Volume 9

This editorial invites the submission of letters, case studies and brief papers describing issues of rural concern emerging from the H1N1 (swine flu) pandemic.

What does history tell us about the shift in health status in rural places? And what are the links to the current economic recession? Read this editorial to find out...

This highly accessible editorial examines the impact of the current economic recession on the health of those who live in the rural north-west USA.

What are the social determinants of good health status for Jamaican men? This article provides a comprehensive discussion of the topic and how this information can be used for targeted health planning.

Public health nurses are considered an essential component of the rural public health system. This interesting article describes public health nurses in remote areas of Idaho, USA, and offers an insight into differences from and similarities with public health nurses in other geographic areas.

Do age, gender and place play a role in the differences in mortality between rural and urban locations? This article provides some answers from an examination of mortality patterns in rural and remote Canada.

People who live in remote areas have a higher rate of melanoma yet a poorer outcome. This pilot study of an Australian Royal Flying Doctor intervention suggests skin cancer care need not be compromised by geographical location.

For those interested in rural medical workforce issues, this interesting study from Japan examined the factors that predicted physicians would 'stay rural' over 22 years.

Global health service reform can have unintended consequences for those in rural and remote areas. This Scottish study of the implementation of a national nurse-led telephone triage system is an interesting addition to the literature.

For a fresh look at student selection and the within-course experiences most likely to provide committed rural practitioners, this compact report of a large study by Australia's newest medical school has much to offer.

Asian cultures have developed childbirth customs over thousands of years and these are different from contemporary perinatal care in Australia. This excellent Tasmanian qualitative study helps us understand the perinatal health care likely to be desired by Asian mothers.

One of Australia's worse droughts provides the context for this study on the fragile link between social support and coping.

How can we describe rural nursing practice? What are some examples of threats to clinical expertise in rural areas? This Canadian study answers these questions and more...

Medication error is very common and can be life threatening for frail aged patients transferred within Australia's increasingly complex healthcare system. This rural pilot study identifies some of the issues and also importantly offers solutions that are unique to the rural context.

This rural ecological study into the respiratory effects of industrial pollutants on kibbutzim children in Israel responded to a specific public concern. However, it has a wider relevance to the disposal of hazardous chemical waste, a common concern of many rural populations.

Current rural clinical school students who have chosen to spend an exciting time during their clinical training in the bush are among the best advertisements for a career in rural Autralia. This positive study might present a "rose tinted" view of life in the country as a Western Australian medical student, but it does provide more evidence and data to encourage future students to "go rural".

Is it still valid to assume that rural populations living traditional lives are protected from hypertension? This West African study provides evidence that mean blood pressures of rural people are not very different from their urban counterparts, putting them at equal risk of hypertension.

Appropriate pre-hospital thrombolysis can be life-saving, especially for rural MI patients. What then are the barriers to providing this essential therapy - and how can they be overcome? This Scottish GP study identifies some thought-provoking human and system factors.

Spontaneous onset of labour followed by a normal delivery is becoming a rarity in 2009 obstetric practice, whether in an urban private hospital or in a rural area. Do women really want intervention? This interesting qualitative study gives an insight into what women really feel about this important topic.

Changes to Japan's health system have implications for the treatment of rural patients with haematological malignancies. This pilot study looks for solutions.

Rehabilitation services as we know them originated during World War II with the aim of returning injured servicemen to active duty. These days, when rural residents must undertake hospital-based rehabilitation, a worthy goal is to return them to a facility close to home. This novel project analysed the introduction of rehabilitation services in two small Australian rural hospitals. As a bonus to interesting and specific conclusions, this study also offers insight into the process of change in the rural inpatient setting.

Health status of rural residents in Jamaica was generated from their national cross-sectional study. To discover the predictors of health status among rural residents in this island country, read this article.

This comparative study of the practice location of graduates from two medical schools in the Democratic Republic of the Congo adds some unique elements to the rural workforce literature

A common issue for rural and remote health professionals is the lack of access to continuing education and an associated sense of professional isolation. Are vieoconferencing communities the answer? This small study from Australia identifies some practical issues and raises a question about knowledge acquisition.

What health care do Australian rural Aboriginal adolescents want and need - and who is most likely to successfully provide it? This study provides a timely reminder that assumptions are often unhelpful.

Many words have been written about specific challenges to the retention of rural doctors. This study of rural Canadian family physicians offers a unique main finding.

Focus groups among rural community residents in British Columbia, Canada were conducted to find out about their experiences with Primary Health Care services. Read this article to find out what was said about access, inequity and continuation of care.

In technology-driven specialties such as radiology, specialists no longer live in rural communities. Although an x-ray report may be just a "click" away, when a doctor on-call is confronted with a patient and an x-ray, it is reassuring to be able to discuss that x-ray with an on-site colleague. In rural areas that colleague is likely to be a radiographer. This study looks at ways of providing training for rural radiographers so they can assist with image interpretation.

A lack of knowledge about contemporary cancer care may prevent rural GPs from being involved in the cancer care of their patients. This is problematic for rural families who may need to make regular round trips of hundreds of kilmotres for routine cancer treatment. This education program from South Australia represents a first step in engaging with local rural clinicians in the care of rural cancer patients.

Childhood obesity has been associated with cardiovascular disease in adulthood. This study suggests that rural Greek children, once assumed to be protected by diet, are now at risk.

Intimate partner violence is a worldwide public health issue, with consequences ranging from psychological and physical injury to death. This rural Rwandan study identifies some associated factors that may inform local interventions.

Telehealth aims to provide remote practitioners with another set of eyes - and patients an expert opinion without expensive and time-consuming travel. It sounds so easy. These authors, however, show us there are pitfalls to be wary of when setting up a telehealth service.

Are you interested in the nutritional status of your community? This article describes a rigorous process for determining a reliable tool for investigating malnutrition in rural areas.

Partnerships, collaborations and capacity building are common words used when talking about rural health research. This article focuses on all aspects of the research process in regard to collaborative rural health research. Importantly, lessons learned are shared with the readers.

When local, state, and national efforts are coordinated, there is great potential to address challenging areas such as childhood obesity. Solutions that work at the local level must involve the individuals who comprise the community, especially those most involved with lifestyle, diet, and interventions. Thus, the solutions for childhood obesity suggested by this small Appalachian study are informed by the perspectives of local school students, and their teachers and parents.

While undergraduate rural medical education is well advanced in some world regions, in the UK there is no tradition of rural clinical placements. This research offers a glimpse into the early views of UK medical students about rural health and its relevance to their learning.

The provision of health and social care services to older rural people is a concern worldwide. This study, part of a wider northern European project, asked older residents in remote Scottish Highland communities what they want. Their voice was clear in response.

Rural youth drug and alcohol use - what are the issues (according to parents in Ireland)? This qualitative study will be thought-provoking, for parents, community, clinicians and policy-makers in any country.

When this large Indian study asked why rural women were not using public healthcare facilities some fundamental issues were identified.

In the United States the old, older, and oldest populations are set to double and even triple in some more rural states, while primary care services either remain stable or decline. Geriatric evaluation will become even more challenging in rural locations with fewer rural primary care physicians and more complex patients. The authors of this study identify Illinois rural primary care physicians as taking on the challenge of geriatric depression, despite greater than expected prevalence, insufficient resources, and other barriers to care. In doing so they provide another example of rural practices taking on the challenges of the future ahead of others in the nation.

In resource-low rural areas of the developing world, culture and sensitivity for all re-treatment TB patients is not feasible. This helpful study informed by India's RNTCP methodology suggests which patient groups to target.

A prolonged illness and death from lung cancer poses enough challenges for families and health care providers. The high media profile of asbestos-related cancers put extra stresses on sufferers, those potentially at risk and the larger community. These issues are explored in this case study of an affected region in Australia.

Is there a difference between rural and urban adults' contraceptive choices? Read this cross-sectional study to find out.

Arguments surrounding point of care testing in general practice are often based on problems in maintaining and credentialing staff. This important national study offers an education solution that is relevant to both rural and urban general practice in Australia.

For over 100 years osteopathic physicians have made significant contributions to the US rural workforce, with the highest percentage of graduates found in rural practice. However their impact on improving health access in rural areas may be reduced with changes to admission, training, and a continued trend to less choice of rural practice and family practice with each class year - even with a doubling of osteopathic graduates by 2017. This study surveys osteopathic medical students and residents about their rural practice interest, and explores financial and other factors important to securing the future rural workforce.

The small mountain kingdom of Lesotho decentralised oral health services management to districts. Following this, public sector dentists identified barriers to effective oral health service planning for its rural population.

The authors of this article report the very exciting outcomes of a large health promotion program in Papua New Guinea. They show that empowering village-level health workers with education, appropriate tools and support mobilises community leaders and results in meaningful improvements in health promoting environments and practices.

Ensuring high school students are aware of opportunities to help them study medicine is crucial for the future of the rural medical workforce. This timely paper reminds us of the continuing need to make sure the next generation of doctors is aware of their options.

In rural primary care a number of factors, such as a patient's needs and the seriousness of their disease, determine hospital referral. Aside from patient factors, have you ever considered whether locum doctors and regular GPs have different patterns of referral? This interesting Norwegian study did just that.

Childhood obesity is an increasing problem in America, and populations both rural and underserved can add important clues to finding solutions. Studies of prevalence, characteristics, and changes over time are the beginning of a process of change for better health outcomes. This Appalachian study makes an important contribution.

What personal characteristics and experiences of allied health professionals influence their decision to practice in rural and northern locations? How can these findings be used to recruit and retain new graduates to these locations? Read this article to find out more...

This article provides a snapshot of the accommodation issues faced by adults with intellectual disability living at home with parents or in supported accommodation in an Australian regional setting. What are the hopes and dreams of this ageing and vulnerable population and their carers - and what is the reality?

In a remote, rural region of Brazil where women face complex healthcare access issues, this project brought the barriers down to breast and cervical screening participation. The authors reflect on their successful outreach strategies.

The one-year Flinders University program for undergraduate education located in rural general practices has set the standard for medical education in Australia and internationally. This results of this study suggest that half of these graduates are on a rural pathway. The article considers why the other half is not, applying unique typology that includes 'The Frustrated' and 'The Metro Docs'.

This ethnographic study from Kenya compared traditional healers with the biomedical approach, revealing important differences. It revealed important barriers to biomedical care, which have implications for the uptake of other rural healthcare services.

You can bring your job opportunities to over 1500 health professionals and organisations per day. Advertise your vacancy online at www.rrh.org.au (free of charge for Australian RCS and UDRH financial contributors; nominal charge for others). Enquiries to jenny.bigelow@rrh.org.au

Too often young women's health has been subsumed under reproductive health risks. Qualitative studies of how women negotiate potential risk have been useful, but this article goes further by listening to women's broader experiences. They identify life course circumstances where interventions may be beneficial in assisting women to achieve their goals and to be resilient to health threats.

Placement experiences have the potential to influence medical career decision-making. What, then, are the pre-placement expectations and actual experiences associated with rural GP placement. This unique, small South Australian study will make thought-provoking reading for those interested in the rural GP workforce.

A farm injury affects not only the immediate family but also the community where the injured farmer lives. This article from Australia shows that better progress could be made in educating farmers to look out for their own safety.

Australia has been significantly affected by the H1N1 pandemic. This article argues that rural and remote areas would have been better served by maintaining the containment phase of the response after it was lifted in cities.

Immigrant populations are becoming more common in rural areas of western countries. Healthcare professionals need to become more familiar with such groups' beliefs and practices in order to provide optimal care. This article shares insights about a practice among South Asians that is linked to oral cancer.

The 10th Australian National Rural Health Conference (Cairns, 17-20 May 2009) is an important rural health event. In support of it, and to stimulate wider debate, Rural and Remote Health has commissioned a series of editorials on selected conference themes. This is the second in the series, entitled "Rural health in a time of cataclysm".

The 10th Australian National Rural Health Conference (Cairns, 17-20 May 2009) is an important rural health event. In support of it, and to stimulate wider debate, Rural and Remote Health has commissioned a series of editorials on selected conference themes. This is the fourth in the series, entitled "Ten ideas for building a strong Australian rural health system".

Is the higher rural rate of prostate cancer mortality a concern among men in your rural population? This commentary discusses it in the context of differing urban-rural screening rates for PSA.

The global response to swine flu has been forceful in an attempt to prevent a repeat of the devastating influenza pandemics of last century. This Australian commentary reviews early local and worldwide responses while the severity of this virus remains unknown.

Read about the swine influenza (H1N1) pandemic from the perspective of rural populations in developing countries.

By reviewing over 120 articles, this paper provides an up to date global view of what works and what doesn't in relation to increasing the numbers of health professionals working in rural and remote communities.

Occupational therapists, like all health professionals, are in short supply in rural areas. This literature review echoes for OTs the lessons we have learned about the rural medical workforce and the potential positive impact of curriculum and rural placement.

With a worldwide increase in skin cancers, rural GPs must be prepared to diagnose and treat the potentially lethal Merkel cell carcinoma. The regimen outlined in this case report from remote France offers such patients the greatest chance of survival.

This short communication reviews the state of cancer services in rural Australia and points to the most promising opportunities for eliminating the urban - rural disparities in cancer survival rates. Rural and Remote Health urges readers from all regions to tell us about successful rural cancer programs that work where they live.

Telehealth is becoming an indispensible adjunct to rural health services; however, its introduction is rarely problem-free. Knowing the telehealth priorities of rural hospital administrators and physicians can only assist the successful expansion of telehealth services.

High rates of diabetes among First Nations is a concern among healthcare professionals. Perhaps part of the solution is to increase our understanding of diabetes risk factors. Find out what these authors discovered about pre-diabetes among a First Nations sample in rural communities in Alberta, Canada.

This short communication suggests enhanced primary care strategies to cure the ailing Greek health care system.

Aboriginal people in Australian have been disproportionately affected by the novel influenza strain H1N109. As anticipated in an article published in this journal earlier in the year, the official approaches to engaging public support for reducing transmission have proved largely irrelevant for Aboriginal communities. This article is a start to documenting the ways in which pandemic strategies must be altered if they are to protect Indigenous and other distinct social groups.

Mongolia's recent rapid social and economic transition has led to social disadvantage among some dispersed rural and urban sub-populations. This project report chronicles the micro-planning processes involved in health access of these at-risk groups. A highlight is the mapping of difficult to reach populations that "brought the health data alive" and contributed to meaningful information exchange from district to national level.

For those interested in providing mandatory education for rural health professionals, this report from Idaho, USA is a must read.

Translating new government health policy initiatives into improvements in clinical care is easier said than done. These researchers have helped GPs in rural Victoria, Australia to achieve this in mental health care through the development of an "Internet Tool Box".

Defining key competencies for professional practice is a challenge for every health profession. Although this eloquent Australian study concerns senior rural allied health professionals, it identifies many competencies common to differing professional groups.

Most rural health research is motivated by a desire to improve health but this paper shows how the process of conducting research on cervical screening led to improved services for Aboriginal women.

The rural clinical schools in Australia have led the way to developing alternative models of medical education in small rural communities. These medical educators have used RCS principles to develop a community based medical education program in the medium sized city of Darwin, in Australia's remote 'Top End'.

Continuing professional development for rural health professionals in Uganda was revitalised using information and communication technology - with some unexpected side benefits.

Building research capacity in a rural health authority is a goal often beset by challenges. Read this project report to find out how a rural health authority in British Columbia, Canada, met their specific challenges, their experiences along the way and the lessons learned as they attempted to integrate research into their organization.

To revitalise the ageing and depleted RN workforce in Australian rural areas, many recruitment strategies are required, including training people in their own community. This article shows how a regional university used an innovative workshop to convert 63% of potential nursing students into actual enrolments.

This letter reports the rare incidence of tropical Mycobacterium ulcerans disease (Buruli ulcer) in a newborn in rural Africa.

This helpful letter from India suggests that even in resource-poor or remote-health centers clinicians can provide optimum clinical care based on accurate blood analysis.

Too often public health planning fails to address health inequalities. This review from Australia shows that worldwide strategies to prevent and address pandemic influenza disregard disadvantaged populations. For Indigenous Australians this neglect could be fatal because strategies fail to take into account community realities, including the impact of history.

This scientific letter from Uganda is a reminder to clinicians and educators to be vigilant for needlestick injury and its potential sequel.

Now the H1N1 pandemic has been declared, rural areas globally will be developing response plans. The advice in this letter is based on experience gained from a rural Scottish outbreak. It can only assist others in this major and urgent task.