Volume 8

The paradigm for 21st century health care is health professionals working together in a team. Best care means patient access to psychologists, dietitians, speech pathologists, physiotherapist, radiographers and others, yet little is known about the allied health workforce in rural Australia. This exciting report foreshadows a national study that will define the Australian rural allied health workforce to inform workforce planning.

Many nations are now culturally and ethnically diverse and this extends to their health workforce. However, in Australia relatively few overseas-born, Australian-trained health professionals take up rural or remote positions. This small qualitative study on Vietnamese-born, Australian-trained health professionals practising in rural Australia raises questions about their acculturation process, with direct implications for recruitment and retention.

What motivates diagnosis self-disclosure when stigmatization and discriminatory treatment are likely to follow? This small study from rural Southern Africa examines the disclosure experiences of those suffering from tuberculosis in the context of the HIV/AIDS pandemic.

Chronic diseases are on the rise and many are being managed by a complex combination of medications which can be incomprehensible for patients. Good communication is essential and for Australian Aboriginal people, Aboriginal health workers are the most appropriate source of information. This trial of an education program shows how pharmacists and Aboriginal health workers can have two-way learning to improve the information available to patients.

While there have been many studies on some of the proximal causes of poor vision in rural areas, such as trachoma or diabetes, there have been relative little attention paid to other factors. This review assesses the evidence for differences in prevalence of poor vision, access to services and demographic, occupational and environmental which provide the context for understanding the challenges posed by rurality.

Land mine injuries can be catastrophic and generally occur in rural and remote areas. In Iran, a short training in trauma care for rural health workers has improved care for these trauma victims. Read how they went about it.

Is community based, interdisciplinary learning feasible or useful for undergraduate radiographers? This study from East Africa's oldest teaching institution is thought provoking.

There are few studies that examine rural nurses' job satisfaction. This US based study highlights which community and personal factors are linked to rural nurses' job satisfaction.

The cost of food has been skyrocketing across the globe, affecting food security and the capacity to have a nutritious diet. This study of food stores in large and medium sized rural towns in Victoria, Australia uses a new tool to identify population groups who may be vulnerable as a result of high food costs.

Advanced abdominal pregnancy can present special challenges for physicians in remote areas. This case report and review of the literature may help avoid potentially catastrophic complications for mother and baby.

Practical approaches, public health, health access improvements, and Rural Health Roundtables belong together. The authors describe a common sense approach within and between rural communities that can address a variety of routine, emergent, and future rural health topics.

The traditional Mediterranean diet has been linked to lower rates of cancer and coronary artery disease. Is the diet being maintained by Greek children? Read this article to find out...

The inverse care law suggests that the most needy get the least resource. This Scottish study provides evidence that cancer mortality in rural and remote patients is compounded by an increased travel burden.

A doctor is often needed after hours in a rural community. This article from New Zealand demonstrates that collaboration may provide a sustainable solution.

The health of women impacts on the health of the family and society, and this is certainly so in Ghana, where rural women are among the most disadvantaged. This commentary outlines some multi-sectorial strategies to improve the health of Ghanaian women.

How does an entire country work towards increasing the rural content in medical school curricula? This article describes what happened recently in Vietnam.

Rural nursing work involves knowing one's community which leads to increased commitment to local residents and helps ensure quality maternity care is provided.

Are rural patients disadvantaged in their post-acute coronary syndrome management? This small survey from the Riverland in South Australia is thought-provoking.

Difficult airway management in rural areas can be terrifying for rural practitioners. This Australian article from Queensland suggests a way forward in managing this rural emergency.

Economic analysis is a powerful tool to arguing for better health. These Central Australia authors demonstrate how using economic concepts can demonstrate the powerful benefits of addressing environmental health to improve population health.

This study of intimate partner violence in Nigeria identifies a range of wider social, cultural and religious issues that must be considered and addressed.

This RIPPER initiative from the University of Tasmania, Australia, brought together health sciences undergraduates to promote rural health team collaboration and practice intention. Was it successful? It was a ripper!

Heterotopic pregnancy (the co-existence of intrauterine and ectopic pregnancies) is said to be rare but increasing in incidence. This case report highlights some treatment difficulties - and the role of family physicians in reducing maternal mortality in resource-limited settings.

Rural students are often seen as a 'minority' group that is prejudiced against in relation to admission to health professional courses. However, when brought together with other 'minorities', such as low income, poor access to high schooling, poor infant nutrition etc, this article makes the point that it is actually the MAJORITY of students who are prejudiced against in current health professional admissions policies - and the result is less choosing to practice in rural and remote regions. Check out the article to see for yourself.

The mature women who are often Australian regional nursing students do not match the assumptions we have of undergraduate students. This fascinating study follows such students on a unique educational 'crusade' toward their goal of graduation.

Is there life after placement? This small look at a larger study examines the lives of Australian rural men and women after their care recipient is admitted to residential care. Do they reconnect with the community, or do they continue their carer role? Read this research to find out.

In geographically small countries, what influence does rural and remote undergraduate medical student experience have on subsequent practice location? In the absence of evidence, this Scottish pilot study begins at the beginning in seeking to identify why medical students chose an extended remote and rural program - and what impact this had on their academic performance.

Do you want to understand the comparative lengths of service in rural communities you can expect for training different types of health professionals? This article from North America introduces an innovative method and uses it to compare various health professional training outcomes for rural communities.

Children and young people need to be managed in an environment that is safe and appropriate - they shouldn't just be put in with the adults. This interesting study gives the clinician's perspective on how different it feels to see children in a purpose-designed place.

"Sense of belonging" - the title sums it all up when student nurses learn in small facilities that are indeed family units. This ethnography is useful not only for rural nursing, but for all health professional training in rural areas or in self-contained urban units serving those in most need of health care.

Is there value in a 2-week rural clinical rotation for final year medical students? Students certainly think so! This article from South Africa demonstrates that students appreciate the excellent opportunities in rural communities to develop relevant practical skills, and want more of the same.

Read this article to see the amazing health results of a 'meal at school' intervention for girls in rural Pakistan.

For academics, finding the right words to describe the reality of students' clinical placement experience, and to define a clinical curriculum can be a great challenge. These authors have done a commendable job that will assist others facing the same tasks.

Is there a simple solution to providing more family medicine graduates for under-served rural populations? This US research from New York City suggests there is.

This project report describes how a medical relief team in Ethiopia adapted their ineffective patient screening processes to suit local circumstances, to good effect. It provides a reminder that the purpose and scope of any intervention need to be clarified.

This preliminary report from Malawi describes a process of developing standards for maternity care together with a multidisciplinary team of health professionals. This early involvement of the team, as opposed to an outside panel of experts, was found to be feasible and may be key in ensuring sustainable implementation of standards.

This positive study on rural practice intention following a rural health placement in Tasmania, Australia, challenges us to capatalise on these intentions to enrich the rural health workforce with new graduates.

Exceptional circumstances require exceptional solutions. In Australia's remote Northern Territory, physicians from outposts can be trained to take simple X-rays. After their initial training a manual is their Bible. This article describes the process of revision for this vital document.

Residential aged care units are often the site of end-of-life care for ageing Australians. This important task deserves appropriate funding that recognises the complexity of the work. The important background information for policy-makers in this article has the potential to improve the lot of terminally ill elderly Australians.

Addressing the poor maternal and child health outcomes of disadvantaged groups is a high priority in all countries. This article by a South Australia team describes a partnership between Aboriginal and non-Aboriginal health workers to provide appropriate and holistic care to Aboriginal women and their children.

Improving basic knowledge of diabetes is necessary to improve uptake of treatments to prevent eye complications. See new evidence in this study from rural India.

In North America and other world regions with an underserved rural population, a common lament is that medical graduates "just don't go". Our co-regional editor suggests another perspective in this provocative editorial.

Tracking the outcomes of students placement is easier said than done - most go their own way after graduation and are lost to follow up. Congratulations to a group of researchers from rural Victoria, Australia, who have reversed this trend! Now, read the article to see if their study supports the value of rural placements - or not.

Patient satisfaction is important, from community clinics to private services. This small satisfaction survey from rural India suggests that quality care is possible in community outreach dentistry.

How to secure an adequate supply of medical graduates for rural populations? Read about Japan's answer to this universal question.

Tents, tipis and yurts - all are discernable in the complex, contemporary structures that are our portable field hospitals. Find out how and much, much more by reading this comprehensive article from the US.

In the shadow of an ageing rural nursing workforce, an important question concerns the attributes desired among the new cohort of graduate rural nurses. This detailed Australian consumer research has identified some key outcomes that will equip future rural nurses for a career in the bush.

As risk factors for heart disease spread beyond boundaries of geography and socioeconomics, populations are becoming more equal regarding the impairment of heart function. These detailed data on heart failure and myocardial infarction from Maine USA illustrate variations in the rural-urban continuum as well as across socioeconomic indicators and beyond, providing clues for those hoping to improve health care outcomes.

Complementary medicine or therapy is very common but little is known about utilization. This brief study of CM use and access compared rural and urban Indiana populations across 20 different CM approaches with some interesting results.

Towns, states, and nations have realized the need to be supportive to those who deliver care in rural communities where 'everyone' knows 'everything'. This can be a great concern when the subject involves newborns where 'bad things' will happen even with the best of care. Practitioners sometimes have a difficult time moving on. This work explores social and other consequences and adds suggestions for support such as Australia's Dr Doc program.

What is it like to return to a workplace with a new qualification that comes with higher community expectations? This eloquent qualitative study explores the difficulties experienced by enrolled nurses who become registered nurses while working in a rural community.

Malnutrition with its multiple morbidities is a major problem among women in developing countries - but is there also a rural-urban disparity? This study provides some evidence based on data drawn from 26 countries in sub-Saharan Africa.

Act locally; think globally. In Norway, narratives of rural practice, funded GP research and virtual rural medical meeting places are just three of the NCRM strategies to address the worldwide decline in rural medical services.

The time has indeed come for a North American section of our journal. This inaugural editorial from North American co-regional editors, Robert C Bowman and Judith C Kulig, invites you to share their vision.

What is perception and what is reality in the area of childhood obesity? The authors explore these concepts using adolescent focus groups in four Appalachian high schools to determine influences involving the media, schools, and lifestyle factors. Differences translated through culture can make a healthy reality more challenging.

Since 1942, Australia's Royal Flying Doctor Service telemed consultations have been supported by remotely located medical chests. Read about the contents of these chests, and a description of this unique model of pharmaceutical support for remote medical practice.

For the 85% of Australians living by the coast, being water safe is a part of life. This culture isn't always found in the bush. This project looks at an innovative strategy for providing and implementing a water safety program.

Increasing violence in youth is a perplexing problem. Those interested in solutions might just want to listen to the young people involved. Considering "bullying perspectives" is a good place to start, as illustrated by this article.

The authors of this brief letter suggest the awareness-raising benefits of oral health community education to discourage a potentially harmful habit.

Disappointed about the progress of interprofessional activities in rural health? This thought-provoking and practical commentary from the UK suggests a redesign of learning activities may be fruitful.

For the 50% of rural cancer patients who must undergo radiation therapy for cancer, both access to and obtaining acurate information about that treatment is difficult. This article highlights the information gap and foreshadows action to assist rural GPs to meet this patient need.

Obtaining an X-ray in a small rural community where rural GPs have to also act as radiographer can be a challange. This qualitative study from Australia gives an insight into the GPs' view of this aspect of health care.

In the beginning there was oral health, or sometimes limited oral health, as in the case of First Nation's children. As these authors point out, oral health problems are increasingly linked to major causes of death, such as cardiac disease. Collaborative interventions can improve oral health in at-risk children, provide important training, and connect academic, public health, and rural communities. School-based interventions can be controversial. They can also work.

As obesity reaches epidemic proportions, new perspectives can be valuable. This urban versus rural comparison of fifth grade children does identify differences in nutrition, activity levels, and degree of obesity.

The Australian government emergency response to the state of Aboriginal child health and safety in the Northern Territory has been the subject of a number of letters to the editor of this journal. This letter considers the ethical implications arising from this intervention justified on the basis of public health.

The world's population became more urban than rural for the first time in 2007. Economic changes can drive rapid population shifts in nations such as Jamaica. Rural residents are perceived to have better quality of life, compared to urban residents in this most common genetic disorder in Jamaica. Patient environments are increasingly considered in health equations. Changing patient perceptions of quality of life may accompany displacements for any number of reasons involving agriculture, economic changes, the side effects of financial speculations or miscalculations, drought, or conflicts between nations, peoples, or ways of life.

Appropriate medical care for minority rural populations requires consideration of the linguistic and cultural origins of the health workforce. This article traces the development of a 1963 Norwegian medical education initiative to provide appropriate physicians for the Sami people. Do you have an interest in the impact of medical education on improving the health indicators of First Nations or other minority rural groups? Read this article.

Community intolerance to alcohol abuse is increasing. In Australia, the new Labor government has called for greater efforts to discourage irresponsible alcohol use. But how do we measure alcohol harm in a community? If we cannot answer that, we cannot tell if interventions are successful. This paper from rural New South Wales, Australia, describes lessons from a pilot to compile data on alcohol harm from emergency departments and policy records.

If rural communities have not been exposed to the diversity of cultures typical of major cities, the resettlement of refugees can bring challenges to effective healthcare delivery. This article eloquently describes some of the complex cultural factors underpinning the belief systems of West Africans. As such it is a valuable resource for promoting the understanding of a patient who is also refugee.

Tobacco is a rural contribution to the world, but the health impacts of tobacco have not been considered for certain rural populations such as adolescents. This article reviews important steps to addiction, the prevalence of the tobacco problem, and the characteristics of those at risk. The article has great relevance for those who hope to improve health care in teens and adults in rural areas or beyond.

Rural and remote emergency services can become a symbol of hope for the community. Read how this occurred in a mine-infested region of rural Iraq.

The explosion of information about immunization (and sometimes mistakes) creates uncertainty. This is multiplied by alternative viewpoints and anecdotes spread across the web, where information is much more accessible than actual data and research. However often absent is the perspective of the patient (or, in this case, the parent of the patient). Our authors collaborate with rural nurses to explore this perspective.

This letter asks the question: "What is India doing to improve its neonatal mortality rate, especially in rural areas?"

How is technology affecting our traditional methods of academic debate? How is this relevant to rural academics?

Adapting curricula to rural training is common, but it is possible to fail to prepare professionals for the unique aspects of life in rural locations. The developers of the Professionals in Rural Practice course share their unique blend of community action research and interprofessional training as they attempt to bring professionals even closer to a rural decision.

Should health warnings for cigarettes be written in the local language?

This article from rural Australia explores the men's self-reported health behaviours with their attitudes regarding body image and management of their own health. This type of context-specific population data are vital to develop and monitor health communication strategies targetting me.

Severe workforce shortages are customary in rural health. They are unavoidable, right? Wrong - according to this article from rural Australia which described a successful program which transformed a region from one shunned by psychiatrists to one which was highly attractive and that proved its ability to attract and retain these scarce specialists. There are no magic bullets or secret incantations; just commitment, perseverance, empathy, and a determination to create an excellent service through solid recruitment and retention strategies.

As 2008 commences, one of the biggest concerns of Australia's medical educators is how on earth to provide high quality training for the 3000 first year students by 2010/2011! This article from James Cook University suggests an intersting solution that may apply in communties Australia-wide, assisting with that bulge in student numbers while also providing community and professional benefits.

Do you want to have your say about how climate change might affect your rural community? RRH is publishing a special climate change edition for the 2008 Oluympics in Bejing! If you would like to contribute to the special edition please read this editorial.

Small rural towns are the setting for this intriguing study comparing how the roles of two professions -- pharmacy and social work -- are influenced by community need and professional ethics.

Rural and Remote Health readers are invited to view this reply to the comment on the 2007 article "Developing the accredited postgraduate assessment program for Fellowship of the Australian College of Rural and Remote Medicine". Further comments on this issue may be posted in the site's discussion area.

The field of social geography has the potential to increase our understanding of the causes and consequences of metal health and illness in rural settings. Researchers and practitioners will equally find this commentary thought-provoking.

Despite the rhetoric of media and policy statements, addressing Indigenous health inequalities is not an impossible task. There are proven solutions. This letter from a former medical officer in an Aboriginal community suggest the principles that will underlie effective change.

Rural and Remote Health readers are invited to view this comment on the 2007 article "Developing the accredited postgraduate assessment program for Fellowship of the Australian College of Rural and Remote Medicine". Further comments on this issue may be posted in the site's discussion area.