Rural and remote health最新文献

{"title":"Barriers to oral health service access for rural and remote Australian children: a mixed-methods systematic review.","authors":"Hanin Bakhaider, Somayyeh Azimi, Marc Tennant, Estie Kruger","doi":"10.22605/RRH10305","DOIUrl":"https://doi.org/10.22605/RRH10305","url":null,"abstract":"<p><strong>Introduction: </strong>Children living in rural and remote communities experience challenges in dental care access. While several studies have reported barriers contributing to inequalities in services utilisation, a synthesis of evidence is lacking for those underserved children. In this review we explore the barriers and challenges to accessing oral health services among children and families living in rural and remote Australia.</p><p><strong>Methods: </strong>This review followed the Joanna Briggs Institute methodology for mixed-methods systematic review. We structured our review question using the PICO framework (population: children and their families; phenomena of interest: barriers to oral health service access; context: rural and remote Australia). We conducted a comprehensive literature search across multiple databases, including Medline, Scopus, and Web of Science from December 2024 to January 2025 with no publication-date restrictions. We used the following keywords and Medical Subject Headings: 'children/paediatric', 'barriers', 'accessibility', 'oral/dental health', 'rural/remote areas', and 'Australia'. We complemented database searches with screening the reference lists of included studies and hand-searching in Google Scholar and relevant websites (Australian Institute of Health and Welfare, Australian Bureau of Statistics, and World Health Organization). We included qualitative, quantitative, and mixed-methods studies that reported barriers to children's oral health services in rural and remote Australia (including Indigenous and non-Indigenous populations). We excluded studies conducted outside Australia, letters to the editor, conference abstracts, opinion articles, and studies on medically compromised children. We imported articles into Covidence for de-duplication, screening, and data extraction by two independent authors. We assessed methodological quality using Joanna Briggs Institute critical appraisal tools and synthesised evidence using a convergent integrated mixed-methods approach.</p><p><strong>Results: </strong>This review included 31 studies: 12 qualitative, 17 quantitative, and 2 mixed methods. Using the ecological model framework, we organised the barriers into four levels: system, policy, community, and individual. At the system level, geographic distance, limited service availability, and the cost of dental care emerged as significant barriers. At policy level, barriers were restricted access to water fluoridation and insufficient government financial support for oral health care, compared with other health services. At the community level, the impact of social determinants of health, along with the historical cultural oppression, colonisation, and loss of land, reduced both utilisation and confidence in oral health services. At the individual level, low oral health literacy, lack of dental insurance, fear, anxiety, and the presence of multiple competing priorities further discourage care-seeking.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"26 2","pages":"10305"},"PeriodicalIF":2.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic evaluation of maternal healthcare services for Indigenous and rural people: a systematic review.","authors":"Ahmad Akmal Ahmad Nizam, Leny Suzana Suddin, Khalid Ibrahim","doi":"10.22605/RRH10468","DOIUrl":"https://doi.org/10.22605/RRH10468","url":null,"abstract":"<p><strong>Introduction: </strong>Indigenous and rural populations worldwide continue to face persistent maternal health inequities driven by geographic isolation, cultural barriers, socioeconomic constraints, and historical mistrust of healthcare systems. While targeted maternal health programs have been implemented, there remains limited evidence on their economic effectiveness. This systematic review was conducted to assess the cost-effectiveness of antenatal, intrapartum, and postnatal interventions in Indigenous and rural contexts, with the goal of informing resource allocation and policy reform. This is the first comprehensive global synthesis of full economic evaluations in Indigenous and rural maternal health.</p><p><strong>Methods: </strong>Following PRISMA 2020 guidelines, we searched six major databases (PubMed, Cochrane Library, International Health Technology Assessment Database, ProQuest, Cost-Effective Analysis Registry, and Centre for Reviews and Dissemination) and relevant grey literature for full economic evaluations published between January 2004 and April 2025. Eligible studies had to report both costs and health outcomes for maternal health interventions in Indigenous and/or rural populations. Titles, abstracts, and full texts were screened independently by two reviewers, with disagreements resolved by consensus. Data were extracted using a piloted template and assessed for methodological quality using the CHEC (Consensus Health Economic Criteria)-Extended checklist, while risk of bias was appraised using the Bias in Economic Evaluation tool. Costs were converted to 2024 US dollars and adjusted for purchasing power parity to allow cross-country comparison. Due to heterogeneity in interventions and outcomes, findings were synthesised narratively and grouped by intervention type.</p><p><strong>Results: </strong>From 1095 records, 42 studies reporting 50 full economic evaluations across 25 countries met inclusion criteria. The majority were cost-effectiveness analyses (n=30) or cost-utility analyses (n=15). Over half of the included evaluations scored ≥95% on the CHEC-Extended tool, indicating strong methodological rigour, although limitations were noted in the frequent use of narrow healthcare payer perspectives and incomplete sensitivity analyses. Five main categories of intervention emerged: community-based and culturally adapted models, such as participatory women's groups and birthing on Country; clinical and diagnostic innovations, such as misoprostol distribution for postpartum haemorrhage prevention and rapid syphilis screening; health system strengthening strategies, including ambulance services, emergency obstetric referrals, and mentorship programs; digital and mobile health tools; and financial incentives, particularly when integrated with quality improvement measures. Incremental cost-effectiveness ratios ranged from 8.52 to 2001 per disability-adjusted life year averted.</p><p><strong>Conclusion: </strong>Cultur","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"26 2","pages":"10468"},"PeriodicalIF":2.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147676366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From outback to operating room: aeromedical retrieval and management of open-fracture trauma patients in Western Australia.","authors":"David Robertson, Christine Grobler, Kiran B Venkatesulu","doi":"10.22605/RRH10044","DOIUrl":"https://doi.org/10.22605/RRH10044","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with open-fracture injuries represent a high-risk cohort and require timely management to reduce complications such as infection, non-union and chronic pain. Early antibiotics and definitive surgical care are key interventions that improve outcomes. In Western Australia (WA), vast distances and limited access to healthcare services outside the metropolitan area can result in delays to treatment and necessitate aeromedical retrieval. This study compares the management of open-fracture patients presenting directly to the state major trauma centre, Royal Perth Hospital (RPH), versus rural/remote patients retrieved by the Royal Flying Doctor Service Western Operations (RFDSWO).</p><p><strong>Methods: </strong>A retrospective audit was conducted on open-fracture patients presenting to RPH in 2023. Patients were divided into primary presentations (direct to RPH, n=60) and secondary presentations (RFDSWO retrieval, n=30). Data collected included demographics, injury characteristics, antibiotic dosing, and timings such as time of injury, first healthcare contact, retrieval, arrival at RPH and first operation.</p><p><strong>Results: </strong>Secondary presentations were retrieved from a median distance of 1246 km. The median time to retrieval was 14 hours, with 73% retrieved within 24 hours of injury. This prolonged retrieval time was reflected in the median time from injury to arrival in RPH emergency department, which was 1.5 hours for the primary presentation group and 19.5 hours for the secondary presentation group. Median time to surgery was also longer in the secondary presentation group (19.5 hours v 36.3 hours) as well as median time from injury to antibiotic administration (2.7 hours v 11.1 hours). Cefazolin as a first-line antibiotic was appropriately given in 92% of cases; however, patients rarely received the recommended broader spectrum antibiotics for severe or contaminated wounds.</p><p><strong>Discussion: </strong>The observed delay in provision of appropriate antibiotics and definitive surgical management stems from geographic and resource challenges experienced in WA's rural and remote areas. This is further complicated by prolonged time to initial healthcare contact as well as extended retrieval times. Current guidelines do not consider the isolated and low-resource environments that are present in much of WA. New RFDSWO clinical guidelines have been developed for the management of open fractures, including emphasis on the importance of early and appropriate antibiotics as well as a protocol for the use of RFDS medical chests stocked with oral antibiotics to bridge delays to IV antibiotics.</p><p><strong>Conclusion: </strong>Given the vast size and sparse population of WA, rural and remote patients with open fractures face delays to crucial interventions when compared to similar patients presenting to a metropolitan trauma hospital. Enhancing early antibiotic administration protocols and educat","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"26 2","pages":"10044"},"PeriodicalIF":2.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical cancer screening uptake and its determinants among rural women in North Central Nigeria: a cross-sectional study.","authors":"Samuel Azubuike, Maryam Adamu","doi":"10.22605/RRH10433","DOIUrl":"https://doi.org/10.22605/RRH10433","url":null,"abstract":"<p><strong>Introduction: </strong>Cervical cancer is the third most common cancer in Nigeria, with 13,676 new cases and 7093 deaths in 2022 (according to GLOBOCAN estimates). Cervical cancer survival is poor in Sub-Saharan Africa, with nearly half of diagnosed women dying within 3 years. Most cases occur in women aged 15-44 years, resulting in significant social, economic, and psychological consequences. Despite this disease being preventable and curable when detected early, many Nigerian women present at advanced stages due to low awareness, misconceptions, and limited screening. Previous studies have been largely hospital-based or limited in scope. This study assessed knowledge, attitude, and screening uptake of cervical cancer among rural women in North Central Nigeria and identified significant predictors of these outcomes.</p><p><strong>Methods: </strong>A community-based cross-sectional study was conducted in Omala local government area, Kogi State, Nigeria between September and October 2023. Using multistage sampling, 416 women aged 15 years and above were recruited from four rural communities to ensure representativeness. Data were collected by trained interviewers through a semi-structured, pretested questionnaire administered by face-to-face interviews or self-completed depending on literacy levels. The instrument included sociodemographic variables, four domains of knowledge (general, risk factors, signs/symptoms, screening), attitude assessed on a five-point Likert scale, and uptake of cervical cancer screening. Consolidated knowledge scores were calculated and categorized as poor or fair/good. Willingness to undergo screening was categorized as 'yes', 'no' and 'not sure'. Logistic regression models were fitted to identify independent predictors of knowledge, attitude, and uptake, with results expressed as odds ratios (ORs) and 95% confidence intervals (CIs). Ethics approval was obtained from the National Open University of Nigeria, and informed consent was secured.</p><p><strong>Results: </strong>Most participants were 40 years or less (71.7%) and married (58.2%). Overall, 41.7% had fair/good consolidated knowledge of cervical cancer, with substantial variation across domains: general knowledge (59.2%), knowledge of risk factors (15.5%), knowledge of signs and symptoms (26.8%), and knowledge of screening (45.2%). Only 42.3% recognized HPV infection as a risk factor, while fewer than one-third recognized intermenstrual or postcoital bleeding as symptoms. Mass media (36.7%) and hospitals (26.6%) were the most common sources of information. The median attitude score was 3.3, with positive attitude expressed toward the curability of cervical cancer if detected early and to the effectiveness of Pap smears and vaccination. Nonetheless, only 12.2% of women reported ever undergoing screening although 36% expressed willingness to undergo a screening test. Reported barriers included lack of knowledge about the test (23.3%), absence of symptoms","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"26 2","pages":"10433"},"PeriodicalIF":2.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distributed learning as a means of delivering socially accountable medical training.","authors":"Steven Lillis, Rawiri Keenan, Joseph Scott-Jones, David McCormack, Ross Lawrenson, Lara Oertly","doi":"10.22605/RRH9583","DOIUrl":"10.22605/RRH9583","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"26 1","pages":"9583"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147435189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The feasibility of an early-years motor skill school-based intervention research project in a low-resource area of South Africa.","authors":"Janke van der Walt, Arifa Sheik Ismail, Marianne Unger, Lyndsay Adamson, Alyssa Isaacs, Winita Jansen van Rensburg, Nonhle Nkambule, Jenna Petersen, Nicola Ann Plastow","doi":"10.22605/RRH9883","DOIUrl":"10.22605/RRH9883","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Innovative, inclusive and resource-efficient screening and intervention methods are essential to address motor skill impairment among preschool children and prevent long-term consequences. This study explores the feasibility of implementing a unique motor skill program for preschool children in low-resource rural areas of South Africa, addressing the heightened risk of motor skill impairment in this demographic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Employing a quantitative pre-post quasi-experimental design with convenience sampling, the research involved assessing children using the second edition of the Movement Assessment Battery for Children (MABC-2) to evaluate their motor skills. Key objectives included assessing the program's recruitment, consent, attrition, adherence, and attendance rates, alongside determining its effect on motor skills. Children who scored less than the 5th percentile of the MABC-2 total score were included in the study and schools were randomly assigned to an intervention and control group. The Hopscotch program was facilitated by an occupational therapist over 8 weeks. Two weekly group sessions focused on gross and fine motor skills through obstacle courses, ball games and craft activities. All participants in the groups were re-assessed following the intervention. The control group received the same intervention following the post-assessment. Quantitative attendance checklists were analyzed to determine consent, assent, attrition and attendance rates. The feasibility of the MABC-2 as a data collection instrument and outcome measure was reported according to test completion rate and cost. The initial effect of the program was determined through analysis of the pre-and post-intervention MABC-2 scores using descriptive statistics while independent samples t-test were used to determine statistically significance of between-group differences. The minimal important difference (MID) for MABC-2 scores was considered to determine the clinical significance of the results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The results revealed a high consent rate (98.08%) and a 0% attrition rate, with significant attendance at program sessions (93.75%). While independent samples t-tests indicated no statistically significant differences in motor skill improvements between the intervention and control groups, analysis considering the MID demonstrated clinically significant improvements in overall motor skill proficiency and balance for the experimental group. The cost of the MABC-2 exceeded the planned budget and amounted to 77% of the total study cost. The duration for testing was one school morning for each pre- and post-test when done by five researchers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The study highlights the feasibility of conducting intervention research in low-resource settings. It notes the challenges of using the MABC-2 due to its cost and time requirements and reports on the initial effect of the program ","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"26 1","pages":"9883"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147356167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strengthening harm reduction services for Aboriginal and Torres Strait Islander people who inject drugs: a reflexive assessment using the CONSIDER statement.","authors":"Emily Pegler, Gail Garvey, Lisa Fitzgerald, Eddie Fewings, Amanda Kvassay, Daniel Morris, Geoff Davey, Diane Rowling, Nik Alexander, Andrew Smirnov","doi":"10.22605/RRH9519","DOIUrl":"10.22605/RRH9519","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Accessible, culturally responsive, and high-quality harm reduction services, including needle and syringe programs and regional services, are essential for addressing disproportionate rates of blood-borne viruses (BBVs) and STIs among Aboriginal and Torres Strait Islander people who inject drugs. However, there is limited understanding of stakeholder perspectives to guide service design, and this is exacerbated by limited engagement with Aboriginal and Torres Strait Islander people who inject drugs. This project used the CONSolIDated critERia for Strengthening the Reporting of Health Research Involving Indigenous Peoples (CONSIDER statement) domains to critically reflect on this project's research design and governance, as a foundation for increased stakeholder engagement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The research was a partnership between university-based researchers, Aboriginal and Torres Strait Islander community-controlled health organisations, and community-based harm reduction services. Participants were Aboriginal and Torres Strait Islander people who had injected drugs within the previous 12 months, recruited at needle and syringe progams in two regional sites, and one major city in Australia. Meeting notes, stakeholder feedback from fieldwork activities, correspondence with research partners, and stakeholder interviews were analysed using a reflexive thematic approach and the 17 CONSIDER statement domains.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Using the CONSIDER statement as a reflexive tool, we identified establishing equal research governance and partnerships with Aboriginal and Torres Islander organisations and people helped ensure that our research processes and activities honoured cultural safety and meaningful engagement with communities. Collaborating with local service providers, we identified community-led strategies for developing culturally safe and accessible harm-reduction programs, supporting participant recruitment, establishing treatment referral pathways, and adapting research to community priorities. Preliminary stakeholder interviews provided a safe space for service providers and a consumer representative to voice their perspectives on service and policy development to address community needs and offer their advice on research activities. To date, positive outcomes of the project include capacity-building opportunities for stakeholders and Aboriginal project team members to exchange cultural knowledge, develop research skills, and present findings at conferences and policy forums.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Researchers identified that project timelines should be flexible and adapt to community events and circumstances. Future research should allow feasible time frames for consultation with local health services and service providers. Engaging with research projects can be challenging for people with lived experience; it is recommended that researchers engage meaningfully and tran","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"26 1","pages":"9519"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147356102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urban and rural inequities in end-stage kidney disease: a 7-year (2012-2018) random-effects panel study of healthcare access and catastrophic expenditure.","authors":"Sun Mi Shin","doi":"10.22605/RRH10113","DOIUrl":"10.22605/RRH10113","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"26 1","pages":"10113"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining rurality: evaluating the options for the development of a new regional-rural admission scheme for professional medical programs at the University of Auckland.","authors":"Jessie Colbert, Kyle Eggleton, Daniel J Exeter","doi":"10.22605/RRH9712","DOIUrl":"10.22605/RRH9712","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Pathways aimed at increasing the medical workforce in regional and rural areas in Aotearoa New Zealand have been implemented in universities, such as the Regional and Rural Admission Scheme (RRAS) at Waipapa Taumata Rau | The University of Auckland, to address urban-rural variations in health outcomes. A recent review of the university's scheme suggested the program was not providing equitable opportunities for students from a rural background as originally intended. Therefore, an updated RRAS was required to be developed to address these inequities, creating a more genuine scheme that may more strongly contribute to developing the regional and rural workforce in New Zealand.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We developed a methodological framework to identify and evaluate candidate rural definitions for the purposes of developing a new RRAS for the university. Following an extensive literature review, we utilised two sets of criteria to select candidate rural definitions, which were then evaluated using visual evaluation (mapping) and exploratory analysis. Candidate definitions were modified to use a three-group (rural-regional-urban) version to be suitable for use as an updated RRAS. We used a de-identified student dataset of applicants enrolled for the MBChB medical program at the University of Auckland from 2017 to 2023 (inclusive) and population counts from the New Zealand 2018 Census to investigate differences in potential admission numbers under each candidate definition. The New Zealand Index of Multiple Deprivation 2018 was used to assess the distribution of potential admission numbers by area-level socioeconomic status. We also examined the suitability of the candidate definitions by ethnicity, specifically for students of M&#257;ori ethnicity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We selected two candidate definitions for exploratory analysis: Geographic Classification for Health (GCH) developed by the University of Otago, and the urban accessibility classification 2020 (UA 2020) by Stats NZ. We found that the three-group modified version of the UA 2020 definition consistently classified a higher proportion of students as regional and rural compared to the current RRAS and the alternative candidate definition, the three-group GCH. The modified UA 2020 was found to classify a higher number of M&#257;ori students and those living in less-deprived neighbourhoods as rural when compared to the other definitions. Therefore, our final recommendation is to update the existing RRAS using a three-group modified version of the UA 2020 by Stats NZ. Our proposed version will refocus attention to address the under-representation of rural students admitted to professional health programs at the University of Auckland, while not disadvantaging regional students.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The updated RRAS will assist in supplementing the future professional rural medical workforce, and subsequently help to reduce heal","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"26 1","pages":"9712"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147521986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pesticide retailers' safety awareness in Türkiye: implications for occupational and environmental health in agricultural settings.","authors":"Nezaket Özpolat Çakar, Ozgur Bilek, Ali K Kenziman, Mahmut S Yardim, Sibel Kıran","doi":"10.22605/RRH10672","DOIUrl":"10.22605/RRH10672","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>This cross-sectional census study was conducted among 435 registered plant protection product retailers in Mersin Province, T&uuml;rkiye. 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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"26 1","pages":"10672"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147475130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}