Volume 23

Urban and rural areas have particular characteristics that impact the health and mortality of their inhabitants. In Mexico, the leading causes of mortality are cardiovascular diseases, diabetes mellitus, cancer, and accidents, but the differences in these trends between urban and rural populations is not clearly understood. This study describes the adjusted mortality rate in rural and urban areas and analyzes trends between 2000 and 2019.

Las zonas urbanas y rurales tienen características particulares que impactan en la salud y mortalidad de sus habitantes. En México, las principales causas de mortalidad son las enfermedades cardiovasculares, la diabetes mellitus, el cáncer y los accidentes; pero las diferencias en estas tendencias entre las poblaciones urbanas y rurales, no están completamente claras. Este estudio describe la tasa de mortalidad ajustada en áreas rurales y urbanas, y analiza las tendencias entre 2000 y 2019.

Áreas urbanas e rurais possuem características particulares que impactam a saúde e a mortalidade de seus habitantes. No México, as principais causas de mortalidade são as doenças cardiovasculares, diabetes mellitus, câncer e acidentes, entretanto, asdiferenças destas tendências entre populações urbanas e rurais não é bem compreendida. Este estudo descreve as taxas ajustadas de mortalidade em áreas urbanas e rurais, bem como analisa as tendências entre 2002 e 2019.

Rural residents have an increased risk for dementia and face significant barriers accessing information, caregiving support, and memory-related services. Physical inactivity increases the risk of Alzheimer's disease, and rural communities experience barriers to participation in physical activity. This small pilot study focused on implementing and evaluating the feasibility and safety of a synchronous, remotely delivered, aerobic exercise telerehabilitation program for persons with subjective cognitive decline living in rural northern Minnesota, USA. The exercise intervention was synchronous, remotely supervised, moderate intensity activity using a recumbent bicycle. With no drop-outs, no adverse events, and an 85% session participation rate, the study provides evidence of preliminary feasibility of synchronous audiovisual telerehabilitation programs delivered to rural residents at risk for dementia.

Colorectal cancer (CRC) remains a priority health concern within the United States and globally, with rural residents disproportionately impacted. This study used the concept mapping approach to explore cultural issues affecting the use of CRC screening and inform future education and prevention efforts among agricultural operators.

Maternal morbidity and mortality in the USA are higher than in other developed nations and continue to rise. Infant mortality, likewise, is higher in the USA than in other developed nations. Limited availability of maternal health services, particularly in rural areas, contributes to this crisis. This protocol describes the evaluation of a USA government-funded project that seeks to address the shortage of quality maternity care in rural and underserved areas by strengthening partnerships, enhancing maternal care training of Family Medicine residents and obstetrics fellows, and improving the transition from training to rural practice for residents and fellows.

Rural Generalists (RG) provide holistic and complex medical care in multiple settings (eg general practice and hospitals) across the lifespan in rural and remote areas of Australia. RGs are frequently faced with making clinical decisions about whether patients can be managed locally or need to be transferred. This Original Research study explores RG therapeutic reasoning approaches in a simulated emergency scenario in the rural and remote context.

Health workers in rural and remote areas are called on to treat a large range of diseases, provide multiple health services, and perform a wide variety of procedures. All physicians undertake lifelong learning to maintain, develop or increase the knowledge, skills, professional performance and relationships used to provide services to patients, the public or the profession. Since the mid-1960s, many government and non-government organizations, including the World Health Organization, have conducted continuing education programs for rural health workers. This systematic review and meta-analysis examines the effectiveness of continuing education for health workers in rural and remote areas.

Community-level factors, such as urban–rural status and pre-existing economic conditions, may increase risk for severe COVID-19 (defined as hospitalization, admission to the intensive care unit, intubation, mechanical ventilation, or death). Rural populations have a higher prevalence of comorbidities associated with severe COVID-19 (eg obesity, diabetes, and heart disease) and less access to adequate testing and healthcare facilities than urban populations. However, COVID-19 is more transmittable in densely populated areas.This Original Research article adds to the evidence base surrounding the incidence of severe COVID-19 outcomes in rural and urban USA. Data from over the course of 2020 are explored for medically underserviced areas (MUA) and non-MUA in Minnesota and Montana. Findings, including a shift in greater incidence from urban to rural over the year, may significantly inform future pandemic response planning.

This article reports on a study conducted in partnership with a remote First Nation in northern Canada. The study utilised concept mapping to develop a framework for identifying gaps in oral health care for Indigenous youth. Findings of the concept mapping and framework development process can provide information on strategies to improve preventive oral health services for Indigenous youth living in rural and remote communities.

The nature of the HIV epidemic in the United States and Canada has changed with a shift toward rural areas. Sexual and gender minority people who live in rural areas are less likely to have had an HIV test in the past 12 months compared with those who live in non-rural areas. Using data from 508 participants, this Original Research article assesses the independent contribution of distance and time required to travel to receive an HIV test on recent uptake of HIV testing.

Although most countries struggle to deliver adequate healthcare resources and services to rural communities, resulting in poorer health outcomes for rural-dwelling people, little attention has been paid to the need for policy to address inequities in rural and urban service delivery. Rural proofing, the systematic application of a rural lens across policies to ensure they adequately account for the needs, contexts, and opportunities of rural areas, provides a strategy to ensure rural contexts are fully considered when designing health programs and interventions. Young healthcare professionals (HCPs) will be called upon to advocate for and lead the implementation of rural proofing efforts, so their perceptions, ideas, and knowledge of rural proofing are integral to the future of rural health care. This Original Research article explores the knowledge and understanding of rural proofing among young rural HCPs from around the world.

Non-communicable chronic diseases are a major global public health concern, with impacts including premature death and disability as well as high costs for health systems and society. The burden of these diseases tends to fall disproportionately on populations with greater social vulnerability. Despite this, little is known about the prevalence of chronic diseases in rural riverside populations in the Amazon, where people live their daily lives with the dynamics of the rivers, making a living by fishing and plant extraction. People in these populations experience socioeconomic and health vulnerabilities and have limited regular access to health services. This study investigates the prevalence and risk factors of hypertension and diabetes in a rural riverside population of the Brazilian Amazon.

 As doenças crônicas não transmissíveis são uma grande preocupação global de saúde pública, com impactos que incluem morte prematura e incapacidade, bem como altos custos para os sistemas de saúde e para a sociedade. A carga dessas doenças tende a recair desproporcionalmente sobre as populações com maior vulnerabilidade social. Apesar disso, pouco se sabe sobre a prevalência de doenças crônicas em populações rurais ribeirinhas da Amazônia, onde as pessoas vivem seu cotidiano com a dinâmica dos rios, vivendo da pesca e do extrativismo vegetal. As pessoas dessas populações vivenciam vulnerabilidades socioeconômicas e de saúde e têm acesso regular limitado aos serviços de saúde. Este estudo investiga a prevalência e os fatores de risco para hipertensão e diabetes em uma população rural ribeirinha da Amazônia brasileira.

Las enfermedades crónicas no transmisibles son un importante problema de salud pública mundial, con impactos que incluyen muerte prematura y discapacidad, así como altos costos para los sistemas de salud y la sociedad. La carga de estas enfermedades tiende a ser desproporcionadamente mayor en las poblaciones con mayor vulnerabilidad social. A pesar de esto, poco se sabe sobre la prevalencia de enfermedades crónicas en las poblaciones rurales ribereñas de la Amazonía, donde las personas viven su vida cotidiana con la dinámica de los ríos, ganándose la vida con la pesca y la extracción de plantas. Las personas de estas poblaciones experimentan vulnerabilidades socioeconómicas y de salud, y tienen un acceso limitado a los servicios de salud. Este estudio investiga la prevalencia y los factores de riesgo de hipertensión y diabetes en una población rural ribereña de la Amazonía brasileña.

Rural patients with a hand injury often receive initial hand surgery and rehabilitation in metropolitan or larger regional centres. Access to follow-up treatment for rural patients after the initial phase of care can be affected by transport options, distance, staff shortages and availability of hand therapists (occupational therapists or physiotherapists who have specialised skills in optimising functional use of the hand and arm after injury). After experiencing an increase in volume and complexity of hand therapy referrals, Toowoomba Hospital, a regional hospital in the Darling Downs Health Service (DDHS) in rural Queensland, Australia, found their existing model of care did not meet the needs of rural patients or therapists, risking poorer clinical outcomes. This Project Report describes the development and success of a new shared-care model by the DDHS – The Rural Hand Therapy Project – designed to better support rural hand therapists and rural patients in accessing follow-up hand therapy services closer to home.

Rural education during all levels of medical training has been found to promote careers in rural medicine but many rural health services are limited in their ability to fulfil the supervision requirements for all levels of learners (from student to fellowship). Medical students have been successfully rurally trained via Longitudinal Integrated Clerkships (LIC), during which they’re exposed to a range of clinical settings and disciplines, facilitating continuity of supervision over the clerkship duration. Portland District Health (PDH) is among the first health services in Victoria to implement this model of training for interns. This Project Report describes the novel internship program provided at PDH and explores the experiences of participants involved during the initial year.

Translating health research knowledge into practice and policy ensures that research results in real-world improvements in health practice, quality of care and health consumer outcomes. Health-professional-led research tends to address real-world practice issues and, therefore, the findings tend to be more readily translated into practice. However, capacity-building strategies are needed to support health professionals to engage in practice-based research and translation. This is particularly critical for rural and regional health services, which often exist in communities that experience poor health outcomes compared with urban communities. The authors of this article ask: what are rural health researchers’ perspectives on capability-building requirements for emerging researchers to enable the translation of research into health practice?

Near-peer learning (NPL), where learners proactively teach and learn with their peers and discuss questions with teachers, has been found to improve participation, collaboration and learning in medical education. In Japan, NPL applied in rural contexts has been found to improve motivation and self-directed learning in family medicine and community-based medical education (CMBE). However, a lack of psychological safety among peers and medical teachers (in part because of the professional hierarchy that exists among medical professionals) may impinge on the implementation of NPL in CBME. This study investigated the effects of NPL on the psychological safety and learning of medical trainees in rural CBME.

Frozen section pathology consultations during surgery are essential for determining breast cancer stage and informing breast cancer treatment. However, pathologists are in short supply in rural areas, which may delay treatment for rural-dwelling patients. One possible solution is performing remote intraoperative frozen section consultation using telepathology: sending whole-slide images of frozen sections to pathologists at other institutions during surgery to rapidly check the condition of a resected specimen. Previous preliminary studies have reported that remote intraoperative frozen section consultation has an accuracy of 92% or better. This study evaluates the feasibility of telepathology in the post-disaster setting of Fukushima, Japan, reporting on the accuracy of remote intraoperative frozen section consultation of breast cancer sentinel lymph node biopsy and the time required to introduce telepathology at a leading breast cancer institution.

In this invited Editorial, Dr Jon Griffin discusses rural and remote access to laboratory medicine and cancer histopathology services and the potential of digital pathology to transform rural and remote cancer pathology, providing faster diagnoses and building local expertise through training, mentorship and computer-aided diagnostics.

Amazonian riverside populations are characterized by living in close connection with the ebbs, flows and floods of rivers and relying on traditional methods for producing food. People in these populations typically have little access to basic resources, including health care. Research on food consumption by traditional non-indigenous populations is scarce, but it is thought that changing environmental and social conditions is resulting in less reliance on traditional food production and more reliance on grocery stores and cheap, ultra-processed foods with low nutritional value. This article analyzes the food consumption of a rural riverside population on the Rio Negro River, Manaus County, Northern Brazil.

As populações ribeirinhas da Amazônia caracterizam-se por viver em estreita conexão com as vazantes e cheias dos rios, bem como pela utilização de métodos tradicionais na produção de alimentos. Tipicamente, os indivíduos destas populações têm pouco acesso a recursos básicos, incluindo a atenção à saúde. São raras as pesquisas sobre o consumo alimentar de comunidades tradicionais não indígenas, entretanto, acredita-se que mudanças ambientais e sociais têm resultado numa redução da produção tradicional de alimentos e no aumento da dependência por supermercados e alimentos ultraprocessados baratos e de baixo valor nutricional. Este artigo analisa o consumo alimentar de populações rurais ribeirinhas do Rio Negro, no município de Manaus, Estado do Amazonas, norte do Brasil.

Las poblaciones ribereñas amazónicas se caracterizan por vivir en estrecha conexión con los cauces, corrientes y crecidas de los ríos; y depender de métodos tradicionales para producir alimentos. Las personas de estas poblaciones suelen tener poco acceso a los recursos básicos, incluida la atención médica. La investigación sobre el consumo de alimentos por parte de las poblaciones tradicionales no indígenas es escasa, pero se cree que los cambios en las condiciones ambientales y sociales están dando como resultado una menor dependencia de la producción de alimentos tradicionales y una mayor dependencia de las tiendas de comestibles y de los alimentos ultra procesados más baratos y con bajo valor nutricional. Este artículo analiza el consumo de alimentos de una población rural ribereña de Río Negro, municipio de Manaos, en el norte de Brasil.

Participation in international academic conferences provides social, emotional and intellectual growth among attendees, but equitable access to conferences remains an issue, especially for early career professionals and delegates from low- and middle- income countries. This report describes the success of a global project of the World Organization of Family Doctors (WONCA), the 'Rural Early Career Ambassador Integration' project, which was implemented for the 2022 World Rural Health Conference held at the University of Limerick, Ireland.

As a result of lockdown measures to control COVID-19, medical schools across the world adapted teaching and training methods. In many places, this involved a shift away from face-to-face teaching and the adoption of online and virtual learning. Rather than move online, the medical school of Stellenbosch University, South Africa, instead moved substantial components of clinical training away from the traditional urban tertiary academic medical centre and into regional and district hospitals. This study examined the perspectives of final phase students regarding the quality of their restructured training at distributed health facilities during the COVID-19 pandemic and compared the perspectives of rural site students with metropolitan site students.

In Australia, voluntary assisted dying (VAD) laws have passed in each state. As is the case with many health services, inequitable access to VAD within regional communities is a pressing concern. When designing and implementing VAD laws, Western Australia implemented several initiatives to mitigate regional inequities. This Original Research article draws on the early experiences and reflections of key stakeholders to report on regional provision of VAD in Western Australia and explore the effectiveness of the initiatives introduced.

This paper describes the outcomes of a decade-long Rural Community Internship Training (RCIT) Program in Victoria, Australia. The program comprises a year of internship training delivered in smaller rural communities, including up to 20 weeks’ general practice experience working with qualified rural generalist doctors and visiting specialists, along with 8–10-week terms in emergency, general medicine and surgery in nearby larger regional hospitals. Results suggest that up to 9 years post training, 61% of interns pursue General Practice, 40% currently work in the same region and 97% work at extended scope.

This Letter to the Editor reports on the success of an educational support system specifically designed for remote novice writers engaged in case-report writing. A remote writer was provided with lectures, available on demand, and tailored and personal workshopping and feedback using Google Docs. With this support, the writer was able to successfully focus, deepen and accelerate the writing process, despite their remote location.

Acute appendicitis is the most common general surgical emergency worldwide. Antibiotic treatment is considered safe and effective for uncomplicated appendicitis and appendectomy remains the preferred option for acute appendicitis in most cases; however, differentiation between these diagnoses can be difficult, particularly in rural or remote areas such as rural Tibet, which has a unique social and cultural landscape that might influence the clinical characteristics of appendicitis. This study investigated the clinical characteristics and applicability of the routine risk prediction models of acute appendicitis for rural Tibetan populations.

The COVID-19 pandemic, one of the greatest challenges to societies and global health systems in the last hundred years, has necessitated an examination of the role and initiatives of primary health care. This scoping review identifies and synthesizes the individual and collective primary health care initiatives and innovations developed to face the COVID-19 pandemic in rural and remote areas around the world.

A pandemia de COVID-19, um dos maiores desafios no último século às sociedades e aos sistemas de saúde em todo o mundo, necessita de um exame sobre a contribuição de iniciativas da Atenção Primária em Saúde. Esta revisão de escopo identifica e sintetiza iniciativas individuais e coletivas desenvolvidas pela Atenção Primária à Saúde para enfrentar a pandemia de COVID-19 em localidades rurais/remotas pelo mundo.

La pandemia de COVID-19, uno de los mayores desafíos para las sociedades y los sistemas de salud mundiales en los últimos cien años, ha requerido un examen del papel y las iniciativas de la atención primaria de salud. Esta revisión sistemática exploratoria identifica y sintetiza las iniciativas e innovaciones individuales y colectivas de atención primaria de salud desarrolladas para enfrentar la pandemia de COVID-19 en áreas rurales y remotas de todo el mundo.\\\\\

People living in rural areas often face health inequities as a result of limited access to healthcare resources and healthcare professionals. This Letter to the Editor describes how, while ChatGPT (a generative pre-trained transformer with a large language model foundation) cannot replace the expertise and personalized care provided by healthcare professionals during remote consultations, the AI tool might serve as a valuable virtual ally for health in remote communities in areas including healthcare information, health education and promotion, symptom triage and telemedicine, mental health support, health monitoring and reminders, language and cultural sensitivity, and data collection and public health surveillance.

Decreased function of musculoskeletal, cardiorespiratory and nervous systems as a result of aging can prevent elderly people from performing their daily activities. Assessment of physical performance can therefore help determine health interventions for this population, providing crucial information for the risk of future dependence, worsening or diagnosis of chronic diseases, risk of falls and other aspects of morbidity and mortality. However, people living in rural areas generally face greater difficulties in accessing health services and have poorer health conditions than people living in urban areas. This Original Research study tests the association of sarcopenia and physical performance with the use of primary health care services by elderly people living in rural riverside areas in the Amazon, Brazil.

A redução das funções dos sistemas musculoesquelético, cardiorrespiratório e nervoso como consequência do envelhecimento pode impedir indivíduos idosos de executar suas atividades de vida diária. A avaliação do desempenho físico pode fornecer informações relevantes sobre o risco de dependência, quedas, piora ou diagnóstico de doenças crônicas, dentre outros aspectos relacionados à morbimortalidade, podendo auxiliar na escolha de intervenções adequadas. Entretanto, moradores de áreas rurais têm maior dificuldade de acesso a serviços de saúde e piores condições de saúde em comparação aos moradores de áreas urbanas. Este estudo original avalia a associação de sarcopenia e desempenho físico com o uso dos serviços de atenção primária à saúde entre idosos moradores de áreas rurais ribeirinhas na Amazônia brasileira.

La disminución de la función de los sistemas musculoesquelético, cardiorrespiratorio y nervioso como resultado del envejecimiento puede impedir que las personas mayores realicen sus actividades diarias. Por lo tanto, la evaluación del rendimiento físico puede ayudar a determinar intervenciones de salud para esta población, proporcionando información crucial para el riesgo de dependencia futura, empeoramiento o diagnóstico de enfermedades crónicas, riesgo de caídas y otros aspectos de morbilidad y mortalidad. Sin embargo, las personas que viven en zonas rurales generalmente enfrentan mayores dificultades para acceder a los servicios de salud y tienen peores condiciones de salud que las personas que viven en áreas urbanas. Este estudio de investigación original describe la asociación entre sarcopenia y rendimiento físico con el uso de servicios de atención primaria de salud, por parte de personas mayores que viven en zonas rurales ribereñas del Amazonas, Brasil.

Supporting student clinical placements in rural and remote locations is a strategy to address health workforce shortages in rural and remote areas of the Northern Territory (NT), Australia. A commonly used method for determining post-graduation workplace location is an online survey, but response rates are typically very low. Another method is to use the publicly available postcode of residence of health professionals registered with the Australian Health Practitioner Regulation Agency (AHPRA). However, not all health disciplines that have clinical placements in the NT require professional registration. This Research Letter compares previously published workplace location outcomes derived from an online survey of a student cohort who completed a clinical placement in the NT with workplace locations based on recent AHPRA registration.

Sarcopenia, the gradual loss of muscle mass, strength and function with age, and back pain both directly impede the daily activities of older people, increasing their time spent in bed and shortening their healthy lifespan. Prevention and treatment are therefore crucial in reducing medical expenses and enhancing quality of life. Older individuals living in rural areas can experience different daily activity levels, occupations, and environmental factors from those living in urban areas. In some countries, older women in rural areas have been reported to have greater handgrip strength and walking speed, but a higher prevalence of back pain, than older women in urban areas. This Original Research article investigates the correlation between sarcopenia and spinal function in older women living in a rural area (Sunchang County, Korea).

Self-measured blood pressure monitoring (SMBP) has been used successfully to manage hypertension amongst rural patients in multiple nations. This work provides a mid-point assessment of a SMBP program in West Virginia, USA, a highly rural Appalachian state where population rates of hypertension exceed the national average. Results suggest that when integrated into clinician workflows, SMBP significantly reduces the number of patients with uncontrolled hypertension; these findings were consistent across patient sex, zip code, and clinic location.

The Galapagos Islands were a model of successful COVID-19 management from the developing world. The Galapagos experience can teach important lessons to the local, regional and international public health community: even in communities where resources may be limited, the intersection of academia, local governance, and proactive strategies can dramatically uplift health outcomes and safeguard populations. The unwavering commitment to protecting both inhabitants and visitors has solidified the islands' stance as a paragon for public health management in the face of global adversity.

As Ilhas Galápagos foram um modelo de sucesso na gestão da COVID-19 entre países em desenvolvimento. A experiência de Galápagos pode trazer importantes contribuições à Saúde Pública nos níveis local, regional e internacional: mesmo em comunidades onde os recursos podem ser limitados, a intersecção entre academia, governança local e estratégias proativas podem melhorar drasticamente os resultados em saúde e proteger as populações. O inabalável comprometimento para a proteção de moradores e visitantes consolidou as Ilhas Galápagos como um modelo de gestão em Saúde Pública diante de uma adversidade global.

En las Islas Galápagos se aplicó un modelo de gestión exitosa de la COVID-19 en el contexto de países en vías en desarrollo. La experiencia de Galápagos deja lecciones importantes a la comunidad de salud pública local, regional e internacional: incluso en comunidades donde los recursos pueden ser limitados, la intersección de la academia, la gobernanza local y las estrategias proactivas pueden mejorar drásticamente los resultados de salud y salvaguardar a las poblaciones. El compromiso inquebrantable de proteger tanto a los habitantes como a los visitantes, ha consolidado la postura de las islas como modelo de gestión de salud pública frente a la adversidad globalque significo la Pandemia.

Many countries have national infectious disease surveillance systems but these can be hampered by limited timeliness, representativeness and sensitivity and therefore might miss local outbreaks that occur in small communities. This study reports on the development and implementation of a voluntary, local community-based ophthalmology sentinel surveillance system in Isa city, a rural area in Japan.

In early 2020, despite efforts to contain the spread of the SARS-CoV-2 virus (COVID-19), transmission across Ecuador grew exponentially, quickly overwhelming the Ecuadorian healthcare system. A similar scenario transpired in several Latin American countries, with the Americas experiencing millions of cases and deaths by 2023. However, a massive screening campaign and travel restrictions were successful in managing transmission in one province of Ecuador, the Galapagos Islands, with one island remaining entirely COVID-19-free during 2020. This retrospective study of testing data from the Galapagos Islands provides lessons from the first wave of the COVID-19 pandemic.

No início de 2020, apesar dos esforços para conter a propagação do vírus SARS-CoV-2 (COVID-19), a transmissão no Equador cresceu exponencialmente, sobrecarregando rapidamente o sistema de saúde equatoriano. Um cenário semelhante ocorreu em vários países latino-americanos, com as Américas experimentando milhões de casos e mortes até 2023. No entanto, uma campanha massiva de triagem e restrições de viagem foram bem-sucedidas no gerenciamento da transmissão em uma província do Equador, as Ilhas Galápagos, com uma ilha permanecendo totalmente livre de COVID-19 durante 2020. Este estudo retrospectivo de dados de teste das Ilhas Galápagos fornece lições da primeira onda da pandemia de COVID-19.

A principios de 2020, a pesar de los esfuerzos para contener la propagación del virus SARS-CoV-2 (COVID-19), la transmisión en Ecuador creció exponencialmente, sobrepasando rápidamente al sistema de salud ecuatoriano. Un escenario similar ocurrió en varios países de América Latina, experimentando millones de casos y muertes hasta 2023. Sin embargo, una campaña de detección masiva y restricciones de viaje lograron controlar la transmisión en una provincia de Ecuador, las Islas Galápagos, con una isla que se mantuvo completamente libre de COVID-19 durante 2020. Este estudio retrospectivo de datos de testeo en las Islas Galápagos brinda lecciones en la primera ola de la pandemia de COVID-19.

The COVID-19 pandemic demonstrated how rapidly a novel viral respiratory pathogen can impact healthcare systems. This is particularly important in low and middle-income countries, where existing health infrastructure is inadequate and where the rate of existing communicable and non-communicable disease is already high. In Papua New Guinea (PNG), despite public health information and guidance, vaccine hesitancy has been identified as a major challenge for local management of COVID-19. Meanwhile, non-government organisations have reported that PNG health systems, already overburdened by escalating rates of communicable diseases including tuberculosis and malaria, are on the brink of collapse as COVID-19 cases increase. In this Original Research study, the authors surveyed community members, community leaders and healthcare workers to understand the accessibility of vaccines for the general community in provincial PNG, the level of (and reasons for) community vaccine hesitancy and ways to strengthen vaccine acceptance among target groups within the community.

Preparing rural youth for careers in health care is essential for addressing workforce shortages and improving access to health services in rural communities. In this study, the authors implemented an online mentoring program for rural youth that successfully increased participants’ interest in healthcare careers and provided the knowledge and skills for transitioning to post-secondary education. Suggested refinements to broaden the impact of the Rural eMentoring program include enabling personalization within the curriculum, adding new discussion topics relevant to rural youth, and meeting the needs of rural Indigenous learners.

Water is scarce for more than 40% of people globally, and among those with access to water, approximately 23% (1.8 billion) rely on a fecally contaminated water source. Diarrheal disease, which is prevalent in areas with limited access to water, sanitation, and hygiene (WASH), causes chronic consequences in children, including decreased growth, undernutrition, and impaired cognitive development. In Latin America, diarrheal disease kills more than 75,000 children annually, while in the Peruvian Amazon, the prevalence is as high as 50% for Indigenous children. This study reports on the prevalence of childhood diarrhea, access to WASH, and the association of childhood diarrhea with WASH indicators in Shawi communities along the Armanayacu River, Peru.

El agua es escasa para mas del 40% de las personas globalmente, y entre aquellos con acceso al agua, aproximadamente un 23% (1,8 billones) depende de una fuente de agua contaminada fecalmente. La enfermedad diarreica, que es prevalente en zonas con acceso limitado al agua, saneamiento e higiene (WASH), causa consecuencias crónicas en los niños tales como retraso del crecimiento, desnutrición y deficit en desarrollo cognitivo. En Latinoamérica, la enfermedad diarreica causa mas de 75 mil muertes en niños anualmente, mientras que en la Amazonia Peruana, la prevalencia es tan alta como el 50% de los niños indígenas. Este estudio muestra la prevalencia de diarrea en niños y su asociación con indicadores de acceso a WASH, en las comunidades SHAWI a lo largo del Rio Armanayacu en Perú.

A água é escassa para mais de 40% das pessoas em todo o mundo. Entre aquelas com acesso à água, aproximadamente 23% (1,8 bilhão) dependem de uma fonte de água contaminada por fezes. A doença diarreica, que é prevalente em áreas com acesso limitado à água, saneamento e higiene (WASH), causa consequências crônicas em crianças, incluindo crescimento reduzido, desnutrição e desenvolvimento cognitivo prejudicado. Na América Latina, a doença diarreica mata mais de 75.000 crianças anualmente, enquanto na Amazônia peruana a prevalência chega a 50% para crianças indígenas. Este estudo relata a prevalência de diarreia infantil, acesso a WASH e a associação de diarreia infantil com indicadores de WASH em comunidades Shawi ao longo do rio Armanayacu, Peru.

Many countries, including Brazil, have a rising life expectancy and an aging population, both of which will have considerable implications for health systems. In Brazil, a quarter of the population will be older adults by 2024. Screening older adults at risk for worsening health can provide an opportunity for detection and intervention, thus preventing adverse clinical outcomes and enabling the most efficient use of health resources. This Original Research article uses data from the first follow-up of the EpiRural Cohort Study to determine the prevalence of, and factors associated with, vulnerability among rural community-dwelling older adults living in the municipality of Rio Grande, Rio Grande do Sul, Brazil.

Vários países, incluindo o Brasil, vivenciam um aumento da expectativa de vida e da população idosa, o que terá consideráveis implicações para os sistemas de saúde. Até 2024, os idosos representarão um quarto da população brasileira. O rastreamento de idosos em risco de piora da saúde é uma oportunidade para detecção e intervenção, prevenindo desfechos clínicos adversos e permitindo o uso mais eficiente dos recursos em saúde. Este artigo original utiliza dados do primeiro acompanhamento da Coorte EpiRural para determinar a prevalência e os fatores associados à vulnerabilidade entre idosos moradores da área rural do município do Rio Grande, Estado do Rio Grande do Sul, Brasil.


Muchos países, incluido Brasil, tienen una esperanza de vida en aumento y una población que envejece, lo que tendrá implicaciones considerables para los sistemas de salud. En Brasil, una cuarta parte de la población serán adultos mayores en 2024. La detección de adultos mayores con riesgo de empeorar su salud puede brindar una oportunidad para la detección y la intervención, previniendo así resultados clínicos adversos y permitiendo el uso más eficiente de los recursos de salud. Este artículo de investigación original utiliza datos del primer seguimiento del Estudio de Cohorte EpiRural para determinar la prevalencia y los factores asociados con la vulnerabilidad entre los adultos mayores que viven en comunidades rurales del municipio de Rio Grande, Estado de Rio Grande do Sul, Brasil.

People living in rural areas experience higher rates of many chronic diseases than people living in urban areas. An issue that is underexplored in rural areas is obstructive sleep apnea (OSA), a condition in which a person’s breathing is paused while asleep as a result of partially or wholly blocked airways, causing drops in oxygen levels. OSA is experienced mostly by men and older people and is strongly associated with serious comorbidities, including hypertension, heart attack, stroke, diabetes, major depression and early mortality. Despite this, rural patients are likely to encounter barriers to diagnosis and treatment because of a lack of locally available healthcare services.This study explores the proportion of diagnosed and undiagnosed OSA in men living in rural areas in Australia.

Viral diseases transmitted by mosquitoes of the Aedes genus are a priority public health problem worldwide. Colombia is one of the most affected countries in Latin America, with a significant burden of dengue, chikungunya, and Zika. In particular, the incidence and mortality rates of dengue have been increasing since the 1950s. There are no specific antiviral therapies for treatment of dengue and mass vaccination is not available yet, so prevention and control requires unprecedented coordination of efforts, including those of the general community. However, previous research has revealed a mismatch between the realities about dengue fever and the understanding of people going about their daily lives. This article analyzes risk discourses around dengue, Zika and chikungunya constructed by lay people, community leaders and disease control experts from the fields of medical anthropology, medical sociology and public health.

As doenças virais transmitidas por mosquitos do gênero Aedes são um problema prioritário de saúde pública em todo o mundo. A Colômbia é um dos países mais afetados da América Latina, com uma carga significativa de dengue, chikungunya e zika. Em particular, as taxas de incidência e mortalidade da dengue têm aumentado desde a década de 1950. Não há terapias antivirais específicas para o tratamento da dengue e a vacinação em massa ainda não está disponível, portanto a prevenção e o controle requerem uma coordenação de esforços sem precedentes, incluindo os da comunidade em geral. No entanto, pesquisas anteriores revelaram uma incompatibilidade entre as realidades sobre a dengue e a compreensão das pessoas sobre suas vidas diárias. Este artigo analisa discursos de risco sobre dengue, zika e chikungunya construídos por leigos, líderes comunitários e especialistas em controle de doenças das áreas de antropologia médica, sociologia médica e saúde pública.

Las enfermedades virales transmitidas por mosquitos del género Aedes son un problema prioritario de salud pública a nivel mundial. Colombia es uno de los países más afectados de América Latina, con una carga importante de dengue, chikungunya y Zika. En particular, las tasas de incidencia y mortalidad del dengue han ido en aumento desde la década de 1950. No existen terapias antivirales específicas para el tratamiento del dengue y la vacunación masiva aún no está disponible, por lo que la prevención y el control requieren una coordinación de esfuerzos sin precedentes, incluidos los de la comunidad en general. Sin embargo, investigaciones anteriores han revelado un desajuste entre las realidades sobre la fiebre del dengue y la comprensión de las personas sobre su vida cotidiana. Este artículo analiza los discursos de riesgo sobre el dengue, el Zika y el chikungunya construidos por legos, líderes comunitarios y expertos en control de enfermedades de los campos de la antropología médica, la sociología médica y la salud pública.

Randomised controlled trials (RCTs) are the gold standard method for evaluating health and care interventions including medicinal products and services. To alleviate health inequalities experienced by rural patients, it is important that researchers are able to effectively recruit rural participants into their RCTs. This systematic review protocol is designed to quantify the effects of randomised evaluations of strategies to recruit rural participants to trials.

The unique history and social context of rural and frontier communities often creates stigma for those seeking to address mental health challenges. Creative expression can be used as a strategy to facilitate community integration and address mental health, particularly in a time where socioeconomic disparities, pandemics, and climate change impacts can intensify health impacts.

People in sexual minorities experience increased risk relative to heterosexual people for a number of chronic diseases. In rural areas, sexual minorities also face substantial barriers to care as a result of persistent internalized stigma and stigma from care providers. As rural populations have a consistently higher burden of chronic disease than urban populations, this study used data from the National Survey on Drug Use and Health to assess the chronic disease risk for rural people in sexual minorities.

Although sex work is not criminalized in Brazil, female sex workers experience prejudice and discrimination. In rural areas, which tend to be poorer regions, female sex workers experience inequities in gender, race, class and, above all, bear marks of struggle and survival. This study reports on the meanings that women in the experience of paid sexual work living in rural areas attribute to the quality of life, according to Sartre's phenomenological perspective.

Aunque el trabajo sexual no esta criminalizado en Brasil, las trabajadoras sexuales femeninas experimentan prejuicios y discriminación. En zonas rurales, que tienden a ser mas pobres, estas trabajadoras sufren inequidades de genero, raciales, socioeconómicas y por sobre todo están marcadas por la lucha y la sobrevivencia. Este estudio describe los significados que le atribuyen a la experiencia de vivir del trabajo sexual pagado en zonas rurales, respecto de la calidad de vida de acuerdo a la perspectiva fenomenológica de Sartre.

Embora o trabalho sexual não seja criminalizado no Brasil, as trabalhadoras do sexo sofrem preconceito e discriminação. Nas áreas rurais, que costumam ser regiões mais pobres, as trabalhadoras do sexo vivenciam desigualdades de gênero, raça, classe e, sobretudo, carregam marcas de luta e sobrevivência. Este estudo relata os significados que as mulheres na experiência do trabalho sexual remunerado residentes no meio rural atribuem à qualidade de vida, segundo a perspectiva fenomenológica de Sartre.

Suicide claims the lives of more than 700,000 people every year worldwide, and for farmers and agricultural workers, who experience a range of personal and occupational stressors, the risk is particularly high. Qualitative research examining farmer suicide has grown in recent years and provides a rich description of farmers' lives leading up to their suicide that cannot be easily captured by quantitative surveys. This systematic review and meta-synthesis, the first to utilize qualitative data about farmer suicide, examines the risk and protective factors preceding farmer suicide from the perspectives of their partner, relatives, or individuals who worked closely with them. The authors use this information to generate a conceptual model, the FARM framework, that offers a new way of understanding farm culture, occupational stressors, and farmers’ well-being and provides direction for future research and guidance for practical interventions.

Indigenous peoples in Latin America often experience a high prevalence of mental ill health and suicide as well as inequitable access to healthcare services. In addition, mental health and wellbeing tools used in community services are often based on western concepts or generalized from non-Indigenous population validations, which can result in inaccurate assessments and misdiagnosis of mental health conditions in Indigenous peoples, as well as a failure to recognize the strengths that Indigenous peoples may possess in coping with challenges. This Original Research article presents the results of a descriptive cross-sectional study that was carried out with the participation of the community leaders of the Indigenous peoples of Colombia.  It describes the intercultural creation and validation and psychometric characteristics of the PACES scale, a tool used to evaluate parenting, behavior, emotions and risk of suicide in community settings or in primary care mental health services in Colombia.

Os povos indígenas da América Latina frequentemente experimentam uma alta prevalência de doenças mentais e suicídio, bem como acesso desigual aos serviços de saúde. Além disso, as ferramentas de saúde mental e bem-estar usadas nos serviços comunitários geralmente são baseadas em conceitos ocidentais ou generalizadas a partir de validações de populações não indígenas, o que pode resultar em avaliações imprecisas e diagnósticos incorretos de condições de saúde mental em povos indígenas, bem como na falha em reconhecer os pontos fortes que os povos indígenas podem possuir para lidar com os desafios. Este artigo de Pesquisa Original apresenta os resultados de um estudo transversal descritivo que foi realizado com a participação dos líderes comunitários dos povos indígenas da Colômbia. Descreve a criação e validação intercultural e as características psicométricas da escala PACES, uma ferramenta usada para avaliar parentalidade, comportamento, emoções e risco de suicídio em ambientes comunitários ou em serviços de atenção primária à saúde mental na Colômbia.

Los pueblos indígenas de América Latina a menudo experimentan una alta prevalencia de problemas de salud mental y suicidio, así como un acceso desigual a los servicios de salud. Además,los instrumentos de salud mental y bienestar que se utilizan en los servicios comunitarios a menudo se basan en conceptos occidentales o se generalizan a partir de validaciones de poblaciones no indígenas, lo que puede resultar en evaluaciones inexactas y diagnósticos erróneos de las condiciones de salud mental en los pueblos indígenas, así como en la falta de reconocimientode las fortalezas que los pueblos indígenas pueden poseer para hacer frente a estos desafíos. Este artículo original de investigación presenta los resultados de un estudio descriptivo de corte transversal que se realizó con la participación de los líderes comunitarios de los Pueblos Indígenas de Colombia. Describe la creación y validación interculturales, así como las características psicométricas de la escala PACES, una herramienta utilizada para evaluar la crianza, el comportamiento, las emociones y el riesgo de suicidio en entornos comunitarios o en servicios de salud mental de atención primaria en Colombia.

There is an undersupply of general surgeons in rural Australia and in rural areas worldwide. Although other medical specialties, including general practice, obstetrics and gynaecology, ophthalmology and emergency medicine, have established rural training schemes in Australia, general surgeons undertaking their 1–3 years of subspecialty Post-Fellowship Education and Training (known as ‘fellowships’) are largely limited to metropolitan institutions and no accredited rural surgical training is funded by the federal government. Despite funding limitations, a rural general surgery fellowship was established in Bendigo, a rural town in central Victoria, in 2011. This Original Research article reviews Bendigo Health’s general surgical fellowship program to determine if rural general surgery fellowships can assist in sustaining a rural general surgery workforce.

Allied health (AH) professionals require discipline-specific expertise and a diverse generalist skill set to manage the complexity and demand for health care in rural and remote areas. Access to relevant continuing professional development (CPD) that sustains the development of generalist capabilities is a key strategy to support workforce development and the retention of rural and remote AH professionals. This study evaluated an online education program specifically designed as CPD for rural and remote practice, and the impact on the professional development, healthcare services and recruitment and retention of AH professionals undertaking this program.

Aspire2Heath is a novel health career outreach program offering rural secondary school students in Queensland, Australia, the opportunity to experience and learn about health careers without leaving their communities. Exposing students to health career promotional activities can increase interest in health careers and potentially increase enrolments in healthcare education, with the aim of eventually alleviating workforce shortages and potentially enhancing population health outcomes. This study assesses Aspire2Heath's short-term impact on student interest in health careers and reports on educational activities that generated the greatest student interest.

Community health worker (CHW) programs can play a significant role in improving health at a community level by providing a range of preventive and treatment services. Although large-scale CHW programs have been implemented in many countries, implementation strategies vary considerably and evidence of program effectiveness is not consistent. South Africa is currently investing in CHW programs. This study explored perspectives on the programs and investigated stakeholder perspectives on the supervision model. The authors provide guidance on how to improve the implementation of CHW programs in South Africa and globally.

Rates of firearm violence and injury are notably high within the United States. This Research Letter uses CDC WONDER data to demonstrate that rates of firearm-involved suicide mortality are higher in very rural areas than metro regions. Further research and development of rural-specific suicide prevention efforts are encouraged.

Aboriginal Community-Controlled Health Organisations (ACCHOs), like other primary care organisations in Australia and internationally, were required to respond rapidly to physical distancing requirements during the COVID-19 pandemic. A key component of the response was the adoption of telehealth to continue meeting the healthcare needs of Aboriginal and Torres Strait Islander Peoples. This study evaluates the uptake, acceptability and requirements for delivery of telehealth primary healthcare services for Aboriginal and/or Torres Strait Islander Peoples by a rural ACCHO, Budja Budja Aboriginal Cooperative, in Halls Gap, Victoria, during the pandemic.

Xingu Indigenous Park (XIP), the largest Indigenous territory in Brazil, protects the environment and the traditional way of life for the 16 Indigenous groups that live there. Access to XIP by non-Indigenous people is limited but, in recent decades, new roads and more people living in the vicinity of the park has increased exposure to different infectious agents. The Indigenous population is constantly dealing with shortages in medical care. This study evaluated the frequency and potential impact of chlamydia, gonorrhea and high-risk human papillomavirus on the Indigenous women of XIP.

El Parque Indigena Xingu (XIP), el mas grande territorio indígena en Brasil, protege el medio ambiente y la forma de vida tradicional de los 16 grupos indígenas que ahi viven. El acceso al XIP por personas no indígenas es limitado, pero en las décadas recientes, nuevos caminos y el aumento de personas viviendo en la proximidad del parque, han incrementado la exposición a diferentes agentes infecciosos. La población indígena esta constantemente lidiando con la escasez de cuidados médicos. Este estudio evalúa la frecuencia y el potencial impacto de agentes como clamidia, gonorrea y papilomavirus humano de alto riesgo en las mujeres indígenas del XIP.

O Parque Indígena do Xingu (PIX), o maior território indígena do Brasil, protege o meio ambiente e o modo de vida tradicional dos 16 grupos indígenas que ali vivem. O acesso ao PIX por não indígenas é limitado, mas, nas últimas décadas, novas estradas e mais pessoas morando no entorno do parque aumentaram a exposição a diferentes agentes infecciosos. A população indígena lida constantemente com a escassez de atendimento médico. Este estudo avaliou a frequência e o potencial impacto da Clamídia, Gonorreia e Papilomavírus Humano de alto risco nas mulheres indígenas do PIX.

There is an increasing number of undergraduate health professions students being trained along a continuum of care from central academic hospitals to remote distributed training sites. This is an essential healthcare education reform for contextually relevant training. With the progressive expansion of distributed training in South Africa academic coordination at these sites is crucial. This study explored the experiences of university employed rural academic coordinators responsible for student learning and community engagement on distributed platforms in South Africa.

In Indonesia, traditional medicine is well-known and practiced from generation to generation. The 2013 and 2018 results of the Indonesian Basic Health Survey indicated that, despite a lack of coverage by the National Health Insurance scheme, the use of traditional health services is increasing and it seems they are even expected to fill the gap in health coverage caused by a lack of modern health facilities in rural areas. This article reports on the use of traditional health services in rural Indonesia and how this relates to socioeconomic factors.

There are limited available data describing referral, triage patterns and wait times for rural paediatric outpatient clinics to guide health service planning and delivery. Collection and reporting of such data are imperative for determining community need for services. To gauge the needs of a local community, this study examined the source of referrals, patient demographics and problem types for all new patients who attended an appointment during the initial year of a new rural paediatric outpatient service in rural Victoria, Australia.

The rising prevalence of obesity (which is higher in rural than urban areas) is one of the most serious public health challenges. Over the past decade, several national guidelines have been established for the Norwegian health sector to meet the challenges of childhood overweight and obesity and ensure professionalism and standardization of health services. This study determined the extent to which public health nurses in rural Norway feel equipped to address overweight and obesity within these guidelines.

Providing culturally and linguistically appropriate rehabilitation services to older Indigenous adults is challenging, particularly within rural and remote settings. This article describes the community participatory action research process used to develop and evaluate a Community Rehabilitation Worker program to serve First Nation elders in Treaties 5 and 9, Canada. The resulting curriculum, which incorporates culture, spirituality, traditions, local language, and reintegration of elders into the community, is now being implemented. The authors reflect on the importance of a participatory approach when developing programs and services for Indigenous peoples.

Adolescent pregnancies are a major public health concern in low- and middle-income countries, affecting more than 20 million girls under 19 years of age globally every year and potentially causing poor health outcomes for mothers and infants. In Turkey, due to the country’s cultural structure, social norms and traditions, minor marriages and adolescent pregnancies continue to be widely seen in some regions. This study determined changes in anxiety, depression and perceived social support in pregnant adolescents after provision of a Psychosocial Support-Based program in rural eastern Turkey.

In the remote Kimberley region of Western Australia, the prevalence of dental disease is significantly higher than other regional centres. Access to timely dental care for remote Aboriginal communities remains a challenge and is both a state and national priority, but establishing permanent full-time dental services is generally not considered viable nor sustainable because of the vast, remote and sparsely populated  area. As a result, the Kimberley Dental Team, a non-government, volunteer-led organisation, was established by community invitation to ‘fill the gaps’ and extend dental care to areas of unmet need. This paper describes the development, resources, operational factors and organisational characteristics of the Kimberley Dental Team.

Bites by venomous snakes, recognised as a high-priority neglected tropical disease by the World Health Organization, are the cause of more than 64,000 deaths annually in India. Extensive spread of COVID-19 meant action to address the pandemic (diversion of health system resources, mobility restrictions and economic impacts) took precedence over action on other health conditions, including snakebite. This study collected facility-level data from multiple health facilities to quantify the effect of containment measures for COVID-19 on snakebite care in several rural areas in India.

Maldistribution and retention of health professionals in underserved areas are global problems, and burnout is one reason that health professionals leave rural areas. Nurses are the frontline health workforce and are critical in a health service facility. National Indonesian regulations have a target of 180 nurses per 100,000 people, but several rural provinces do not meet this target. Chronic burnout is linked to depression, and nurses have a higher risk of depression than the general population. This article reports on resilience and depression in Indonesian nurses and finds that the resilience profiles of Indonesian nurses differ from those of doctors, so tailored approaches are required to support nurses, improve resilience and improve workforce retention.

Rural areas worldwide face a continued shortage of suitably trained workforce to deliver healthcare services. In Papua New Guinea, workforce shortages are a continuous stressor on the delivery of healthcare services, including in the allied health professions, which are in their infancy in terms of provision of university-qualified practitioners. This study used a survey and focus group of University of Papua New Guinea Bachelor in Medical Imaging Science (BMIS) students to explore factors influencing choice to pursue rural radiography careers.

This Editorial shares lessons from the National Rural Health Association’s Rural Health Equity Conference and 46th Annual Rural Health Conference, San Diego, California, USA in May 2023.

The COVID-19 pandemic was a major public health challenge for island communities. A peer support group was set up across British islands, led by Directors of Public Health, with the aim of using an action research approach to identify and share learning to inform aspects of the management of COVID-19 that were unique to island communities. This Project Report investigates the key public health lessons that can be learned from the COVID-19 pandemic across island communities around Britain.

This Letter to the Editor responds to a Scoping Review published in RRH Vol. 23, Issue 1 titled 'The safety of anaesthesia delivered by rural generalist anaesthetists: a scoping review of the literature' (https://doi.org/10.22605/RRH7358). The present authors draw attention to broader issues related to anesthesia services in remote areas, including the need for generalist rather than specialist providers in rural environments. They identify the need to involve local multidisciplinary healthcare teams in exploring options to improve anesthesia services in rural areas, and highlight the impact of lack of access to care when key services are withdrawn.

China has the heaviest burden of stroke in the world, and this burden has increased in the past 30 years. Stroke outcomes are worse in rural areas than in urban areas as a result of poorer living conditions but also because of the time it takes to access time-sensitive treatment. Rural and regional clinics and hospitals often lack the necessary imaging equipment and there is often a long travel distance to access appropriate care. Using data available in patient records, this Original Research article reports on the time lags from the onset of stroke symptoms to arrival at a stroke center for two archipelagic regions in China: main island (urbanized) and outer islets (rural).

Severe mental disorders (eg major depressive disorder, bipolar mood disorder, schizophrenia and other psychotic disorders) affect 4% of the adult population globally and account for 26.1% of reported mental disorders in South Africa. Informal caregivers are the backbone of recovery for persons with severe mental disorders, particularly in rural areas where access to mental health services is limited. This article reports on the extent of subjective and objective burdens among informal caregivers of persons with severe mental disorders in rural South Africa.

This unique population-based study explored the role of wage differentials among allied health professionals across urban, rural and remote settings. Important imbalances were found in the gender and geographic distribution of the allied health workforce, although the impact of wage was not demonstrated as a financial incentive for rural and remote practice. This paper adds considerably to the rural healthcare literature by focusing on AHPs, a critical asset for the healthcare system.

In general practice, technical procedures have many areas of application, including prevention (eg vaccination or cervical smear), diagnosis (eg group A streptococcus testing), and treatment (eg wound dressing). These procedures require specific skills that are based on both knowledge and manual abilities. Along with communication, knowledge, clinical reasoning, emotions, values and reflection, technical skills are a dimension of medical competence and a part of the general practice curriculum in many countries. Lists of core technical procedures have been developed in Canada, the USA and Australia to serve as bases for training general practice students, but none is currently available in France. This study uses data collected as part of the ECOGEN study from 20,613 patient–GP encounters in rural and urban locations to describe the frequency and type of technical procedures in French general practice.

Rural populations routinely rank more poorly than urban populations on common health indicators. Although the complex interplay of various social determinants of health may partially explain this, some of this disparity may result from unique challenges healthcare providers face in rural settings. This Original Research article identifies several multidimensional barriers to healthcare access by patients and provision by healthcare providers in rural western Pennsylvania, USA. Patients experience cost-related barriers, more providers are needed to combat workforce shortage and burnout, and care delivery methods such as telehealth, satellite clinics, or advanced practice providers can help bridge the gaps caused by geographic dispersion. The authors recommend that policy efforts target all these aspects to appropriately address rural healthcare needs.

With the worldwide shortage of physicians living and practicing in rural and remote areas, it is important to understand better the nature of rural practice. A recent study that investigated the lived experience of rural doctors introduced the concept of clinical courage: a rural doctor’s adaptability and willingness to undertake clinical work at the limits of their training and experience to meet the needs of their patients. This article describes the steps taken to develop a sound clinical courage questionnaire and presents the questionnaire, ready for testing with rural clinicians and refinement.

Kowanyama, a very remote community in Cape York, northern Queensland, has a very high burden of disease and is ranked among the top five most disadvantaged communities in Australia. The community has access to 2.5 days per week of fly-in, fly-out GP-led Primary Health Care (GPLPHC) for a population of 1200 people. All patients requiring higher-level health care undergo aeromedical retrieval to a larger centre. This Short Communication reports that, on the basis of a clinical audit of aeromedical retrievals in 2019, greater access to GPLPHC may lead to fewer retrievals/hospital admissions for potentially preventable conditions and it might be cost-effective and improve patient outcomes to have a full-time on-site Rural Generalist GP-led service in this and other remote communities.

Attracting and retaining healthcare workers in remote and rural areas is still a global challenge, but is critical for achieving sustainable development goals. In Indonesia, to meet the target of universal health coverage, the government has established the National Social Security System – Healthy Indonesia Card with the Social Security Administering Agency managing health insurance and services for the community. To support this, it is necessary to have an equal distribution of health workers, including specialist doctors in hospitals. This Original Research study analyses the contextual factors that influence the retention of specialist doctors in rural Indonesia.

Nurses are often on the frontline of disaster management, providing care to patients with physical, mental, and emotional turbulence and acting as educators for disaster prevention. However, the literature suggests that nurses are underprepared to respond to disasters. This study examined the preparedness for disaster response among nurses in rural and urban primary healthcare settings in Tanzania. The results suggest that nurses are poorly prepared for disaster responses, while those in rural settings are at a great disadvantage.

Delivering high-quality medical education in rural areas is of critical importance for producing skilled graduates who may be more inclined to later practice rurally. However, little attention has been given to understanding how rural clinical training may impact patients, host organisations, and rural communities where students undertake their training, despite engagement from these stakeholders being crucial to the success of rural training opportunities. This article describes how a series of consecutive student placements in a single practice of a small rural community have driven a series of clinical audits and interventions that continuously fed into the next placement, resulting in improved management of chronic disease. This evidence is important in demonstrating the impact that rural clinical training can have on health care and local health outcomes, while maintaining a high-quality student experience, and for identifying the program elements contributing to its success so that similar strategies can be more widely adopted.

The SARS-CoV-2 (COVID-19) pandemic brought about instability in healthcare providers worldwide, including in rural settings. In 2020, non-urgent elective care was suspended to free up hospital capacity in response to the pandemic. This Original Research article reports on the impact of COVID-19 on the surgical services offered at the Balfour Hospital, Orkney Islands, Scotland.

People residing in rural areas of New Zealand have poorer health outcomes than those living in urban areas and this is accentuated for Māori. Internationally, in high income-countries, rural hospitals have been recognised as important healthcare providers, improving access to and integration of health services for rural communities. It is estimated that around 15% of New Zealanders rely on rural hospitals for health care, but there is no current description of rural hospital services and little published research regarding their role or value. This Original Research article presents the results from an exploratory study of the perspectives of rural hospital leadership on the place of rural hospitals in the New Zealand health system.

Transgender patients experience a myriad of barriers to accessing health care and receiving high-quality, non-discriminatory care. In rural Appalachia, people with intersectional identities often have limited choices in providers along with other systemic barriers to obtaining competent and safe health care and experience increased risk of poorer health outcomes. This article reports on the development and implementation of a transgender healthcare provision training program for rural-serving medical residents in primary care in South Central Appalachia.

Although the output from health training institutions is increasing in most low-resource settings, the rural workforce availability remains low and suffers frequent rural–urban attrition. Improved retention – having healthcare workers stay longer in the post – is likely to alleviate the crisis. We interviewed healthcare workers and policymakers in Malawi and Tanzania to explore their perspectives on factors affecting retention. While policymakers’ views centred around the national-level retention policies, health workers considered the welfare of families and the immediate community more important in deciding to stay or relocate from a post. This article highlights the need to align retention policies with healthcare workers’ expectations.

In Papua New Guinea (PNG), tuberculosis (TB) is the leading cause of death from an infectious agent and many cases are multidrug-resistant. Optimising models of care for TB patients living in the Torres Strait/PNG international border region has been particularly difficult; geographical, geopolitical and socioeconomic challenges in the region have created healthcare disparities that affect diagnosis, referral pathways, treatment and management of TB patients. Delays between symptom onset and commencement of effective treatment contribute to ongoing TB transmission. This study assessed improvements in time to commencement of effective treatment in patients diagnosed with drug-resistant TB in the Torres Strait/Papua New Guinea cross-border region.

Poor mental health is under-recognised in rural locations. Although the prevalence of mental disorders is similar in rural and urban areas, suicide rates are 40% higher in rural communities. The level of readiness and engagement of rural communities to adapt to, or even acknowledge, poor mental health can impact effective interventions. This Review examines how community engagement, participation and empowerment were used in the development and implementation of interventions aimed at improving mental health of adults residing in rural communities of the USA, UK and Guatemala.

Despite the availability of preventive medication, tuberculosis (TB) kills millions of people every year. People in vulnerable populations (eg people with HIV/AIDS, health professionals, and those living in poverty) in low and middle-income countries are at particularly high risk. Practical public health strategies are required to effectively reduce the global TB burden. TB infection control measures emerged as a potential preventive public health strategy to prevent TB transmission in a health setting and spreading into the community. This review examined the current evidence for tuberculosis infection control measures, including administrative, environmental, and respiratory controls, in reducing TB transmission and explored the barriers and enablers of these measures in resource-constrained primary healthcare settings.

Debriefing following a critical incident is utilised across many different fields, including the military, aviation and health care, and is associated with clear benefits for team performance. Healthcare professionals working in rural and remote areas face a variety of unique barriers that may make debriefing challenging. This Commentary presents an example that illustrates the complexities of a critical incident in a remote service and outlines evidence-based strategies to support team members in rural and remote areas to debrief effectively, including the use of technology, formal teaching in university curriculums and regular practice via simulation.

Significant policy initiatives have been implemented in Australia to ensure people in rural and remote areas have appropriate access to health services, with increasing interest in allied health. The allied health focus has been centred on pharmacy and physiotherapy so far, and there is limited evidence about the role osteopathy plays in rural and remote populations. In Australia, osteopaths are university-trained and government-registered allied health professionals who manage predominantly musculoskeletal complaints using manual therapy, exercise and patient education. This Short Communication reports on the demographic, practice, and clinical management characteristics of Australian osteopaths in rural and remote settings.

This research reports on patient and community physician satisfaction with a teleneurology program that provided consultations to 14,241 patients at 12 community-based hospitals between 2014 and 2021. Results show high levels of satisfaction with using tablet technology for teleneurology consultation.

Australians living in regional and remote communities face several barriers when accessing health care. Voluntary assisted dying (VAD), presents a new challenge for these communities. Western Australia is the second Australian state to implement VAD laws and, to date, is the jurisdiction with the greatest need to address such inequities due to its vast geography. This article identifies and explores initiatives introduced during the law-making and implementation stages of the law reform to address regional and remote access inequities.

Universal access to health services and universal health coverage are needed to achieve good health for all, yet rural communities face a variety of access barriers. As part of an effort to 'rural proof' health systems, it is therefore imperative to identify and act on the factors limiting access to health services by rural and Indigenous communities. This article provides a comprehensive overview of the wide range of access barriers faced by rural and remote communities and discusses the potential for barrier assessments to contribute evidence for rural proofing of national health policies, strategies, plans and programs.

The general principles of healthcare quality are well articulated internationally, but less has been written about applying these principles to rural contexts. Research exploring patient and provider views of healthcare quality in rural communities is limited. This study investigated what was important in healthcare quality, particularly for hospital-level care, for rural New Zealand communities.

In this Letter to the Editor, which responds to an article recently published in Rural and Remote Health titled ‘The impact of politics, religion, and rurality on COVID-19 vaccine hesitancy in Oregon: a cross-sectional study'(https://doi.org/10.22605/RRH7140), the authors further consider the influence of politics, race, education, social network and religion on individual views on COVID-19 and vaccination and the role of doctors and medical scientists in this new paradigm.

Despite policies aimed at universal health coverage by ensuring availability and accessibility of general practitioners (GPs), medically underserved areas (or ‘medical deserts’) are still present in Europe. This systematic review summarizes and compares literature on interventions and their potential effectiveness in GP recruitment and retention in these underserved areas.

The supply of new general practitioners (GPs) sufficient to meet the population’s health needs, particularly in rural and remote areas, continues to be a major global workforce distribution challenge. In Australia, despite substantial investment in rural workforce support, insufficient medical graduates are choosing a general/rural practice career. Medical training at postgraduate level remains strongly reliant on hospital experience in larger hospitals, potentially diverting interest away from general/rural practice. The Rural Junior Doctor Training Innovation Fund (RJDTIF) program offered junior hospital doctors (interns) 10 weeks in a rural general practice, aiming to increase their consideration of general/rural practice careers. This study evaluates the educational and potential workforce impact of the RJDTIF program.

Access to ultrasound imaging services is limited in rural areas and point-of-care ultrasound (POCUS) has the potential to reduce this gap. This exploratory study assessed how POCUS is utilised by doctors in contemporary Australian rural general practice. Doctors reported limited confidence for certain scans and used POCUS predominantly for obstetric indications. Attention to the barriers to POCUS utilisation is needed to realise the potential benefits for the health of rural communities.

People do not receive regular dental care for several reasons. This may result in tooth loss and other health effects. Dental care may be a bigger challenge in rural settings, where there are several barriers to care. This study used Behavioral Risk Factor Surveillance System (BRFSS) data and examined dental visits and tooth loss for US Indigenous American Indian/Alaska Native (AI/AN) adults in rural vs. urban settings. In adjusted analyses, AI/AN adults in rural vs. urban settings had a similar frequency of dental visits in 2020 with 33% higher odds of having missing teeth. The author recommends interventions to maintain teeth in AI/AN adults in rural settings.

Rural generalist anaesthetists (RGAs) are central to the delivery of elective and emergency anaesthesia and the acute care of critically unwell patients in much of rural and remote Australia. Without a well-trained RGA workforce of sufficient numbers, Australia would struggle to provide anaesthetic services outside of urban locations or make viable other crucial healthcare services that are reliant on anaesthetic support such as obstetrics, surgery, emergency medicine and critical care. This paper details a systematic review of the literature specifically asking the question: ‘What is the current evidence of the ‘safety’ of anaesthesia delivered by RGAs?’

Every year, an estimated 15 million infants are born preterm worldwide. Women residing in rural and remote areas of Australia experience increased rates of adverse perinatal outcomes and are at almost twice the risk of having a preterm infant than women residing in major cities. Mortality and morbidity rates are higher for preterm infants born in non-tertiary centres, thus women are generally transferred to metropolitan tertiary centres to give birth. This study investigates the experiences of women from rural areas who have had a preterm infant admitted to a neonatal intensive care unit.

Various reactions of the body are activated during stress, including activation of the hypothalamo-pituitary-adrenal endocrine axis and the autonomous nervous system. This activity can be assessed by the measurement of biological stress marker molecules – salivary α-amylase and cortisol – as well as heart rate, and blood pressure monitoring. This article reports on the stress levels produced by the daily professional routines of rural general practitioners in Bulgaria.

Bootheel Counties (Dunklin, Mississippi, New Madrid, and Pemiscot) experience some of the worst health outcomes in Missouri. In this study, a collaborative team of academics, practice partners and community health workers were engaged in a participatory strategy development process to identify social and organizational determinants of accessing health care in the Bootheel counties and to collectively prioritize identified issues and develop strategies for change. Participants identified several individual, social, community, and organization-level barriers to accessing health care, including cost, lack of transportation, lack of information about services, lack of coordinated care, lack of trust, and racism and classism in local healthcare systems.

Remote delivery of assessment, consultation, and therapy via digital communication technologies in mental health services is important in rural locations, and has rapidly increased due to the COVID-19 pandemic. This study investigated the factors that should be considered in the development and evaluation of digitally-mediated service provision for children and young people with social, emotional, and mental health (SEMH) needs.

This conference declaration, the Limerick Declaration on Rural Health Care, an outcome of the 19th World Rural Health Conference in Limerick, Ireland in 2022, is designed to inform rural communities, academics and policymakers how to achieve the goal of delivering high quality health care in rural and remote areas most effectively, with a particular focus on the Irish healthcare system. Congruent with current evidence and best international practice, the participants of the conference endorsed a series of recommendations for the creation of high quality, sustainable and cost-effective healthcare delivery for rural communities in Ireland and globally.

Chagas disease (CD), a devastating infectious disease caused by the protozoan parasite Trypanosoma cruzi, affects 6 to 7 million people worldwide, with 30,000 new cases reported each year. CD is endemic to 21 Latin American countries, but has spread more widely in recent decades. In Latin America, CD is spread most often via the feces of the 'kissing bug', which can infest housing, particularly in poorer rural areas. Prevention programs therefore often focus on the interruption of household transmission. This study evaluates current knowledge of CD among youth in the three communities of southern Ecuador.