Rural Americans lack adequate health care access and quality.1 More than 10% of Americans live in federally designated health professional shortage areas where they have limited or nonexistent health care services. The shortages apply to physicians, nurses, nurse practitioners, physician assistants, dentists, pharmacists, and many allied health professionals. Generally, the smaller, more isolated, and poorer the community, the worse the shortage problem becomes. 2To make matters worse, rural populations are older and poorer than their urban counterparts and often have more limited insurance coverage.3,4 People in rural communities often have high rates of chronic conditions, accompanied by increased prevalence of problem health behaviors including smoking, obesity, and lack of exercise.2 The need for core health services (eg, primary care, medical and hospital services, long-term care, oral health care, and public health services) is enormous.Rural

Clinical reasoning is increasingly recognized as a crucial component of the occupational therapy process. Different types of clinical reasoning used by occupational therapists have been identified, including scientific, procedural, interactive, narrative, conditional, and pragmatic reasoning. This article describes the use of the case method in the University of New Mexico undergraduate occupational therapy curriculum to facilitate development of occupational therapy students' problem-solving and reasoning abilities. The case method is a component of problem-based learning that emphasizes small group work to solve clinical problems that are presented as case studies. Students are presented with a variety of case formulas including paper or written cases, videotape cases, simulated client cases, and real client cases to promote the development of specific types of clinical reasoning. Problem-based learning may also hold promise as an educational strategy for fieldwork students and clinicians.

Mothers of children with disabilities have identified multiple challenges associated with achieving occupational balance in their lives. Occupational therapists are just beginning to explore the occupational and time use strategies that mothers use to successfully care for their children and get through the day in a positive manner. The Person—Environment—Occupation model was used to guide an occupational therapy intervention program called “Project Bien Estar,” which was designed to increase the satisfaction, time use, and occupational performance of mothers of school-aged children with disabilities. This article focuses on the rich content of the group discussions and individual reflections, providing insight into the world of women caring for children with disabilities. Thematic analysis was used to identify person, environment, and occupation factors that contribute positively and negatively to the mothers' well-being, and the effects of the occupational therapy intervention are discussed.

The Agricultural Cooperative Extension Service model offers academic health centers methodologies for community engagement that can address the social determinants of disease. The University of New Mexico Health Sciences Center developed Health Extension Rural Offi ces (HEROs) as a vehicle for its model of health extension. Health extension agents are located in rural communities across the state and are supported by regional coordinators and the Offi ce of the Vice President for Community Health at the Health Sciences Center. The role of agents is to work with different sectors of the community in identifying high-priority health needs and linking those needs with university resources in education, clinical service and research. Community needs, interventions, and outcomes are monitored by county health report cards. The Health Sciences Center is a large and varied resource, the breadth and accessibility of which are mostly unknown to communities. Community health needs vary, and agents are able to tap into an array of existing health center resources to address those needs. Agents serve a broader purpose beyond immediate, strictly medical needs by addressing underlying social determinants of disease, such as school retention, food insecurity, and local economic development. Developing local capacity to address local needs has become an overriding concern. Communitybased health extension agents can effectively bridge those needs with academic health center resources and extend those resources to address the underlying social determinants of disease.

The purpose of this study was to explore the feasibility of a modified mindfulness intervention for reducing binge eating. Participants (n = 25) were recruited from the general public for a Mindfulness-Based Stress Reduction (MBSR) course. The standard MBSR format was modified to include brief eating exercises. There was no control group. Participants completed the Binge Eating Scale and other self-report measures before and after the course. There was a decline in binge eating as well as state anxiety and depressive symptoms. Reduced binge eating was related to increased self-acceptance and reduced state anxiety. The results are discussed with regard to laying the foundation for future research on the effects of mindfulness on eating.