga dessas doenças tende a recair desproporcionalmente sobre as populações com maior vulnerabilidade social. Apesar disso, pouco se sabe sobre a prevalência de doenças crônicas em populações rurais ribeirinhas da Amazônia, onde as pessoas vivem seu cotidiano com a dinâmica dos rios, vivendo da pesca e do extrativismo vegetal. As pessoas dessas populações vivenciam vulnerabilidades socioeconômicas e de saúde e têm acesso regular limitado aos serviços de saúde. Este estudo investiga a prevalência e os fatores de risco para hipertensão e diabetes em uma população rural ribeirinha da Amazônia brasileira. Las enfermedades crónicas no transmisibles son un importante problema de salud pública mundial, con impactos que incluyen muerte prematura y discapacidad, así como altos costos para los sistemas de salud y la sociedad. La carga de estas enfermedades tiende a ser desproporcionadamente mayor en las poblaciones con mayor vulnerabilidad social. A pesar de esto, poco se sabe sobre la prevalencia de enfermedades crónicas en las poblaciones rurales ribereñas de la Amazonía, donde las personas viven su vida cotidiana con la dinámica de los ríos, ganándose la vida con la pesca y la extracción de plantas. Las personas de estas poblaciones experimentan vulnerabilidades socioeconómicas y de salud, y tienen un acceso limitado a los servicios de salud. Este estudio investiga la prevalencia y los factores de riesgo de hipertensión y diabetes en una población rural ribereña de la Amazonía brasileña.   Thu, 16 Nov 23 00:00:00 +0000 The Rural Hand Therapy Project - providing hand therapy services closer to home Rural patients with a hand injury often receive initial hand surgery and rehabilitation in metropolitan or larger regional centres. Access to follow-up treatment for rural patients after the initial phase of care can be affected by transport options, distance, staff shortages and availability of hand therapists (occupational therapists or physiotherapists who have specialised skills in optimising functional use of the hand and arm after injury). After experiencing an increase in volume and complexity of hand therapy referrals, Toowoomba Hospital, a regional hospital in the Darling Downs Health Service (DDHS) in rural Queensland, Australia, found their existing model of care did not meet the needs of rural patients or therapists, risking poorer clinical outcomes. This Project Report describes the development and success of a new shared-care model by the DDHS - The Rural Hand Therapy Project - designed to better support rural hand therapists and rural patients in accessing follow-up hand therapy services closer to home. Tue, 14 Nov 23 00:00:00 +0000 A case study of a novel longitudinal rural internship program Rural education during all levels of medical training has been found to promote careers in rural medicine but many rural health services are limited in their ability to fulfil the supervision requirements for all levels of learners (from student to fellowship). Medical students have been successfully rurally trained via Longitudinal Integrated Clerkships (LIC), during which they're exposed to a range of clinical settings and disciplines, facilitating continuity of supervision over the clerkship duration. Portland District Health (PDH) is among the first health services in Victoria to implement this model of training for interns. This Project Report describes the novel internship program provided at PDH and explores the experiences of participants involved during the initial year. Sun, 12 Nov 23 00:00:00 +0000 Translating research into rural health practice: a qualitative study of perceived capability-building needs Translating health research knowledge into practice and policy ensures that research results in real-world improvements in health practice, quality of care and health consumer outcomes. Health-professional-led research tends to address real-world practice issues and, therefore, the findings tend to be more readily translated into practice. However, capacity-building strategies are needed to support health professionals to engage in practice-based research and translation. This is particularly critical for rural and regional health services, which often exist in communities that experience poor health outcomes compared with urban communities. The authors of this article ask: what are rural health researchers' perspectives on capability-building requirements for emerging researchers to enable the translation of research into health practice? Thu, 09 Nov 23 00:00:00 +0000 Psychological safety and self-regulated learning through near-peer learning for the sustainability of rural community-based medical education: grounded theory approach Near-peer learning (NPL), where learners proactively teach and learn with their peers and discuss questions with teachers, has been found to improve participation, collaboration and learning in medical education. In Japan, NPL applied in rural contexts has been found to improve motivation and self-directed learning in family medicine and community-based medical education (CMBE). However, a lack of psychological safety among peers and medical teachers (in part because of the professional hierarchy that exists among medical professionals) may impinge on the implementation of NPL in CBME. This study investigated the effects of NPL on the psychological safety and learning of medical trainees in rural CBME.   Wed, 08 Nov 23 00:00:00 +0000 Digital pathology: a crucial piece of the rural and remote cancer care puzzle In this invited Editorial, Dr Jon Griffin discusses rural and remote access to laboratory medicine and cancer histopathology services and the potential of digital pathology to transform rural and remote cancer pathology, providing faster diagnoses and building local expertise through training, mentorship and computer-aided diagnostics. Tue, 07 Nov 23 00:00:00 +0000 Telepathology in intraoperative frozen section consultation of breast cancer sentinel node biopsy in Fukushima, Japan following the 2011 triple disaster: diagnostic accuracy and required time during the early implementation phase Frozen section pathology consultations during surgery are essential for determining breast cancer stage and informing breast cancer treatment. However, pathologists are in short supply in rural areas, which may delay treatment for rural-dwelling patients. One possible solution is performing remote intraoperative frozen section consultation using telepathology: sending whole-slide images of frozen sections to pathologists at other institutions during surgery to rapidly check the condition of a resected specimen. Previous preliminary studies have reported that remote intraoperative frozen section consultation has an accuracy of 92% or better. This study evaluates the feasibility of telepathology in the post-disaster setting of Fukushima, Japan, reporting on the accuracy of remote intraoperative frozen section consultation of breast cancer sentinel lymph node biopsy and the time required to introduce telepathology at a leading breast cancer institution. Tue, 07 Nov 23 00:00:00 +0000 Food consumption profile of rural riverside populations Amazonian riverside populations are characterized by living in close connection with the ebbs, flows and floods of rivers and relying on traditional methods for producing food. People in these populations typically have little access to basic resources, including health care. Research on food consumption by traditional non-indigenous populations is scarce, but it is thought that changing environmental and social conditions is resulting in less reliance on traditional food production and more reliance on grocery stores and cheap, ultra-processed foods with low nutritional value. This article analyzes the food consumption of a rural riverside population on the Rio Negro River, Manaus County, Northern Brazil. As populações ribeirinhas da Amazônia caracterizam-se por viver em estreita conexão com as vazantes e cheias dos rios, bem como pela utilização de métodos tradicionais na produção de alimentos. Tipicamente, os indivíduos destas populações têm pouco acesso a recursos básicos, incluindo a atenção à saúde. São raras as pesquisas sobre o consumo alimentar de comunidades tradicionais não indígenas, entretanto, acredita-se que mudanças ambientais e sociais têm resultado numa redução da produção tradicional de alimentos e no aumento da dependência por supermercados e alimentos ultraprocessados baratos e de baixo valor nutricional. Este artigo analisa o consumo alimentar de populações rurais ribeirinhas do Rio Negro, no município de Manaus, Estado do Amazonas, norte do Brasil. Las poblaciones ribereñas amazónicas se caracterizan por vivir en estrecha conexión con los cauces, corrientes y crecidas de los ríos; y depender de métodos tradicionales para producir alimentos. Las personas de estas poblaciones suelen tener poco acceso a los recursos básicos, incluida la atención médica. La investigación sobre el consumo de alimentos por parte de las poblaciones tradicionales no indígenas es escasa, pero se cree que los cambios en las condiciones ambientales y sociales están dando como resultado una menor dependencia de la producción de alimentos tradicionales y una mayor dependencia de las tiendas de comestibles y de los alimentos ultra procesados más baratos y con bajo valor nutricional. Este artículo analiza el consumo de alimentos de una población rural ribereña de Río Negro, municipio de Manaos, en el norte de Brasil. Fri, 03 Nov 23 00:00:00 +0000 Enhancing early career professionals' representation and engagement at international conferences: WONCA “Rural Early Career Ambassador Integration” project Participation in international academic conferences provides social, emotional and intellectual growth among attendees, but equitable access to conferences remains an issue, especially for early career professionals and delegates from low- and middle- income countries. This report describes the success of a global project of the World Organization of Family Doctors (WONCA), the 'Rural Early Career Ambassador Integration' project, which was implemented for the 2022 World Rural Health Conference held at the University of Limerick, Ireland.   Thu, 02 Nov 23 00:00:00 +0000 Lessons from innovation in medical education during the COVID-19 pandemic: student perspectives on distributed training As a result of lockdown measures to control COVID-19, medical schools across the world adapted teaching and training methods. In many places, this involved a shift away from face-to-face teaching and the adoption of online and virtual learning. Rather than move online, the medical school of Stellenbosch University, South Africa, instead moved substantial components of clinical training away from the traditional urban tertiary academic medical centre and into regional and district hospitals. This study examined the perspectives of final phase students regarding the quality of their restructured training at distributed health facilities during the COVID-19 pandemic and compared the perspectives of rural site students with metropolitan site students.     Tue, 31 Oct 23 00:00:00 +0000 Accessing voluntary assisted dying in regional Western Australia: early reflections from key stakeholders In Australia, voluntary assisted dying (VAD) laws have passed in each state. As is the case with many health services, inequitable access to VAD within regional communities is a pressing concern. When designing and implementing VAD laws, Western Australia implemented several initiatives to mitigate regional inequities. This Original Research article draws on the early experiences and reflections of key stakeholders to report on regional provision of VAD in Western Australia and explore the effectiveness of the initiatives introduced. Thu, 26 Oct 23 00:00:00 +0000 Outcomes of rural generalist internship training in Victoria, Australia This paper describes the outcomes of a decade-long Rural Community Internship Training (RCIT) Program in Victoria, Australia. The program comprises a year of internship training delivered in smaller rural communities, including up to 20 weeks' general practice experience working with qualified rural generalist doctors and visiting specialists, along with 8-10-week terms in emergency, general medicine and surgery in nearby larger regional hospitals. Results suggest that up to 9 years post training, 61% of interns pursue General Practice, 40% currently work in the same region and 97% work at extended scope. Wed, 25 Oct 23 00:00:00 +0000 Exploring the efficacy of an educational approach of case-writing for remote learners: insights from a novice writer This Letter to the Editor reports on the success of an educational support system specifically designed for remote novice writers engaged in case-report writing. A remote writer was provided with lectures, available on demand, and tailored and personal workshopping and feedback using Google Docs. With this support, the writer was able to successfully focus, deepen and accelerate the writing process, despite their remote location. Fri, 20 Oct 23 00:00:00 +0000