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Adaptive shifts in amygdala-hippocampal theta coupling govern aversive learning and extinction.

Authors: Sonkusare S, Ding Q, Weirich C, Feng Y, Liu W, Yang R, Mandali A, Sallie S, Casero V, Cao C, Li D, Sun B, Zhan S, Voon V
Journal: Nature communications
mental health psychology open access

Abstract

Nurses play a central role in delivering healthcare to rural populations in the United States, where residents experience persistent health disparities and reduced access to care [, , ]. Most recent census data reports that 19.3% of the U.S. population lives in rural areas []. Rural residents are typically older, have lower incomes, experience higher rates of chronic disease, and have worse nonmedical factors (e.g., economic stability, educational quality) than their urban counterparts []. These challenges are compounded by longstanding rural healthcare workforce shortages, with 64% of nonmetropolitan counties designated as primary care Health Professional Shortage Areas, compared to 41% of metropolitan counties []. Workforce shortages and related financial pressures have also contributed to the closure and loss of essential service reductions in rural healthcare facilities, such as 146 rural hospital closures between 2005 and 2023, and more than 25% of rural hospitals losing obstetric services across the United States [, ]. Ultimately, these rural hospital closures and loss of services have forced rural residents to travel farther for essential care, creating additional barriers to their healthcare access []. Preparing a nursing workforce capable of meeting the needs of rural populations is, therefore, a priority. Rural nursing has emerged as a distinct area of practice demanding broad clinical competence, autonomy, adaptability, and the ability to provide comprehensive care across the lifespan [, ]. In addition to strong clinical skills, rural nurses must also effectively engage with local communities, develop partnerships, and respond to the unique cultural, social, and environmental contexts that influence health in rural settings. These competencies extend beyond those typically emphasized in traditional nursing curricula and require educational experiences that prepare graduates for the realities of rural practice. Consequences of lacking rural‐specific training may lead to higher turnover and retention issues and decreased quality of care []. Despite the importance of rural nursing, rural health‐related content remains inconsistently integrated into Bachelor of Science in Nursing (BSN) programs. Prior research suggests that out of 237 BSN programs, fewer than half include any rural health content, but little is known about the content characteristics []. Curriculum that includes a rural‐related focus such as community engagement, population health, underserved communities, and social determinants of health (SDOH) is critical for preparing nurses to provide context‐sensitive care.