Rural and remote health最新文献

Aotearoa New Zealand faces an ongoing shortage of GPs (family physicians), disproportionately affecting rural and underserved communities. Although this issue is global, solutions must be context-specific. Traditional medical education pathways in New Zealand have not produced a workforce representative of or committed to serving these populations. This has created a situation where primary health care is increasingly difficult to access, particularly for rural and marginalised communities, with inevitable consequences of poor health outcomes and increased secondary care utilisation. Social accountability as a basic principle of undergraduate medical training has been suggested since the 1990s as a method of solving some of these issues. Distributed learning with a significant portion of experience and training in rural and provincial community primary care practices as well as utilisation of rural and provincial hospitals, embedded within a socially accountable framework, offers an innovative model of medical training. This short communication outlines the rationale for and structure of a proposed new graduate-entry, 4-year medical program in Aotearoa New Zealand that emphasises rural and provincial community-based training. We argue that this model is both urgently needed and potentially generalisable to other nations grappling with similar workforce inequities.

Introduction: End-stage kidney disease (ESKD) imposes a significant financial burden due to its long-term treatment and represents a growing health issue worldwide. Health inequalities arising from urban and rural geographic disparities remain pressing global issues. South Korea operates a universal and inclusive healthcare system aimed at achieving health equity, with catastrophic health expenditure (CHE) widely recognised as a key indicator for measuring the financial burden associated with diseases. This study aims to assess health equity between urban and rural individuals with ESKD by identifying health status, healthcare accessibility, household finances, financial burden, and CHE factors.

Methods: This study utilised longitudinal data comprising 421 observations of ESKD from 105 individuals in the 7-year dataset of the Korea Health Panel (2012-2018). Non-parametric statistics were used for cross-sectional analyses to determine subject characteristics at baseline, and mixed-effects panel logistic regression and linear regression for longitudinal studies accounting for time-varying effects. Additionally, population-weighted analyses were conducted to address potential sampling bias in the panel data.

Results: Among those with ESKD, 34.3% resided in rural areas. Over a 7-year period, the cumulative prevalence of CHE was 24.6% in urban areas, 30.6% in rural areas, and 26.7% overall. Over the 7-year panel data, no significant differences in health status or household financial indicators were identified between urban and rural areas. However, regarding healthcare accessibility, the adjusted odds ratio (AOR) for inpatient utilisation in rural compared to urban areas was 2.72 (95%CI 1.41-5.25). Conversely, the AOR for outpatient use was 0.14 (95%CI 0.02-0.80). After population weighting, the prevalence of CHE (AOR 1.40, 95%CI 1.39-1.42) and the prevalence of impoverishment (AOR 1.56, 95%CI 1.54-1.57) were significantly elevated in rural compared to urban areas. Factors associated with higher CHE prevalence included being female (AOR 1.83, 95%CI 1.02-3.16), lowest household income (AOR 6.55, 95%CI 1.67-25.72), inpatient utilisation (AOR 5.36, 95%CI 2.86-10.03), and being aged 65 years or older (AOR 1.71, 95%CI 0.88-3.31). In the population-weighted analysis, CHE was higher in rural areas than in urban areas (AOR 1.22, 95%CI 1.20-1.23).

Conclusion: Health status and household financial equity between urban and rural individuals with ESKD in South Korea demonstrate positive outcomes of a universal and inclusive healthcare coverage system. Nevertheless, regarding healthcare accessibility, living rurally exhibited lower outpatient and emergency room visits alongside higher inpatient utilisation, indicating greater challenges in CHE. Tailored adjustments to the healthcare system are needed to address the vulnerabilities of rural place.

Introduction: Pesticide retailers occupy a critical position in agricultural systems, acting as key intermediaries between regulatory frameworks and end users. The safety information they provide at the point of sale can substantially influence pesticide handling practices and exposure risks. However, limited evidence exists regarding pesticide retailers' occupational health and safety (OHS) awareness and the factors that shape their communication of safety information to buyers.

Methods: This cross-sectional census study was conducted among 435 registered plant protection product retailers in Mersin Province, Türkiye. Data were collected using a structured questionnaire assessing occupational characteristics, pesticide exposure, use of personal protective equipment (PPE), safety behaviour, safety awareness, and the extent of safety information provided to buyers during pesticide sales. Of the 299 participating retailers, 275 valid responses were included in the analysis (response rate 63.2%). Factors associated with adequate safety information provision were examined using univariate and multivariate logistic regression analyses.

Results: Less than half of the retailers (47.6%) reported providing buyers with adequate information on safe pesticide use, while 40.7% reported inadequate information provision. Higher PPE use, stronger safety behaviour, and greater safety awareness were independently associated with adequate information provision. In contrast, age, sex, professional experience, and pesticide application status were not significantly associated with information sharing. Knowledge gaps regarding legal OHS responsibilities were substantial, despite many retailers operating in legally defined hazardous workplaces.

Conclusion: Pesticide retailers' communication of safety information at the point of sale appears to be driven more by individual safety behaviour and awareness than by professional background or experience. Strengthening OHS awareness and fostering a stronger safety culture among pesticide retailers may enhance risk communication and contribute to safer pesticide use in agricultural settings.

Introduction: Risk management in emergency services in remote or rural areas is vital for ensuring safety and effective care. These settings present complex challenges that demand well-planned, efficient, and swift approaches. Remote locations are defined here as geographically isolated places, with limited, difficult or slow access to services, infrastructures and/or communications. The perception of risk by healthcare professionals in these areas is crucial for informed decision-making and improved service management. This work presents the first study of existing scientific evidence concerning healthcare professionals' perceptions of risks in remote emergency settings.

Methods: A scoping review was conducted in accordance with a previously published protocol, using the Scopus, PubMed, LILACS, Cochrane, CINAHL, and Web of Science databases. The review followed the Population, Concept, and Context framework, focusing on healthcare professionals (population), risk perception (concept), and emergency care in remote settings (context). Studies published in English or Portuguese were considered, with no restrictions on publication date. Eligible study designs included observational, quantitative studies, qualitative studies, and systematic reviews. Data extraction and validation were performed independently by two reviewers.

Results: Based on the inclusion criteria, 26 articles were selected for analysis. The review focused on study objectives, methodological approaches, key hazards examined, primary risk perceptions reported by emergency healthcare professionals in remote settings, perceived challenges, and identified coping strategies.

Conclusion: The analysis revealed that studies predominantly focus on individual risks or fragmented understandings of hazards. Risk assessments are typically based on ad-hoc methods, with an emphasis on clinical judgment and decision-making processes. None of the reviewed articles approached risk assessment using a consequence-probability framework as recommended by internationally accepted standards.

Introduction: Rural health systems depend on family and other unpaid care partners to bridge gaps created by distance, workforce shortages, and limited infrastructure, yet evidence about their delivery-facing roles is dispersed. Therefore, the objective of this study was to map how unpaid caregivers contribute to rural health delivery, identify common enablers and barriers, and summarize reported outcomes for patients, caregivers, and health systems.

Methods: We conducted a scoping review in accordance with PRISMA-ScR guidelines. We searched MEDLINE, Embase, CINAHL, PsycINFO, Scopus, Web of Science Core Collection, and ProQuest from January 2000 to September 2025. Eligible English-language studies examined unpaid caregivers supporting individuals of any age in rural/remote/frontier settings where caregiver activities intersected with health service delivery.

Results: Forty-five studies were included. Eight recurring domains described caregiver work: coordination and navigation; medication and treatment management; telehealth mediation; monitoring and early triage; transport and home or environmental adaptation; cultural and linguistic brokerage and trust-building; palliative, disability, and long-term support; and caregiver competence and burden. Barriers included device gaps, fragmented hand-offs, limited respite, and travel costs. Programs integrating caregivers reported improved adherence, continuity, and earlier escalation.

Conclusion: Unpaid caregivers are important members of rural care teams. Formal recognition, resourcing, and measurement, alongside investments in coordination infrastructure, broadband, respite, and financial supports, are essential for sustainable and equitable rural care.

Introduction: This scoping review mapped the population characteristics, methodologies, content, and publishing trends of primary research focused on rural LGBTQ individuals since the year 2000.

Methods: We conducted a search using Academic Search Ultimate, CINAHL, Embase, MEDLINE, and PsycINFO and uploaded the relevant citations into Covidence. Our inclusion criteria were peer-reviewed journal articles that presented primary data, were published in English since 2000, recruited rural LGBTQ populations in the US, and reported health-related dependent variables by rural LGBTQ populations. From an initial pool of 13,284 articles, 167 met the inclusion criteria after title/abstract and full-text review.

Results: Of the 167 included articles, the majority focused on sexual minority men and adults, and used nationwide samples. Over 80% of these studies were formative in nature. Over half of the articles recruited participants through venue or organization sampling or advertisements on social networking apps. In 30% of articles, investigators self-described the area or population as non-urban. Half of the studies offered individual compensation for participation. The predominant content area was sexual health. Approximately half of the articles were published in journals dedicated to LGBTQIA+ health/studies or HIV/AIDS and other sexually transmitted infections.

Conclusion: The findings from this review have the potential to inform future research, program development, and funding priorities related to rural LGBTQIA+ health locally and globally. We recommend that future studies diversify populations and ages, broaden health topics beyond sexual health, and integrate effectiveness-implementation hybrid designs to ensure that interventions are evidence-based and acceptable, and sustainable in rural contexts.

Introduction: Violence against women is an ongoing and pervasive public health issue. In North America, the rates of intimate partner violence (IPV), sexual violence (SV), and gender-based violence (GBV) increase for those living in rural, remote and Northern (RRN) areas. These individuals face distinct challenges in accessing services; however, to date, no reviews have systematically summarized the scope of evidence on this topic. As a result, there is a need for more research that explores the lived and living experiences of IPV and SV among individuals marginalized by gender in RRN areas.

Methods: The research team conducted a scoping review following the framework outlined by Levac and colleagues to determine the existing evidence on the lived experience of SV and IPV among those marginalized by gender in RRN areas in the US and Canada. The databases Embase, PubMed (including Medline), APA PsycInfo, Web of Science, CINAHL, SocINDEX, ProQuest Dissertation and Theses Global, and LGBTQ+ Source were searched.

Results: The search was conducted by a librarian. Following removal of duplicates 2329 records were screened for title and abstract eligibility. A total of 316 records were retrieved for full-text screening, and 33 records are included in this scoping review. This included 26 records focused on IPV, five on GBV, and two on SV.

Discussion: Overall, the scoping review determined a paucity of research on SV in RRN areas of North America. Most records in RRN areas focus on IPV. There was discrepancy in the terminology used within manuscripts, and some did not include a definition of the concept being written about. It is important for all authors writing about IPV, GV, and SV to provide definitions to assist readers in analyzing the results. Additionally, the recruitment of participants from most research projects within this scoping review centered on services that provide care for those impacted by SV and IPV, which limits recruitment to those who have already sought out assistance. More research needs to be done to engage those who have not sought help, but who have experienced SV. Lastly, rates of IPV, SV, and GBV among Indigenous populations in Canada are higher than in all other populations, yet there was a gap in the literature reviewed regarding the experiences of individuals from this population in RRN areas.

Conclusion: By increasing the voice of victims/survivors in this area, there is potential to advocate for more services, as well as reduce stigma in these areas. Something must be done to decrease the rates of IPV and SV in RRN areas, and further research and knowledge development could be vital in advancing prevention efforts.