Volume 15

By developing comprehensive educational activities and a strong research focus, this study shows how rural general practices can move towards functioning as mature academic units.

There many published studies on health quality. Some consider social determinants of health, but beyond income and education are daily living conditions involving air, water, clothing and housing. These authors explore such issues, as perceived by US migrant farmworkers.

Persons with disabilities are vulnerable to stigma and discrimination, social isolation and physical barriers to accessing support services. For those living in rural areas, this study found previously undocumented context-specific experiences that could be used to improve policy implementation and service provision.

Innovative integrated clerkships for medical students offer rural healthcare services an opportunity to really integrate education with service. Perspectives from a multi-disciplinary group of stakeholders confirm the significant clinical exposure, skill and teaching capacity in these previously unrecognised placements but caution that realising the potential of health services needs careful management.

Readmission rates are being used to measure "quality" but the measurements can vary due to other factors such as patient factors rather than care factors. Women's health care offers the opportunity to look at low risk and higher risk conditions. Do rural hospitals have higher or lower readmission rates?

To produce health professionals who are oriented towards addressing community priority health needs, training in medical schools in Uganda includes a component of community based training, during which time they are supervised by faculty from their university. Although many students were satisfied with their supervision, challenges remain. Using ICT could be a solution to some of these challenges.

Ongoing workforce shortages affect the provision of mental health services to rural and remote communities. These qualitative findings provide depth to and support students' changes in interest toward working in a rural environment.

As part of the Australian Rural Clinical Training & Support program researchers are making valuable contributions to rural health research. This study reports a benchmark of research strengths and highlights areas that should be strengthened.

Water security is a basic component of life but for many communities, it is something that is not easily achieved. This article reports on an exploratory study that addressed water insecurity of a remote Indigenous community in sub-Arctic Canada.

Development assistance funding for health services has decreased in Namibia while the incidence of non-communicable diseases has increased. Innovative approaches, such as this mobile clinic, can provide cost effective wellness testing services at the workplace to help address the growing issue of non-communicable diseases.

This survey gives insights into what moves some medical students to consider the rural life and what keeps others from leaving the city.

The health of rural residents can be met through innovative solutions. The feasibility study presented here discusses a palliative care approach in rural areas and found that it can enhance the quality of life of rural residents who need this assistance.

A new generation of health professionals is being produced and care gaps still exist in rural and remote areas. Is this new generation still influenced by origin, training factors and practice support?

Perinatal mortality rate is regarded as an indicator of the quality of prenatal, obstetric and neonatal care in an area, which also reflects the maternal health and socioeconomic environment. Our findings that prematurity, poor accessibility and high parity were significantly associated with perinatal deaths in this tribal population are therefore of concern.

Can we differentiate care preferences among rural residents in need of palliative care? This study answers the question.

When designing oral health policies a focus on rural communities is strongly advised, as described here for one of Chile's most rural areas.

Selling tobacco or not selling is about perception. Messages from the mainstream media may not be a good fit with populations outside of the mainstream. What did the authors learn about Appalachian populations that could be helpful to those desiring to decrease tobacco use?

Mental health providers and administrators are the experts regarding recruitment and retention of key mental health personnel. What do they say about the challenges of providing mental health in rural Nebraska?

Are there rural-urban differences in perceived ease of access to substances such as alcohol and tobacco? Read this article to find out.

An innovative pilot program could be the key to successful cultural awareness programs for medical students.

Can a simple intervention trialled in Turkey change final-year medical students' negative perceptions of working in a rural area?

Despite efforts to address malnutrition and premature death among rural Indian children, optimal exclusive breastfeeding rates have not been achieved. With a high level of infant mortality and under-nutrition and a low exclusive breastfeeding rate in rural Odisha, the findings of this study could be used to design appropriate intervention strategies.

To address physician shortages in rural areas, more than 80% of medical schools in Japan have introduced a quota program that provides educational and financial support to students placed in medically underserved areas after graduation. The aim of this study was to investigate the students' willingness to remain in these areas after the obligatory period, and to identify factors associated with willingness to stay.

An unrecognised consequence of health professional shortages in rural and remote regions is the shortage of role models to inspire school students to become health professionals. These findings help explain why few students from rural and remote Australia go on to become health professionals and subsequently provide information and attract students for future rural health workforce recruitment and retention.

To help address rural workforce shortages, this regionally based College of Medicine and Dentistry favours rural origin applicants and provides students with early and repeated exposure to rural experiences. These data suggest that this selection process does not compromise academic standards and produces many graduates who choose to work rurally.

To help attract and retain the 'right' graduates to the rural workforce and mitigate the ongoing rural doctor workforce shortage, this study compares demographic, temperament and character trait profiles of general practice Registrars across three Australian training pathways. The combination of trait levels that tend to differentiate Registrars on a rural path correlate strongly with high levels of resilience, which may be of greater benefit for the rural context.

Climate change is a major foreseeable public health threat. Complex community-level assessments about climate change can offer actionable information about priorities for health sector adaptation.

In some rural world regions people living with disability still suffer a high degree of social exclusion. Can community disability workers make a difference?

Vulnerable or neglected populations are often more disadvantaged during epidemics as health systems are designed to produce the best outcomes for the majority of the population. The research framework described here allowed the voices of a vulnerable group to be heard, listened to and appropriate action taken to mitigate their risk of disease pandemics.

Many rural hospitals in Australia are unable to recruit or are not large enough to sustain employment of a full-time pharmacist, leading some nurses to undertake medication-related roles outside their scope of practice. This study explores medication management gaps in rural hospitals with no on-site pharmacist, including consideration of inpatient consultation services, assistance with accreditation matters and system reviews, and input into pharmaceutical distribution activities.

To plan effective interventions for recruitment of doctors to rural areas, it is crucial to understand 'what works' and 'why' in each specific country and region. Central to this study was understanding the views of graduates regarding practicing as a doctor in Wales, and how their perceptions and future career options were affected by contact with practitioners in rural environments.

What are retention factors for registered practical nurses in rural Ontario? This cross-sectional study to gives some answers.

Although it is known that tailoring primary health care delivery to rural regions can significantly address the poorer health outcomes of these areas, enacting that change remains a challenge. This research describes how a rural community driven by strong self-determination, participation and partnerships established a successful and culturally relevant primary health care service.

Young men are the most frequent victims of road traffic crashes, with alcohol and physical vulnerability playing large roles. The impacts on families who rely on these young men for economic survival are also discussed in this retrospective record review.

Overseas-born workers contribute significantly to Australia's aged care workforce, yet often in low-paid roles. This small regional study suggests workplace reforms to enhance the employment experience of this vital group.

A novel research method was used to assess the contribution of local dwelling types to the transmission of malaria in Benin, West Africa.

A promising intervention for building the public health nutrition workforce in remote Indigenous community store settings is described. Working to improve the food supply is challenging but there is value in being supported by like-minded colleagues.

Living in either urban or rural areas does influence a woman's chance of presenting for antenatal care, but does not influence the place of birth.

Income increases the empowerment of women and is associated with reduced fertility in this study. It is therefore one of the key issues for changing the lives of rural women in Bangladesh.

This study adds to the growing evidence that training medical students in rural areas delivers graduates that work rurally. The additional year spent in a rural area, even when their medical school was in a regional city, significantly affected graduates' work place choices after graduation.

Have recent policy changes improved the distribution of rural physicians in Iran?

Addressing mental health issues among rural and remote populations remains a challenge. This article reports on the intersection between PHC and mental health disorders among a remote population in Quebec.

Interhospital transfers can provide insight into regional healthcare efficiency. By monitoring these transfers, evidence of real needs, priorities and interconnections can emerge to positively inform new healthcare policy.

To address Argentina's critical healthcare shortage in rural settings, this study built on international research showing that difficult working conditions and low remuneration push new medical graduates into cities instead of rural districts. One-third of students in the present study expressed altruistic motivations for choosing rural areas for their future practice, indicating that increased support from government and medical schools may tip students' choices in favor of underprivileged regions.

Among Aboriginal and Torres Strait Islander peoples there is a higher incidence of heart failure, leading to more hospitalisations and deaths than for non-Aboriginal people. By working in collaboration with heart failure experts, Aboriginal researchers and patients, a culturally safe heart failure resource has been developed for Aboriginal and Torres Strait Islander patients.

Appropriate healthcare-seeking practices of mothers are important to prevent child death. This study in Ethiopia recommends promotion of treatment during antenatal care, postnatal check-up and community conversation to reduce the incidence and impact of diarrhea in children.

Snakebite envenoming is a major cause of morbidity and mortality in rural areas of the tropics. Timely administration of effective antivenom remains the mainstay of management. This study explores the causes and effects of delay, distance and time taken to access care on snakebite outcomes in Nigeria.

As in the rest of the world, rural-urban inequalities in China are increasing in every dimension including, as studied here, fitness and sporting opportunities.

The establishment of Rural Clinical Schools through government funding has been a significant policy initiative in Australian rural health. Since the policy was implemented, graduates have chosen rural practice because they have positive learning experiences, good infrastructure and support within rural areas.

Farmers have a heightened suicide risk compared to the general population. This study contributes a better understanding of suicide among farmers in different job positions, and highlights the need for tailored suicide prevention initiatives that consider age- and job-specific suicide risk and protective factors among farmers.

The majority of health professionals in Australia are non-Aboriginal. Are the attitudes and characteristics of those who work with Aboriginal populations conducive to closing the gap?

Argentinian farm workers are at high risk of physical, chemical or biological injury. The findings of this study may suggest a path to greater farm safety.

Rural-remote communities report higher smoking rates and poorer health outcomes than metropolitan areas. Catering for the unique challenges of the rural-remote setting is necessary if anti-smoking programs are to be efficacious, cost-effective and capable of improving rural-remote health outcomes.

Indigenous Australians suffer a high burden of chronic disease and hospitalisation. This study explored reasons for their low level of access to an important medication safety tool.

Obesity continues to progress in an epidemic fashion in the United States. Studies have indicated more problems for rural populations. Additional studies can help to confirm or deny the rural contribution as well as indicate other possible reasons.

Cancer mortality disparities have been observed between rural and urban regions in north-eastern Greece. Health promotion and education, including improved access to medical facilities and early cancer screening, can help mitigate the burden of cancer and extend long-term survival rates.

Indonesia is experiencing unequal distribution of health services between rural and metropolitan areas, leading to poorer health for rural populations who have limited access to primary care physicians. To address this imbalance, this study explores intrinsic factors perceived by medical students to be important when choosing the location of their future practice, as well as a government program that places medical students in rural and remote areas.

Rural populations are struggling with opiod addiction compounded by a lack of facilities and personnel to help. Family physicians are the most important source of workforce, but can they address this complex problem? The authors supply an important study of buprenorphine treatment specific to rural family physicians.

Knowledge about type 2 diabetes and attitudes toward the condition are known to affect compliance and play an important role in diabetes management. In this study of a rural region, more than 65% of the population thought that there is no cure for diabetes, and more than 90% did not know the essential combination of drugs, diet and physical activity in type 2 diabetes treatment, suggesting significant implications for their diabetes management.

Little is known about the academic and professional staff involved in the Australian Government's Rural Clinical Training and Support program. Addressing this knowledge gap will positively affect workforce and succession planning.

Mosquito-borne diseases are a serious global problem, particularly in tropical and subtropical countries such as Nepal. In these rural areas, topical application of citronella oil can be employed as an easily available, affordable and effective alternative mosquito repellent to prevent mosquito-borne diseases.

Do rural variations matter with regard to infant mortality? Researchers in Maine examine 11 years of data in the state of Maine by rurality tier.

Which is more important to outcomes, the family/community approach or the impact of health professionals? The authors explore these cultural and other issues with newly diagnosed diabetics in the US diabetes belt.

Emergency physicians are one of few types of physicians increasing in the rural United States. The authors ask questions about the preparation of emergency physicians and the differences between training in rural and in urban settings.

Around 80% of households in rural Vietnam are at risk of avian influenza outbreaks through poultry farming. It is vital that programs are available to support access to vaccines, medical equipment and information about preventing and controlling this pathogen.

Aging in rural communities poses unique challenges that affect older adults' quality of life. In this population in rural Brazil, factors associated with the quality of life of older adults in rural areas were similar to those found in urban areas, but the rural context may influence these variables in unique ways.

Rural background is a strong predictor of practice intentions and preferences, key factors in addressing health workforce shortages in rural and remote settings. This study provides insight into the broader range of interrelating and complex personal, contextual and experiential factors affecting the career decisions of medical graduates.

Because most physicians prefer to work in urban areas, rural populations suffer difficulties in accessing healthcare services, resulting in poorer health outcomes. By finding out what motivates physicians to practice in rural areas of Turkey, this study provides valuable insights to redress this imbalance.

Although Australian medical school programs improve cultural safety through training at an individual level, learners tend to internalise the patterns of behaviour they are commonly exposed to. In this study, clinicians, academics and professional staff demonstrated differences in their cultural safety profile, indicating the need for a tailored approach to cultural safety learning.

Is community development the answer to improve oral health? This article provides the details to show that it can be effective.

Can rural generalists safely and effectively perform colonoscopy? This international review yielded information on specialty types and quality in rural colonoscopy providers.

The United States is a leader in grandparents raising children. What challenges are African American grandparents facing in rural America?

Evaluation and monitoring of primary health care requires the establishment and maintenance of an appropriate data system. This audit provides us with an indication of how accurate routinely collected data in the electronic system is compared to the paper medical records that have traditionally been considered the gold standard.

Are place and race important considerations with regard to breast cancer outcomes?

This study found that weather is at the core of rural life - flood and drought contribute to decreased wellbeing from stress, anxiety, loss and fear, whereas social connectedness promotes resilience.

What are the drivers of change and what will help them find a voice?

Rural clinicians require expertise across a broad range of specialties, presenting difficulty in maintaining currency of knowledge and application of best practice. FOAMed provides content to augment traditional education, reducing delays from knowledge translation and increasing knowledge about cutting edge techniques.

Central American countries face a shortage of rural health physicians, exacerbated by a lack of rural exposure during training, fewer role models in rural areas, a lack of funding for programs, and low collaboration between clinical and educational systems. This review article discusses ways to overcome these challenges with creative solutions and new partnerships.

The 'colonization of birth' had devastating effects on remote Canadian Aboriginal families. This review considers the healing role of the nurse, among other strategies for recovery.

Rural and remote communities experience a disproportionate burden of communicable diseases compared to their urban counterparts. This systematic review identified communicable diseases that cause considerable morbidity in remote Aboriginal communities, with growing recognition of other social and environmental factors that can influence the burden of disease.

Although medical-legal partnerships in Australia are in their infancy, they could support the needs of rural people living with mental health concerns. This review article presents recommendations for developing medical-legal partnerships between mental health providers and lawyers in rural Australia.

DDT is an inexpensive but toxic chemical, endorsed by WHO for indoor spraying as part of global efforts to control malaria. However this review asked: What are the chronic adverse effects of long-term DDT exposure in children?

Attracting health professionals to work in rural locations in Australia and elsewhere is a well documented challenge. By addressing the diversity within and between professions and reflecting the different stages at which allied health professionals enter rural practice, recruitment and retention strategies can be established to better meet their needs.

The shortage of physicians in rural and remote communities is an ongoing problem. Read this article to find out which factors predispose urban students to choose a career in rural medicine.

In Australia, modifiable cardiometabolic risk factors are in excess in rural and remote communities. High quality community-level health promotion is paramount for the management of population health risk in such settings, especially in the context of reduced access to healthcare services. This study examined the extent to which formal frameworks and the adoption of socio-behavioural theories were reported in health promotion programs designed to reduce cardiometabolic disease risk in rural and remote settings.

This study cautions against the use of Fly-in Fly-out and Drive-in Drive-out services without concurrent development of well-resourced primary healthcare services.

Access to allied health services outside major population centres is a global challenge. This comprehensive review from Australia suggests educational and policy directions to boost and retain the rural allied health workforce, starting at undergraduate level.

Although the international community has condemned sorcery related killing and violence in Papua New Guinea, effective and appropriate interventions at a community level remain elusive. This case is a unique and intriguing example of biomedical and sociocultural integration in which a family sought a medical explanation of their relative's death to prevent rumours of sorcery and reduce the risk of related violence.

Rural patients face disadvantage in accessing medical services that patients in urban settings may take for granted. This report describes a patient who presented early to medical services following the onset of symptoms, but who was delayed in accessing treatment through the particularities of living in a remote area.

Although many medical schools incorporate distance learning into their curricula, assessing students at a distance occurs much less often due to the inherent challenges. This article focuses on lessons learned from implementing an objective structured clinical exam to address these challenges.

The shortage of GPs in rural and remote Australia has led to a lack of continuity in the medical supervision of patients with diabetes, resulting in poor outcomes. This article describes a nurse-led cycle of diabetes care and the factors that patients consider important in diabetes self-management.

This study confirms high rates of teenage pregnancy, prematurity, low birth weight and perinatal mortality in a rural township in the Solomon Islands. Three low cost interventions to reduce the rate of prematurity and low birth weight infants are discussed.

Sleep deprivation can be debilitating among CPAP users in remote areas with lack of electricity or in areas of frequent power outages. Knowledgeable primary care physicians can help sleep apnea patients improve treatment compliance to mitigate morbidity and long term complications.

As the number of regionally based academic health faculties and clinical schools in Australia grows, it is imperative to assess the relevance of these programs for improving rural workforce outcomes. This article describes James Cook University's tracking system for medical graduates, which has resulted in a 98% complete longitudinal tracking database that enables exploration of the patterns of practice of its medical graduates.

To overcome serious challenges concerning recruiting and retaining GPs, three small and remote municipalities developed an inter-municipal service. The increased continuity of patient care and creation of a robust professional environment for young doctors are discussed.

Placements in developing countries can be professionally life changing experiences for medical students. This placement in the Solomon Islands not only provides multidisciplinary Australian students with a great experience, but also leaves a long term legacy to the community.

To put a blindness prevention program into practice in remote districts of Eastern Taiwan, a Mobile Vision Van Unit was established to work as a community eyecare station. This model was found to be highly feasible in its efficiency and cost-effectiveness in communities with deficient medical resources.

Effective role model programs designed for remote Indigenous youth can have positive outcomes for both role models and the program recipients. Cultural safety training is an important factor for preparing role models and for building their cultural competency.

While this community-based rural model was developed in response to increased suicides in Australia's smallest state, it may contribute to suicide prevention in broader rural jurisdictions.

Germany is facing an increasing shortage of medical doctors in rural areas as current graduation rates do not counterbalance the loss due to retirement. This study describes how even short-term courses in rural practice can help reduce barriers that prevent physicians from working in these areas.

How can occupational therapy services be culturally relevant and safe in very remote Indigenous settings? In this personal view, the Churchill Fellowship author reflects on observations made in Canada, USA and Australia.

Rural health care faces serious, yet similar challenges around the world. This paper describes the international advocacy and leadership shown by the WONCA Working Party for Rural Practice to advance the health of the world's rural people. Much has been achieved in the past two decades, but there is still much more to do.

This letter offers a strategy for stabilizing patients with potential c-spine trauma in remote or under-equipped rural hospitals.

Quality improvement in health care can be accomplished, but a high level of transient staff makes this difficult to achieve and sustain.

Plastination is a low-cost and effective method for preserving specimens for use in secondary and rural teaching hospitals and in nursing schools.

Letter to the Editor: JCU's emphasis on rural, remote, Indigenous and tropical medicine, placements in rural or remote localities, and skills appropriate for independent practice prepare medical graduates for remote environments.

Mobile technology can play a vital role in extending healthcare support and services to rural populations. This research shows how a smartphone app could be a useful tool for young adults wanting to quit smokeless tobacco.

In remote populations suffering from a disproportionately high burden of disease, we help build the case for better resourced and more collaborative care.

Malnutrition during adolescence has serious consequences for growth and development, a situation experienced by many adolescent girls in developing countries. This study reports the presence and effects of malnutrition in both rural and urban adolescent girls in Ethiopia.