Volume 17

Japan’s over-65 population is expected to surpass 30% in 2030, making it the first super-aged society in history. With this rapid demographic and epidemiological transition, medical education in Japan needs comprehensive reform. Community-based medical education, particularly in small rural medical institutions, with a focus on primary care, should be central to the reform. 

Malaria is prevalent in more than 80% of townships in Myanmar. Most of the existing malaria control programs are developed and directed by health authorities and communities are only passively involved. This study implemented an active community participation program using the participatory learning approach in a village and found that it scored higher for outcomes including participation in malaria control activities, community knowledge about malaria and change in practice than a village employing a routine malaria control program.

This article reports on the results of a survey of rural lesbians in the United States which assessed access to and experiences with women's healthcare as well as preventative behaviour. Results suggest that rural lesbians experience more health risks than their urban counterparts.

This study examines how well prepared high schools are to deal with a life threatening emergency during school athletic programs. The authors identify financial and other challenges for rural schools, and recommend training and certification of coaches in the absence of trained healthcare personnel at sporting events.

This study examined the prevalence and safety of self-medication in patients attending rural and remote family physicians in Slovenia, and the factors associated with it. People tend to seek more information on self-medication but the main sources are lay informants. Further studies are needed to explore the safety of such practices.

Deployment and retention of a sufficient number of skilled and motivated human resources for health at the right place and at the right time are critical to ensure people's right to access a universal quality of health care. This study identifies the factors that determine the retention of qualified healthcare workers in rural areas of Senegal.

Delay in initiation of tuberculosis (TB) treatment may have an enormous impact on disease transmission, development of drug resistance, outcome and overall survival of TB patients. Delay in initiation of treatment after diagnosis is mostly due to health system failure and has immense programmatic implications; this is the first study of TB treatment delay in an Indian setting.

In rural areas with few doctors, Penrose drains are sometimes avoided in minor surgeries for soft tissue trauma or small subcutaneous tumors, even though the drain would prevent hematoma, because of the limited availability of professional postsurgical care. This study reports on the development of a simple fixation method for Penrose drains that is safe and particularly suitable for minor surgeries in rural areas where there are no resident doctors.

This study found a disparity between dental care service utilization in urban and rural areas in Taiwan, despite 15 years of universal health insurance coverage. This suggests that factors other than affordability may play a role.

Exposure to undifferentiated patient presentations is increasingly common in medical education, particularly in longitudinal integrated placements. This research, from an international research workshop attended by clinician teachers and medical educators who work in rural primary care, explored clinicians' perspectives of how students develop their clinical reasoning: by learning from patients; from their supervisors; and by understanding the context of their clinical interactions.   

There are very few prospectively recruited studies examining the outcomes of an ICU admission for a life-threatening illness, especially in regional areas. This study, from Alice Springs Hospital, Central Australia, followed a heterogeneous cohort of survivors of critical illness to 5 years and found disproportionately high ongoing morbidity (and correspondingly high rates of healthcare utilisation) and mortality (and at a young median age) than comparable international studies.

An oral health care program (professional care and eight weeks of education) administered at rural public health sub-centers for Korean rural residents older than 40 years resulted in a change in oral health behaviors and a substantial reduction in gingival bleeding.

Maldistribution of the primary care workforce remains a key problem characterising geographically large countries like Australia and the USA. This study found that rural recruitment and retention of doctors is influenced by a rural town's amenity (e.g. local community infrastructure such as housing, schools, health facilities and transport), not just professional issues (e.g. after-hours support and locum relief). This evidence is important in understanding the role of place characteristics and rural population dynamics in the recruitment and retention of rural doctors.

Agricultural communities have unique healthcare requirements owing to the high rate of workplace deaths, preventable injuries and illness. They typically also have limited access to services. To address these needs, the University of Iowa, USA, established a course in agricultural medicine, which has since been adapted for Australian students. This article reviews the educational and practice outcomes of students who have completed the agricultural medicine course in Australia and the USA.

This article describes the use of in-depth qualitative interviews with healthcare professionals to examine opportunities and challenges in promoting CRC screening in rural areas. Findings suggest opportunities to increase rates through alternative healthcare delivery models such as accountable care organizations.

Aboriginal children in Canada experience significant disparities in health in comparison with their mainstream peers. The Aboriginal Children's Health and Well-being Measure (ACHWM) was developed within one First Nation community, the Wiikwemkoong Unceded Territory, to meet the need for a culturally relevant measure of health and wellbeing for Aboriginal children (ages 8-18 years) in Canada. This article describes the relevance of the ACHWM beyond Wiikwemkoong.

The Australian Aboriginal and Torres Strait Islander population has a higher cancer mortality rate and a lower 5-year survival rate for all cancers than the non-Aboriginal population and barriers to accessing medical treatment and health services, particularly for people living in regional and remote locations, have been identified. This article reports on the usage, acceptability and usefulness of the Cancer Healing Messages flipchart and patient flyer, which were developed by Cancer Council South Australia to assist health professionals in discussing cancer and the cancer journey with Indigenous cancer patients and their families and improve access to health care. 

This article examines cardiovascular disease risk factors in children and adolescents in West Virginia. Contrary to previous literature suggesting a straightforward link between rurality and cardiovascular risk factors, the authors found mid-sized metropolitan areas presented with the highest risk, and recommend future longitudinal studies to explore mechanisms between cardiovascular risk factors and rurality.

Although the association between child mortality and socioeconomic status is well established, the role of household assets as predictors of child mortality, over and above other measures of socioeconomic status, is not well studied in developing nations. This study investigated the contribution of several household resources to child mortality, beyond the influence of maternal education as a measure of socioeconomic status.

Marginalization is a significant issue in Mexico, involving a lack of access to health services with different impacts on Indigenous, rural and urban populations. Although health coverage is highly concentrated in urban areas in Mexico, shortages are mostly concentrated in rural areas where Indigenous groups represent the extreme end of marginalization and access to medical coverage. Inadequate access to health services in the Indigenous and rural populations throws the gravity of the public health problem into relief.

This study of spatial access to cancer centers in British Colombia, Canada, uses GIS mapping to explore the relationship between socioeconomic status and travel time in urban, suburban and rural areas. Longer travel times were found for patients living in the most socioeconomically deprived neighborhoods, and the authors suggest the combination of spatial and socioeconomic barriers may significantly impact low-SES patients' ability to receive cancer treatment.

This study utilised FITNESSGRAM data to evaluate differences in overweight and obesity prevalence across different gradations of rurality. Results suggest that students in suburban environments demonstrate lower levels of overweight and obesity than urban and rural counterparts.

Difficulties in accessing allied health services, especially in rural and remote areas appears to be driving the use of telethealth services to children in schools. This study investigated the experiences and views of school executive staff and therapy assistants regarding the feasibility and acceptability of a speech-language pathology telehealth program for children attending schools in rural and remote New South Wales, Australia.

Community based rehabilitation (CBR) focuses on empowering persons with disabilities to access a wide range of services, and the essence of CBR is captured in several global frameworks. This study used proof-of-concept methodology to determine the extent to which countries in southern Africa have adapted the global frameworks available for CBR. In the countries that do have policies to guide CBR, the content and structure of the policies is weak and focused on health interventions only, missing several key concepts from the global frameworks and disadvantaging persons with disabilities living in rural and remote communities in southern Africa.

This study examines obesity in college students living in rural and urban areas of Kentucky. Findings suggest that living in economically distressed rural Appalachia is associated with excess body weight in college students independent of individual-level socioeconomic factors, depressive symptoms, and health behaviors.

This qualitative case study explores how a rural women's shelter adapted to a changing role with increased integration of health and social services. The authors report relationship building, community mobilization (both education and empowerment), and redesigning delivery were implemented as adaptation strategies.

Medical student professional development has been linked to their participation in patient care. This study found a relationship between community size and the extent to which students felt valued and the likelihood of them participating in patient care. Perceptions of value and the likelihood of participation decreased as community size increased.

Not enough medical graduates choose to work in rural and regional areas, especially in general practice. The Pūkawakawa Programme, a year-long regional and rural experience for selected Year 5 students from the University of Auckland‘s Medical Programme in New Zealand in partnership with the Northland District Health Board and two Primary Health Organisations, is found to be an important contributor to the regional and rural workforce of the Northland District, New Zealand. The academic–clinical partnership has been shown to support a regional and rural clinical learning environment.

Maintaining an adequate medical workforce in rural and remote northern Australian towns has been a challenge for many years. Based on medical graduates from James Cook University, Queensland, Australia, this study provides the first Australian evidence that likelihood of remote medical practice is enhanced by investment in a 'remote pipeline' - medical education via clinical schools and internships in rural/remote locations, with a later option of a rural generalist pathway. The proportion of medical graduates working in remote practice may also be increased by preferentially selecting Indigenous Australian applicants and applicants who score highly for communication, teamwork, self-reliance and motivation for rural and remote practice.

A public health surveillance model was developed following earthquakes on Kefalonia, Greece, in 2014. It involved daily reporting of clinical symptoms by local healthcare clinics and close observation by mayors for any unusual health events. The model provided assurance of quick identification of any possible outbreaks.

This article reports on the findings of a qualitative investigation into the experiences of new registered nurses (RNs) transitioning into the rural acute care environment. Findings related to transition supports and challenges suggest implications for developing strategies for support and retention.

This article examines the potential for a text-message-based smoking cessation intervention to reach American Indian college students. Results offer insight into cell phone access, internet use, and preferences regarding the use of digital media for health information among American Indian college students.

Many rural and remote communities are characterised by significant inequities in primary healthcare service availability, quality, performance and sustainability. This article investigates how best to ascertain the costs of delivering high quality primary healthcare services in rural locations of different population sizes, and to describe the methodological issues associated with such an exercise.

This article offers a theoretical model to portray the complexity of factors influencing the experiences of rural emergency medicine physicians. Identification of a range of factors, both previously and not previously identified in the literature, can contribute to systems improvement.

This article examines the effects of a Canadian program aimed at improving recruitment and retention of dieticians to rural and remote practice locations. Findings suggest that distributed and community-engaged learning models can be successful in augmenting the rural and northern dietetics workforce.

International fee-paying (IFP) graduates from the Tasmanian medical program make an important contribution to the Australian mainland metropolitan medical workforce, but play only a small role in workforce development for Tasmania and rural and remote Australia. Most IFPs do not choose to work rurally. Rurally focused medical programs need to consider how they place IFP students to meet both the learning and career needs of IFP students and the goal of the rural medical programs in developing a rural workforce.

Globally, sustained smoking reduction campaigns are targeted toward reducing individual and public risk and harm caused by tobacco smoking, but the research examining the effect of smokeless tobacco is remarkably scant. This paper reports on the chewing of wild tobacco, commonly known as pituri and mingkulpa, as is practiced by Australian Aboriginal groups across a broad geographical area.

This article explores issues in rural emergency department care for older adults with dementia from the perspective of healthcare professionals. Findings suggest strategies to minimize harm in emergency department transitional care among this population.

Mobile emergency simulation offers innovative continuing medical educational support to regions that may lack access to such opportunities. This study evaluated Canadian rural health care providers' satisfaction from high fidelity emergency simulation training using a modified motorhome as a Mobile Education Unit.

The Australian community aged-care sector is facing a growing workforce crisis, particularly in rural and regional areas. This paper reports on the experiences and perceptions of a small sample of service managers who are accountable for care provision in regional and rural locations, where recruitment and skill needs are contoured by disproportionate aged populations, distance and reduced service availability.

This study examined hospitalisation and public dental service records and found that residents of rural communities in Queensland, Australia, experience poorer oral health and are a greater risk of hospitalisation for dental conditions compared with the whole of Queensland. Although public dental services account for a small proportion of all dental care across the state, service utilisation data provide a unique insight into the population groups that may not be accessing public dental services. In the rural context, more effective use of the local workforce and a flexible approach to funding models could have a positive impact on access to dental care.

This study documents the limited focus on rural oral health that exists in national oral health policies from eight different English-speaking countries. It supports the need for an increased focus on rural oral health issues in oral health policies, particularly as increased oral health is clearly associated with increased general health.

Up to 33% of Australians have untreated dental decay and up to 34% of Australian adults have inadequate dentition. The majority of dental care in Australia is provided by private practice, with patients bearing the cost of consultation and treatment. Low-income earners can access subsidised care through public dental clinics, but demand has outstripped the capabilities of the public system, resulting in long waiting lists. This study found that utilisation of the existing network of private dental practices across Australia for delivery of subsidised dental care could dramatically increase geographic reach (improving service availability in rural and remote areas), reduce waiting lists, and make good oral health a more realistic goal to achieve for the economically disadvantaged members of our community.

Interviews and questionnaires were used to identify the differences between Rural Health and Remote Health and produce a detailed and rigorous description of Remote Health. This work will assist policymakers, health planners, teachers and researchers to develop an appropriate workforce, models of service delivery and policy that are relevant, appropriate and effective and ensure a more equitable distribution of resources and health outcomes across the entire continent.

Little evidence exists about the impact of strategies to increase rural retention in developing countries. To address Thailand's long-lasting critical shortage of doctors, two new government-funded projects to increase the production of rural doctors have been employed through collaboration between the Ministry of Education and the Ministry of Public Health. This study describes the impact of this national collaborative approach on the production and retention of doctors in rural health services.

This research presents cross-sectional analysis of the "Caregiving in the U.S. 2015" survey conducted by the National Alliance for Caregiving (NAC) and AARP Research. Findings suggest a need to understand culture and other characteristics of rural care providers when interpreting self-reported health status.

Understanding the contextual conditions for building rapport between health professional learners, and reflecting on these, potentially will lay the foundation for collaborative practice when these learners become health professionals. This commentary focuses on how the core contextual conditions for interprofessional-rapport-building opportunities (shared space, adequate time and balance of disciplines) were considered in one rural centre.

In New Zealand, a unique set of postgraduate pathways has evolved to train rural medical practitioners in extended scopes of generalist practice. This article describes these pathways and the history of their devolopment.

This paper reports on the key findings from seven CRE service evaluations to better understand what made these primary health care (PHC) models work where they worked, and why.

Telehealth may be cost effective for healthcare delivery, but it is unclear how well used or how appropriate it is for chronic conditions management for Indigenous peoples. This review of primary research studies worldwide found that although telehealth is promising, a lack of robust studies make tangible conclusions difficult. A better overall understanding of telehealth use with Indigenous peoples, including delivery of culturally competent health care, true consultation and cultural competency of the professionals involved would be helpful.

This paper reviews the factors contributing to suicide in older rural males in Australia. Living with experiences of drought, dramatic weather change, lower employment opportunities, out-migration, changing family dynamics, ageism in the community, economic change and competitive labour markets all add to the diverse experience for an older person who is ageing in a rural setting.

A case study from rural Greenland is used to highlight the potential for radiographic detection of osteoporotic fractures in the absence of other testing capacity in remote areas. Use of available technology, specifically lateral chest radiograph, enabled the diagnosis of fragility fractures and the timely initiation of treatment for osteoporosis.

This article reports on the introduction of an asynchronous telemedicine partnership (TECS) that allowed rural veterans to receive eye screening in their primary care office, rather than travelling to a specialist center. The program increased access and reduced healthcare costs for both the healthcare provider and the veteran.

This short communication reports on the results of a monitoring program aimed at detecting Avian Influenza virus prevalence among hunter-harvested birds from a remote First Nation community. This research points to the benefits of community-level surveillance of Avian Influenza virus in remote subsistence hunting communities.

In this short communication, the authors describe an innovative approach to IPE for medical students and physician assistants in the clinical setting. Reflections from a pair of students highlight the potential value of a concurrent clinical placement.

Honduras is the second poorest country in Central America, and roughly 50% of the population lives in rural areas. This pilot study examined how a pediatric telehealth network linking these areas to larger health centers may improve patient access to care, and physician access to educational opportunities.

Health Justice Partnerships (HJPs) provide an innovative service model offering an integrated health and legal service for a community. HJPs are particularly well suited to meet the needs of young people and those in regional locations experiencing complex legal issues. This paper presents interim findings from research examining the impact on young people, and the implications on practice for staff in the partner organisations, of an HJP in a large regional area in Victoria, Australia.

People living with chronic obstructive pulmonary disease (COPD) outside of urban areas have higher rates of hospitalisations, but hospital admissions and lengths of stay are reduced for people with COPD who participate in an integrated disease management program. This review explores the type and cost-effectiveness of COPD management interventions located in rural or remote settings of Australia and New Zealand in order to inform planning and ongoing service development.

Although cervical cancer is the leading cause of cancer mortality in Honduras, and yearly screening services are available in this community, knowledge and access barriers exist for cervical cancer screening services by Pap smear for women in rural and remote Honduras. The findings of this study will guide regional and collaborative effort to improve cervical cancer screening services.

This article presents a unique pathway for care aimed specifically at spinal patients. As a result of the shift of the spoke direction from the existing hub and spoke model, patient care is being redirected successfully with great benefit to a rural department.

This project report describes how simulated medical scenarios were used to improve collaboration among wilderness medicine professionals. The authors present sharing as a core concept of a grounded theory with application for interprofessional education, particularly relevant to rural and remote contexts.

This study describes two instances in which the mental health care of Australian Aboriginal and Torres Strait Islander clients was culturally inappropriate and/or inadequate. The author reflects that culturally safe therapeutic interventions, supported by reflective thinking and practice, can promote understanding and improve care.

This article examines the history of rural training track residency programs in the United States over the past 30 years. This account reveals the significance of a community of practice for ongoing support and development of these programs.

Papua New Guinea has a special history in regards to the training of Community Health Workers (CHWs) and is currently preparing its frontline health workforce to serve the people who live in rural and remote settings (85% of the total population of 7.3 million). This article identifies and explains the five major developmental stages in the current CHW training program, as well as the changes that have occurred over the past century.

Employment and working conditions have powerful effects on health equity and agriculture is one of the most hazardous sectors. This study examines the 1-year incidence of accidents among agricultural workers in Oguzeli district, Gaziantep, Turkey, and determines the types and causes of injury, and influencing factors, as well as identifying possible intervention issues for prevention.

This article reports that Mid-Upper Arm Circumference (MUAC) is a viable cost- and time-effective measurement tool for screening women at risk of under nutrition in a rural setting.

Sickle cell anaemia occurs globally and over 230,000 infants are born with the condition in Africa annually, 50-80% of whom die before the age of 5 years. The financial impact is hugely devastating, especially for rural households in Sub-Saharan Africa - where 60% of the entire population live - with very limited access to even routine health care. There is an urgent need for health policy makers to pay attention to recent developments in gene therapy for Sickle Cell Disease, a treatment approach directed principally at treating the cause rather than the symptoms of genetic diseases.

Food insecurity is a complex issue which affects many Aboriginal people living in Victoria. The Victorian Population Health Survey results suggest that community food programs are a central component of many rural and regional Victorian Aboriginal Community Controlled Health Organisations.