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PubMed2003

Community based program to improve firearm storage practices in rural Alaska.

OBJECTIVE: To develop and evaluate a pilot program to reduce unauthorized access to firearms by youth by distributing gun safes and trigger locks to households. DESIGN: Pilot intervention with pre/post-evaluation design. SETTING: Two Alaska Native villages in the Bristol Bay Health Corporation region of southwest Alaska. SUBJECTS: Forty randomly selected households with two or more guns in the home. INTERVENTION: Initially, a focus group of community members who owned guns was convened to receive input regarding the acceptability of the distribution procedure for the gun storage devices. One gun safe and one trigger lock were distributed to each of the selected households during December 2000. Village public safety officers assisted with the distribution of the safes and provided gun storage education to participants. MAIN OUTCOME MEASURES: Baseline data were collected regarding household gun storage conditions at the time of device distribution. Three months after distribution, unannounced onsite home visits were conducted to identify if residents were using the gun safes and/or trigger locks. RESULTS: All selected households had at least two guns and 28 (70%) of the 40 households owned more than two guns. At baseline, 85% of homes were found to have unlocked guns in the home and were most often found in the breezeway, bedroom, storage room, or throughout the residence. During the follow up visits, 32 (86%) of the 37 gun safes were found locked with guns inside. In contrast, only 11 (30%) of the 37 trigger locks were found to be in use. CONCLUSIONS: This community based program demonstrated that Alaska Native gun owners accepted and used gun safes when they were installed in their homes, leading to substantial improvements in gun storage practices. Trigger locks were much less likely to be used.

Adolescent↗
PubMed2003

Development of a Rural Asthma Management Model, RAMM.

INTRODUCTION: The prevalence of asthma in Australia is increasing and places a significant cost burden on the community as well as reducing individuals' quality of life. In the late 1990s, asthma was the sixth National Health Priority in Australia and the prevalence of asthma in the Loddon Mallee region (LMR) of Victoria was approximately 1% higher than the State average. Four LMR local government areas had close to double the State average hospital admission ratios for asthma. AIM: The aim of this project was to develop a Regional Asthma Management Model (RAMM) and strategies for its implementation throughout the LMR, as a tool to implement a major health priority of both the Victorian State and Australian Commonwealth governments: to improve health outcomes for people with asthma. METHODS: A literature review was undertaken to identify best practice in asthma management for use as the basis of questions in workbooks designed to profile and compare current asthma management practice in the LMR. The workbooks were sent to all acute hospitals, community health centres and asthma educators in the LMR. The completed workbooks were returned and respondents elaborated on the workbook data at one of five subregional workshops. A survey was also undertaken to identify the range of asthma management strategies currently used by regional general practitioners (GPs) and to invite their views on ways to improve asthma management in the region. To gain consumer input into the RAMM a semi-structured group interview was held in an urban area and individual interviews were held in two rural areas in the region. A multidisciplinary reference group provided guidance to the project and a documentation design team was convened. RESULTS: Of the 19 workbooks sent to individual acute hospitals, 15 (78.9%) were completed and returned; 13 of 14 workbooks (92.8%) sent to individual community health centres were completed and returned. Fourteen of 15 asthma educators identified in the LMR were employed in the acute hospitals and community health centres that returned the workbooks; one asthma educator worked privately. Of the 215 GP surveys distributed, 38 surveys (17.6%) were returned. The majority of this small sample of GPs supported developing a uniform regional approach to asthma management based on NAC guidelines. Consumers interviewed suggested treating doctors, and/or EDs provide patients and carers with written instructions regarding acute asthma attacks and advice on management strategies for the ensuing 24-48 hours. A regional profile of asthma management practice was produced and compared with identified best practice. Gaps in practice and services were identified and responsive recommendations formulated. The National Asthma Campaign (NAC) guidelines were used as the basis for RAMM documentation, a package which consisted of a Regional Asthma Clinical Pathway and Emergency Department (ED) Package. CONCLUSION: The RAMM developed during the project provides documentation to assist best-practice asthma management by regional EDs and acute hospitals. The methodology and outcomes of the RAMM reflect the geography of the region, with multiple service providers from different locations managing a person with asthma across the primary, secondary and tertiary continuum. The RAMM methodology has the potential to be applied to other diseases and to other rural environments. Although the RAMM was designed for rural areas it could be easily adapted to suit the metropolitan environment. Implementation and evaluation of RAMM documentation is in progress.

Journal Article↗
PubMed1990

A systems analytical framework for rural to rural migration studies in developing countries.

"This study is an attempt to examine a substantial and important migration type in developing countries, in this case, rural-rural migration. Its focus is on the development of an explanatory model to account for the determining factors for, and impact of, rural migration. Recognising the diversity of causal factors in rural migration in traditional societies of the world, the model proposes that the rural-rural migration phenomenon is better understood within the systems analytical framework."

Demography↗
PubMed1992

China's Cooperative Medical System: its historical transformations and the trend of development.

The rural Cooperative Medical System (CMS) in China came into existence in the 1950s. Along with the development of the collective economy of agriculture and the promotion of this system by the Chinese Government, the coverage rate of the CMS in the rural areas increased from 1955 through the end of the 1970s, when it was estimated that 90 percent of the rural population was covered by the CMS. Since the rural economic reform in the early 1980s destroyed the rural collective economy on which the CMS was based, The coverage rate of the CMS went down to 5 percent. After 1985, the coverage rate of the CMS began to increase gradually because of the development of the collective fund for supporting the CMS and the governments' efforts to strengthen the CMS. The structure of CMS has changed over time. Traditionally, the CMS was organized at the village level. In order to increase the risk-sharing ability of this system, the trend is for it to be organized at the township level in the future.

China↗
PubMedDate not supplied

[Dynamics of physical development of Chuvash rural school children (1884-1999)].

Analysis of the statistic indices height and body weight in schoolchildren has demonstrated their positive changes in all age and sex groups for 115 years. The maximum height and body weight increases are observed in the time intervals 1962-1966, 1966-1982 which show statistically significant increases in the indices in virtually age-sex groups. In the past 15 years height increases have preserved; however, their increase rate has decreased; there is a negative trend for body weight to change, which is more pronounced in girls. The findings suggest that there is a tendency for developmental acceleration to be stabilized, which are not contradictory to the global epochal processes of growth and development. The changes in body weight may be regarded as negative, which is caused by present socioeconomic problems in our country. Physical development monitoring in children and adolescents permits development and implementation of regional and federal programmes for health promotion to ensure the population's sanitary well-being.

Adolescent↗
PubMed2000

High HIV incidence and prevalence among young women in rural South Africa: developing a cohort for intervention trials.

OBJECTIVE: To measure prevalence and model incidence of HIV infection. SETTING: 2013 consecutive pregnant women attending public sector antenatal clinics in 1997 in Hlabisa health district, South Africa. Historical seroprevalence data, 1992-1995. METHODS: Serum remaining from syphilis testing was tested anonymously for antibodies to HIV to determine seroprevalence. Two models, allowing for differential mortality between HIV-positive and HIV-negative people, were used. The first used serial seroprevalence data to estimate trends in annual incidence. The second, a maximum likelihood model, took account of changing force of infection and age-dependent risk of infection, to estimate age-specific HIV incidence in 1997. Multiple logistic regression provided adjusted odds ratios (OR) for risk factors for prevalent HIV infection. RESULTS: Estimated annual HIV incidence increased from 4% in 1992/1993 to 10% in 1996/1997. In 1997, highest age-specific incidence was 16% among women aged between 20 and 24 years. In 1997, overall prevalence was 26% (95% confidence interval [CI], 24%-28%) and at 34% was highest among women aged between 20 and 24 years. Young age (<30 years; odds ratio [OR], 2.1; p = .001), unmarried status (OR 2.2; p = .001) and living in less remote parts of the district (OR 1.5; p = .002) were associated with HIV prevalence in univariate analysis. Associations were less strong in multivariate analysis. Partner's migration status was not associated with HIV infection. Substantial heterogeneity of HIV prevalence by clinic was observed (range 17%-31%; test for trend, p = .001). CONCLUSIONS: This community is experiencing an explosive HIV epidemic. Young, single women in the more developed parts of the district would form an appropriate cohort to test, and benefit from, interventions such as vaginal microbicides and HIV vaccines.

Adolescent↗
PubMed1985

[Return migration and the development of a rural commune in Basilicata].

"This study, based essentially on a survey of 80 returnees, examines the extent to which return migration has contributed to processes of economic change in an agro-town in southern Italy, Bernalda (Potenza)." The authors conclude that return migration has had only a limited impact on the economy because of the low demand for skilled labor in the area of origin. (summary in ENG, FRE)

Demography↗
PubMed1998

Development of the Rural-Urban Demand Indicator (RUDI).

In this article we describe development of RUDI (Rural-Urban Demand Indicator), a multivariate interval level measure of demand for health services. RUDI ranks counties by population and purchasing power and was developed for use in a wide variety of health-related research and for policy analyses. RUDI is based on microeconomic theory and Grossman's (1972) extension of the theory, that the family produces health and that the family's demand for health services is derived from the demand for health. Two factors define RUDI: DEMOS (demographics) and EWB (economic well-being). These two factors accounted for 66.2% of the variance observed in 1990 census data. A variety of other analyses offer evidence of known- groups, convergent, factorial, and predictive validity.

Analysis of Variance↗
PubMedDate not supplied

A strategy for developing environmental health indicators for rural Canada.

Our understanding of and ability to describe rural health conditions can be considerably enhanced by the use of rural health indicators which allow us to compare rural and nonrural areas or areas differentially located on the urban-rural continuum in terms of various health conditions. However, while health indicators abound, there are very few that can be used to describe the health conditions of rural Canada. This paper discusses the concepts of health in a rural context and adopts a broad definition of health that goes beyond the mere absence of disease or impairment. We propose five broad categories of health indicators: health status indicators, health determinant indicators, health behaviour indicators, health resource indicators, and health service utilization indicators. The most commonly used health indicators in Canada and the datasets from which they are derived are examined in order to assess their applicability to "communities" or "regions". This review highlights the strengths and limitations of various datasets and indicators and their applicability to the "community" and "regional" scale for rural environments. Finally, challenges in data availability and use are discussed as they relate to rural health indicator development.

Canada↗
PubMedDate not supplied

Epidemiology of chronic suppurative otitis media and deafness in a rural area and developing an intervention strategy.

Of 613 children evaluated in a village in Haryana 94 (15.3%) were observed to have chronic suppurative otitis media (CSOM). Fifty eight (61.7%) children had hearing impairment. CSOM contributed to 71.6% of the hearing impaired (58/81). On analysis of association of CSOM with literacy and socio-economic status of mothers, and age, sex, and upper respiratory tract infections (URI) in children positive correlation was observed only with URIs (P < 0.001). Literacy and socio-economic status of the mothers did not correlate significantly with knowledge about treatment seeking, and ear cleaning practices, probably due to the narrow range of incomes and literacy levels. An intervention program consisting of play, demonstrations, health charts and slogans, and aural cleaning and antibiotic drops was introduced.

Adolescent↗