Volume ten, Issue 2

Rural and Remote Health is proud to announce its special issue 'Human Health at the ends of the earth'.

Guest editors Dr Laura Arbour (UBC Medical Genetics and the Island Medical Program) and Dr Alan Parkinson (Centers for Disease Control & Prevention's Arctic Investigations Program (CDC), along with RRH's co-North American Regional Editor Professor Judith C Kulig, invite you to read these special articles ON CIRCUMPOLAR HEALTH WITH THESE PARTICULAR THEMES: the impact of place on health; the health status of individuals living in circumpolar regions; the accessibility of health services; and the preparation of health professionals.

Take the link in this alert to the issue Editorial, the gateway to this unique collection, which concludes: "...all the articles ...inform us about the complexity of health and healthcare services in circumpolar regions. They ...remind us that terms such as 'rural,' 'remote' and 'northern' are contextual experiences where place matters everyday on an individual and collective level."

This US research examined provider perceptions of diabetes education and its accessibility, according to Appalachian regional "economic distress" and rurality. Read the conclusions of those who know - the answers may surprise you.

This commentary from India opens with a quote from Nehru: "You can tell the condition of a nation by looking at the status of its women". If this is so, then in terms of the five key issues in women's health these authors discuss, all is not well in rural India.

Being overweight is a common issue worldwide for both urban and rural children. Surprisingly this NZ study finds it to be a greater problem among-- (read the article to find out!).

Coordinated care is a hallmark of optimal cardiac care post-discharge, but this can be challenging when patients, cardiologists and primary care physicians are all in different locations. This study compared the hospital re-admissions of urban and rural veterans after congestive heart failure episodes. While all patients need good follow-up care, the situation of rural older veterans illustrates the importance of coordinated care approaches.

Japan attempted to resolve rural physician shortages using standard approaches but still came up short. Their ultimate solution appears to have been in the design of Jichi Medical University, a rural medical school that involves all levels of government, aligning selection and specific training for a guaranteed rural workforce. Could this model work in other countries?

Rural Americans have served in the military at high levels, a pattern that continues today. These rural veterans can face extreme barriers to health care, including disability, poverty and typical highly centralized US healthcare facilities. In a compassionate project, telehealth monitoring was trialled to improve outcomes and support for older rural veterans with complex care needs. The authors describe a unique initiative that could also improve the disadvantage suffered by other hard-to-reach rural populations.

What is the role of rural residence in treatment delay during myocardial infarction? The answer may seem obvious, but this small study from the Greek island of Crete had some unexpected findings.

Rural versus urban is always an interesting perspective. Training in rural sites and urban sites does result in a different experiences for emergency medicine residents. However, rural plus urban training may complement the training of emergency physicians, equipping them to address a broader array of emergency care needs.

This recounting of program experience from the USA offers a generalizable "how to" guide for using medical education to address the workforce needs of a rural state.

When the Canadian Community Health Survey was used to test the relative income hypothesis as it relates to health status among rural and urban Canadians there were some surprising findings. This article has significant policy implications for public health.

It has been said that rural individuals with a diabetes diagnosis do best when their self-care is skilfully monitored by an appropriate healthcare professional. Read what Appalachia healthcare providers have to say about diabetes services in this underserved rural US region.

Question: How can scarce eye care services be maximised for those with visual impairment in the rural, developing world? Answer: By producing skilled program managers. To find out how, read this short report from the Postgraduate Diploma in Community Eye Health course at South Africa's University of Cape Town.

What do rural North Carolinians know about renal health and the treatment for chronic kidneys disease? This US study identifies barriers to renal knowledge and health care, along with community members' suggestions for marketing renal health information and screening.

Neuropsychiatric complications of typhoid fever are not uncommon in the tropics, however a patient presenting with depressive features can confound the rural physician. For one patient with typhoid fever, self-medication and a belief that psychiatric problems are caused by demons resulted in a delay in presentation. Intervention by a social worker in a community psychiatric centre meant that she received belated but appropriate care.

How do we deal with the obesity and related diabetes epidemic among First Nations peoples in Canada? These authors suggest taking a 'whole school framework' approach among First Nations students in rural and remote communities in British Columbia, Canada. They emphasize the feasiblity of their evaluation, and its results.

Impoverished areas in rural locales around the world struggle with an insufficient number of healthcare professionals. This article discusses a residency training program in Loreto, providing a Peruvian perspective on this global issue.

You've read about it in Africa, Australia, the UK and US: fewer medical students are going into general practice, and fewer still are prepared to work in a rural area. Now read about this issue from the perspective of German GPs. Their thoughts and solutions, both unique and familiar, add to this well researched phenomenon.

Public or private, the grass always appears greener on the other side - the Australian rural healthcare system wouldn't survive without both. This article gives an insight into some of the issues and perceptions of rural allied health professionals working in private practice.

This retrospective, cohort study focused on healthcare utilization or location of death for rural persons with respiratory illnesses. Among other information, readers will find out which factors were different for rural and urban residents with this type of illness.

For rural residents the world over, access and equity are prognostic considerations for cancer survival. This large-scale study from New Hampshire USA asks the question: is geographic access to mammography screening related to a woman's late or early stage at breast cancer diagnosis? The authors examine the evidence, including the contribution of age, health insurance status and seasonal influence.

What is the desired rural practice environment for generations X and Y GPs? "Latte rural"! To find out what coffee has to do with rural workforce, read this intriguing Australian research into the motivation of the next generations of rural GPs.

This letter from Norway continues a conversation on pre-hospital trauma data.

Women in over 130 small Australian rural communities can no longer deliver their baby in their home town. Instead they face the hazards of many hours road travel to their planned birthing centre while in labour. This qualitative study shows the profound impact of this change on many.

This letter alerts RRH readers to the plight of India's forest-dwelling tribal communities who are suffering unintended health consequences from official conservation policies.

"...This is the way we do it in the real world." The transition from theoretical setting to clinical practice site can be an anxious time for student nurses. When there is a difference between what was taught and what is practised, do students fall into the theory-practice gap? This interesting article explores a crucial issue.

Hypertension is a major public health problem and its prevalence increases with age. This unique rural Greek study shows that, where the elderly are concerned, greater efforts are required in hypertension prevention and control.