Volume 12

The enormous impact of suicide on families and the wider rural community calls for urgent attention and action. A starting place is in seeking to understand key associated factors - in this case, those established by Northern Territory coroners in Australia.

Rural health practitioners are, by necessity, experts in improvisation using materials to hand. The innovative device reported by these Nigerian authors can be adapted to any oral health clinic, remote or rural, in developed or developing context, to improve preventive dental care and general health outcomes.

This description and discussion of a pilot, remote Aboriginal community care service model will inspire others to address the integrated delivery of aged, disability and mental health services in similar contexts - in a culturally appropriate way.

To resolve shortages of workforce at the local level, evaluation and planning is needed that is specific to the local level and integrated at higher levels, along with training capabilities. The CHC Community Apgar Questionnaire is just such a tool to help with evaluation and planning.

Telehealth is an increasing part of healthcare delivery in remote and rural settings but to date evaluation is limited. This article reports an evaluation of the ethical competencies of behavioral health providers, offering suggestions for continuing education to improve telehealth services.

Healthy People 2020 sets important goals in areas such as oral health, but to reach these goals the United States will need to do much better in areas such as oral cancer screening. Deficits in dental care, decreased access to health insurance coverage, and personal habits represent a challenge. A study of oral cancer screening of Appalachian women in Ohio can help guide those who are attempting to move less healthy populations toward Healthy People in 2020.

Despite evidence that the debilitating Parkinson's disease may be more prevalent in rural communities, little is known about the life quality of those affected. This Australian study compared the impact of the disease on a rural population with those affected in an urban location.

Ever wondered about nursing in remote Greenland? This short report on Greenland's nurses' scope of practice and self-perceived competency over a range of patient encounters was part of a countrywide audit.

Abstracts now available at Rural and Remote Health from the 2012 MICRRH (Mount Isa, Queensland) conference "Are You Remotely Interested... in Prevention? Building a Culture of Safety".

Over half a decade since the introduction of Accredited Social Health Activist (ASHA) workers in rural India, how can a knowledge-practice gap in village-level child health be improved?

In regional areas, where patients are ageing, specialists scarce and GPs often generalists, this study suggests a novel way increase the knowledge and confidence of GPs, while decreasing their professional isolation.

Dementia care has been described as a journey through which the care providers move. This article reports on original research that documents this journey in relation to the type of information needed by care partners in rural settings.

Globesity studies continue with more populations and age groups indicated. A rural serving university offers the opportunity to explore obesity relationships and stressful obesogenic environments past, present, and future for an entire region - especially a border region with substantial Hispanic population.

In this new editorial, RRH offers an essential guide to rural primary care research. The European Regional Editor and his co-author look at the issue with both a wide lens and also in helpful detail, giving readers the benefit of their combined wisdom and experience.

Australia's largely privately financed dental services mean reduced access for many in need. Using hospitalisation for surgical removal of impacted teeth as an indicator of service access, this study identified disadvantaged groups nation-wide as a guide to the allocation of resources and services.

This research from the University of Western Sydney adds to the medical education evidence for long-term rural placements. The authors place their own results in the context of recent, similar Australian studies.

At a time period where rural workforce shortages continue worldwide, new sources of information and analysis are needed. Studies that interview the rural origin health professional students can make valuable contributions. Does training offer an escape or do students see training as an opportunity to serve their families, neighbors, and communities of origin?

Do specific factors increase the risk of symptomatic gallstone disease during polar residence? This short report of four cases among a year-long Indian Antarctic expedition provides some clues.

Much has been written and published globally about recruiting rural medical workforce to underserved rural locations. This latest contribution from Turkey surveyed an entire year cohort of graduating physicians to define their views on working in underdeveloped areas, opinions of recent policy initiatives, and to identify incentives and disincentives to working away from major hospitals and cities.

Eight women die every hour in India due to complications of pregnancy and child birth. This study reports on data from Andhra Pradesh as part of a longitudinal study on childhood poverty, and examined the effect of factors such as caste, education and prenatal care on the women's use of skilled institutional obstetric care.

Healthcare policies impact rural America through increasing barriers to health access, insufficient health workforce, increased patient waiting times, and decreased time with patients. Studies demonstrate the consequences for elderly rural Americans in need of better care, especially in mental health care. Is anyone listening?

In Australia, live kidney donation is a critical source of organs for transplant. While nephrectomy is now a common procedure with low morbidity, what is the financial cost of this altruistic act to non-metropolitan donors?

There are great changes and challenges in the American nation's pharmacies. This article moves beyond simplistic newspaper headlines to the challenges facing the pharmaceutical component of rural community health care. It is also a model article for those planning to address various abuses at the local and individual level, rather than waiting for government assistance.

Dilated cardiomyopathy is a significant health problem in rural Africa. This case report alerts clinicains in rural areas to an uncommon presentation.

Palliative care in remote areas is often beset with difficulties, resulting in suboptimal symptom control. These authors studied 24 home palliative-care patients on an island in south-eastern Japan and demonstrate the effectiveness of using a clinical pathway in palliation in a remote setting.

Mental health assessment and mental health care for the elderly remain challenging in many rural areas. Much must be understood to move the people in a community towards better mental health. This article is a good primer for community based interventions that help people in areas such as properly identifying mental health issues and separating mental health changes from aging changes.

The United States has increased the number and distribution of Federally Qualified Health Centers. Studies such as these are needed to help understand rural populations and insured and uninsured population differences so that interventions can be more efficient and more effective.

For rural health clinicians to participate in continuing professional development it is necessary to transcend conventional educational methods - or so say these authors. They present a different approach to interprofessional learning that is both flexible and adaptable.

This commentary by a well-known Australian rural medical educator puts the case for extending the successful medical Remote Vocational Training Scheme supervision model to all health professions.

Rural vocational experiences commonly involve generalist rotations, but rural specialists are also needed. The typical pattern of packing specialty and sub-specialty training into a few most concentrated locations will not assist physician distribution. Studies such as this one are needed to help understand the impact of rural experiences on various types of specialties.

Access to health care is vital for every migrant's health and wellbeing. With interracial marriages increasing in rural and urban Australia, this study looked at factors affecting healthcare access for intermarried Filipino women in rural Tasmania.

This project report from the Solomon Islands concerns the cooperative investigation of local and visiting researchers into the late or non-presentation of islanders with TB. As well as identifying local answers to a global question, the authors have show how a small project can inform the development of large service changes.

The abuse of oxycodine has reached epidemic levels in some remote communities in Canada. To address this addiction, a withdrawal support service was developed and is described here in the hope it will help other communities struggling with similar issues.

With Greece currently striving to limit its health expenditure, what is the role of rural primary health care, and how can the effectiveness and efficiency of PHC services be improved? This study sought the opinions of the PHC providers in the regions of Epirus and Crete.

Extensive dental decay impacts a child's nutrition, health and wellbeing. Amid indications that the oral health of Australian Aboriginal children is worsening, this important review collates the evidence, comparing Aboriginal with non-Aboriginal children, by state, rural/urban location and over time. The evidence speaks for itself.

Generations of Australian Aboriginal people have been exposed to traumatic events with devastating psychosocial and health consequences, including psychiatric morbidity and mortality, and medical complications. This study suggests that a high prevalence of undiagnosed posttraumatic stress disorder (PTSD) in this population group leads to misinterpretation of symptoms - with tragic consequences.

Much has been published about access to rural palliative care (PC) in the developed world. This unusual qualitative study considered the experience of a small number of specialist healthcare participants who provide community PC in remote, isolated areas of rural South Africa, where a patient's prognosis and even diagnosis may not be known, and people follow traditional ways of caring.

The challenge of childhood obesity increases even as malnutrition continues. Rural situations may offer some unique insights as to the contributions of physical activity, culture, eating habits, and social determinant factors that can shape dietary disturbances.

How do farmers manage stress - and is their way of coping unique? This complex study surveyed South Australian farm men and women of all ages at a time of severe drought to provide a glimpse into psychological distress and coping within the Australian farming community.

Is the 'fly in/fly out' (FIFO) model used successfully in industry the answer to Australia's crisis in sustaining medical services for its rural, remote and Indigenous populations? This personal perspective adds an authentic voice to the debate.

Mental health professional deficits are common across the United States, but what about rural areas or more isolated rural areas? Studies of mental health workforce must include consideration of rural access, rather than just focusing on psychiatry. In this study hospital leaders were surveyed for information about local healthcare workforce.

Australian rural GPs often provide emergency and inpatient services. Whether accredited GP-Anaesthetists or 'occasional intubators' for emergency patients, most can expect to encounter 'difficult airways' that require specific equipment and procedures. As a first of its kind, this recent online survey sought to understand rural preparedness for such a clinical situation, including access to equipment and training, and awareness of the guidance available in established algorithms and local protocols.

In the Solomon Islands where a relatively small population is spread across 1000 islands, the cost of medical transport to a central referral hospital has been inflated by inappropriate referrals. This unusual study analysed patient transport data to discover where improvements to inter-island referral could strengthen the quality of health care.

Neonates in rural South Australia with the birth defect developmental dysplasia of the hip, are increasingly at risk of late diagnosis with routine screening by physical examination. This pilot study suggests that ultrasound is a feasible rural diagnostic option to greatly reduce late detection.

This project report from in fragile, post-conflict Timor-Leste's shows what can be done with dedication, careful management and the partnership of government with NGOs to improve rural residents' access to vital eye care services.

Throughout the developed world, an ageing population is increasing governmental health expenditure, especially on institutional care. This is so for Japan where the rural population is ageing most rapidly. In a shifting public-policy environment, these authors investigated whether providing home-care support for disabled elderly people is a cost-effective option.

An audit of one rural procedural GP's 3000 serial colonoscopies suggests that GPs can provide rural Australians with safe and high quality access to colonoscopy.

Few periods of time strain health care delivery to the limit as much as an epidemic. Did rural emergency rooms in Ontario measure up to the stress of H1N1?

This landmark conference highlighted research and on-the-ground action to improve long-term health outcomes for Indigenous Australians.

Postpartum haemorrhage can be life threatening in rural maternity clinics without the resources of a major hospital. This letter describes two relatively simple intrauterine tamponade techniques which may be life-saving in resource low environments.

When disaster strikes, the integrity of the water supply paramount. This short report on the 2010 floods emergency in rural northern Pakistan concerns the experience of assessing damaged community water systems. The discussion of treatment for microbiologically contaminated potable water will be relevant in any context.

Ghana has one of the highest physician emigration rates in the world, and its rural citizens are doubly disadvantaged by remaining physicians' preferences for urban posts. To find a solution, these researchers surveyed a country-wide, entire-year cohort of medical students, focussing on specific lifecourse factors that may predispose to rural practice.

This Indian-Swedish study shows that with planning and collaborative organisation, improvements can be made to a range of health and mortality indicators in maternal and child populations - even in the most remote and economically disadvantaged rural communities.

For an essential guide to reporting rural and remote health research, the Journal offers a new, informative editorial from the pens of the Editor in Chief and two of our Regional Editors.

Backyard poultry raising risks human infection with avian influenza but it is an essential source of food and income for women and subsistence farmers throughout the rural, developing world. This qualitative, observational study reports some alarming poultry-keeping practices, but also provides evidence, in the participants' own words, that established public health control strategies need creative reinvention.

For subsistence farmers whose work is manual, repetition strain injury leading to low back pain (LBP) is an occupational risk that can have devastating social and economic effects. In the South-south region of Nigeria, where farmlands are cleared from dense rain forest, the physical demands of farming are great. These authors sought to determine the prevalence and predisposing factors of LBP among this unstudied group with the aim of reducing their occupational risk.

In rural Tanzania where the majority of the population resides, improvements in maternal and neonatal health are hampered by high health worker shortages and care is mainly provided by lower-level cadres of staff. These researchers used in-depth interviews to focus on the job satisfaction of existing primary care staff and their motivation to perform their roles. While this is local research, the findings may assist those seeking to improve primary care performance in settings with similar health disadvantages.

Despite legislation, unqualified private rural health providers dominate rural health delivery in Haryana, India. While this study identified some alarming practices and deficiencies in their work, it also suggests a potential to use their efforts constructively.

Social determinant studies usually involve large populations being left behind. Sometimes it is important to understand how factors such as lack of income, social distance, and geographic distance interact with disease to result in poor health. A single case can illustrate social exclusion.

Food security has increasingly been an issue in rural and remote communities. This study provides convincing evidence for the support of a school snack program in a remote community in northern Ontario, Canada.

Motivated by a mix of social, community and governmental accountability, many medical schools involve rural community members in the undergraduate student selection process. These Flinders University researchers investigated the motivation and more of a sample of South Australian community members who make this pro bono contribution.

Action learning: learning by sharing real problems with real people. Can rural health managers in your region replicate the positive experience of these African participants?

Is there a gender difference in the mental health of rural adolescents? This study into the interplay of depression, gender and rural residency for Australian youth will be essential reading for mental health clinicians and service planners.

The most recent medical schools added in the United States have been a disappointment for primary care and for rural outcomes but there are some exceptions. One newer school has started well in the primary care and family practice areas most needed as indicators of future rural workforce. Students were surveyed regarding their intent for rural practice and this was compared to characteristics such as origin of student and spouse and Myers-Briggs Personality Type.

With cancer mortality higher for Indigenous Australians in Queensland, these authors mapped relevant support services and assessed access barriers for (mostly) rural Indigenous clients. Location was just one factor identified.

Rural suicide rates are of global concern. Is low service access a contributing factor? This forensic record review from Scotland assessed hospital, mental health or general practice contact in the month before death by suicide for Highland residents. The contribution of location is discussed with implications for rural services.

Best practices for employment and services for those with serious mental illness in rural locations is the focus of this article. It reports on a qualitative study that identifies the most important factors to help ensure that people with serious mental illness have an opportunity to participate in a full life, including work.

Access to care is difficult for rural populations that are often remote with low resources and barriers to transportation, but access can be even more challenging for children and for children with special needs. Then there is the challenge of such children in need of dental care, perhaps their most prevalent health care need. These needs represent a great challenge facing Appalachian parents and caregivers.

Much attention has been paid to patient aspects of care, but this is often focused on cost savings or marketing services. It is refreshing to see a study that interviews the patients and populations in most need of care - migratory agricultural workforces. More studies focused on better understanding and improved awareness just might improve access, improve quality, and decrease costs.

Missed handoffs are a problem when diabetic patients depart the hospital in need of follow-up care. Is the lack of follow up a function of rural location or other factors unique to patients? To prevent fumbles, more practice is needed - and more research.

Community assessment is an unfamiliar road that must be traveled, with cultural perceptions, barriers to care, and coping strategies represent the roadmap to improved health for rural communities.

If pregnancy affects a woman's oral health and her oral health affects the foetus (and, subsequently, the child), accessible oral health care is an essential element of rural maternal and child health services. This comprehensive study from Sri Lanka compared rural with urban pregnant women on a range of oral health indicators, including their beliefs about the safety of dental care during pregnancy.

In the context of the rapid disappearance of small rural maternity units in rural Australia, is what rural women want sustainable and safe? Tasmanian maternity health providers discuss a different model of care.

This 3 phase Australian participatory research study provides insight into the working world of acute care rural clinicians. The participants from New South Wales identify challenges to rural practice but also make a positive contribution with practical solutions and strategies unique to the rural sphere of practice.

Fly in/fly out services are increasingly being proposed for remote health services. Are they the answer? What does the evidence say?

Rural physicians who become rural medical educators soon realize that it is difficult or impossible to do rural medical education without the rural community. One solution has been rural preceptorship experiences, but not always do students find out as much about rural communities. Five days of immersion can help students to explore rural communities and rural life.

In order to understand the complexity of rural and remote allied health professions' recruitment and retention, this international review assessed positive and negative motivating factors intrinsic to the work. The result is accessible, evidence-based advice for rural health organisations wanting to recruit and keep its allied health staff.

Does the effect of medical students' short-term rural placements endure and influence eventual practice location? This study from New Zealand revisited graduates' student intentions to find out.

The development of teeth begins in intrauterine life. However, the health of women in Russia and particularly in the remote Northwest region has worsened during the time of transition from Socialism to market economy. The hypothesis of this thought-provoking study is that poorer maternal health, combined with low access to dental health preventive programs, has increased the prevalence of caries the rural among children of this region.

Are workforce factors also access barriers to rural disability therapist services in NSW, Australia? After wide consultation, these authors present the evidence.

As urgent cardiac reperfusion is lifesaving in ST elevation myocardial infarction, how does the frequency and outcome of rural GPs' initiation of thrombolysis in small EDs compare with that of larger regional centres? While this small study from south-eastern Australia is encouraging for the prognosis of rural patients, it also raises questions about delays in presentation.

For decades the Indonesian Government has implemented and refined strategies to improve the distribution of health workers to remote areas. This author analyses the evolution of Indonesian policy and legislative initiatives in a unique health delivery environment.

In a rural nursing practice course, the students used photovoice to document the challenges and facilitators of rural nursing practice. This interesting article reveals the benefits of this specific research method - in this case, helping students to discover the uniqueness of rural nursing practice.

Specialized health services are not always available in remote locations. This article focuses on the integration of psychogeriatric care in northern British Columbia, Canada and presents the findings from an examination of this process.

In the context of Nigeria's severe coastal environmental degradation from oil spillages, an impoverished rural population favours the use of crude oil from those same spillages as a traditional medicine, resulting in toxic complications, particularly among rural children. In this first study of its kind, the authors surveyed the use of crude oil among rural mothers in an attempt to understand this toxic practice.

Do access barriers to diagnosis and treatment of prostate cancer disadvantage the survival of rural men? This systematic review considered worldwide incidence, ethnicity, mortality and - above all - location.

In the Dominican Republic, multidisciplinary teams of healthcare professionals organize 'health fairs' for rural residents. This article describes the process and what they discovered about the health of participants from three rural villages in 2009 - along with wider implications for improving the Dominican health system.

How do small towns concentrate upon the candidates most likely to migrate to a rural practice? Studies of physicians and physician characteristics indicate different probability of migration when considering origin, gender, age, training, and proximity measures. The right candidate could be closer than you think.

The 'voices from the bush' of expert Australian remote area nurses report alarmingly high levels of workplace violence. The variety of hazards and contributing factors indentified say loudly that expert, urgent action is required to manage the workplace risk of this highly skilled but highly vulnerable group.

'Individual members of the family contribute to the health of the family, but the child is often the catalyst for health promotion within the family, not only the siblings to the unborn child, but also the unborn child'. So state the authors of this unique literature review that examines and interprets the intricate and complex construction of family in the indigenous Inuit culture, and in so doing illuminate the central role of the child.

Rural, minority populations with language and healthcare coverage issues can face great barriers, especially in areas such as the prevention of disease. This is captured in Hispanic rural populations in Georgia via a study of HPV vaccine utilization. The article is an outstanding example of "how to do" such studies and "why" qualitative approaches are important contributors to the development of better healthcare delivery.

A rapid increase in physicians does not necessarily correct a urban-rural maldistribution; however, would an insufficient supply of physicians worsen an existing rural inequity? This study answers the question by applying spacial competition models to the situation of Japan. Regardless of location, if you have an interest in rural physician workforce strategies do not miss this article.

Is location or socioeconomic status more important in food security? This study of rural and metropolitan South Australia considered both, building on the authors' earlier work. While a plentiful and healthy diet is required for individual and community health, this article questions the affordability of healthy food in rural areas of South Australia.

As in the rest of the world, Australia's Northern Territory is feeling the impact of rural nurse shortages as the baby boomers retire and significant nursing knowledge is lost. However the unique challenges of the NT's often remote nursing posts and its small local and mobile, imported workforce call for specific solutions. This undeniably small study yields a wealth of novel strategies and recommendations to entice older rural nurses to remain involved in the workforce - on their own conditions.

It is accepted now that rural undergraduate educational experience has a positive impact on rural workforce recruitment. For Australian medical students this means long-term rural GP clerkships - but are these students a financial liability or significant contributors to the practice? This Australian study analysed qualitative data from their GP supervisors, and financial and patient activity data from participating New South Wales medical practices to find out.

Due to chronic rural health worker shortages, in small-town Australia paramedics may now provide first-line primary care. As a result of broad consultation in south-eastern Australia and supported by multiple case-study methodology, this article puts the case for a 'rural expanded scope of practice' model for paramedics.

Authors highlight the problems facing rural low-income families as more families with more chronic conditions and more challenging situations try to access fewer providers. The characteristics of rural families may worsen health situations - just as changes in health designs may or may not help address the problems facing rural families.

Why are Australian rural and remote communities underserved by dietitians - and what can be done about it? The data from dietitians and their managers from 6 rural New South Wales sites contributes to a solution.

High Sub-Saharan African maternal mortality rates are unmatched in the world. These researchers focused on an extreme example, Msambweni District in Kenya, to determine the attitudes and beliefs that influence rural women to deliver their babies without skilled supervision. Admittedly this is a small local study, but the evidence from hospital staff and the parturant women themselves suggests a wealth of strategies likely to be relevant and useful in similar contexts with similar concerns

Technology can be an asset for care provision in rural and remote locations, however there are some disadvantages. This qualitative study of stroke survivors generated useful information for making videoconferencing work for other remote individuals in group-based programs.

In an unusual approach, this research combined scientific method with traditional environmental knowledge to inquire into climate change and food security for Aboriginal Peoples in northern Ontario, Canada. The researchers focus on the extreme climatic events of one summer and subsequent distribution of subsistence fish species.

In Central Appalachia where there are few roads and fewer providing health care services, but the Health Wagon has delivered most needed care since 1980. Those desiring to understand rural barriers to care can best learn by locally solving health access woes.

In India, as in many countries and all world regions, rural health services are disadvantaged by a shortage of graduate health staff. This small study into the rural health attitudes and work intentions of Indian medical students begins to build the evidence required for change.

What is needed to improve child survival in rural Kenya? This study used Kenya Demographic and Health Survey mortality rates for under-fives to identify key risk factors impacting on child survival rates.

This study from one faculty of dentistry in South Africa determined factors likely to inhibit rural students' enrolment and eventual graduation. While only a small study, it is one of only a few that report on dental students in Africa. It will make interesting reading for those concerned with rural health workforce shortages in resource-low locations.

The participants' quotes eloquently describe the experience of being 'sent into exile' when older rural Australians are unable to access residential care in their home communities. Their voices define a major theme from a larger study.

The chronic disease burden associated with overweight and obesity among Aboriginal Australians calls for early intervention. However, does routine data on BMI-for-age provide adequate estimation of future risk among the children in these communities?

Is the decade-plus Australian Rural Clinical Schools (RCS) initiative addressing the rural medical workforce shortage? One RCS has monitored its impact on graduates for as long as 9 years. Its latest survey concerns career location and speciality choice, as well offering a perspective on the reality of career choices and life decisions as a graduate in the medical workforce.

There is an expanded understanding of health status variation between urban and rural areas. This article adds to this by discussing heterogenity in health between and within several categories of rural areas.

This reflective piece from a psychologist working with Canadian Aboriginal peoples integrates the personal with the professional. However, her recommendations and lessons learned will be useful to other health professionals who work with Indigenous peoples in other geographic regions.

This letter from Lesotho proposes a scheme to enable universal health coverage in Sub-Saharan Africa, which would be of particular benefit to underserved rural and remote populations.

Web access and high quality telecommunications are crucial elements underpinning health, economic development and social cohesion in rural and remote communities. Is the NBN the knight in shining armour or is some of the armour rusting and constrictive? Former Minister for Health in the Northern Territory, Peter Toyne, provides an important perspective in this Editorial on this crucial time in Australia's history.

The Ateneo de Zamboanga University School of Medicine experience in the Philippines suggests a cost-effective model of producing rural doctors to work in under-served rural communities. This is the first in-depth report from the innovative and socially accountable medical school located in one of the most difficult places in the world for physicians to work.

Fee for service has been unable to keep up with the rapidly rising costs of delivering primary care in the United States. Rural Health Clinics have grown rapidly over recent decades, in no small part because the funding is based on 'reasonable and allowable costs'. Studies such as this are greatly needed to examine performance areas such as the efficiency and effectiveness of Rural Health Clinics.

Smoke-free laws and graphic warning labels are public health measures, but laws may not be effective if populations do not agree. How do rural Appalachian populations feel about such measures?

Recruitment still reigns as a major factor in practice location choice, but physicians at different stages of a career do have different motivations including work/life balance, medical need, and family. The findings of this interesting study suggest that more research is needed that considers differing generations of physicians and different types of specialties.

Are medical students' career choices influenced by their preceptors? And what role, if any, does the duration of rural placement play in students selecting a primary care career? This comprehensive review of the literature has the answers, in what should be essential reading for medical curriculum designers and policy-makers.

Decreased physical activity is a common concern about youth, regardless of urban or rural context. This study used photovoice to generate information about rural youth activity; find out what the study revealed while learning about an innovative research method.

Immigrant and refugee groups in rural communities and smaller cities do not always have easy access to health resources. This US article discusses the use of unique 'health advisors' (a role distinct from medical interpreters), to assist this population gain access to comprehensive and culturally safe prenatal and pediatric care.

In this report of an Australian multi-university study, the authors describe a "winning combination" of factors as the most significant predictor of a medical undergrad's rural practice intention.

International medical graduates (IMGs) make a substantial contribution to Australia's rural medical workforce, despite the multiple challenges faced in their new professional and cultural environment. This evaluation of the innovative Victorian GIPSIE (Gippsland Inspiring Professional Standards among International Experts) program shows that much can be done to support and assist the adjustment and continuing development of IMGs who commit to working in rural health services.

Rural residents often miss out on cardiac rehabilitation programs. This pilot program report demonstrates that it is possible to conduct such a program in a rural area by accessing local social capital - and that the results may extend well beyond the benefits to participants.