ABSTRACT At present, the rural revitalization drive faces issues such as the disconnection between the policy framework and rural realities, and the failure to coordinate multiple goals resulting in fragmented benefits. Green and Beautiful Countryside (GBC) represents an effective path for promoting rural revitalization. Taking the case of Zhuhai’s GBC initiatives, this paper emphasizes the necessity of embedding rurality into GBC construction based on strategic goals of the GBC model. Building on an analysis of the GBC concept, it identifies key contents of ‘Green Creation, Beauty Enhancement, Wealth Generation, and Education Development,’ A cognitive framework for a ‘Green and Beautiful Countryside’ coupling operational system has been established, guided by rural revitalization as the overarching principle, structured around the Ten Thousand Villages Project, and centered on rurality as the main focus.. Under this framework, the implementation status of land-based and island-based rural practices are examined, and practical pathways for realizing the GBC vision are proposed. Theoretically, by clarifying the interactive relationships among ‘rurality’, ‘green and beautiful villages’ and rural revitalization, this study deepens the theoretical paradigm of green and beautiful village construction. Practically, it provides a replicable path reference for Guangdong Province to implement rural revitalization initiatives.

Teletherapy may increase mental healthcare access in rural and remote communities that have limited access to mental health care. Clinicians practicing rural and remote teletherapy must be responsive to the ways that rurality and remote service provision impact their patients and practice. However, the unique challenges of remote clinical practice, when clinicians and patients are located in different settings, are not well understood. It is often not feasible for independent clinicians to provide rural teletherapy using models developed by large healthcare institutions, and current teletherapy practice guidelines underemphasize the ways rural, situational, and environmental pressures impact teletherapy with rural and remote patients, especially in culturally and geographically diverse settings like Alaska in the US. Therefore, to better understand these challenges, this study explored the critical events that informed Alaskan clinicians' approaches to teletherapy with rural patients, and how those 'turning point' events subsequently influenced their practice. This qualitative study used the critical incident technique and thematic analysis to explore critical events that most informed Alaskan clinicians' approaches to rural and remote teletherapy. Participants (n=26) were licensed mental health clinicians who had provided teletherapy to rural patients in Alaska and did not live in the patients' community themselves. Each participant provided written responses to an anonymous online survey that asked them to describe a critical event relating to rural teletherapy practice, their perceived outcome of the event, and an optional narrative describing what would have better prepared them for the critical event. The study's authors followed an iterative process of coding, reflexive discussion, consensus, and recoding throughout the thematic analysis of critical events. Participants' narratives revealed situations where clinical, cultural, ethical, technological, and/or administrative concerns interacted with rural environmental pressures to create novel situations that required thoughtful and complex responses. Many narratives illustrated advanced integration of teletherapy and rural mental health competencies. Specific themes included attending to rural cultural and contextual (situational and environmental) factors; responding to crises, traumas, and complex clinical concerns; navigating technological barriers and ethical challenges; and practicing clinical and administrative flexibility in light of unique circumstances with their rural and remote patients. In response to what would have better prepared them for these events, participants identified greater awareness and experience, more training and education, and better resources and infrastructure. The results suggest a need to integrate and expand existing teletherapy and rural mental health competencies to include contextual assessment, responsivity, and reflexivity, as well as to integrate specific teletherapy skills into a cross-contextual framework. This study introduces the concept of contextual humility, an expansion of the previously established concept of cultural humility in rural teletherapy, which emphasizes responsiveness to situational and environmental factors as they overlap with, but are distinct from, cultural dimensions of rural teletherapy. Insights from Alaskan clinicians who have adapted to the unique challenges of rural and remote teletherapy highlight the need for clinical training tailored to rural and remote settings and updated approaches to teletherapy that integrate contextual humility across competency domains.

BackgroundAs robotic surgery has grown in prevalence, robotic residency curricula have evolved. University of North Dakota (UND) instituted a formal curriculum in robotics in 2018. We sought to investigate trends in robotic exposure for residents and subsequent use of robotic surgical systems in practice.MethodsA survey of recent graduates was conducted regarding robotic experience during residency, training or certification outside of residency, current use of robotics in practice, and practice type and setting. Graduate years 2014-2018 and years 2019-2023 were pooled into "pre-curriculum" and "post-curriculum" groups respectively. Mann-Whitney U test was used to compare quantitative data, and categorical data was analyzed using Fisher's exact test.ResultsWe observed a significant increase in robotic cases completed during residency (0 vs 25, p=0.004), an increase in the number of residents who received training in robotic surgery during residency (38% vs 100%, p=0.009), and a significant decrease in number of days missed from practice to obtain robotic surgery training or certification (3.5 vs 0, p=0.02). There was no significant association between training during residency and use of robotic surgery system in practice, or between rural practice setting and use of robotic surgery system in practice.DiscussionAmong UND graduates, robotic exposure during training is likely not the determining factor leading surgeons to incorporate this technology into their practices. Our findings echo national data showing increasing use of robotics in general surgery. Robotic surgery has a significant and growing presence in rural general surgery.

Background: Health represents a multidimensional concept shaped by cultural, social, economic, and environmental influences. Contemporary understanding emphasizes a holistic approach that integrates physical, mental, social, and spiritual domains to achieve overall well-being. The present study was undertaken to assess various determinants that influence health among the general population of Hubli–Dharwad, with particular attention to the contribution of spiritual health. Methods: A community-based cross-sectional study was conducted among 200 randomly selected participants from urban and rural practice areas attached to KIMS Hubballi. Data were collected using a semi-structured questionnaire covering demographic, physical, mental, social, and spiritual dimensions of health. Descriptive statistics were expressed in frequencies and percentages, and associations between variables were analyzed using the Chi-square test. Results: Among the 200 participants, 95% reported belief in spirituality; of them, 43 % had overall health scores above the median. Only 10% of the non-believers achieved comparable scores. Significant associations were observed between mental and social health as well as between spirituality and overall well-being (p<0.05). Conclusion: The findings indicate that spirituality, in conjunction with physical, mental, and social well-being, plays a pivotal role in maintaining holistic health. Incorporating the bio-psycho-socio-spiritual model into community health practice may strengthen preventive and promotive health strategies.

ABSTRACT Academics whose research and teaching are focused on healthcare professions are essential for Australians’ access to healthcare. Academics based in regional and rural communities and universities face challenges of workforce precarity and high workloads, which threaten the sustainability of their careers and, consequently, rural health workforce training. Their careers ensure a pipeline of healthcare professionals for rural practice. The present research used the sustainable career framework and systems theory framework to explore the careers of health academics whose work predominantly occurs in regional and rural contexts. A systematic literature review following the PRISMA protocol identified nine articles which generated findings pertaining to challenges to sustainable careers, including person and place-based factors; workload, expectations, and reality; and tensions and pressures between clinical and academic activities. Future research is needed to understand the influence of regionality and place on health academics’ career trajectories.

Introduction Cancer screening uptake in Georgia is only 13%. We aimed to assess cancer screening recommendations and referral practices among primary health care providers (PHC) and factors associated with these practices. Methods We conducted a cross-sectional survey of 2,958 doctors and nurses in PHC in November 2023, using descriptive, bivariate, and multivariate analyses to assess the association between provider characteristics, system-level factors, and practices in recommending and referring for cancer screening. Results Respondents were predominantly female (95%), mean age of 57.5 years, family doctors (56%), with >20 years’ work experience (60%) and rural practice (67%). Almost all (98%) reported actively recommending and referring patients for cancer screening; however, 64.7% did so for only 1–5 patients per week, while 12% reported none. Predictors of higher recommendation and referral rates (≥6 patients per week) included being a family doctor (AOR 1.36; 95% CI: 1.11–1.67; p = 0.003), working in the capital city – Tbilisi (AOR 1.36; 95% CI: 1.14–1.95; p = 0.003), receiving comprehensive cancer screening training (AOR 1.49; 95% CI: 1.04–1.68; p = 0.024), reporting adequate infrastructure (AOR 1.39; 95% CI: 1.07–1.81; p = 0.015), reporting proper public promotion (AOR 1.41; 95% CI: 1.12–1.78; p = 0.003), and perceiving screening as part of their role (AOR 1.87; 95% CI: 1.52–2.30; p < 0.001). Conclusions Despite strong belief in cancer screening, recommendation and referral rates remain low, underscoring the urgent need for policy reforms to enhance education, raise awareness, and improve infrastructure for effective cancer screening initiatives.

Abstract This article focuses on early modern rural economic practices, investigating the scope for action that emerges when we trace how money was handled, loaned and borrowed. The aim is to contextualize probate inventories and interlink them with other sources to reveal the plurality of economic activities in which people engaged. We look at two case studies from early modern southern Tyrol between the sixteenth and the late eighteenth centuries: a wealthy widow who held her first husband’s agricultural estate in usufruct and managed it successfully over many years, and an innkeeper whose probate inventory is testament to his substantial businesses, commercial activities and family financial dealings. Both can be termed rural entrepreneurs based on their skilful economic activity, from lending and trading to saving, which only becomes apparent when the legal procedures and documents are closely examined. The main sources are local court records, and in the first case we examine their interlinkage based on a database. The results not only expand our knowledge of female and male rural actors but also enable us to observe social groups and their pluri-activities and credit relations, particularly within the middle stratum of a rural economy a socio-economic middle stratum that has received little attention to date.

Exploring the Advantages of Rural Spaces for Teaching and Learning STEM: a Scoping Review of Research Exploring How Rural Social Spaces Enable STEM Education Practices

Real-world utilization of bispecific antibodies for treatment of diffuse large B-cell lymphoma (DLBCL) in the US community oncology setting

To investigate why rural general practitioners prescribe opioids for people with chronic non-cancer pain, with the aims of explaining geographic differences in opioid prescribing and improving pain management in rural areas. Qualitative study; interviews with convenience sample of rural general practitioners. Seventeen rural general practitioners who had prescribed opioids for people with chronic non-cancer pain during the preceding twelve months; the interviews were undertaken during 11 September 2023 - 31 May 2024. Contextual and individual factors that influence decision making by rural general practitioners about prescribing opioids for people with chronic non-cancer pain. We found that rural opioid prescribing is influenced more by health care system deficiencies than lack of knowledge among practitioners. Two major themes were identified: systematic constraints (insufficient time for alternative management strategies and the influence of Medicare remuneration); and limited access to multidisciplinary pain management (limited availability of non-pharmaceutical treatments, colleagues for consultation, and referral pathways). Participants described feeling trapped between brief consultations and complex deprescribing requirements; Medicare remuneration schedules encourage shorter appointments (and therefore continuing current management) rather than comprehensive pain management. Implementing evidence-based guidelines was difficult in rural areas with limited resources. The limited availability of allied health services further restricted alternative pain management approaches. Participants reported greater psychological pressure to justify opioid deprescribing than prescribing. Doctors acknowledged that the evidence for the value of opioids for managing chronic pain was limited but felt caught between inadequate system resources and patient demands. We found a marked disparity between evidence-based guidelines for chronic pain management and the reality of rural medical practice. Rural doctors operating in a difficult context resort to prescribing opioids because of systemic inadequacies rather than lack of awareness of their limited value. Chronic pain management in rural areas could be improved by better Medicare support for longer pain management consultations, improved access to allied health, rural area-specific guidelines that take resource constraints into account, and improved support for general practitioners in pain management and deprescribing.

This article connects rural sociology and personal life theory by considering how conceptions of love, childhood and family life are understood in Swedish rural contexts. Complex personal rural life narratives are presented from the perspective of the ‘ordinary’. Our result accounts for how imagined families and rural life arrangements are negotiated and how families that are happy with their personal lives conceptualise their choices in relation to their rural homes. Finding a partner and establishing a happy family impacts the choice of where to live and how to work. We argue that the informants’ attempts to negotiate their imagined family ideals and rural lives involve attempting to counterbalance contemporary ideas of gender equality within their rural everyday life practices. When they are unable to fulfil their imagined families successfully, they experience a ‘debt of love’ within their family.

To explore the effect of Croatia's 2013 Primary Care Payment Reform on patient care. The performance of one rural family practitioner group practice in Breznica was assessed one year before and one year after implementation. Using an exploratory case study design with quantitative methods, we examined outcome variables linked to the new payment model. Drawing on publicly available activity reports, we conducted linear regression analyses to identify potential associations. We observed changes in most incentivized outcomes, notably increases in preventive check-ups and decreases in hospital referrals. Some indicators, such as the increase in prescribing despite financial disincentives, remain inconclusive and highlight the need for further investigation. These findings are preliminary but provide valuable hypotheses for guiding more rigorous, longitudinal, and multi-site studies.

Objective In order to reduce unnecessary antibiotic prescribing, diagnostic processes require improvement for children in primary care. Design Post hoc analyses of randomised controlled intervention study. Setting Eighty general practitioner (GP) practices throughout Latvia. Intervention In the first study period, one GP group received combined interventions (access to CRP POCT and GP education), while the second GP group continued usual care (control group). In the second study period, the GP groups were switched – previous control group received combined intervention, but previous intervention group re-established usual care, but the long-term education effect was evaluated in this group. Subjects Children with acute infections consulted by a GP. Main outcome Impact of combined intervention and long-term education on testing level (CRP, full blood count, Strep A test, influenza test, urinalysis and X-ray) before antibiotic prescribing. Patient- and GPs- related predictors (including practice location and access to laboratory services) of diagnostic testing were also analysed. Secondary outcome was antibiotic prescribing according to the test results. Results Diagnostic testing was significantly increased in the combined intervention group versus the usual care group (aOR 11.1, 95% CI 8.0–15.3); however, it was decreased in the long-term education group (26.4%) (aOR 0.5, 95% CI 0.3–0.8). Rural practices and a longer expected time of laboratory results were associated with a more pronounced increase in diagnostic testing in the combined intervention group (aOR 37.6, 95% CI 17.9–79.0; aOR 23.2, 95% CI 14.1–38.0, respectively). It was found that a low CRP value, negative Strep A test or normal X-ray often did not convince GPs to withhold antibiotics. Conclusion The availability of CRP POCT and GP education results in a much higher level of diagnostic testing prior to antibiotic prescribing, especially in rural regions. Further improvements in more rational testing and the interpretation of results to guide appropriate antibiotic prescribing are essential. Trial registration: ISRCTN registry - ISRCTN34931655

This study explores how the LEADER programme in rural Estonia aligns with the concept of smart rurality by leveraging technology, innovation, and collaborative governance to address rural development challenges. Specifically, it investigates the social value created through grassroots approaches, focusing on how Local Action Groups (LAGs) foster social cohesion, trust, and regional resilience. Using a qualitative methodology, 26 semi-structured focus group interviews were conducted with representatives of LAGs, local government officials, and entrepreneurs across Estonia. The findings reveal that the LEADER programme empowers stakeholders by aligning development initiatives with local needs, fostering social cohesion, and building trust within communities. Estonia’s LAGs have successfully reduced bureaucracy, enhanced cross-sector collaboration, and ensured efficient resource use. However, challenges such as favouritism and a lack of transparency persist, reflecting broader critiques of the programme across Europe. By framing these findings within the concept of smart rurality, the study demonstrates how collaborative governance and social innovation contribute to rural resilience. Estonia’s experience highlights the potential of regionally tailored solutions to balance social, economic, and environmental priorities. The study concludes by advocating for further research using mixed methods to engage diverse stakeholders, improve the evaluation of social value, and advance inclusive and sustainable rural development. In addition, recommendations for advancing rural development practices are provided, emphasizing strategies to enhance inclusivity, transparency, and alignment with sustainability goals.

This paper explores moral education strategies in university public art education through the "Three-Aspect Holistic Education" framework, focusing on three key dimensions. First, comprehensive participation establishes a holistic education matrix involving public art instructors, counselors, and support staff, integrating ethical values into teaching practices, student club activities, and campus maintenance. Second, continuous integration creates a cohesive educational journey spanning enrollment, mid-term studies, and graduation phases, achieving moral education coherence through guided tours, thematic projects, and performance evaluations. Third, multidimensional expansion develops diverse educational platforms combining campus lectures, cultural festivals, partnerships with external art museums, and rural practice programs. This approach provides a practical roadmap for moral education in university public art programs.

Background: Moral distress can negatively impact nurses, patients, and the healthcare system and has been well-documented in high-acuity care environments. Levels of moral distress and experiences of moral distress have been reported as high and severe among nurses in high-acuity care environments; however, the levels and experience of moral distress are unknown in rural clinic nurses. Research Question/Aim/Objectives: This study sought to gain a broader understanding of moral distress in nurses working in rural clinic settings. The aims were (1) Determine the level of moral distress among rural clinic nurses; (2) Examine the relationships of moral distress levels, demographic characteristics, and work experience variables of rural clinic nurses; (3) Identify themes regarding the perceived experiences of moral distress of nurses working in rural clinics; (4) Explore how aspects of rural practice impact moral distress for rural clinic nurses. Research Design: Convergent mixed methodology gathered quantitative and qualitative data in parallel, employed correlation and thematic analysis, respectively, then data were merged. Participants and Research Context: Informed by Rural Nursing Theory, a consecutive sample of 52 nurses across four states were surveyed using the Measure of Moral Distress for Healthcare Professionals and narrative questions. Ethical Considerations: The healthcare system and University IRBs granted exempt status. Findings/Results: The mean moral distress was 74.7 (SD = 76.8), range was 0 to 246, and no significant relationships were found between moral distress, demographics, or work experience variables. Four main themes were identified: (1) Lack [of something] Leads to Moral Distress (2) Barriers to Patient Care and Adherence (3) Inappropriate Healthcare Utilization (4) Care and Practice Factors that Lead to Moral Distress. Conclusions: Rural clinic nurses experience moral distress for reasons unique to rural practice, while other triggers are shared with urban nurses. Further research is warranted on sources of moral distress for rural clinic nurses.

Sustainable surgery in Ireland: Policy, practice, and the role of institutions.

Evolving nursing roles in assisted dying services in New Zealand: A scoping review.

BackgroundEnhancing the retention of medical professionals in regional, rural and remote (RRR) areas requires a multi-faceted strategy that acknowledges and addresses the contextual barriers doctors face when deciding whether to continue practising in RRR hospitals. Gaining a deeper understanding of these factors can inform evidence-based workforce planning and policy development to mitigate the rural physician shortage across Australia. This study aimed to explore motivators and perceived barriers among junior medical doctors when choosing their training location- whether in RRR hospitals or metropolitan settings- during the early years of postgraduate training.MethodsA qualitative study was conducted using virtual one-on-one interviews. The setting included four Hospital and Health Services (HHSs) in Northern Queensland, Australia (Townsville, Cairns, Mackay and North West). Participants were doctors in training from intern level to postgraduate year 5 (including prevocational and early vocational doctors). Twenty-five interviews were transcribed verbatim. Data were thematically analysed, through an inductive approach.ResultsMost participants were female (n = 19) and aged under 29 years (n = 21). The motivations for choosing RRR hospitals among most Australian-trained doctors included proximity to family, a desire for adventure, rural upbringing, peer recommendations, and the availability of benefits through incentivisation schemes. For many recently graduated doctors, regional hospitals were considered the “right size”, offering a broad range of specialties without feeling lost in the crowd often associated with larger metropolitan hospitals. Barriers included limited job opportunities in rural settings, challenges in securing preferred rotations, social isolation, lack of camaraderie in the workplace, and the cost of living.ConclusionThis study provides valuable insights into the key pull and push factors influencing doctors’ decisions to train/ work in RRR areas. At both the HHS and national levels, these findings can help guide decision-makers and employers on where to invest to positively influence doctors’ choices regarding training and practice locations. A multifaceted approach is needed, with interventions tailored to doctors’ specific needs, particularly those that support family life, increase rural exposure, and offer competitive remuneration.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-025-13465-3.

ObjectiveTo identify contextually relevant indicators to measure the quality of surgical and obstetrical care in low-volume rural hospitals using a consensus-based methodology.MethodsA modified Delphi process was implemented in which participants were asked to rate the priority of proposed evaluation metrics over two rounds. Two Delphi surveys were electronically administered in 2019, approximately one month apart. Fifty-one health care professionals from across Canada, including rural proceduralists and quality improvement experts, were invited to participate. All quality measures in the first round were proposed by the study team. The second round included measures that did not reach consensus in the first round and measures suggested by respondents during the first round.ResultsThirty individuals participated in Round 1 (59% response rate). Of the 30 respondents from Round 1, 23 participated in Round 2 (77% response rate). 115 of 177 proposed measures (65%) reached positive consensus in Round 1 or 2. Expert participants agreed that these measures should be prioritized/included when evaluating surgical and/or obstetrical quality in rural hospitals. No measure reached negative consensus in either round. Open-text comments offered practical guidance on how to interpret and use surgical and obstetrical quality data within a rural context. Many respondents believed that rare adverse outcomes have low relevance at rural hospitals where volumes are low, procedures are almost all lower complexity day cases (Cesarean section being the major exception), and patients are typically healthy.ConclusionThe modified Delphi process resulted in the identification of surgical and obstetrical quality indicators that are contextually embedded in the realities of rural practice. The methodology allowed for the consideration of factors often overlooked by normative urban-based approaches, including team-based care characteristic of rural hospitals and limited access to specialist care and imaging services.