Volume 5

This issue of Rural and Remote Health marks a significant change in the management structure of the Journal.

Read Issue 2 Editorial: 'Rural and remote communities ­ innovation in the midst of adversity' by Paul S Worley, Editor-in-Chief

Two international journals, Education for Health and Rural and Remote Health, have joined forces to publish a joint edition focusing on rural and remote health education initiatives. Ten peer-reviewed articles have been chosen from a large pool of submissions. The articles can be found at either Rural and Remote Health or Education for Health and will be published in hard copy by Education for Health. Together, they provide an international snapshot of innovation in this field.

If collaboration can be achieved by two high profile journals, just imagine what could be achieved if more organisations decided to join forces! An editorial by Art Kaufman, written especially for this joint edition, explores such opportunities. Many thanks to the staff and reviewers from both journals who have worked so selflessly to see this work come to fruition. Enjoy the articles and keep up your own good work!

The ten articles plus two editorials that make up this joint issue are listed below:

Editorials

The Network: Towards Unity for Health, building a 'Star Alliance' among kindred organizations

Special issue in collaboration with 'Education for Health': on this joint issue

Project Reports

Seeing, thinking and acting against Malaria: a new approach to health worker training for community empowerment in rural Gambia

The rural physician associate program: new directions in eduction for competency

Combined research and clinical learning make rural summer studentship program a successful model

Educational and health services innovation to improve care for rural Hispanic communities in the USA

Evaluation of a required statewide interdisciplinary rural health education program: student attitudes, career intents and perceived quality

Implementing the CanMEDS^TM physician roles in rural specialist education: the multi-speciality community training network

Original Research

Advances in rural medical education in three countries: Canada, The United States and Australia

Student-developed problem-based learning cases: preparing for rural healthcare practice

Review Article

The impact of medical students on rural general practitioner perceptors

Short Communication

The education part of telehealth

Just because a rural clinician is trained and allowed to undertake an emergency intervention doesn't mean they will do it when the situation arises. Why? This study explores this important issue.

Rural health services enjoy managers who have experience of working 'on the floor'. But do we provide adequate management training for clinicians who are promoted to such a role? This article, from rural Australia, explores this important issue.

What factors in student rural placements impact on student attitudes? Read what this group discovered.

Rural communities are often described as 'close-knit'. This can have both advantages and disadvantages. This article looks at this issue from the perspectives of those who identify as same-sex attracted women.

Activities of daily living are important indicators of the functional status and wellbeing of older persons. This Spanish cross-sectional study offers an objective guide for studying activities related to the life-style of older people in rural and urban community settings.

Early postgraduate, or junior doctors, are still required to practise in rural and remote communities, and they continue to face numerous issues and difficulties. This Australian study explores the barriers to compentent and confident practice that junior doctors face in rural and remote locations.

Re-skilling rural practitioners is a challenging issue for countries around the world. Read how Australia is ensuring rural practitioners are able to provide a much needed radiology service to their communities.

Recruitment and retention of rural practitioners are important subjects in the current health policy agenda of many European countries. The authors of this article carried out a survey of primary healthcare professionals in the Scottish Highlands in order to explore whether the internationally identified determinants of recruitment and retention of the rural health workforce apply in the area. This survey confirms the association between rural background and rural working, and indicates also that professional isolation and perceived lack of access to amenities are important issues for those working in rural areas. It may be of interest not only for rural practitioners across Europe but also for health planners and policy makers.

Adolescence is a special time of opportunity for impact regarding education, careers, and personal health. Often there are few points of contact between adolescents and those who could help them with life-changing decisions, particularly in rural communities. The solution to better information and better outcomes may be the adolescents themselves. Participatory methods can be valuable in bringing teens and those who hope to improve health outcomes together for best long term results.

Melanoma is considered one of the most malignant cancers. Its appearance is related to various factors, including recurrent sunburn. During the summer holidays approximately 14 million tourists from northern European countries visit Greece. This Greek study aimed to discover the extent of local and other European visitors' awareness of the harmful effects of sun exposure.

Are you involved in rural health education? Do you worry whether your students are covering the whole curriculum? This article presents an interesting way to track and stimulate student learning in a rural location.

When rare, but potentially fatal, conditions present to your rural practice, do you know what to do? This study examines the responses to one such condition, Irukandji syndrome.

Can new technology help rural clinicians deal with chronic disease? New evidence in relation to point of care pathology and diabetes in rural communities.

This study from the island of Crete describes an innovative approach to encouraging cervical screening among traditional women. Could it be adapted to your community?

Does the level of training of rural doctors improve the quality of care in rural communities? It may appear there is an obvious answer - Yes! But what hard evidence do you have to support this assertion? This article provides important preliminary evidence for emergency departments in large rural centres.

Rural nursing presents significant challenges. This exploratory study highlights some of these challenges and presents opportunities for others hoping to improve the supply of rural nurses. It is a useful discussion piece for those currently in training. Similar issues involve a wide range of health professionals in rural areas.

There are many challenges to providing evidence-based preventative care in remote settings. This article describes some Australian experience in relation to preventing pyelonephritis in pregnancy.

Would your patient records be a reliable source to determine the prevelance of illnesses in your rural or remote community? This interesting study on gastrointestinal disorders from Crete identifies just this problem.

There is much evidence supporting rural undergraduate education experiences as a longterm workforce strategy. But does this mean that any rural intervention will work? This article from Tasmania throws up some interesting questions.

The interface between primary care and specialty care is a key consideration in health care cost and quality. Physicians in rural areas have different patterns of referrals, but is this geography, training, or experience? What do 800 physicians say about this important area?

The results of this study suggest that an opportunity to acculturate students into the rural lifestyle is lost when students' placements are insufficiently long for them to put down roots. Does this echo your experience?

There is considerable international effort to develop appropriate education and training for rural practice. But, do our assessment processes undermine or reinforce these good intentions?

Rabies, a lethal viral disease, is still prevalent in some countries, including rural Romania. This article reports on actions undertaken in Romania with the aim of establishing a surveillance system and controlling the animal reservoir of the virus. Data on cases of human rabies and the exposed rural population are illustrated, while the authors also report the results of the rabies immune prophylaxis schedule, which was administrated to all exposed subjects.

Is your rural health service struggling? Read this article to hear practical wisdom from selected rural health services in South Africa that have overcome diffculties to be recognised success stories.

Can IT effectively overcome the isolation of students undertaking rural placements? This preliminary evidence from Australia helps answer the question.

Will increased access to broadband internet help rural health professionals? This research from New Zealand shows there are more issues to be addressed before this potential can be fulfilled.

Understanding Relationships between Diabetes Mellitus and Health-related Quality of Life in a Rural Community does a masterful job of helping readers to understand the interactions between quality of life, disease, co-morbidities, and aboriginal status in an isolated rural location. It also provides a blueprint for the cooperation needed for such studies.

How can epidemiology data derived from one part of the world be used in another rural region? This article provides a useful method in relation to heart failure in rural Australia.

Increasing attention is given today to Indigenous knowledge, especially when related to health and medicine. This serves various purposes, including research and education. The integration of Indigenous medical knowledge into the curricula of educational institutions is also an important implication of such research. The authors of this article investigated Indigenous traditional medicine, given together with Western medicine to cancer patients in Pakistan. This excellent article could help researchers and rural practitioners who work in a rural setting and want a better understanding of patterns of usage of certain therapeutic modalities.

This paper addresses a challenging issue for both practitioners and health policy makers: the inequality in human supply in rural and remote areas. The authors attempted to compare the inequality in the provision of primary care physicians in two rural and remote prefectures of two neighbouring countries in Albania and Greece; two countries where information about primary care is limited. They calculated the population per physician ratio for each primary care unit in each prefecture in order to plot the Lorenz curves and measure the Gini coefficients for the comparison of the physicians' workforce in the two rural districts. It is an interesting study, which also discusses the methods of quantifying the inequality and limitations of the inequality indices.

Do you want to know how to support the families of rural health professionals? This article from Australia provides useful data to inform your support strategies.

Do we limit the effective particiation in continuing professional development by not valuing 'informal' approaches? This study of rural midwives from Ausralian informs this debate.

What factors would you include to determine the quality of your rural or remote health care? Whose views would you seek? This research from Australia provides a valuable contribution to the debate.

Any debate about whether procedural services undertaken by rural generalists should be supported requires timely evidence. This Australian article provides just that, from the perspectives of rural doctors, regional specialists, patients, family members and medical administrators.

How can theory underpin our efforts at recruitment and retention of rural health professionals. Read this article to learn of a new conceptual model from southern Australia.

The authors from the Institute of Rural Health introduce the concept of Rural Proofing for Health, a new approach or systematic methodology, which explores to what extent rural sensitivity is embedded into policy making. They provide some key information about how it can be assessed. Health policy-makers will find this article interesting, when they are considering the needs of people living in rural and remote communities.

Confused about the difference between mentoring, clinical supervision and precepting? You are not alone! This article summarises the international consensus on these roles and describes the implications for rural nurses.

It is the first of two articles that focus on issues that require consideration when undertaking rural health research. Read this article for an exploration of the planning of rural research.

It is the second of two articles that focus on issues that require consideration when undertaking rural health research. Read this article for an exploration of the conduct of rural research.

This article offers a primer on how to get started in videoconferencing, focusing on practical approaches to technical and protocol issues.

This report details a large-scale screening project for diabetic retinopathy in rural southern India. Could this approach be adapted for use in your community?

Is there a place for specific research training for effective research in rural and remote locations? Read this article and see if you agree with the authors.

Can providing students with an intense introduction to rural practice and/or Indigenous culture result in a positive change in opinion about these aspects of medical education? "Rural weeks" are part of the first and second year curricula at the University of Adelaide Medical School, South Australia - read about their experience.

Rural practice requires high level emergency skills. How can you ensure these are present throughout a country? This article shows how international co-operation has improved neonatal resuscitation skills in rural South Africa.

Teamwork is important in rural practice. It therefore makes intuitive sense that learning in teams would be good preparation for rural practice. This article from Australia provides insight into the issues you may face in developing such a program.

This interesting project report moves the RRH readers and both researchers and practitioners to Central Asian Republic of Kyrgyzstan, a geographically remote and mountainous rural region that is struggling for economic recovery and the maintenance of basic standards of public health. It offers an excellent example on building capacity through the introduction of a new public health curriculum that aims to improve the Kyrgyz students' skills and knowledge in this remote region. The readers could find some of the implemented ideas and proposals interesting and test them in suitable places.

Alzheimers provides significant challenges to families. Support for caregivers can be particularly important for those in rural areas. Savvy Caregiver programs can help communities to provide support. Designers should anticipate some differences for those in rural communities when compared with urban.

This article summarises the key issues discussed in a EURIPA Day (Belgrade, June 2004), in addition there are several statements on emergency rural health. Problems are illustrated with the proposals for improvement, and rural practitioners and health planners from other European countries facing the same problems will find this contribution interesting.

Remote Practitioners' Association of Scotland, Annual Conference, November 2004

As the title suggests, surely this is a report of the most rural conference ever held. Can you beat it?

Teleconferencing is a necessity in most rural environments. This enjoyable article includes helpful tips and a collection of experiences of great value.

In this article Iain Mungall studies the centralisation and specialisation of hospital services and explores their impact on the quality of care offered to rural and remote communities. This article introduces several views and an interesting debate on how the health services will keep the balance between living in rural/remote and urban areas. It also makes several recommendations on how the professions have to respond to the new challenges set by the NHS.

"The rural world and its population have their own characteristics, different from the urban world, which contribute to creating a unique framework for physician-patient communication and relationship." So begins this unique Personal View from Spain - recommended reading for every rural doctor.

The US Rural Physician Associate Program (RPAP) has trained 1063 medical students in rural communities for the past 34 years and produced 658 primary care physicians and 521 physicians who currently practice in rural communities. Read more about this sucessful program in this Personal View.

Telehealth is being considered as a solution for overcoming the barrier of isolation in rural health. But is it always the best solution? This personal view gives a perspective from rural India.

We all know that informed policy development is crucial to improvement of rural health services. Informing this policy development through providing an international peer-reviewed evidence base is one of the aims of Rural and Remote Health. In this invited personal view, the Hon Julie Bishop, Minister for Ageing in the Australian Government, clearly outlines the raft of policy initiatives that underpin Australia's progress in rural health.

How best to prepare young doctors for general practice? This Letter from Greece has some useful suggestions.

TB is a major killer worldwide. But how much of its impact is attributable to simple household behaviours? This letter from India raises some thought provoking hypotheses in this regard.

When specialist medical care is scarce, this Letter to the Editor describes a possible solution.

The author of this letter asks, "Why are we still seeing a reduction in services in rural hospitals?"

This letter to the editor offers a unique solution to the problem of retaining rural GPs in small communities.

This Letter "The positive impact of rural medical schools on rural intern choices" offers interesting evidence from South Africa.

Available online now: book review by Prof David Wilkinson, of "Beyond the Divide: Women's experiences in rural Victorian psychiatric rehabilitation services" by Marg Brooks.

Do you need to track and report on student placements in your rural region? See what you think of this web-based solution from South Australia.

Would you like to be part of a Journal Club but there is no-one close enough to join in? This article gives encouragement for how technology can assist in overcoming such barriers.

The FRAME questionnaire will ensure that not only will comprehensive national outcomes be measured and progressively reported as students enter the rural workforce but also that individual Rural Clinical Schools have a tool that will allow modifications to be made to their programs as they mature and develop so that the results can be optimised.

The oral health of the Indigenous community in South Australia's mid-north has been a concern for some years. This project report describes the setting up of a culturally sensitive, quality dental service within an already operating the Aboriginal Health Service.