New research shows that between 2001 and 2019 the supply of general surgeons in the U.S. decreased by 29.1% in rural areas, and 18% overall. This is a crucial finding as general surgeons play a critical role in rural health care.

General surgeons in rural areas decrease the need for patients to travel for routine surgery, provide backup to rural primary care providers in emergency care, obstetrics, and orthopedics, and contribute substantially to the financial health of rural hospitals. The study also found rural general surgeons are older than their urban counterparts and fewer surgeons in rural areas are women. The research was conducted by the HRSA-funded WWAMI Rural Health Research Center.

For victims of sexual assault, high-quality health care provided by sexual assault nurse examiners (SANEs) is associated with improved health and prosecutorial outcomes. However, very little is known about access to SANEs.

Sheridan Miyamoto, assistant professor and SAFE-T Center principal investigator, and Elizabeth Thiede, nursing doctoral student and 2021 ENRS Student Conference Scholarship Award winner, wanted to learn more about whether rural areas in particular may have disparate access to SANEs.

“If rural areas have limited SANE availability, then rural victims of sexual assault may be at risk of receiving lower-quality care, which has implications not only for their health but also for prosecutorial outcomes,” stated Thiede.

The research recently was published in The Journal of Rural Health.

To examine rural access to SANEs, Thiede and Miyamoto analyzed data from the International Association of Forensic Nurses (IAFN) as well as data collected from 43 rural Pennsylvania hospitals.

The IAFN data showed that certified SANEs — those who have met rigorous qualifications and passed a certification exam — were only present in 16.7% of rural counties. The data collected from individual hospitals confirmed that very few have certified SANEs on staff and, instead, most rely on registered nurses with varying levels of additional training in sexual assault care.

Thiede and Miyamoto also found that most of these hospitals are not able to provide continuous sexual assault care coverage. This may lead them to encourage victims to seek care elsewhere or to rely on health care providers without additional training and experience in sexual assault care when victims present to emergency rooms.

Miyamoto and Thiede suspect that the absence of certified SANEs in the majority of rural Pennsylvania counties could be indicative of barriers to meeting certification requirements for rural SANEs. The two suggested one likely barrier to certification is the difficulty obtaining the supervised practice hours required for certification eligibility.

“Rural communities face challenges in recruiting, training, and retaining SANE nurses. Creative solutions are needed to increase access to quality sexual assault care.” Miyamoto stated. “The intent of the Penn State Sexual Assault Forensic Examination Telehealth (SAFE-T) program is to pair less experienced nurses working in rural areas with expert SANEs to receive examination support, precepting, and peer review via telehealth technology. Programs like this show great promise in growing and sustaining a rural SANE workforce.”

To continue ensuring that rural sexual assault victims receive expert quality sexual assault care, further research is needed to better understand how hospitals make decisions related to how they will provide sexual assault care and how ecological factors, such as hospital resources, the population size of the surrounding community, organizational culture, and state-level oversight may influence this decision-making.

More information about the SAFE-T Center and their work can be found on the website.

Preventing Chronic Disease released a collection of oral health articles. These articles include topics such as inequities in access to dental care, disparities in prevalence of oral disease, the relationship between oral health and chronic diseases, and the impact of COVID-19 on access to oral health services and disease monitoring. The articles provide a snapshot of why oral health needs to be elevated as a policy priority by being integrated into discussions and policy decisions about health. Addressing the social, behavioral, and environmental determinants of health as part of oral health care offers a new approach to prevention and treatment.

Click here to view the articles.

The U.S. Preventive Services Task Force (USPSTF) released a final recommendation statement on screening for hearing loss in older adults. The Task Force concluded that more research is needed to determine whether to screen older adults for hearing loss before they have symptoms. To view the recommendation, the evidence on which it is based, and a summary for clinicians, please go here. The final recommendation statement can also be found in the March 23, 2021 online issue of JAMA.

A new brief from the Centers for Disease Control and Prevention (CDC) reports on a higher rate of overdose deaths due to heroin and cocaine in urban areas.  In rural areas, however, overdose rates were higher for natural and semisynthetic opioids, synthetic opioids (excluding methadone), and psychostimulants with abuse potential.

A recent MedPage article states that the American College of Gastroenterology (ACG) has updated their colorectal cancer (CRC) guidelines that they last issued in 2009. The decision was made due to data on colorectal cancer (CRC) screening gathered over the past decade. The new recommendations, published online in the American Journal of Gastroenterology, state that screening should start at age 45 for persons of average risk.