https://www.rrh.org.au 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 Sun, 29 Jun 25 21:30:04 +0000 Papir Journal Platform melissa.storey@rrh.org.au (Melissa Storey) webmaster@commonline.com.au (Webmaster) https://www.rrh.org.au/images/rrh_og_branding.jpg https://www.rrh.org.au https://www.rrh.org.au/journal/article/9705 https://www.rrh.org.au/journal/article/9705 During 2021-2022, corresponding with above-average rainfall and flooding in the region, several critically unwell patients with necrotising fasciitis were admitted to the Hervey Bay Hospital (Qld, Australia) intensive care unit. All patients had been in saltwater rivers hunting for green mud crabs or descaling barnacles from their vessels. Cultures revealed Vibrio species to be the agents of infection in four of the patients. Necrotising fasciitis caused by Vibrio species carries a high morbidity and mortality, and often progresses rapidly into a life-threatening soft tissue infection, multi-organ failure and fatal sepsis. This case series reviews the clinical documents for each patient, and data from Pathology Queensland, to highlight a potential public health issue that could become more common with future floods caused by climate change and the cyclic return of the La Niña. Thu, 26 Jun 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9395 https://www.rrh.org.au/journal/article/9395 Research demonstrates rural clinical placements during medical school - especially extended rural placements and especially if they are positive experiences - improve clinical skills and likelihood of practising in rural or remote locations later in a doctor's career. This Original Research article reports on specific clinical learning experiences during a rural placement that contribute to final-year medical students reporting them as 'high quality',  with a focus on whether the supervising doctor's background and training influences the quality of students' clinical learning experiences.   Tue, 24 Jun 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9675 https://www.rrh.org.au/journal/article/9675 Training registrars in rural and remote settings is essential for developing GPs with the relevant skills for the scope of practice and context required. Although many rural and remote doctors may be too busy with their own clinical practice to supervise a registrar, evidence has shown that remote supervision can be effective. Good supervision is more than clinical advice; it also includes attending to the registrar's wellbeing, supporting them through challenging situations, and brokering their relationship with the practice and the community. Guidelines for remote supervision have been developed by the Royal Australian College of General Practitioners (RACGP) to facilitate supervision and learning. This article reports on the practicality, safety, effectiveness and efficiency of the guidelines for the remote supervision of registrars in pilot locations. Sun, 22 Jun 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9468 https://www.rrh.org.au/journal/article/9468 The shortage of health professionals in rural areas is a global issue. One effective approach for increasing the rural health workforce is to establish rural medical education programs involving engagement in rural communities and highlighting rural practice that prepares medical students for careers in rural medicine. In Papua New Guinea, the Divine Word University Bachelor of Medicine and Bachelor of Surgery programs have introduced rural clinical placement blocks for each medical student in the fourth year of study. This Original Research study evaluates medical students' perceptions of rural clinical placement in Papua New Guinea, including their preference to work in rural locations. Fri, 20 Jun 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9650 https://www.rrh.org.au/journal/article/9650 The USA has a shortage of primary care providers in rural areas, especially those trained in pediatrics and mental health. Concerningly, chronic health conditions occur in one out of four children and pediatric mental health diagnoses have increased significantly since the pandemic. Pediatric nurse practitioners in primary care can provide high-level care, positive patient outcomes, lower medical costs, and higher quality of life among patients but the transition to practice in rural settings is challenging and requires training and support. Nurse practitioners who enter practice through residencies or fellowships have better adjustment to practice, reduced burnout and greater intent to stay in their roles. This Project Report uses a pediatric primary care fellowship example to outline the needs of graduate nurse practitioners, describe the rationale for postgraduate training, highlight program content and structure, and identify ways to collect data for evaluating the quality and efficacy of primary care fellowship programs. Fri, 13 Jun 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9309 https://www.rrh.org.au/journal/article/9309 Inter-hospital transfers from rural to urban hospitals in Aotearoa New Zealand are often essential for diagnostic investigations or specialist care that is unavailable rurally. Clinical information is coded and stored for health system analyses, including rural-urban differences in health outcomes. Anecdotally, clinical coding is often performed by clinicians or reception staff without formal coding training in many NZ rural hospitals, and by a designated hospital clinical coding team with university or sub-tertiary coding training in urban hospitals. No NZ literature has been found comparing the accuracy of clinical coding between rural and urban hospitals. This Original Research article examines whether any discrepancies exist in primary diagnosis codes for patients who underwent an inter-hospital transfer from a rural to an urban hospital. Thu, 12 Jun 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9260 https://www.rrh.org.au/journal/article/9260 Over the past 20 years, nearly half of Australia's birthing centres, predominantly in rural areas, have closed. This substantial reduction in number of rural birthing centres has correlated with a 47% increase in births occurring before reaching hospitals. Evidence highlights the comparably poorer outcomes for both mothers and neonates in unplanned out-of-hospital births, with increased incidence of post-partum haemorrhage, perineal tears, delayed third stage of labour and need for neonatal resuscitation. This Scoping Review explores paramedics' confidence in managing prehospital obstetric emergencies, identifies influencing factors and examines the implications of confidence on patient and paramedic welfare. Wed, 04 Jun 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9430 https://www.rrh.org.au/journal/article/9430 Artificial Intelligence (AI) is permeating every industry, including health care, and has the potential to help address common challenges in primary care settings through increasing workforce capacity, optimizing resource allocation, enhancing health research, and reducing burnout. Many Canadian healthcare settings have begun piloting AI scribes, tools that transcribe patient-PCP interactions and create electronic medical record notes, in the hope that they might significantly alleviate administrative burden. This Commentary outlines the administrative burden on primary care providers and the benefits and challenges of AI scribe technology within the context of northern, rural, and remote primary care settings. Mon, 02 Jun 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9398 https://www.rrh.org.au/journal/article/9398 South Africans with disabilities, especially in rural areas, are subjected to poorer access to health care and are more likely to report illness and experience a greater need for healthcare services compared with their non-disabled counterparts. Rehabilitation services in South Africa prior to the pandemic were already considered low priority, but they halted during COVID-19 lockdowns because they were considered non-essential health services. This Original Research article explores the perspectives and experiences of Eastern Cape rehabilitation practitioners who served persons with disabilities in this region during the COVID-19 pandemic. Sat, 31 May 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9140 https://www.rrh.org.au/journal/article/9140 Adaptation over many generations of living in the harsh and extreme conditions of the Russian Arctic has produced a 'northern' type of metabolism, characterized by increased protein-lipid metabolism and minimization of carbohydrate metabolism. Increasing urbanization in the region has resulted in less reliance on traditional diets and lifestyles, leading to increased incidence of obesity and non-communicable diseases. This Original Research study investigates the status of lipid metabolism and variability in body mass related to ethnicity and lifestyle in Russian Arctic residents. Thu, 29 May 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9626 https://www.rrh.org.au/journal/article/9626 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. Tue, 20 May 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9269 https://www.rrh.org.au/journal/article/9269 Intimate partner violence (IPV), any behaviour within an intimate relationship that causes physical, sexual or psychological harm, is a major public health concern worldwide. While the violence prevention research landscape is still evolving, only in the past two decades has it started to become a high priority for practitioners and researchers to devote resources into conducting more primary prevention research. Community-based interventions, particularly community mobilisation interventions, can transform attitudes towards social norms and reduce IPV behaviours when rigorously planned, have a robust theory of change and are rooted in knowledge of local context. This Original Research study assessed the effect of a community mobilisation intervention on attitudes supportive of physical IPV, women's experiences of IPV and men's perpetration of IPV in rural communities of South West Nigeria. Thu, 15 May 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9618 https://www.rrh.org.au/journal/article/9618 While incarcerated, women experience multiple barriers to accessing primary and specialty health care. When women are released from prison, they face barriers to timely access to primary health care, substance use disorder support and treatment, and mental health services, compounded by the need to navigate a complex web of services and systems to access housing and food, reconnect with children and access parenting supports. This Scoping Review identifies what is known about the health outcomes and health experiences of women and gender-diverse people who are currently incarcerated or recently released from prison into rural areas. Wed, 30 Apr 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9103 https://www.rrh.org.au/journal/article/9103 Multiple international studies have shown that farming is one of the occupations in which workers have the lowest mental health scores. Farmers are exposed to unfavorable working conditions, such as long working hours and great physical demands, and may be more reluctant to seek help regarding their mental health than other occupational groups. This exploratory study investigates which facilitators and barriers farmers perceive as important in their everyday lives regarding their mental wellbeing. Mon, 28 Apr 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9536 https://www.rrh.org.au/journal/article/9536 People co-using opioids and methamphetamines are more likely to be homeless, have comorbid severe psychiatric illness and be infected by sexually transmissible infections, and are at higher risk of overdose causing death. Moreover, although medications for opioid use disorder (MOUD) are effective at preventing opioid withdrawal, use, and overdose, research suggests that concomitant methamphetamine use negatively impacts treatment retention and opioid abstinence over time. As opioid and methamphetamine co-use continues to rise in rural counties of the US, the need to understand the prognostic effects of methamphetamine use among individuals initiating MOUD in rural community treatment settings is paramount. This Original Research article examines whether positive methamphetamine urinalysis results predict worse treatment outcomes in four rural US clinics. Thu, 24 Apr 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9549 https://www.rrh.org.au/journal/article/9549 Ultrasonography is increasingly used across medical specialties, including family medicine, where it could reduce diagnostic delays, improve accuracy, and lower healthcare costs but ultrasonography training is not standardized in the family medicine curriculum. This Research Letter reports on the the feasibility and perceived usefulness of a one-day introductory ultrasonography course for family medicine interns at the Brest School of Medicine, France. Fri, 11 Apr 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/8686 https://www.rrh.org.au/journal/article/8686 Australian guidelines for initial management of migraine (an episodic, debilitating form of headache characterised by pain, nausea and aura causing significant personal morbidity), include aspirin, NSAIDs or paracetamol, followed by dopamine antagonists and serotonin receptor agonists, avoiding opioids unless as a last resort. Despite these guidelines, recent Australian studies have shown inconsistency in emergency department prescribing patterns. This Short Communication looks at patterns of prescriber intervention in a rural hospital to hypothesise how rural health barriers and enablers may impact prescription decisions. Wed, 02 Apr 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/8984 https://www.rrh.org.au/journal/article/8984 Health justice partnerships (HJPs) are integrated service models established to mitigate the impacts on health from issues that have a legal origin and that, if left unattended, can be detrimental to the health of individuals. Evidence from HJPs demonstrates the positive contribution of legal services on the mental health of program recipients, including improvements in depression, stress, anxiety and wellbeing upon delivery of legal assistance. This Project Report adds to the limited available research literature about HJPs for youth by presenting the perceptions of regional young people and workers about the impact of legal matters on health and wellbeing and the role of an HJP in the health of young people in regional Victoria, Australia. Sun, 30 Mar 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9490 https://www.rrh.org.au/journal/article/9490 This exploratory study presents self-reported dietary supplement use among peri-menopausal women in rural Hawaiʻi. Regular use of supplements was notably higher in this population compared with results reported in communities in other nations and different geographic regions of the US. As the majority of respondents reported receiving supplement information from a clinician, healthcare providers are encouraged to engage in thoughtful discussion with their patients regarding supplement use.   Mon, 24 Mar 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/8852 https://www.rrh.org.au/journal/article/8852 Rural doctors practising in resource-limited settings display courage when they are required to work at the limits of their scope of practice to provide the medical care that is required by their community. Although courage can be an integral part of clinical practice, the underlying attributes of clinical courage are not well described in the literature. This Original Research article contributes to the study of clinical courage in rural doctors by reporting on testing of a recently developed questionnaire. Better understanding of clinical courage may contribute to training, support and retention strategies for rural healthcare professionals. Thu, 20 Mar 25 00:00:00 +0000