Volume 13

Risk, decision-making and pregnant rural women - what are the connections? This editorial is enlightening.

Faecal incontinence can have a debilitating impact on quality of life - so say these Australian researchers who used a postal survey to establish prevalence among residents of north and far north Queensland.

Can the 'part-time' characteristic of female doctors' workforce participation be an asset? This study from Australia's Rural Clinical School model examines the contribution of this often underrepresented group.

There are many competing health issues in isolated First Nations communities; applying lessons learned from other similar communities can help address this challenge. This article focuses on a retrospective review of mitigation processes applied in a pH1N1 pandemic planning process within a First Nations community.

Barriers to care are a problem for many in rural and remote settings. There are also barriers to participation in the clinical trials that can shape healthcare delivery. The authors explore this important rural-versus-urban perspective.

James Cook University's School of Medicine was established with a mission to address the health needs of rural, remote and tropical Australia. Does early evidence on the first six cohorts' career outcomes support this?

This interesting a secondary analysis of narrative and pictorial data generated information about contributors and challenges to the mental health of Canadian senior rural women. The methodology will be of interest to qualitative researchers; the findings will inform program and community planners.

A study of breast cancer screening is a good measure of progress in healthcare delivery. Are patients identified at earlier stages in this study from Brazil?

Differentiating the impact of geography and access to health care and health outcomes is a limited but growing field. This article addresses these issues among young adult cancer survivors and in so doing heightens our understanding of the links between rurality and health.

Authentic early experience in clinical contexts is a now cornerstone of medical education. A well-known Australian educator begins the discussion of how to equitably use the finite teaching capacity of the Australian healthcare system in medical education.

Diarrhoea among children under 5 years is still a major cause of death in low- and middle-income countries. This community study examined water sources, children's homes and adult behaviour to identify correctable factors in rural south Ethiopia.

This herculean survey of the climate change health and social sciences literature introduces 'concept mapping' as a method to support vulnerable rural communities' adaption to the health challenges of climate change.

Information on prevalence and risk factors for hypertension in rural Zambia contribute to existing global literature.

In a global climate of reduced financial and staff resources for state-funded dental care, innovative solutions are required to ensure emergency care is accessed by those most in need. This study from Australia's smallest state reports the outcome of a dental triage system managed by non-clinical staff.

Ten key questions devised in Niger may assist any school obtain a safer hygiene and health environment.

This school-based, prevalence survey from rural Nigeria demonstrates the far-reaching benefits of early screening for ocular disorders.

What risky behaviours place rural Sri Lankan adolescents at risk of contact with the emerging global public health problem leptospirosis?

Multiple Mini-Interview is increasingly utilized for medical school admissions. Certain personal characteristics are noted to have greater or lesser MMI scores. Is rural origin such a characteristic and what would this mean with regard to rural origin admission rates, already too low?

Rural areas often need additional health professionals and developing local educational sources has been touted as one solution. This article discusses a novel policy simulation to determine if a rural-based dental school would be the best solution in a specific US rural location - an exercise that may assist with strategic workforce planning for other disciplines in other rural locations.

Mature GPs from rural NSW Australia have their say about strategies and other factors that will keep them in the workforce beyond retirement age.

How does a rural GP-implemented DOT program compare with conventional self-administration of TB treatment in terms of treatment adherence and control of transmission? This pilot study from southwest Greece may encourage others concerned with control of this notifiable disease in similar areas.

This locational aspect of a large study from Spain adds rural women's experience of menopause to the literature.

Mobile clinics can make an impact on the health of the most vulnerable children, in the most hard-to-reach locations.

With the closure of rural maternity units in Australia, accurate information about the onset of labour would delay the transfer of women out of their home communities. Is the fetal fibronectin (fFN) test the answer?

What can be done to enhance functional outcomes in high-risk patients admitted to rural ICU? The authors of this small prospective study put the case for follow up.

Can a short, rural practicum assist health science students adjust to the reality of working in a changing and challenging context? This South African study examines students' hopes and experiences, yielding thought-provoking information for all who strive to prepare students for rural practice.

With access to timely revascularisation essential for acute coronary patients, the most remote PCI service in the UK examines outcomes for rural patients before and after introduction of that local service.

As governments and institutions make plans to improve internet access to health information, studies of various populations are needed. Studies of populations with a wide range of ages, incomes, and geographic distributions are ideal for comparison. Offices of Rural Health and other agencies and institutions can learn from a study of Veterans in the state of Alabama.

Indigenous populations across the globe are in transition to westernized lifestyles, placing them at greater risk for metabolic disorders. What can be learned from those in the Maycoba vicinity of Mexico when researchers revisit changes in the local food environment after 15 years?

The name says it all: "How Far Is Too Far?". When rural and remote people must travel for care that may or may not help, how many will suffer travel consequences? The authors examine the travel consequences of false positive mammograms in Canada. When health interventions are marginal in benefit, travel for care may well be important.

What is the contribution of genetics to rural and remote public health policy and practice? The results of this study from Dalmatia challenge the myth of 'one-size fits all', even in closely located rural populations.

Rural and remote health remains challenging for 1 billion people who are without basics such as improved water sources. This study compares diarrheal disease across three different communities by water supply.

Why is there a decline in the number of Australian rural GPs who provide procedural services? These researchers examined the first five years after a GP's advanced rural skills training to see if early intervention can make a difference.

In this time of rapid change in the United States, Accountable Care begins to exert an influence, offering the opportunity to better address the healthcare needs of rural populations. But are Rural Health Clinics adapting to the new designs? This timely publication reports what Rural Health Clinic managers think about potential changes to finances, quality, and personnel.

With a high prevalence of HIV and TB In South Africa, integrated treatment programs are preferred - but does this disadvantage rural patients? This comparative, primary-care program evaluation offers new understandings in multi-dimensions.

A geographical threshold table approach was used in this study to determine child and youth mortality among First Nations. The findings and the method have much to offer for researchers and decision-makers.

The recent implementation of a regionalized medical program (undergraduate rural clinical clerkship) in Sweden provides useful management insights for medical educators yet to introduce this innovation, and for those with well established programs.

Internet based learning modules can be an important source of support for physicians on the front lines. Pediatric care can be quite complex and specialized pediatric centers are rare. Urban and rural emergency physicians need sources of information. Do they access learning modules, each other, or other sources of support? Are there rural-urban differences in the sources of information?

The evidence has long been in, so why do US rural Appalachian women continue to neglect breast and cervical cancer screening? This study used a 'consumer information processing theory' approach.

Conducting research is challenging enough but the challenge is heightened when participants come from diverse backgrounds. This article highlights strategies to assist with equity in recruiting Aboriginal participants, and these can be used by other researchers struggling with similar issues.

Know your population: how infant immunization was boosted among hard-to-reach Tanzanian nomadic groups.

Do bonded rural scholarships translate to a sustained allied health workforce boost, or is more needed to integrate and retain graduates? Scholarship holders and their managers have their say.

What are the barriers to rural Australian men's participation in research? This combination of qualitative material from a small advisory group with a review of the narrative inquiry literature provides a wealth of information for rural health researchers.

Non-resident nurses from Australia's remote Northern Territory manage their lives across multiple locations. This small study uncovers their unique professional challenges.

In rural and resource-low locations, physiotherapy's emphasis on the self-management of chronic conditions should assist community care. However, the experience of service users in a rural Kenyan hospital suggest otherwise, with lessons here for all.

Food security in rural environments and among rural people is a topic that has generated much discussion. This article offers an analysis of food security issues among Canadian First Nations people in an isolated area by providing historical and social contexts.

Health-related travel is often at significant personal and financial cost to rural people. But what about measuring the cost to all of us in carbon? This innovative publication breaks this new ground.

Distance presents an enormous challenge to pharmacists working in rural and remote Australia. This landmark study provides an extensive overview of the rural/remote pharmacy workforce, including their diverse roles and contexts, satisfaction with their work and professional issues.

Racial prejudice, an everyday experience for Aboriginal people in Australia, has detrimental effects on mental and physical health. But negative, prejudicial attitudes among healthcare professionals can increase existing access barriers to services. This study used three tools to examine negative attitudes towards Aboriginal Australians, and suggests an opportunity to address racial prejudice in undergraduate curricula.

Are rural family doctors in Italy effective in their treatment of hypercholesterolemic patients at high cardiovascular risk?

Rural nursing students have lower acceptance rates, but how do they perform during training? And what about students from isolated rural locations? The authors explore rural and urban origin differences in US nursing school and recommend changes in admission and curricula.

Does a decentralised training model have a positive influence on the retention of rural GPs? This study from rural NSW, Australia identified cultural and regulatory influences, and also the roles of choice and chance.

What factors contribute to the higher rates of dental decay among rural and regional Australians? This study of oral health data from NSW identified some significant variables in a population of children.

Studies of career choice or first practice location are common, but not helpful when compared to the decades of contributions of physicians. Instead, longer term studies are needed to answer important questions. The authors of this article explore whether residents trained "outside" contribute more "outside" where health care services are needed, compared to residents from "inside" or with traditional training.

Education, health care, Social Security, and government jobs contribute significantly to economic impact in rural locations. Explore the local economic impact of US rural hospitals with the authors. Anticipate the bleak future with continued cuts to education, Medicare, Medicaid, and rural hospitals. Help return nations to better understanding of the health, economic, and other important contributions of Rural and Remote Health.

Concerns about obesity and overweight youth have risen across North America. This population-based study examined the screen time, sleep habits and physical activity across BMI categories among Aboriginal youth in one reserve community in Canada. The findings will be useful to those planning programs and community-based initiatives.

Why to rural US women have the lowest national rates for colorectal cancer screening?

Australia's remote Northern Territory is an attractive placement environment for allied health students, nation-wide. However the same attributes that attract undergraduates, contribute to attrition of the NT allied health professional workforce. This comprehensive study analyses the NT AHP workforce according to the attitudes and vocational values of those who supervise students, and those who don't.

When the experiences of rural family caregivers were compared with their urban counterparts, both similarities and differences were found.

Are rural and remote populations always underserved in terms of healthcare access? These authors from Japan used distance-to-dialysis-service as the basis for an intricate - and revealing - study.

Determinants of health among rural peoples is well known as an important factor but not always understood. The authors of this article have focused on a unique group - the Old Order Mennonites - to examine health status and health determinants. The process used to successfully conduct the study and the study results about physical health among this group forward the rural health research agenda.

Can 'informal talk' act as a rural health promotion strategy for STI control? This 'eclectic approach to grounded theory' offers a novel approach to a perennial public health concern.

Accurate health-service usage data is essential for equitable service provision, especially for underserved populations - but how accurate is official data? This study used a unique register kept by an Australia Indigenous Mental Health Worker to verify official health system identification of Indigenous status among patients, demonstrating the power of a specific style of record-keeping for a specific population.

Much remains to be done to protect pregnant women against anaemia, especially in resource-low settings. This Ugandan study identifies correctable public health issues that will assist efforts in similar regions.

With Australia's widely dispersed rural populations, is there a better planning tool than 'dentist-to-population ratio' when assessing access to dental services?

This research investigated how Australian health students' rural-placements can be enhanced in multidimensions using a multidisciplinary learning model.

This study from the island of Crete introduces a novel combination of spatial analysis and epidemiological research to map the incidence of glaucoma, cataracts, and refractive errors with rural service-need identification and public health planning in mind.

With regular health assessments recognised as essential for people with intellectual disability, are rural Australians with ID benefiting from Medicare's ACHAs? This small but intricate study - informed by data from GPs, carers and people with ID - explored this issue and the influence of rurality on the wellbeing of those with ID.

Remote and resource poor settings face great challenges regarding the delivery of health care, especially care involving chronic diseases. The authors describe health kiosks as an intervention to gather epidemiologic data and to disseminate needed health information.

Rural primary-care clinicians need knowledge and support resources when faced with dental emergencies. The short Australian dental-emergency workshop and resource kit described may be widely useful for rural ED physicians.

Language barriers are a major problem in many rural areas. But when physicians do speak French, do they locate among populations that are in need of French languages physicians? Authors illustrate the example of Ontario.

With an increase of asthma among First Nations groups, there is increasing need for asthma education materials for use with this population. This mixed methods evaluation of materials currently available for First Nations groups provides useful recommendations.

The heightened concern about obesity and diabetes among First Nation peoples has led to a number of reseach initiatives, research studies and policy plans. This article discusses an asset mapping project with one specific First Nation group of children that was designed to determine how community resources impacted the children's acitivity and eating options.

Deserts are commonly rural and remote and so are food deserts - geographic locations with limited grocery store access. Changing unhealthy food habits can help address high rates of cardiovascular disease. These researchers have partnered with communities and churches to see if the Mediterranean diet is a good intervention for Appalachia.

What's it like to be a learner? West Australian interns compared rural hospital rotations with an urban teaching-hospital environment, in physical, emotional and intellectual dimensions.

Mobile clinics are typically for patients without regular sources of care. Studies of such populations can indicate needs that are not met. These authors have outlined the past few years of healthcare delivery at the Remote Area Medical clinic in Southwest Virginia.

This landmark ophthalmic study from a rural primary care facility in Nigeria examined a decade of surgical eye removal for cause. The results offer an evidence base to assist those concerned for better access to modern eye care in developing nations globally.

Elderly residents in Australian rural aged-care facilities lack access to essential pathology services. Why not extend the now well established in-community point-of-care testing for chronic-disease monitoring in this significant group? The authors of this commentary tell us how it could be done.

The 'realist methodology' included selected grey literature in this traditional systematic review. The result is a value-added determination of cultural and learning factors for South Pacific health personnel that will be of equal interest to other researchers and rural educators.

Aboriginal patients in need of end-of-life care are unlikely to access palliative care services. This review asks why, and outlines the basis for more appropriate care models for these first Australians.

There is extensive debate and discussion about successful processes to recruit new graduates to underserved areas including rural locations. The authors completed a scoping review of relevant interprofessional practice articles to look for some answers--read this article to discover what they found out.

How can current health services can be tailored to address the needs of American Indigenous communities? This review article on health ownership provides much food for thought and its recommendations may be applicable in geographic areas beyond the USA.

This case report not only reflects the clinical challenges of rural practice, but also what can be achieved in rural hospital medicine.

These educators provided diabetes education to rural healthcare professionals in the Scottish Highlands: did participants prefer videoconferencing or face to face?

Parental accommodation is a key consideration in pediatric oncology, especially for rural families faced with long distances to treatment. This small but thoughtful study from Sydney Children's Hospital explored multiple aspects of travelling families' accommodation needs and experiences.

As the population ages, cardiac-valve aortic stenosis becomes more prevalent. Are remote-area patients with this condition disadvantaged by later presentation in Scotland?

China's New Rural Cooperative Medical Scheme was designed to provide affordable health care for rural residents who faced potential impoverishment due to medical expenses. This policy report describes the wide-ranging scheme's 2003 roll-out in Guangxi Zhuang Autonomous Region, where the high ethnic minority population posed special policy challenges.

In common with many countries, rural Scotland's ageing population has a rising incidence of dementia. This project report describes the successful partnership of NHS Highland and a specialist university department to translate a dementia strategy into services for rural and remote elders in need in Scotland's islands, small towns, villages and isolated hamlets.

Evidence joins policy in this background to the establishment of Queensland's Rural Generalist Pathway in Australia.

Cervical cancer impairs or ends too many lives worldwide. Higher income, urban, highly educated women can be overscreened at high cost for little result. Meanwhile lower income, rural, less educated women have little or no screening. These authors share their experience in cervical cancer prevention efforts in Bolivia.

Rural residence presents a severe challenge to accessing holistic maternity care that meets cultural, psychological and social needs. This specific analysis examines the plight of Australian women in a remote region of the Northern Territory who have been disadvantaged since 2006 by the closure of their regional birthing service.

The unaddressed surgical disease burden of rural people in resource-low environments is starkly revealed by this report. The author participants in a Nigerian surgical outreach team demonstrate what can be achieved - both surgically and in building local capacity.

This project report presents a Greek experience of setting up sustainable community oriented medical education. Crucial to this successful program was careful planning to potentiate the voluntary efforts of self-selected, multi-professional teachers for a large group of students annually.

This detailed Nigerian report of a successful undergraduate rural-immersion dental program will assist others to put theory into practice.

Sustainable medical school-Indigenous community partnerships are possible. This Australian project report shows how.

A potentially difficult primary care transition in Nepal, from centralized to local management, showcases the value of inclusive capacity building - and careful planning.

Can academic leadership be transformational in improving health care in resource-low rural health systems? This report distils the collective wisdom of leading South African and international clinicians and academics into precise recommendations for change.

Can senior paramedics support emergency physicians in remote hospitals? This personal view from Israel suggests a novel solution to a global workforce problem.

Will Queensland's landmark 'Rural Generalist Pathway' fulfil its promise to redress rural medical workforce issues? This review of the principles and implementation of the pathway, including challenges, will be of great interest to those watching from other Australian states as their own rural generalist training programs are rolled out.

Four Australian nurses speak as one, adding the new graduate perspective to the current FIFO debate.

How to meet the needs of Indigenous Australian patients and communities when planning research and providing clinical care - a must-read for all who are committed to 'Closing the Gap'.