Volume 16

In Papua New Guinea, local and international non-government organisations are attempting to fill gaps in health service provision. This project explored the training content and methodology of Touching The Untouchables, a small Indigenous non-government organisation that has trained a network of village volunteers in health promotion and safe motherhood.

Physician undersupply in rural areas is prevalent worldwide, with reluctance to work in rural areas linked to limited opportunities for education and participation in cutting-edge clinical practice. However, Fukushima has experienced an increase in physicians following a series of disasters, suggesting that countermeasures for physician undersupply in rural areas may include rigorous research programs and media activities.

The closure of rural maternity services in industrialized countries is underscored by assumptions of efficiencies of scale leading to cost-effectiveness, with scant evidence to support this. To clearly understand the cost-effectiveness of rural services we must take the broadest societal perspective to include not only health system costs, but also those costs incurred at the family and community levels.

It is difficult to gain a broad but accurate understanding of the health concerns for rural communities with regard to unconventional gas mining because the evidence has grown very recently and rapidly, is complex and largely based in the USA. This communication concisely distils the research evidence on key concerns, highlighting the Australian situation where evidence exists.

Female seasonal agricultural workers experience social, financial and health-related problems that differ from those in the general population, including low education level, lack of social insurance, housework and agricultural activities together, and a lack of paid work. The present study describes significantly lower health for female seasonal agricultural workers compared to the general Turkish population, with a need for multidisciplinary approaches to improve outcomes for this group of disadvantaged women.

Against the backdrop of poor availability of oral care services in rural and remote areas, there is growing interest in the adoption of teledentistry services. Addressing the barriers that delay the implementation of a teledentistry service can establish an evidence base to inform future decisions about this technology.

This research focuses on evaluation of patient perceptions of the usability a Virtual Health Room, an ehealth initiative in Sweden. A clear distinction is observed between the technical performance of the ehealth initiative and its overall contribution to health care and access such that both should be considered in evaluation frameworks.

Rural communities continue to experience significant challenges recruiting and retaining physicians. This study describes the implementation of the Community Apgar Questionnaire to differentially diagnose a community's relative strengths and challenges in recruiting and retaining GPs, while supporting health facilities to prioritise achievable goals to improve long-term retention strategies.

In this article, the authors review available data on prescription opioid use among Aboriginal people in Canada. While indicators suggest high levels of misuse, data is limited, and they recommend improved monitoring to inform culturally and contextually appropriate interventions.

Despite the continental dimensions of Brazil and its enormous cultural diversity, only some medical schools in this country offer students the opportunity to acquire work experience focused on medicine in rural or remote areas. This study develops and validates a framework of competencies for a longitudinal medical training program in rural medicine as an integrated part of medical training in Brazil.

The present research emphasises the need to increase oral health promotion efforts, and to improve access to routine and restorative dental care for children in Timor Leste. Changing demographics and the adoption of a more Western diet will have large implications for the oral health sector.

There are many examples in Rural and Remote Health of well crafted and implemented research that has benefited our knowledge base and helped rural residents. Applying the framework suggested in this editorial has the potential to reiterate the dynamic nature of rural from a strengths rather than deficit basis.

The decision to choose an RCS placement is a marker of rural career intention and a positive rural training experience for students of both rural and metropolitan backgrounds. It may be important to identify other-preference students and their specific social support needs to ensure a positive perception of a future rural career.

This article describes the policies on early elective delivery and vaginal birth after cesarean in rural maternity hospitals in the US. Further research is needed to support implementation of national recommendations in a variety of rural and urban hospital settings.

ACS are life-threatening medical emergencies that require urgent treatment, posing particular challenges for systems of health care in regional and remote parts of the world characterised by large distances and widely dispersed populations and healthcare facilities. Systems of care in ACS require consideration of the perspectives of the patient, the health system and healthcare disciplines and services.

Disaster preparedness of the community is an essential disaster-mitigation strategy to protect human life and to prevent injuries and property damage. Because the proportions of people with good knowledge of disaster and disaster preparedness were quite low in this study, the program to improve the effectiveness of community mental health nurses should be revitalised in Aceh, then expanded to other provinces of Indonesia.

This study investigated how a new food desert affected family food acquisition and storage behaviors in a small rural community. Food pricing was a stronger influence on food acquisition behavior than food access, but both should be addressed if the effects of a food desert are to be offset.

The cadetship is an effective link between medical school and rural practice. The success of the program relies in part on the mentoring, networking and other educational opportunities available to cadets, which serve to foster their interest and provide a structured pathway to long-term rural practice.

Although evidence demonstrates that unintentional injuries are preventable, they are a leading cause of death, particularly in low- and middle-income countries such as the Solomon Islands. This review aimed to explore the incidence and burden of unintentional injuries in the Solomon Islands, and to explore the potential role of occupational therapy in preventing unintentional injury, based on current activities in other low- and middle-income countries.

Snowmobiling among young people in Scandinavia frequently leads to accidents and injuries. This article reveals how young people experience and interpret accidents, including variation between the evaluations made by girls and boys, and outlines a prevention strategy.

A person's capability to access services and achieve good eye health is influenced by their behaviours, perceptions, beliefs and experiences. The purpose of the present study was to better understand the unique social context regarding beliefs, perceptions and emotional responses to vision impairment in Papua New Guinea, and to identify programmatic and policy implications.

Telehealth has the potential to address many of the key challenges to providing health care in Australia, and six key factors associated with the success and sustainability of services are identified. This review provides information for policy makers, governments and public and private health services that wish to integrate telehealth into routine practice, and for telehealth providers to enhance the sustainability of their service.

For those who live and work in rural/remote settings, there are social, occupational, health and environmental challenges. Some of these are shared with families and individuals who are associated with military life. This article explores the relevance of the body of military psychology knowledge to the management and support of those living and working in rural/remote industries and locations, particularly within Australia.

This study explores healthcare providers' perspectives about community health, healthcare access and wellbeing in the context of a disaster recovery event in South Carolina. Following a disaster, agencies must be prepared for long-term, potentially chronic ailments, particularly in underserved, rural communities, and healthcare providers can offer a well-rounded assessment of community needs

The significant impact of mental ill-health in rural and remote Australia is well documented. This paper considers the Mental Health Academic project and its four key aims: (i) initiatives to address specific access barriers; (ii) supporting recruitment and retention of rural mental health staff; (iii) developing the skills of the existing workforce; and (iv) developing innovative approaches to student placements.

This article examines utilization of an Emergency Department during the subacute period following a natural disaster (tornado). The authors identify approaches to increase preparedness in the case of a comparable disaster scenario.

This project report examines the role of Area Health Education Centers in promoting interest in rural practice. Findings support the contributions of academic-community partnerships with AHEC to supporting rural practice upon graduation.

Early detection of developmental difficulties is universally considered a necessary public health measure. This study describes the developmental monitoring practice in two remote Australian Aboriginal primary health care services and identifies gaps in the delivery of developmental monitoring services.

How do remote health professionals describe a sustainable remote health workforce and how can it be achieved? According to this study, it is about an appropriate mix of health professionals with suitable personal characteristics and professional attributes to meet the remote populations' needs.

Although general practitioners in Italy undertake both practical and theoretical study to obtain their qualification, until recently the practical component was not assessed. As a means to bridge any resulting gaps in the students' education, the Emilia Romagna Regional Health Authority developed a real-time system that allows students to review their experiences and share this information with their tutors.

Ethiopia is on the way to developing a nationwide viable system for health supply chain management. However, there are still challenges. A strategy is needed for the further development and sustainability of human resources in its health supply chain.

The impacts of hospital closures are harsh, affecting not only the patients that depend on them but also the economy in rural areas. We discuss recent healthcare reforms that have put rural hospitals at risk of closure, and the steps that these hospitals may take to ensure their sustainability into the future.

How effective are outreach placements in building the clinical confidence and communication skills of dental students? This study from India supports the incorporation of outreach program placements into the existing dental curriculum.

Ensuring sufficient mental health human resources for South Africa is challenging for public primary health care, especially in rural areas. This analysis examines the role of mental health nurses, who are seen as the backbone of this sector.

As a strategy for addressing the shortage of rural clinicians, many clinical schools require students to undertake placements in rural settings. This study evaluated teaching at a new accommodation and education hub in rural England to gain a broad indication of its effectiveness and acceptability.

Language barriers create many challenges for rural and Northern Ontario francophones receiving health care. This paper identifies barriers experienced by both French-speaking and Non-French-speaking rural and Northern Ontario physicians when serving francophone patients.

Staff in acute rural hospitals face challenges when providing person-centred care for patients with dementia and delirium. An inexpensive program to improve quality of care is described in this context, and reasons for the program's effectiveness are canvassed.

Because psychosocial support programs can play a key role in cancer survivorship care, there is a need to improve accessibility for rural patients with geographic barriers to participation. Our experiences delivering a group-based videoconference program in cancer survivors are described.

There is considerable variation in the physiotherapy services available to different rural communities. This article describes the variation in local service provision, the factors influencing service provision and the impact on availability of physiotherapy services.

Most teachers recognize the importance of having a healthy school food environment but are less aware of factors within the school that influence students' eating behaviors. This study examined the food-related practices and beliefs of rural elementary and middle school teachers as role models for healthy eating.

The Cumbria Rural Health Forum was formed to collaboratively improve rural health and social care delivery in the county of Cumbria, England. This article describes the Forum's hands-on approach to exploring the use of digital technologies for health and care.

Are rural perinatal surgical sites sustainable and how does the satisfaction of providers underpin their recruitment to and retention at such sites? This article was developed as part of a larger review investigating the viability and efficacy of decentralized models of service.

To facilitate rural career uptake in Australia, medical students undertake training through rural clinical schools. This study examines students' perceptions of the supports provided by these schools and their impact on intention to work rurally.

There are numerous initiatives to address recruitment and retention of health care providers in rural areas. This article reports on a rural track program among students to ascertain their experiences. Using photovoice participatory research increased understanding of the students' experiences

Recruitment and retention of rural health care providers has been a long standing problem. This study focused on the typical length of practice among physicians in Mississippi providing helpful insights for enhancing retention of this group of providers

Uneven geographic distribution of physicians is a major healthcare issue in Iran, both in terms of the number of physicians in rural areas and the proportion of these physicians who are female. This study explores the relationship between the personal characteristics of recently graduated specialists and their choice of practice location.

Outdoor workers are at risk of developing skin cancer because they are exposed to high levels of harmful ultraviolet radiation. These two case studies highlight a number of contextually bound workplace characteristics related to sun safety, with several recommendations.

Although rural residents are benefitting from the current New Cooperative Medical Scheme in China, the influence of this voluntary health insurance program on specific diseases is unknown. For rural patients with nephrotic syndrome, this study found significantly decreased expenses for patients who were part of the scheme, as well as more accurate diagnoses and therefore better targeted therapies.

In sub-Saharan Africa, rural-urban inequalities in child survival are explained by maternal education, household socioeconomic status and access to healthcare services. How are these influenced by household dynamics (sex of household head and household structure), and do such dynamics affect childhood mortality?

Research from Africa on the challenges of raising a child with autism is virtually non-existent. Consideration of these findings could inform the initiation of community-based rehabilitation services in rural settings where parents play an active role.

With calls for community empowerment and participation in health interventions, interest has been raised in volunteer health workers acting as representatives of local communities. This study examines the dynamic interface between local communities and the government in the selection of community health worker volunteers in a rural community.

Are there disparities of lead exposure among rural populations? This study focused on lead exposure among children in Mid-Appalachia.

In remote tourist destinations with no resident GPs, who delivers services to the growing number of seasonal tourists with chronic health conditions? This study examines connections between the theory and practice of nurse practitioner models within the context of a remote community based practice.

This study examines issues in mental healthcare workforce supply and shortages in rural areas, using Nebraska as a setting for analysis. The authors identify issues in workforce planning and policy which limit equal access to mental healthcare in rural regions.

The Mais Médicos program aims to alleviate the shortage of doctors in priority regions and to diminish regional inequalities in health. This report describes the program's implementation and the allocation of doctors to target areas.

How do GPs estimate the usefulness of POC tests and does their use differ between rural and urban areas? This study aimed to expand the knowledge base around POC tests and how they are used by GPs.

Can decentralised medical training assist recruitment to underserved regions? This paper describes the different outcomes of strategies used at JCU to bolster recruitment and retention of medical graduates.

There is a long way to go to remove the barriers that rural women experience in accessing reproductive care, including the pervasiveness of abortion stigma. Services closer to home may help reduce the inequities in access to health care experienced by these women.

There is a positive correlation between diabetes knowledge and self-efficacy. Future diabetes educational interventions should place a greater emphasis on increasing knowledge among rural women, emphasizing the causes of diabetes, complications and treatment procedures.

What does the extent of Chlamydia testing across the Scottish Highlands reveal about access to sexual health care in remote and rural settings? The results of this study support the case for customising sexual health services to the most rural areas.

How did a new radiotherapy clinic influence the overall utilisation of health services for prostate and breast cancer patients over a 3-year period? Less travel distance and time to treatment suggest improved access to services and patient care.

Does mentorship make a difference in the transition of nurses to rural healthcare environments? Read this article to find out about the facilitators and barriers to mentorships

How can we expand the provision of core high-quality PHC services to the many small and diverse non-metropolitan communities that currently lack them? This study investigates the transition of a single-community integrated model of PHC service delivery to a rurally 'networked' model of PHC delivering PHC to multiple communities.

This scoping review focuses on community-based peer support initiatives for rural adults with chronic conditions. The articles that were reviewed provide pertinent information about such programs that can be adopted in other rural areas.

If rural community postings can influence students to practise in these areas after graduation, it is important that students enjoy their experience, yet only a quarter of these students are satisfied with their rural posting. This study of final year medical students in Nigeria seeks to find out why this is so.

A structured postgraduate training program was established to address students' intentions to work in a rural area. Although nearly half claimed that the rural day changed their attitudes positively, it had little effect on the participants' work intentions.

A lack of support structures in rural and remote Australia limits the ability of health services to develop research skills in their staff and to conduct research within their organisations. Partnering with primary health care organisations creates the potential for ongoing research activity.

Disability and long-term dependence are frequent outcomes of this rare bacterial infection, with life-long implications for children with this condition. This case report highlights the challenges for rehabilitation and safe discharge to a remote community with limited support services.

Recruitment and retention of health personnel in rural areas is an ongoing issue. This article focuses on spousal perspectives and their impact on whether or not physicians stay in rural communities.

What are the challenges facing health professionals within the public sector in rural South Africa? This article explores the tension between top-down policy-making and bottom-up pressure, finding that street-level bureaucracy acts as an important terrain for improving the implementation of services and therefore advocacy and health system improvement.

This innovative model emphasizes optimal utilization of scarce healthcare resources in rural areas. It eliminates the need for unnecessary travel and keeps costs low for medical facilities and patients alike.

Barriers to sexual decision-making in a rural town is the focus of this article. The authors provide examples of supportive factors for adolescents and for institutions such as schools.

There is little information about the availability of the dental workforce in Canada. This article employed membership directory with geographic coordinates to determine the location of this workforce. The authors concluded that urban areas have a higher concentration of the dental workforce showing again the limited access to health care providers by rural residents.

To ensure the health of Scotland's substantial rural population, NHS Scotland established a Fellowship for graduate GPs to pursue their education in rural medicine. Given the level of funding support, it is important that its influence on recruitment and retention is understood. This study suggests that approximately three-quarters of graduates are retained in important roles in rural Scotland.

Technology can be used in many ways to benefit rural residents. This article discusses an E-consult process used to improve bone health; comparisons between rural and urban clients is highlighted.

A lack of kidney specialists in rural and remote areas of Jordan means that patients with kidney diseases have limited access to appropriate health care and disease management. This study assesses the impact of a live, interactive telenephrology service on rural and remote patients with kidney diseases in terms of access to health care, proper diagnoses, establishment of treatment plans and subsequent improvements in quality of life.