Remote Communities Research Articles

Current-use pesticide exposures in remote Inuit communities

ABSTRACT The global use of pesticides is increasing; however, few studies have examined the exposure of current-use pesticide exposure in Inuit populations. Some current use pesticides are also capable of long-range transport, potentially increasing exposures to northern populations. The study aim was to analyse pesticide (chlorophenoxy, organophosphates, and pyrethroid pesticide) biomarker levels in pooled samples from an Inuit population in Nunavik, Quebec. Thirty pooled samples from the Qanuilirpitaa? 2017 survey (Q2017) from individuals aged 16–80 years were included. Creatinine-adjusted arithmetic (AM) were compared by sex, age, and region sub-groups, and geometric mean concentrations (GM) were compared to those in the Canadian Health Measures Survey (CHMS). Most analysed pesticide biomarkers were detected, and PNP (a metabolite of methyl and ethyl parathion), trans-DCCA (a metabolite of pyrethroids), and 3,5,6-TCP (a metabolite of chlorpyrifos) had the highest concentrations. Concentrations in Q2017 were largely similar to or less than CHMS concentrations. Although not significant, there was a general increase in 2,4-D (a chlorophenoxy biomarker), 3,5,6-TCP, 3-PBA (a metabolite of pyrethroids), and trans-DCCA with increasing age. Concentrations were also somewhat higher in females versus males, but these were not significant. Environmental exposures to current use pesticides were detected in Nunavik and concentrations were similar to or less than those in the general Canadian population. Regular monitoring of current use pesticide exposures is recommended given the increasing global use of pesticides.

Analyzing the Public Health Impact of Adopting Telehealth after a Pandemic: A Business Model

Abstract: In response to the global shift in healthcare delivery due to the COVID-19 pandemic, this study investigates the adoption of telehealth technologies and assesses their long-term sustainability within new public health paradigms. Telehealth, accelerated by the pandemic's demands, offers a unique perspective on evolving healthcare delivery methods that emphasize accessibility and efficiency. By employing a mixed-methods approach, which synthesizes quantitative data with qualitative insights from various stakeholders, this research evaluates how telehealth has enhanced the delivery of medical services, especially in remote and underserved communities. Despite challenges related to technological infrastructure and regulatory constraints, our analysis of revenue models and cost-benefit evaluations suggests that telehealth is economically feasible and possesses significant market potential. The findings advocate for robust policy support and technological investment to enhance global telehealth accessibility and implementation. Additionally, the study highlights the necessity of expanding educational training for healthcare professionals to effectively adapt to telehealth systems. These strategic measures are pivotal for promoting the widespread application and sustainable development of telehealth, positioning it as a cornerstone in the future landscape of global healthcare. Continued research is recommended to further refine telehealth models and develop comprehensive frameworks that address emerging healthcare challenges and disparities.

Determinants of Small and Rural Local Governments’ Renewable Energy Program Adoption in Cascadia

Aim: This study aimed to investigate the determinants of renewable energy policy adoption by small and rural local governments in Cascadia. Background: Small and rural local governments currently face many ongoing and numerous new challenges that complicate their task of sustaining current public services and programs. How government officials adapt to these changes can affect the long-term viability of local governments in both the U.S. and Canadian contexts. Objective: This study has examined the presence or absence of renewable energy programs in small and rural local governments in the “Cascadia” region of Canada and the U.S. (British Columbia, Oregon, and Washington). Methods: Using surveys and interviews of Cascadia local government leaders during the summer and fall of 2023, correlates of renewable energy policy adoption have been examined, including cultural, demographic, economic, and political factors. Results: Key findings have indicated cities, experiencing population growth, and those with a progressive political orientation to be more inclined to adopt renewable energy policies. Conversely, remote communities have demonstrated a lower propensity for such adoption. Financial constraints, evidenced by the impact of inflation and the necessity for service cutbacks, have been found to negatively correlate with the consideration of renewable energy policies. Conclusion: This study has indicated renewable energy projects to be more often found or contemplated in areas being politically liberal, densely populated, and not predominantly rural. It could be beneficial in shifting the perception of renewable energy from being predominantly an environmental concern to being recognized for its economic benefits.

Community-led diphtheria vaccination campaign to manage a diphtheria outbreak in a remote Aboriginal community.

In 2022, five cases of diphtheria were identified in and around Wujal Wujal, a discrete Aboriginal community in Far North Queensland. This prompted a mass diphtheria vaccination campaign in the community which increased the proportion of residents aged ≥ 14 years receiving a diphtheria containing vaccine in the prior twelve months from 5% to 74%. No further cases were detected in the subsequent twenty-two months.

Improving rural and remote health workforce retention amid global workforce shortages: a scoping review of evaluated workforce interventions.

The aim of this study was to conduct a scoping review of a global body of scholarly and industry (grey) literature for evidence of implemented and evaluated interventions to identify best practice workforce retention strategies for organisations providing health services in rural and remote areas. A scoping review was conducted of the scholarly and grey literature by two independent researchers. This comprised a search of four scholarly databases, and a Google and website search for grey literature. Quality checks were conducted, and a total of 15 documents were included in the literature review. Using the World Health Organisation's categories of workforce intervention (regulatory, education, financial incentives, personal and professional support), the documents were analysed to identify effective workforce interventions. The literature review found evidence of regulatory impacts as well as organisation-level evaluated workforce interventions for education-to-employment pathways (education), remuneration programs (financial incentives) and working and living conditions (personal and professional support) but seldom provided insight into how successful interventions were implemented or evaluated at the organisational level. Further, there was an absence of scholarship contributing to the development of empirical evidence to inform organisations about designing, implementing and evaluating workforce strategies to improve health workforce retention in rural and remote communities. Few studies have focused on evidence-based organisation-level interventions to improve rural and remote workforce sustainability. This article offers insights to shape future intervention implementation and evaluation research for rural and remote health workforce sustainability.

Utilization Postnatal Care Services in Hyolmo Community

Postnatal care (PNC) utilization among the Hyolmo community highlights significant gaps in existing literature and underscores the critical need for targeted healthcare interventions in remote and ethnically distinct populations. This study reveals that, while considerable attention is given to urban and accessible rural populations, remote communities face unique challenges that can impede access to essential maternal health services. The results demonstrate that age, education, and socio-economic factors significantly influence PNC uptake, suggesting disparities that are compounded in remote areas like the Helambu Rural Municipality of Sindhupalchowk District. This study shows that younger mothers, often less aware or hindered by accessibility barriers, are less likely to utilize PNC services compared to their older counterparts. This disparity highlights the necessity for community-specific educational programs that can enhance understanding and encourage the use of PNC services among younger women. Additionally, the influence of education and socio-economic status on PNC utilization points to the broader implications of systemic inequities in healthcare access. Moreover, the study brings to light the role of cultural practices and beliefs in shaping healthseeking behaviors, which varies significantly across different communities. In the traditional beliefs may conflict with modern healthcare practices, there is a clear need for culturally sensitive health interventions that respect and integrate local customs and practices. This research not only contributes to a deeper understanding of the factors affecting PNC service uptake in a specific Nepalese community but also calls for comprehensive policy responses. By addressing the multifaceted challenges faced by the Hyolmo community ranging from geographic isolation to cultural and educational barriers the study advocates for a holistic approach to healthcare. This should include the development of policies that ensure equitable access to health services, enhance community health education, and promote cultural competence among healthcare providers. Ultimately, such efforts are essential for improving maternal and infant health outcomes in remote communities, ensuring that every individual, regardless of their socio-economic or cultural background, has access to the necessary postnatal care.

Assessing the Socio-Economic Impacts of Solar Home Systems on Chingad, Surkhet

This study assesses the multifaceted socio-economic impacts of Solar Home Systems (SHS) on the remote community of Chingad, Surkhet. Employing a comprehensive research framework, we investigate the extent to which the adoption of SHS has influenced the livelihoods, economic activities, and social dynamics within the community. Through a combination of quantitative and qualitative methodologies, we analyzed the economic benefits, social empowerment, and environmental sustainability associated with the integration of solar energy. The limitations of the study included its focus on Chindgad-5, Surkhet. This research employed a descriptive-analytic approach within an exploratory research design. In the study area, a total of 386 households were included, with 188 utilizing solar energy in December 2023 AD from field observation. The research focused on a subset of 36 purposely selected solar home system users. Energy consumption patterns varied among ethnic groups and social classes, and universal electricity access was not observed in the study area. The study integrated both descriptive and exploratory elements to comprehensively address its objectives, utilizing a combination of primary and secondary data. For policymakers, development professionals, and other stakeholders engaged in sustainable energy projects in similar circumstances, the findings offer insightful information about the complex relationships that are present between solar technology and the local socioeconomic fabric. The study provides valuable insights for policymakers, energy planners, and development organizations working towards sustainable and inclusive energy solutions in rural Nepal. The successful integration of SHS not only addresses energy needs but also contributes to economic development and improved living conditions in off-grid communities.

Insights into water insecurity in Indigenous communities in Canada: assessing microbial risks and innovative solutions, a multifaceted review.

Canada is considered a freshwater-rich country, despite this, several Indigenous reserves struggle with household water insecurity. In fact, some of these communities have lacked access to safe water for almost 30 years. Water quality in Canadian Indigenous reserves is influenced by several factors including source water quality, drinking water treatments applied, water distribution systems, and water storage tanks when piped water is unavailable. The objective of this multifaceted review is to spot the challenges and consequences of inadequate drinking water systems (DWS) and the available technical and microbiological alternatives to address water sanitation coverage in Indigenous reserves of Canada, North America (also known as Turtle Island). A comprehensive literature review was conducted using national web portals from both federal and provincial governments, as well as academic databases to identify the following topics: The status of water insecurity in Indigenous communities across Canada; Microbiological, chemical, and natural causes contributing to water insecurity; Limitations of applying urban-style drinking water systems in Indigenous reserves in Canada and the management of DWS for Indigenous communities in other high-income countries; and the importance of determining the microbiome inhabiting drinking water systems along with the cutting-edge technology available for its analysis. A total of 169 scientific articles matched the inclusion criteria. The major themes discussed include: The status of water insecurity and water advisories in Canada; the risks of pathogenic microorganisms (i.e., Escherichia coli and total coliforms) and other chemicals (i.e., disinfection by-products) found in water storage tanks; the most common technologies available for water treatment including coagulation, high- and low-pressure membrane filtration procedures, ozone, ion exchange, and biological ion exchange and their limitations when applying them in remote Indigenous communities. Furthermore, we reviewed the benefits and drawbacks that high throughput tools such as metagenomics (the study of genomes of microbial communities), culturomics (a high-efficiency culture approach), and microfluidics devices (microminiaturized instruments) and what they could represent for water monitoring in Indigenous reserves. This multifaceted review demonstrates that water insecurity in Canada is a reflection of the institutional structures of marginalization that persist in the country and other parts of Turtle Island. DWS on Indigenous reserves are in urgent need of upgrades. Source water protection, and drinking water monitoring plus a comprehensive design of culturally adapted, and sustainable water services are required. Collaborative efforts between First Nations authorities and federal, provincial, and territorial governments are imperative to ensure equitable access to safe drinking water in Indigenous reserves.

‘A window of the world’: itinerant silent cinemas in rural Australia

ABSTRACT Moving pictures connected even the most remote corners of the British Empire with its cultural and economic center. Between 1896 and 1916, transnational silent cinema shaped settler-colonial Australia’s relationship to the British Empire in tandem with the colonies’ move toward federation and political autonomy. Traveling exhibitors were key to this process, bringing moving pictures from the UK, Europe, and the US to Australians who lived outside major cities. This paper explores how itinerant silent cinema shows brought not just the pictures to rural Australian audiences, but also a sense of belonging to an imagined transnational community, through films from the UK, US, France, Italy, Germany, Denmark, and Sweden. Between 1896 and 1905, exhibitors like Maurice Sestier and Wybert Reeve were instrumental in introducing cinema technology, while entertainers like J. C. Williamson, T.J. West, the Marvellous Corricks, and Ettie Wilmott helped maintain the popularity of the cinema in the mid-1900s, in part by incorporating films into variety shows. From around 1910, when permanent cinemas had been established in larger Australian towns, until at least 1914 but in some cases for much longer, itinerant exhibitors and vaudeville shows like Wilmott’s Electric Pictures kept remote rural communities supplied, albeit intermittently, with cinema experiences that connected them to a wider imagined community.

A review of emergency laparoscopic cholecystectomies in Far North Queensland.

Access to laparoscopic cholecystectomy is more limited for remote communities and Indigenous patients internationally. To date, studies exploring the incidence of gallstone disease and access to laparoscopic cholecystectomy in Australian regional communities are limited. This study examined the rates and outcomes of emergency laparoscopic cholecystectomy (EMLC) in Far North Queensland, specifically in Indigenous and remote populations. We retrospectively examined all patients who underwent an EMLC at Cairns Hospital between 2016 and 2021. Over the study period, 634 EMLCs were undertaken. The average annual rate of 56 cases per 100 000 was considerably lower than national estimates. However, rates of EMLC were significantly higher in remote communities and Indigenous patients compared with the remaining cohort. Patients from remote communities were more likely to have pre-existing gallstone disease but were less likely to have been seen in a surgical outpatient clinic prior to admission. Despite this, surgical outcomes for EMLC were comparable to national and international standards. This study highlights the challenges in surgical healthcare provision for gallstone disease in a regional centre. The requirement for EMLC disproportionately effects geographically isolated communities and Australian Indigenous people. Addressing the healthcare barriers to management of GD in regional Australia should be a priority.

Nurse practitioner medication abortion providers in Canada: results from a national survey

BackgroundIn 2017, nurse practitioners (NPs) became the first non-physician healthcare providers authorised to independently provide medication abortion (MA) in Canada. We aimed to report on demographic and clinical characteristics of...

Advancing Economical and Environmentally Conscious Electrification: A Comprehensive Framework for Microgrid Design in Off‐Grid Regions

AbstractThe design of renewable energy systems traditionally emphasizes life cycle costs, often focusing primarily on emissions rather than a comprehensive life cycle impact assessment. This research proposes a four‐tier methodology to balance cost‐effectiveness and sustainability in the electrification of remote areas. Tier 1 focuses on understanding the community context by analyzing electrical load profiles, meteorological data, and component specifications for microgrid design. Tier 2 evaluates the feasibility of various systems, optimizing them through cost analysis and Multi‐Criteria Decision‐Making (MCDM) to rank alternatives. Tier 3 assesses environmental impacts using life cycle assessment, ranking alternatives based on environmental criteria. Tier 4 integrates cost and environmental rankings to determine the most suitable energy configurations, followed by sensitivity analysis to ensure robust decision‐making. The methodology is validated through a case study of an unelectrified remote community, demonstrating that the PV‐Wind Turbine‐Biomass Generator‐Converter configuration is the most robust alternative, proving to be the optimal choice in 50% of the analyzed scenarios, achieving a Cost of Energy of 0.213 USD/kWh while minimizing environmental impact across all 18 criteria considered over a 25‐year life cycle. This novel framework offers a scalable approach to designing renewable energy systems, enhancing sustainable electrification efforts in developing regions.

Costs of medical evacuation and transportation of First Nations Peoples and Inuit who travel for medical care in Canada: A systematic review.

For First Nations people and Inuit who live on reserves or in rural and remote areas, a guideline requires their travel to urban centres once their pregnancy reaches 36-38weeks gestation age to await labour and birth. While not encoded in Canadian legislation, this guideline-and invisible policy-is reinforced by the lack of alternatives. Research has repeatedly demonstrated the harm of obstetric evacuation, causing emotional, physical, and financial stress for pregnant and postpartum Indigenous women and people. Our objective was to describe the costs of obstetric evacuation, as reported in the literature. We conducted a systematic review using online searches of electronic databases (Ovid EMBASE, CINAHL, Ovid Healthstar, PubMed, ScienceDirect, PROSPERO, and Cochrane Database of Systematic Reviews) and identified studies that reported costs related to medical evacuation or transportation in rural and remote Indigenous communities. We performed critical appraisal of relevant studies. We identified 19 studies that met the inclusion criteria. The studies reported various types of cost, including direct, indirect, and intangible costs. Medical evacuation costs ranged from CAD $7714 to CAD $31,794. Indirect and intangible costs were identified, including lost income and lack of respect for cultural practices. Costs associated with obstetric evacuation are high, with medical evacuation as the most expensive direct cost identified. Although we were able to identify a range of costs, information on financing and funding flows was unclear. Across Canada, additional research is required to understand the direct costs of obstetric evacuation to Indigenous Peoples and communities.

Understanding the professional factors that impact the retention of pathology workers in regional, rural and remote Australia.

The objective of this study was to determine what professional factors impact the retention of pathology workers in regional, rural and remote Australia. A cross-sectional survey was used to collect data regarding the professional factors that impact the retention of regional, rural and remote pathology workers in Australia (n = 95). The survey focused on pathology workers' satisfaction with specific professional factors and how long they intended to stay in their current position. Regional, rural and remote (MM2-7) pathology laboratories in Australia. There were a total of 95 participants, including 24 phlebotomists/laboratory assistants, 34 medical laboratory scientists and 29 supervisors/managers, with the majority of participants being from New South Wales, Queensland and Western Australia. Significant positive associations were found between satisfaction with career advancement opportunities, workplace culture and maintaining professional skills with the retention of regional, rural and remote pathology workers. Open-ended responses indicated that personal factors also played an important role in pathology worker retention in regional, rural and remote communities. This study provides important insights into the professional factors that impact the retention of pathology workers in regional, rural and remote Australia. Personal factors were also found to play an important role in retention. These findings have highlighted the need for further research to be conducted to explore the relationship between professional and personal factors and how this impacts the retention of pathology workers in regional, rural and remote Australia.

Impact of colonialism: Where are our stories?

Impact of colonialism: Where are our stories? Geraldine Balzer from the University of Saskatchewan asserts that our stories are found when the Empire comes home; in this impact of colonialism focus. My journey to understanding the impact of colonialism in education and reflecting on how to decolonize my teaching began over thirty years ago in a remote Inuit community in the Canadian Arctic. I loved the world of literature, often losing myself in books, living in worlds that became real as the words on the page found a home in my expansive imagination. However, this was not the experience of my students when they engaged with the same texts that delighted me.

Innovative and best models of palliative and end-of-life care - with focus on rural and remote communities.

The review aims to synthesize the most recent innovative models of palliative care being delivered in rural and remote locations. Worldwide, as the ageing population grows, more people will require palliative care. However, equal availability of high-quality palliative care services remains a significant challenge, particularly in rural and remote communities. Innovative models of palliative care have been developed to address the projected need of people in rural and remote areas. Models that leverage the use of digital healthcare (such as telecare and Artificial Intelligence), the non-specialized palliative care workforce (such as GPs, pharmacists, and family carers), and community driven approaches have demonstrated success in achieving positive palliative care outcomes, such as reduced physical and emotional distress, and family carers feeling more supported. There is a need to support people to remain within their rural and remote communities towards the end-of-life (EOL). While some models of care have been identified to help with this, there continues to be significant difficulties in access to health and social care in rural and remote areas. It is important we build on this research to understand more broadly the models of support for those living in remote and rural communities at the EOL.

The disease burden of untreated chronic otitis media in Indigenous children from remote communities does not improve over time. A longitudinal study.

In Australia, middle ear disease disproportionately affects Indigenous children, leading to poor hearing outcomes. This study aimed to determine the natural history of untreated chronic otitis media in Indigenous children in remote South Australia. Baseline and 3 year follow-up data was collected from Indigenous children aged 5-18 years living on the Anangu Pitjantjatjara Yankunytjatjara Lands. 4-frequency pure-tone audiometry was used to determine hearing levels. Middle ear pathology was determined by video-otoscopy with tympanometry and classified at baseline as group 1 (normal), group 2 (abnormal with intact tympanic membrane), or group 3 (perforated tympanic membrane). A total of 253 children were included in this study. Children in group 1 (20.6 ± 1.5 dBHL; Mean ± SD) had significantly better hearing outcomes at 3 year follow-up than children with abnormal ears (groups 2 and 3) (23.8 ± 7.0 dBHL), P < 0.001. The difference was greatest for group 1 versus 3 (27.6 ± 8.4 dBHL), P < 0.001, followed by 1 versus 2 (22.4 ± 5.8 dBHL), P = 0.009, and between 2 (22.4 ± 5.8 dBHL) and 3 (27.6 ± 8.4 dBHL), P < 0.001. Hearing in Indigenous children with untreated middle ear pathology remains poor at follow-up compared to those without pathology. Intervention is therefore critical to prevent persisting poor hearing outcomes.

Australia's Remote Vocational Training Scheme: training and supporting general practitioners in rural, remote and First Nations communities.

Australia's Remote Vocational Training Scheme: training and supporting general practitioners in rural, remote and First Nations communities.

Why Is Caries Prevention in Children So Difficult? A Narrative Opinion.

Caries is among the most common non-communicable diseases worldwide, yet it is commonly described as preventable. Caries prevention is, however, difficult and complex, since the disease has strong social, parental, behavioral, political, medical/genetic, and psychological elements, and the payment models are targeted at traditional conservative care. The aim of this paper is to discuss some key issues that make caries prevention in children be perceived as "difficult": i) the communication gap between researchers and clinicians, creating unrealistic expectations of intervention efficacy; ii) the skewed distribution of caries and the problem of reaching children with the highest need; iii) limited access to care, which is a threat to oral health, in particular in low-socioeconomic-status, underserviced, and remote communities; and iv) the need to adopt behavior change models to affect the modifiable risk factors that are shared with other non-communicable diseases. Dentists cannot simply rely on fluoride exposure; proper education and training in caries risk assessment, behavior change models targeted at oral hygiene and sugar intake, and collaboration with primary healthcare and local school authorities are avenues that aid in caries prevention and reduce the uneven burden of the disease. Online education and mobile apps may help to promote oral health in areas with shortages of dental work force.

Indigenous Peoples’ evaluation of health risks when facing mandatory evacuation for birth during the COVID-19 pandemic: an indigenous feminist analysis

BackgroundIndigenous Peoples living on the land known as Canada are comprised of First Nations, Inuit, and Métis people and because of the Government of Canada’s mandatory evacuation policy, those living in rural and remote regions of Ontario are required to travel to urban, tertiary care centres to give birth. When evaluating the risk of travelling for birth, Indigenous Peoples understand, evaluate, and conceptualise health risks differently than Eurocentric biomedical models of health. Also, the global COVID-19 pandemic changed how people perceived risks to their health. Our research goal was to better understand how Indigenous parturients living in rural and remote communities conceptualised the risks associated with evacuation for birth before and during the COVID-19 pandemic.MethodsTo achieve this goal, we conducted semi-structured interviews with 11 parturients who travelled for birth during the pandemic and with 5 family members of those who were evacuated for birth.ResultsParticipants conceptualised evacuation for birth as riskier during the COVID-19 pandemic and identified how the pandemic exacerbated existing risks of travelling for birth. In fact, Indigenous parturients noted the increased risk of contracting COVID-19 when travelling to urban centres for perinatal care, the impact of public health restrictions on increased isolation from family and community, the emotional impact of fear during the pandemic, and the decreased availability of quality healthcare.ConclusionsUsing Indigenous Feminist Methodology and Indigenous Feminist Theory, we critically analysed how mandatory evacuation for birth functions as a colonial tool and how conceptualizations of risk empowered Indigenous Peoples to make decisions that reduced risks to their health during the pandemic. With the results of this study, policy makers and governments can better understand how Indigenous Peoples conceptualise risks related to evacuation for birth before and during the pandemic, and prioritise further consultation with Indigenous Peoples to collaborate in the delivery of the health and care they need and desire.