Volume 19

This research reports on health professionals' perspectives on health vulnerabilities and health care for Migrant Agricultural Workers. Findings suggest a need to respond to complex health challenges as well as for more research to assess new programs and supports.

Lack of understanding of the role of palliative care and poor availability of culturally safe specialist palliative care services impact on Indigenous people’s end-of-life decision-making. This study explored Aboriginal people's perspectives and experiences at the end-of-life in a community in Western Australia.

In 2008, the Medical Council of New Zealand recognised Rural Hospital Medicine as a vocational scope of practice with the aims of providing training and professional development standards for medical practitioners and encouraging quality systems to become established in rural hospitals. This case study explores how the new scope has affected health practitioners and the health service at a rural hospital that is part of an integrated primary health care service that serves a largely Māori community in New Zealand’s far north.

Barriers to adolescent primary health care access are complex and include social, behavioural and geographical issues as well as organisational and systemic barriers. This paper describes the first year of implementation of a Doctors in Secondary School Program in a rural setting, Victoria, Australia.

Evaluation expertise to assist with identifying improvements, sourcing relevant literature and facilitating learning from project implementation is not routinely available or accessible to not-for-profit organisations. This article describes how the program management team and an external evaluation consultancy collaboratively designed and implemented a utilisation-focused evaluation for the The Fred Hollows Foundation’s Indigenous Australia Program’s Trachoma Elimination Program.

Respiratory syncytial virus (RSV) is the leading viral cause of acute lower respiratory infections globally, accounting for high morbidity and mortality burden among children <5 years. As candidate RSV vaccine trials are underway, a greater understanding of RSV epidemiology is now needed, especially in paediatric populations with high rates of acute and chronic respiratory disease. This study identifies RSV prevalence in children living in northern Australia, a region with a high respiratory disease burden.

Although tobacco smoking prevalence in the adult Brazilian population is monitored through population-based surveys, most findings come from studies undertaken in urban areas. This study assessed tobacco smoking prevalence and associated factors among elderly people in the rural area of the municipality of Rio Grande, state of Rio Grande do Sul, Brazil.

This Review Article analyses the strategic relevance of interventions to reduce physician shortages in rural areas. The authors first identified and prioritized determinants of physician shortages and then analyzed interventions based on their ability to target those determinants.

Constipation in childhood occurs as a result of multifactorial causes; some possible risk factors include dietary habits, physical inactivity, gender, lower socioeconomic and psychological parameters and medications. This study determined the prevalence of constipation in infants aged 0–12 months in rural areas of Turkey.
 

This Commentary focuses on the value of interdisciplinary teams to address complex care needs for aging rural adults. The authors present a conceptual model for creating and mobilizing interdisciplinary care teams for aging adults in rural areas.

This Clinical Case Report describes diagnosis of Klippel–Trénaunay syndrome (KTS) – a very rare congenital vascular anomaly - in an isolated, rural community. Due to the lack of of medical and surgical sub-specialists in many rural areas, the authors point to the importance of general practitioner awareness of these disorders for diagnosis and management of potential complications.

This Original Research article describes a study with incarcerated, rural women who use drugs to examine their perspectives on co-occurence of mental health challenges and substance use. Findings revealed challenges for these women related to stigmatization and limited treatment resources.

This research article addresses the relationship between distance traveled for medical care and participation in chronic disease prevention and management programs. The authors hypothesized that those who must travel greater distances for medical care would show higher levels of participation in chronic disease management programs. Findings of this study indicate, however, that distance from medical care did not result in greater likelihood of participation in chronic disease management programs.

Abortion has been legal in the Australian state of Victoria since 2008 and medical termination of pregnancy has been available since 2012. Although these developments were expected to improve Victorian rural women’s access to abortion, this has not been borne out in practice. This study explored the knowledge and practice of rural GPs in relation to unintended pregnancy and referral for abortion, using the Grampians region of Victoria as a case study.

This research article reports on a study of rural primary care providers' attitudes towards LGBT populations. Findings suggest that improving rural providers' attitudes towards these individuals may positively affect healthcare for this population. The authors provide insight into potential programmatic interventions and future research needs.

This study describes the physical activity environments in early childhood education and care settings, and identifies child and contextual factors associated with physical activity in these settings. Findings from this study suggest that it is necessary to upskill and encourage teachers to maximise opportunities for physical activity in rural low-income communities in South Africa.

Behavioral determinants can enable or hinder motivation towards registration and donorship and, subsequently, action or inertia towards organ donation. This study explores knowledge, attitudes and general self-efficacy among rural primary care attendants within a recently established ‘soft’ opt-out system.

Adolescents from Indigenous populations in Ratanak Kiri Province, Cambodia experience comparably worse sexual and reproductive health (SRH) outcomes when compared with their urban counterparts. This study identifies factors that may explain the poor SRH outcomes experienced by this population group.

Increased participation in cervical cancer screening is associated with reduced incidence and mortality of cervical cancer. Rurality is a known risk factor for cervical cancer, with women living in rural and remote areas less likely to participate in cervical cancer screening. This systematic literature review and qualitative meta-synthesis explores rural women's perspectives and experiences around accessing cervical cancer screening. Findings could support tailored interventions to increase cervical cancer screening participation rates in this population.

In most western countries, occupational therapy is well established as a crucial aspect of overall health care, but it is still an emerging profession in the developing world. This paper investigates the role of occupational therapy (OT) in the Solomon Islands by examining the experiences and perceptions of OTs and other rehabilitation health workers who have worked there.

Geographic measures of accessibility can quantify inequitable distributions of health care. Although closest-distance measures are often used in Aotearoa New Zealand, these may not reflect patient use of health care. This study examines patterns of patient enrolment in general practitioner services from a geospatial perspective.

Caregivers of children with Fetal Alcohol Spectrum Disorder (FASD) can experience challenges and high levels of stress due to the disruptive behaviours displayed by many children diagnosed with FASD. Although experiences of caregivers raising children with FASD have been documented globally, there is little known regarding the experiences of caregivers in a remote Australian context, and particularly from an Australian Aboriginal perspective. This study investigates the experiences of caregivers in a remote Australian context.

Recent evidence indicates that the oral health for children in Timor-Leste is deteriorating, with 40% of school children experiencing toothache during 2014. This study investigated the caries status and potential risk factors among primary school children in the rural Aileu Municipality of Timor-Leste.

The National Disability Insurance Scheme (NDIS) is the catalyst for a significant shift in the delivery of disability services to people with a disability and their families, including those residing in rural and remote parts of Australia. This study explored the experiences of providing clinical services under the NDIS in a rural area.

For rural-dwelling older people, becoming ill outside GP surgery hours is complex and the barriers faced are often insurmountable at times of greatest need. This research examines how rurality impacts the ability of people aged 65 years and older, in Ireland, to access and use GP out-of-hours services.

Skin infections including scabies and impetigo have a high burden and cause significant morbidity in remote Aboriginal communities in Australia. The aim of this study was to explore Aboriginal parent/carer, healthcare practitioner and service provider attitudes and practices regarding treatment for skin infections in Aboriginal communities in remote communities in the Pilbara, Western Australia.

In Scotland, approximately 5% of out-of-hospital cardiac arrest patients survive to hospital discharge. Improving bystander cardiopulmonary resuscitation (CPR), especially in rural areas, could have a significant effect on the numbers of lives saved. This study systematically reviews whether non-classroom based bystander CPR training is as effective as classroom based training.

Despite being one of the most avoided topics of all time, death is a guaranteed eventuality for us all. However, quality psychosocial care as death approaches is not a guarantee. This study investigated the provision of psychosocial care for palliative clients in rural Australian communities and identified barriers and facilitators of social work referrals to address psychosocial concerns for palliative care clients.

After the commendable achievement of polio free status for the South East Asian Region, the World Health Organization is now focusing on measles elimination, which is still a major contributor of under-five mortality in South East Asia. India has introduced MR (measles and rubella) vaccination throughout the country through supplementary immunization activity. This study reports on the coverage of MR vaccination among the target population in South India.

Indigenous Australians with cancer tend to be diagnosed with more aggressive and advanced-stage disease, receive less treatment, have poorer survival and lower quality of life than other Australians. This study aims to describe the type and extent of unmet supportive care needs of Indigenous Australian cancer patients.

This article reports on a study examining a collaborative, interprofessional program aimed at increasing exposure of Indigenous students to career opporuntunities in healthcare. Results suggest that such programs might increase interest of Indigenous students in health professions. The study also suggests that such programs might increase the the interest of non-Indigenous health professionals in rural practice.

Farming is widely acknowledged as a stressful occupation, with non-injured farmers already at an increased risk of developing significant psychological problems (including high levels of stress, depression and increased rates of suicide). This study investigated the psychological effects of serious farm-related injury on farmers and how this influences their recovery.

This study applied GIS methods to existing data on traumatic injury and access to trauma care. County level disparities were identified, finding that rural residents with the least access to care were the most impacted by the burden of injury. The authors highlight the value of using GIS in combination with other analysis. Rural public health professionals can apply these methods for system optimization, to identify training and resource needs, assess prevention priorities, and advocate for trauma system support.

Tooth loss is associated with poorer oral health, compromised diet, nutritional deficiencies and reduced Oral Health Related Quality of Life (OHRQoL). This study evaluates the impact on OHRQoL of a novel mobile denture service designed and implemented by the Poche Centre for Indigenous Health.

Encouraging rural youth to consider healthcare careers, and healthcare students to consider working in rural settings, were among the goals of the Healthcare Travelling Road Show. Findings from this multiyear, interdisciplinary program emphasize the power of personal interactions and the importance of meaningful community engagement.

Aboriginal and Torres Strait Islander people are more likely to have a stroke at a younger age than the non-Indigenous population and are twice as likely for stroke to result in death. Aboriginal and Torres Strait Islander people living in rural and remote areas are less likely to have access to an acute stroke unit. This study examined the experiences of Aboriginal and Torres Strait Islander stroke survivors in Far North Queensland and made recommendations for a model of care that was responsive to their needs.

The Rural Adversity Mental Health Program (RAMHP) was founded in 2007 with the specific focus of responding to drought-related mental health needs among farmers in rural and remote NSW, Australia. Since then, the program has expanded to include all people in rural and remote NSW in need of mental health assistance. This study reports on the use of a program logic model, which was developed for RAMHP to steer program reorientation, clarify objectives, activities and outcomes and improve data collection.

Recruitment and retention of healthcare professionals in rural areas is a major, worldwide concern. Medical education has integrated community-oriented medical education strategies to help address these challenges. This study explored medical trainees’ preferences regarding place of work and choice of specialty after completing training using either the traditional or mixed Problem-Based Learning/Community-Based Education and Service curriculum in Ghanaian medical schools.

This study explores postgraduate clinical psychology placements in rural and remote locations; in particular, the complexity of developing workplace readiness for psychology students and the role of practice-based education.

This article describes the implementation of a novel technology tool to capture demographic distribution and clinical presentation of patients in rural vision centers using the eyeSmart EMR App in a three-tier eye care network in India.

In Australia, Autism Spectrum Disorder is the most prevalent primary diagnosis of National Disability Insurance Scheme (NDIS) participants receiving individualised funding to date and requires support staff to have specialised skills and experience. This study explores the feasibility, essential requirements and potential barriers in delivering therapy support to regional and remote participants on the autism spectrum via video-conferencing technology.

Rural populations in Australia have a higher prevalence of obesity, cardiovascular disease, type II diabetes and some cancers than urban populations. This study determined associations between socio-economic characteristics (socio-economic position, income, wealth, debt, occupation, social network diversity), dietary attitudes and fruit and vegetable intake for people living rurally in Australia.

Physical activity across the lifespan is essential to good health but participation rates are generally lower in rural areas and among Aboriginal Australians. This study examined physical activity variation by season, setting and type among rural Aboriginal and non-Aboriginal Australian children.

The allied health workforce of Aotearoa New Zealand is under growing pressure, with many health providers finding recruitment and retention increasingly difficult. For health providers in rural settings, the challenges are even greater. This Review provides an overview of allied health workforce development in New Zealand, highlighting opportunities and lessons for future workforce development, and looks abroad to what our allied health colleagues have learnt that could be of benefit to New Zealand.

Rural health needs to be based on robust theory that guides efforts in practice, teaching and research. This paper argues for critical realism as a suitable candidate theory, helpful for articulating, analysing and acting on the factors that contribute to rural health outcomes.

This Original Research article reports on the unmet family planning needs among married women of different economic, social and cultural backgrounds living in rural and urban settlements in Karabuk, Turkey.

Hypertensive disorders in pregnancy account for 12% of all maternal deaths globally. The risks from these disorders might be greater in rural and remote locations. This study explored how an mHealth intervention might support midwives in the management of women with pre-eclampsia in Scottish rural and remote locations.

This Clinical Case Report illustrates a case of anaphylactic shock following a bite of a wild Kayan slow loris (<i>Nycticebus kayan</i>) on a human in a remote area of Sarawak, Malaysian Borneo.

This original research article reports on the results of a study which examined the experiences of individuals who participated by telehealth in studies examining the effects of cancer treatment on sleep and cognition. Findings suggest that use of telehealth might improve the ability of rural residents to participate in research.

This study investigates the differences in ureterorenal stone appearance after gouty arthropathy between Taiwanese Aboriginal and non-aboriginal patients.

Point-of-care ultrasound (POCUS) has the potential to improve access to diagnostic imaging for rural communities. This study evaluates the sensitivity and specificity, impact on patient care including decisions around interhospital transfer, quality and safety, of two common POCUS examinations, FAST (focused assessment with sonography in trauma) and AAA (aortic aneurysm), in the rural context.

Community orientation in medical education, which prepares medical students to become more effective practitioners, is now a global movement. This study investigated medical students’ perceptions of the community-based learning experiences incorporated into the Bachelor of Medicine, Bachelor of Surgery degree at Uttara Adhunik Medical College, Bangladesh.

Concerned about lower rates of colorectal cancer screening in rural areas of the U.S., the authors conducted a systematic review of the literature to identify barriers to screening in this populations. While barriers identified were similar to those perceived in urban areas, specialist shortages, distances to test facilities, concerns about privacy, and attitudes about cancer prevention were identified as disproportionately hampering screening for rural Americans.

There are increasing rates of mental health issues coupled with insufficient resources to provide appropriate support, particularly in rural areas. eHealth initiatives are often proposed to maximise the number of rural mental health consumers able to receive support. This study investigated the factors affecting the likely engagement with the internet, both for general and eHealth purposes within the context of South Australian rural mental health consumers.

A comprehensive registry database of GPs and data linkage was used to investigate mobility patterns of female GPs across remoteness categories. This study shows that on average more female GPs leave practices annually than male GPs and an overall drift exists from rural to urban areas.

This scoping review maps the literature around primary health care (PHC), describing differences between rural and non-rural PHC. Comparison are made across four pillars of the patient's medical home &ndash; access, comprehensiveness, continuity and electronic medical record use. The authors' suggest rural PHC requires specific performance measurement system/s that acknowledge these differences.

This qualitative study used photovoice to explore travel issues experienced by rural registered nurses and student nurses undertaking preceptorships in remote rural areas in Canada. A central finding of the study was that student nurses learn to accept and manage limitations, and capitalize on opportunities, when undertaking rural preceptorships. The challenges student nurses face, without the same occupational health and safety protections as their rural preceptors, are highlighted. The authors suggest that better travel subsidies and road safety measures during rural preceptorships may increase interest in rural career paths.

Colorectal cancer (CRC) patients in regional and rural areas tend to be diagnosed at a more advanced stage than metropolitan patients and have poorer 5 year survival rates. This study investigates the effect of attitudinal and cognitive traits on compliance with, as opposed to participation in, population CRC screening programs in rural, regional and metropolitan environments.

Inequality in health workforce distribution is common in China and many other developing countries. This paper aimed to explore the health workforce in rural China; in particular, the cultivation and retention of village physicians and how to keep pace with health service demand.

Many rural American Indians are at elevated risk for obesity due to physical inactivity. This pilot study sought to test the validity and reliability of the Rural Active Living Perceived Environmental Support Scale (RALPESS) within a rural American Indian population sample. Confirmatory evidence suggests the tool is valid and reliable for use with this population, and may further the development of effective exercise interventions.

Access to medical services for rural communities is poorer than for metropolitan communities in many parts of the world. One of the strategies to improve rural medical workforce has been rural clinical placements for undergraduate medical students. This study explores the workforce outcomes of one model of such placements – the Longitudinal Integrated Clerkship.

With the ability to diagnose malaria with rapid diagnostic tests, interest in improving diagnostics for non-malarial fevers has increased. Understanding how health providers diagnose and treat fevers is important for identifying additional tools to improve outcomes and reduce unnecessary antibiotic prescribing, particularly in areas where access to laboratory diagnostics is limited. This study aimed to understand rural health providers’ practice patterns, both quantitatively and qualitatively, and influences on diagnostic and treatment decision making

Following a percutaneous coronary intervention (PCI), emphasis is placed on healthy lifestyle modification by means of secondary prevention. The literature suggests Australians have difficulty within the period following a PCI, particularly the rural cohort. This systematic scoping review reports on what is known of the health behaviours of this population post-PCI.

Disparities in cancer outcomes between Indigenous and non-Indigenous people are well reported. Some Australian Indigenous communities’ beliefs about cancer may influence health behaviours, support for those with cancer and, ultimately, treatment outcomes. This project aims to make community perceptions of cancer visible, facilitate development of resources representing these perceptions and briefly evaluate the project from the community’s perspective.

In Australia, rural women diagnosed with breast cancer have significantly poorer 5-year survival, with variations in clinical management additionally observed. This study examined the factors that influence treatment decisions of women diagnosed with breast cancer.

Medical workforce recruitment and retention in the Northern Territory (NT) of Australia have been persistent problems. Prior to 2011, NT residents who aspired to study medicine had to leave and study interstate. This article describes the development, implementation, successful early outcomes of and lessons learned from the Northern Territory Medical Program, which commenced in Darwin in 2011.

This descriptive study explores the patterns, costs and providers’ perspectives on patient transportation in remote Northern Canada. The authors identify potential factors associated with utilization and performance that are not fully explained by geography.

Patient self-management skills are an important part of heart failure management. However, there is a lack of knowledge about the effectiveness of nurse-led education on patient self-management and the associated clinical outcomes of rural Chinese patients with chronic heart failure (CHF). This study evaluated the impact of a nurse-led education program on patient self-management and hospital readmissions in rural patients with CHF.

This study investigated the satisfaction and difficulties of the work of primary health care nurses in rural areas.

This research examined whether passive and active surveillance systems produce different estimates of workforce supply. Findings suggest significant differences between passive (licensure data) and active surveillance estimates. Authors identify a need for ongoing surveillance to improve identification of workforce shortages.

Tuberculosis (TB) remains a significant public health challenge in the Solomon Islands. This article presents the results of a clinical audit of hospitalised TB patients in a remote provincial hospital and makes recommendations for the steps required to eradicate TB from the provinces of the Solomon Islands by 2030.

This Clinical Case Report describes a rare respiratory complication in a young primiparous woman following a very prolonged labour in a remote community hospital.

Nurses providing emergency care in rural Australia have different challenges and support needs from their urban counterparts. This systematic scoping review investigates the support needs of these nurses and makes recommendations for the future of the rural nursing workforce.

Strongyloides stercoralis, a nematode that can cause fatal infections in immunocompromised persons, is known to be endemic in tropical Australia. This case report provides further evidence that strongyloides transmission is possible in temperate areas of Australia.

For the past 10 years, skin cancer has remained the most frequent malignant neoplasm in Brazil and worldwide. A skin cancer prevention program run by Barretos Cancer Hospital includes educational activities and medical assistance conducted at the hospital and at a mobile unit. This study evaluated the use of the mobile unit as part of the skin cancer prevention program in remote areas of Brazil.

Recent literature has explored the health and social implications of industrial workers who are involved in a variety of long-distance-commute work arrangements. However, the role of an industrial health worker in caring for this special population of workers is poorly understood and documented in current literature.This study examined the experience of isolation for health workers in industrial settings to better inform industry and education providers.

This population-based study found a significant difference in prostate cancer survival between Appalachian and non-Appalachian Kentucky. The disparity was associated with high comorbidity scores, high poverty rates, and low levels of education, rather than simply geographic location.

This Clinical Case Report provides an insight into hereditary haemochromatosis and the value of recognising the signs and symptoms for early diagnosis and subsequent treatment.

This is the first published study evaluating the impact of haematology point-of-care (POC) testing on acute clinical care in a rural hospital with no onsite laboratory. The study highlights the hidden costs of implementing POC systems and their associated quality assurance programs in a remote-from-laboratory context.

Public health education strives to transform and empower students to engage in policy and practice improvement. However, little is known of the nature of such change among students, especially when studying Aboriginal health and wellbeing, which may involve disrupting long held assumptions and prejudices. This paper reports findings regarding the feasibility, specificity and sensitivity of the Growth and Empowerment Measure in the evaluation of two innovative postgraduate public health electives focussed on Aboriginal health and wellbeing.

This study reports on the case of a 40-year-old male agriculturalist who was bitten by a venomous snake and treated with antivenom.

Primary amoebic meningoencephalitis is an extremely rare, predominantly fulminant central nervous system infection caused by the amoeba Naegleria fowleri. This Clinical Case Report describes the case of a 56-year-old man who presented to the Gold Coast University Hospital in Queensland, Australia, with rapidly progressive primary amoebic meningoencephalitis.

This study explored the experiences and level of awareness among Primary Health Care professionals invited to participate in a school-based intervention for safe Internet use.

Generalism in the health workforce has been established as an important strategy to address health workforce maldistribution. Thus, to best serve the medical needs of northern Australia, the James Cook University (JCU) College of Medicine and Dentistry has a mission to produce graduates who both practise in the region, and have a generalist orientation. This study investigates the postgraduate qualifications and key factors that shaped the current career choice of JCU medical graduates, and whether JCU graduates are more likely to choose generalist careers than other Australian medical practitioners of a similar level of experience.

In Australia, around one in five medical specialist doctors travels away from their main practice to provide regular outreach services in rural communities. This study explored the use of video consultations by specialists providing rural outreach services.

Atrial fibrillation (AF) is a major risk factor for ischaemic stroke and a common presentation in General Practice. This study determined whether patients in a rural population with documented history of AF are prescribed antithrombotic treatment according to recognised guidelines.

This study explores the influences on physical activity among Indigenous children in six rural First Nations communities in Canada. Using a socioecological approach, the authors identified three key impediments to physical activity - recreational technology, caregiver's safety concerns, and barriers to community activation.

For individuals living in rural/remote areas, there are recognised barriers limiting access to specialist services for persistent pain management. This study evaluated a persistent pain management program implemented via a multisite telehealth group model and examined consumer perceptions.

This cross-sectional study of 12 Rural Clinical Schools examined associations between extended rural clinical placement, rural background and location of practice. Findings suggest that students with extended rural clinical placement are more likely to practice in rural locations.

This project report examines the potential for tablet technology in the delivery of teleneurology consultations. Results of the study with 10 community-based hospitals demonstrate tablets as a cost-effective and efficient alternative to traditional telehealth technologies.

Different factors influence recruitment of health professional students to work in rural areas. This study explores the willingness of health students in the Faculty of Medicine Foca, University of East Sarajevo, Bosnia and Herzegovina, to work in a rural area following graduation and the factors influencing their decision to pursue a rural career.

Healthcare systems in many countries struggle with recruiting general practitioners (GPs) for clinics in rural areas, leading to GPs being required to each serve an increasing number of patients and potentially influencing patient satisfaction and the likelihood of malpractice litigation. This study investigated the association between malpractice litigation and local setting characteristics in Denmark.

As the population of Japan ages, care of elderly people is a critical issue for rural communities. Increased physician visits places an extra burden on primary care facilities. Recently, the number of prescriptions for compresses/patches (C/P; known as shippu in Japanese), used for pain relief for orthopedic diseases, has been uniformly restricted during physician visits in Japan. This study reports on the resultant change in the number of physician visits by patients seeking extra C/P prescriptions.

All healthcare providers can influence the delivery and outcome of a palliative approach to care, ensuring that everyone has “equitable access to quality care based on assessed need as they approach and reach the end-of-life”. This study mapped the delivery of palliative care in far west New South Wales, Australia.

Preventing maternal deaths depends significantly on the presence of a skilled birth attendant at child delivery. This study determined whether use of mobile transport vouchers would result in an increased number of pregnant women in Samburu County, Kenya, choosing to deliver at a health facility rather than at home.

This study examined the factors affecting the intent to leave of healthcare workers serving in underserviced areas of Taiwan, including remote locations and isolated islands.

Local rural hospitals often do not have the resources or expertise to manage both maternal and neonatal outcomes in obstetric emergencies, but obstetric transfer can be stressful for the patient and costly for health services. This study describes the clinical reasons for obstetric transfers from a rural area in South Australia and explores predictive factors of likelihood of delivery on transfer.

Community paramedicine is emerging as a potential model to meet rural healthcare service gaps. This qualitative study explores motivators and challenges to participation, and the characteristics of paramedics engaged in this role in two North American programs.

The high incidence of skin cancer in Brazil has resulted in an urgent need for more efficient methods of reducing the time between initial diagnosis and therapy. Such delays are significant in large countries like Brazil, where a considerable proportion of the population live in remote areas with limited access to specialized medical care. This study tested the diagnostic efficiency of a mobile phone app as a screening device for suspicious skin lesions.