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PubMed1979

Trends in blunt abdominal trauma among hospital in-patients. Developments in a Swedish rural district over 30 years.

To analyse changes in background factors, injury pattern, and prognosis regarding blunt abdominal trauma in Sweden, the 30-year postwar (1946--75) development was investigated in a rural district. 396 patients were treated, showing a great increase during the last 5 years. The highest frequency was seen in patients aged 11--30 years. Abdominal trauma occurred most commonly during July and August. The growing aetiological importance of road accidents is shown. Equestrian accidents were common early in the period and again towards the end. The incidence of cerebrally confused patients increased. The organs most commonly traumatized were kidney, liver, and spleen. The frequency of multiple intra-abdominal injuries and also associated extra-abdominal injuries increased with time. There was a tendency towards shorter hospital stays. Mortality rates did not change during the period, even though injuries have become increasingly severe (judged by the Injury Severity Score). It is concluded that the improved care of patients compensated precisely for the increased severity of injuries, as reflected in mortality.

Abdominal Injuries↗
PubMed2004

Rural community and health care interdependence: an historical, geographical study.

The relationships between rural health care and community development were examined over time, for the case-study area of Huron and Perth counties in Southwestern Ontario. The underlying premises were that an historical-geographic study could provide both a perspective on the development of rural health services and explore the interdependent relationship between rural community and health care. The research concentrated on examinations of the 2 key elements of rural health care, namely the rural practitioner and the community hospital. Detailed reconstruction revealed that, over time, both physicians and hospitals moved from a marginal to a central position and identity within the community, in parallel with the stages of community development in the 19th and 20th centuries, with hospitals emerging as major foci of rural sustainability. In the last 2 decades, the strength of the area's rural community health system was successfully marshalled to offset the potentially negative aspects of provincial health care restructuring. This reinforced both the perception and the reality of the interdependence of health services and communities in the predominantly rural area.

Community Health Planning↗
PubMed2003

The Southern Rural Access Program and Alabama's Rural Health Leaders Pipeline: a partnership to develop needed minority health care professionals.

Rural Health Leaders Pipeline programs are intended to increase the number of youth interested in and pursuing health professions in rural communities. This paper presents 2 complementary approaches to Rural Health Leaders Pipeline programs. Two different organizations in Alabama recruit students from 18 specified counties. One organization is a rural, community-based program with college freshmen and upperclassmen from rural communities. Students shadow health professionals for 6 weeks, attend classes, visit medical schools, complete and present health projects, and receive support from online tutors. The second organization is a university-based program that supplements an existing 11th grade-medical school rural medicine pipeline with 10 minority students from rural communities who have graduated from high school and plan to enter college as premedical students in the following academic year. Students participate in classes, tutorials, seminars, and other activities. Students earn college credits during the 7-week program, maintain contact with program staff during the school year, and by performance and interest can continue in this pipeline program for a total of 4 consecutive summers, culminating in application to medical school. Each organization provides stipends for students. Early experiences have been positive, although Rural Health Leaders Pipeline programs are expensive and require long-term commitments.

Adolescent↗
PubMed1993

Rural water supplies: what ways and means?

The development of rural water supplies in Finland is outlined, with particular reference to consumer-managed cooperatives. Lessons are drawn which could be of value in developing countries.

Community Participation↗
PubMed2003

Improving access to capital for health care infrastructure: the experience of the Southern Rural Access Program's revolving loan fund.

Lack of access to affordable capital is a formidable barrier that compromises rural health care infrastructure development in poor rural areas. Commercial lending institutions are often limited in their ability to respond to those needs due to traditional lending criteria: creditworthiness, equity, management ability, experiences, and cash flow or profits. In the Southern Rural Access Program, a development model more frequently used in other sectors has been successfully applied to health care to help clear these hurdles. This paper describes the 5 operational loan funds in Arkansas, Louisiana, Mississippi, South Carolina, and West Virginia receiving support from the Southern Rural Access Program. Two models of loan funds have evolved: those led by health agencies and those led by community development finance institutions whose mission is rural economic development. This paper outlines major distinctive features of these 2 approaches and describes major implementation challenges these loan funds face. Key accomplishments are high-lighted, including the ability to leverage additional resources from state, federal, philanthropic, and private sources through these funds. These loan fund programs provide models for other states interested in improving access to capital to help build the rural health care infrastructure while making health care more economically viable through integration with other community development initiatives.

Capital Financing↗
PubMed1998

The preparation of soy-bean foods for use in rural communities of the developing world.

Since the beginning of 1970, there has been a great breakthrough in the popularization of soy-bean-based food in Nigeria and in many parts of the developing world, especially for use in the prevention of kwashiorkor. Since 1975, soy bean has become a main source of daily dietary protein in many parts of Nigeria as a result of the successful incorporation of soy-bean products into almost all traditional Nigerian foods. This is a review of previous work in Nigeria on eliminating the beany flavour, bitter taste, and flatus factors in soy-bean milk and cooked soy-bean paste preparations.

Developing Countries↗
PubMed1998

Sources of Deforestation in Tropical Developing Countries

/ Key causes of tropical deforestation are investigated using cross-sectional data for 90 developing countries for the period 1981-1990. Regression results reveal that deforestation is associated with both development and scarcity. Deforestation accelerates with expanding infrastructure, trade, debt, investment in the human capital base, and resource-based economic expansion. On the other hand, absolute and relative scarcities-manifested by growing population pressures, food and land shortages, fuelwood dependency, and inequalities in access to land-are also key factors explaining forest loss. Thus, results point to a fundamental environmental conundrum: Development is required if countries are to alleviate scarcity-driven forms of forest exploitation but is itself a major cause of deforestation. Can countries balance development goals with forest protection? Setting aside the issue of its practical realization, the paper concludes that forest sustainable development cannot be achieved by implementing simple technical improvements in land-use practices alone. Securing the foundations for the sustainability of the forest base will require that countries address the underlying social processes driving tropical forest loss as well.KEY WORDS: Tropical deforestation; Developing countries; Rural land-use practices; Development; Scarcity.

Journal Article↗
PubMed2006

Illness severity and propensity to travel along the urban-rural continuum.

In this paper, we examine whether the relationship between severity of illness and the propensity to travel greater distance relative to the norm (defined by peers in one's county of residence) is uniform across the urban-rural continuum of geography or over time. We focus on the elderly in New York State who have been admitted to hospital for ambulatory care sensitive conditions (ACSCs), admissions which are presumed to be representative of usual travel patterns. The two periods of time examined span the implementation of the Balanced Budget Act (BBA) of 1997, which established the Medicare Rural Hospital Flexibility Program, a major national initiative to strengthen rural health care with the development of rural Critical Access Hospitals (CAHs). As the number of NY rural hospitals certified as CAH increased with the expanded funding from the BBA, one might expect to see increased distance traveled by more severely ill rural elderly, as their CAHs referred them to their affiliated support hospitals. The logistic regression estimates support this expectation, highlighting an asymmetrical relationship between relative distance and severity across patients in rural and urban areas. Despite a general decline in average propensity to travel further than the norm across the landscape, severity had a larger impact on travel propensity in rural areas, which increased over time.

Aged↗
PubMed2005

Biotelemetry: could technological developments assist healthcare in rural India.

CONTEXT: In India 60-70% of the population live in rural villages. The rural population suffers from a burden of disease and disorders due to the non-availability of appropriate healthcare personnel and facilities. Since 1950, the Indian Government has responded with a series of five-year plans but has been unable to address the lack of healthcare professionals prepared to work in isolated and rural areas. ISSUE: The use of biotelemetry is proposed as a solution, its advantages and disadvantages are discussed. LESSONS: The development of biotelemetry in India will improve healthcare for the rural and remote population and ease the effects of the shortage of rural healthcare professionals. However, a number of questions remain and require further consideration.

Health Policy↗