Volume twenty-two, Issue 2

Scotland’s healthcare system includes six rural general hospitals that provide a full surgical service to the most remote and rural populations. Constraints of geography and finance, and population need, mean that local delivery of surgical services will be required for the foreseeable future, but these rural hospitals face difficulties in recruiting suitably trained general surgeons. This study describes Scottish surgical trainees’ attitudes towards training and working in remote and rural surgery, perceived barriers to recruitment and potential solutions.

The geographic maldistribution of physicians is a serious problem around the world. Evidence suggests that increasing the number of primary care specialists will help to improve the urban–rural gap in physician supply. This study compares the geographic distribution of family physicians in Japan and the USA – two developed countries without a major system for physician allocation by the public sector, but which differ greatly in the maturity of family medicine (ie length of its history as part of the healthcare system and the population of qualified family medicine experts).

This study contributes to understanding of the challenges experienced by rural healthcare providers in diagnosing and managing traumatic brain injury in their patients. Results from this qualitative study, involving 18 healthcare providers, point to several challenges and barriers to care as well as opportunities to overcome these challenges.

Community Health Workers (CHWs) are effective in sensitising people to diabetes mellitus (DM) and diabetic retinopathy (DR). In Fiji, CHWs attended a one-day DR awareness training course to provide communities with adequate basic knowledge about DM and DR to improve awareness and enhance referrals for DR screening and treatment. This study reports on the impact of this training on CHW knowledge of DR and referral practices in Fiji.

Vaccination is considered an key element in the prevention of COVID-19, but rural Americans are less likely to be vaccinated compared to their urban counterparts. This explorative qualitative study considers perceptions related to COVID-19 vaccination among rural Oklahomans, with the goal of informing strategies to address vaccine hesitancy. Perceived benefits of vaccination, as well as barriers to vaccination are described.

Opioid use disorder (OUD) is a major public health issue in the USA, particularly in rural communities. This study describes how a research team in Virginia used the Stakeholder Engagement in Question Development and Prioritization Method (SEED) to engage the community in creating a roadmap to address OUD in their community. Focus groups provided information that community stakeholders used to develop strategies they felt were needed in their community, and which they felt empowered to implement.

There are approximately 90 Aboriginal and Torres Strait Islander community controlled art centres located across Australia, the majority in geographically remote locations. This national survey of art centres explores how they are supporting older people, including people living with dementia, if and how they are collaborating with aged care services and what challenges and opportunities they identify in these arrangements.

Compulsory rural service is one method of addressing limitations in access to health care in marginalized areas of low- and middle-income countries, including Guatemala. This study explores Guatemalan medical students’ experiences of compulsory rural service and the impact of rural service on their professional development.

Complications of pregnancy and childbirth are a major cause of adolescent death and babies who are born to adolescent mothers are 50% more likely to die than babies with adult mothers. The adolescent birth rate in Indonesia is high. This study identifies the determinants of adolescent birth in Indonesia.

Recruiting and retaining rural primary healthcare professionals is a global healthcare problem. In this qualitative study, Canadian medical educators and institutional leaders were asked about medical education approaches that helped prepare students for rural practice. The authors found that preparing students for rural careers is influenced by many factors, including interpersonal relationships, medical education curriculum, and the personal characteristics of students. The key informants suggest that future research could use the complex systems theory to improve understanding of how to support medical learners in their preparation for rural careers.

Providing postgraduate rural training programs has been recognized as central for successful recruitment and retention of a rural medical workforce. While there have been many documented cases of rural training program development, documented program outcome evaluations are few. This review investigates how postgraduate training and educational programs for rural and remote medicine are evaluated worldwide.

This Commentary considers the use of spatial analysis to depict rural and remote allied health and disability services in Queensland. It suggests that such quantitative approaches to understanding 'thin markets', 'market sufficiency' and 'market diversity' are insufficient. The authors suggest additional considerations that should inform policy, funding and service planning decisions.

The COVID-19 pandemic challenged population health researchers to use remote data collection methods to avoid interpersonal interaction, but the feasibility in low-resource settings had not been investigated. This study reports on experiences from telephone interviews conducted among pregnant women in the Rajarata Pregnancy Cohort, Sri Lanka.

Rheumatoid arthritis (RA), a chronic inflammatory disease that causes functional limitation, disability, and deterioration of quality of life without adequate and timely management, is the most prevalent inflammatory arthropathy worldwide, and is estimated to affect 0.5–1% of the global population and 0.6–6.8% of the Indigenous peoples of the USA, Australia and New Zealand. This study describes attitudes, cultural knowledge, and therapeutic practices of the Misak people of Colombia concerning RA with the aims of strengthening relationships between the community and health professionals and building on an emergent culturally sensitive healthcare model.

Virtual Health Care (VH) provides new opportunities for rural healthcare delivery but also highlights and exacerbates inequities in care. This Commentary describes the implementation of equity-informed knowledge translation processes in rural British Columbia, which can help address these inequities and improve VH for rural regions.

Pain is a common and distressing symptom in people living with cancer that requires a patient-centred approach to management. Since 2010, the Australian Government has invested heavily in developing regional cancer centres to improve cancer outcomes. This study explores patient and carer experiences of care from a regional cancer centre with specific reference to cancer pain management.

The COVID-19 pandemic has highlighted embedded inequities and fragmentation in our health systems that have been perpetuated by traditional health professional education. The authors of this Commentary contend that we must seize this moment to transform medical education and produce a fit-for-purpose health workforce, ready to respond to pandemics and address social injustice and inequality.

In remembrance of Professor Denese Playford.

This paper investigates whether ‘inclusive’ health systems increase societal welfare, as expressed through estimates of healthy life expectancy (HLE). The analysis uses OECD data to explore the relationship between HLE at the age of 65 and four variables that are representative of institutional ‘inclusivity’ or ‘extractiveness’ of health systems. The development of health policies that aim to strengthen 'inclusive' institutions could have a significant positive impact on collective welfare and social cohesion – especially for populations in rural, remote and less developed parts of the world.

Declining house-call rates have been documented worldwide; however, up-to-date data on current rates are lacking, particularly in rural settings. Systematic reviews in this area are inconsistent, but other work, principally qualitative research, demonstrates benefits for both doctors and patients. This study establishes the current rate of, and reasons for, home visits in a rural general practice setting in the north-west of Ireland.

Anemia is a global public health issue that mainly affects children under five years old. In Peru, despite the  reduction in the prevalence of anemia between 2010 and 2018, anemia remains a major concern, especially in high-risk zones such as rural areas. This study examines the difference in anemia prevalence between urban and rural areas and its spatial distribution in Peruvian children aged 6 to 59 months.

Falls are prevalent in patients with Parkinson Disease (PD). Previous work has focused on the impact of motor and non-motor symptoms on falls, but has ignored the impact of environmental factors, such as rurality of residence, economic level and quality and availability of caregiving. This study investigates the prevalence and risk factors of falls in patients with PD and explores the impact of rurality on falls.

Evidence on the association of socioeconomic deprivation with occurrence of acute myocardial infarction is available from international studies and urban settings in western Germany. This study examines this association in rural eastern Germany.

Infections bear a significant burden on healthcare costs worldwide. This Short Communication explores antibiotic and hospital-related costs of infections needing admission in a real-world setting.