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PubMed1982

Women--the underused human resource: education and training of women for community participation.

This article goes beyond the rhetorical issue of women's participation as a key to implementing water supply and sanitation projects and suggests concrete ways in which training and education can make these plans a reality. With the improvements proposed for the International Drinking Water Supply and Sanitation Decade, women could be freed to do other tasks vital to the well being of the family and the community. Women, the "invisible resource" of society, play and essential part in encouraging family members to use technological advances and should be trained to effectively promote their acceptance. The author highlights the influence women have in the field of public health: with adequate training, for example, they can help control the spread of diarrheal disease with proper hygiene and an understanding of the fecal-oral route of infection. Moreover, she says that the central role women play in socializing the young and their permanence within the household make them suitable as trainees and trainers for water and sanitation projects at the community and household levels. Women should be recruited for these roles and should be consulted at every stage of development; while women's bureaus exist in many countries, the author states that planners often hesitate to call on them for assistance. The article describes several innovative training programs and, along with a bibliography, presents separate case studies for Mexico and Panama.

Africa↗
PubMedDate not supplied

Ego development and ethnic identity formation in rural American Indian adolescents.

Ethnic identity development was assessed in the context of ego development in 12- to 15-year-old students from a Southeastern American Indian community. Self-protective was the modal level and was characterized by awareness of ethnic group membership but little exploration or self-reflection. Impulsive adolescents had the least developed ethnic identities and highest levels of interpersonal vulnerability. Conformist adolescents expressed positive feelings about ethnic group affiliation, described relationships as harmonious, but demonstrated moderate social anxiety. Postconformist adolescents had the highest levels of agency, social competence, and identity achievement, but also had high levels of psychological distress and family conflict. Adolescent identity strivings may be understood in context with the level and timing of psychosocial maturity, for which ego development appears a useful marker.

Adolescent↗
PubMed1992

Growth, behavior, development and intelligence in rural children between 1-3 years of life.

In a rural cohort of 625 children registered from 1981 to 1983 in 10 villages of K.V. Block, Varanasi, 196 children were assessed for physical growth, development, intelligence and concept development between 1 and 3 years of age. Home environment was also assessed using Caldwell Home inventory. These rural children remained below 3rd centile of NCHS standard for weight, height, skull and mid-arm circumferences throughout the study. Malnourished children scored poorly in all the areas of development, i.e., motor, adaptive, language and personal social, 9% in Grade I and 16.6% children in Grade II + III had IQ less than 79 (inferior). Concept for color shape and size was poorly developed in malnourished children. Maternal involvement and stimulation was strongly associated with better behavior development and intelligence. Multiple regression analysis showed that the effect of home environment on development and intelligence was of a higher magnitude as compared to status and family variables and nutritional status during 1-3 years of age.

Adult↗
PubMedDate not supplied

Telemedicine in rural care. Part 1: Developing and evaluating a nurse-led initiative.

AIM: To develop and evaluate a nurse-led telemedicine service over a six-month period, linking the senior citizens of a rural village with the town-based general practice. METHOD: Patients, doctors and nurses were asked to complete a questionnaire following video-link sessions. Interviews were also carried out at home with patients, while interviews with nurses and doctors took place in the workplace. RESULTS: Of the 173 consultations with villagers aged over 65, 29 (17 per cent) were conducted by video-link. All those who used this service were sent questionnaires and 18 were returned (62 per cent). Seven of the patients who had received one video-link consultation were interviewed in their homes. All of the patients initially found the video consultation experience strange. Generally, patients found the nurses to have a pivotal role in explaining the service and interpreting their needs. All those interviewed said they would use the service again. The GPs spoke favourably of the service and said that it had saved them time. The nurses involved were positive about the service. Negative comments generally related to technology, for example picture and sound quality. CONCLUSION: All involved in the nurse-led telemedicine service viewed it favourably and patients said that they would use it again. Part two, to be published in next week's Nursing Standard, will discuss the findings of the evaluation in relation to the wider picture of nursing involvement in teleconsultation.

Aged↗
PubMed1985

Clean water provision in rural areas of less developed countries.

The decade of the 1980s is declared as a time to solve global domestic water supply problems. By 1990 international goals include the provision of adequate quantities of clean water to every person on earth. Such goals are justified on the basis of human health, economic well being, political development and equity and public safety. Drawing upon observations from Ethiopia, Malaysia and Liberia, cases where attempts to provide domestic water to villagers and rural town dwellers are presented. In all cited cases attempts to provide safe water have failed or are in jeopardy. Conclusions drawn from these cases include acknowledgement that global goals will best be achieved by approaching local problems one-by-one and recognizing the technical, environmental and human constraints upon safe water provision interact differently from one site to another. To properly plan, implement and maintain safe water systems the current technical solutions must be combined with the contributions of social and environmental scientists on a case-by-case basis.

Communicable Disease Control↗
PubMed2003

Rural general practitioner preceptors--how can effective undergraduate teaching be supported or improved?

INTRODUCTION: General practitioners (GPs) as rural GP-Preceptors play an important role in medical student teaching within the Discipline of General Practice, University of Tasmania, Australia. As well a significant teaching role, they are responsible for apportioning 20% of the mark medical students receive in the General Practice examination at the end of the rotation. The contribution of the student-rural GP preceptor relationship to recruiting and retaining rural GPs has been acknowledged. Despite these important responsibilities, as honorary teaching staff rural GP preceptors receive no formal training in undergraduate education or assessment, nor did they receive formal peer support. METHOD: To address the lack of educational preparation of GP-preceptors, and in accordance with the stringent teaching and assessment standards of the Australian Medical School Accreditation, a tripartite approach was taken to educational skills development among rural GP-preceptors. The Discipline of General Practice conducted a needs-analysis of 64 rural GP-preceptors, and an evaluation by questionnaire of the teaching efficacy of those 64 rural GP-Preceptors and 76 urban GP-preceptors by 64 final-year medical students after their 3-week rural and urban GP attachments. The second intervention, based on the assessment and evaluation findings, was devised and implemented by the University Department of Rural Health. A series of workshops comprised the interdisciplinary educational and support program for GP preceptors, entitled Preceptor Onsite Preparation Program for Information Education and Support, or POPPIES. RESULTS: The rural GP-preceptor needs analysis indicated that the majority of rural preceptors had no clear understanding of how what they taught fitted into the overall curriculum; they believed that their role as a clinical teacher had not been clearly defined by the program director; and also that undergraduate students had little understanding of what they needed to learn during their attachments. In contrast, preceptors believed they understood what students needed to learn; they were confident in performing the role of preceptor; and were familiar with adult learning principles, goal setting processes, effective student evaluation and the provision of appropriate performance feedback. Evaluation of feedback from students revealed that while rural GP preceptors performed well overall in regard to providing quality teaching and learning experiences, there was a significant spread of scores across all criteria, and approximately 15%-25% of students perceived various aspects of their attachment to be mediocre or poor. CONCLUSION: The combined results of the medical student questionnaire and rural GP-preceptor survey indicated both a need and a desire for educational skills development among rural GP-preceptors. On this basis, the interdisciplinary educational and support program for GP-preceptors (POPPIES) was developed and implemented as a series of workshops throughout rural Tasmania. Although no objective data are yet available about teaching outcomes as a result of POPPIES workshops, preliminary responses from attendee GP preceptors indicated that the workshops were effective in addressing educational needs, and in providing rural clinical teachers with professional teaching development.

Journal Article↗
PubMed1992

Culture appropriate indicators for monitoring growth and development of urban and rural children below 6 years.

In this cross sectional study, 2000 apparently normal children aged 0-6 years (1200 urban and 800 rural), were nutritionally and developmentally assessed and their environment scrutinized for possible risk factors. Measurement of mid upper arm circumference (MUAC) using standard techniques revealed malnutrition in 44% of the rural and 24% of the urban children especially in the 2-6 years of age group. Culture appropriate indicators of psycho-social development picked up gross delays in gross motor (GM), vision and fine motor (V&FM) and language skills. Self help, concept hearing (SHCH) skills were recorded as normal while social skills were advanced particularly in the 0-2 years old urban group. By the use of the family protocols, low socio-economic status, malnutrition and 9 other risks factors have been generated for the urban group. No risk factor could be identified for the rural group. Better income emerged as the only real protective factor for the sample showing a direct positive relationship with the 45 skills tested, especially in the 2-6 years age group. Nineteen developmental skills were identified as powerful predictors of development. A prototype home based screening record was constructed for monitoring of growth and development which can be even used by minimally trained primary care worker.

Child↗
PubMed1995

Admissions for injury at a rural hospital in Ghana: implications for prevention in the developing world.

OBJECTIVES: Strategies for injury prevention have been extensively studied in developed nations but not in the developing world. This study sought to determine which mechanisms of injury were common in a rural developing area and which were important contributors to mortality and disability. METHODS: All 614 patients admitted for injuries to a rural African hospital between 1987 and 1991 were analyzed retrospectively for mechanism of injury and outcome, as assessed by mortality and long-term functional status. RESULTS: The leading mechanisms of injury were transport related (29%) and burns (16%). Burns accounted for 61% of injuries in children under 5 years. Mortality was 7.3% in the series, with 24% of deaths owing to transport injuries. Disability developed in 103 (22%) of the 462 survivors available for assessment, with most disability resulting from transport injuries (26% of all disabilities), burns (13%), and agricultural injuries (14%). CONCLUSIONS: Among injured patients who presented for treatment in this rural developing area, the largest burden of mortality and disability was from burns and transport-related injuries. Population-based studies are needed to substantiate whether these should be priorities for injury prevention efforts.

Adolescent↗
PubMed1984

Testing a model that evaluates options for rural Emergency Medical Service development.

The authors developed a model that relates survival from myocardial infarction or cardiac arrest to four classes of interactive variables describing the rural community, the patient, Emergency Medical Service (EMS) system inputs, and EMS system process in caring for the suspected cardiac patient. Using data from 92 EMS systems in three geographically distinct and physically dissimilar regions, the authors found a consistent and significant relationship between the probability of patient survival and cardiac disease severity, age, sex, the presence of a life-threatening arrhythmia, health care resources available to the EMS system, citizen-initiated cardiopulmonary resuscitation, EMS response time, and the presence of a paramedic on the ambulance responding to the call. The model affords the opportunity to enumerate those factors with the greatest influence on cardiac survival within the community and to test expected increases in survival gained through incremental changes in these factors.

Emergency Medical Services↗
PubMed1980

Penetrating abdominal trauma. A comparison of the development during 30 years between a rural and an urban area.

The development of penetrating abdominal injuries during 30 years has been compared between a rural and an urban area. There was an increase in number of injured patients but the causes of injury did not change. In the urban area stab wounds, assaults, and injury combined with alcohol intoxication were significantly more frequent than in the rural, where gunshot wounds dominated. Indications for laparotomy and therapeutic management did not differ. There were minor but statistically insignificant differences in complications and mortality. Although the material is small exteriorization must be recommended as the method of choice in penetrating civilian colon injuries as it is in war injuries.

Abdominal Injuries↗