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Taking primary care continuing professional education to rural areas: lessons from the United Arab Emirates.

OBJECTIVE: To assess the impact of a practice based multidisciplinary educational program. DESIGN: A descriptive account of experiences in introducing a new program of continuing professional development. SETTING: Rural primary health care centres in the United Arab Emirates. SUBJECTS: All staff working in the rural health centres. RESULTS: The educational intervention proved popular and appeared to effect a behavioural change. Teamwork in the health centres showed a marked improvement. CONCLUSION: A practice-based, multidisciplinary educational program using case-based learning proved to be effective when introduced to rural health centres of a developing country with multiracial health care professionals. .

Attitude of Health Personnel↗

Safe drinking water production in rural areas: a comparison between developed and less developed countries.

At the fundamental level, there are remarkable parallels between developed and less developed countries in problems of providing safe drinking water in rural areas, but of course, they differ greatly in degree and in the opportunities for resolution. Small water supplies frequently encounter difficulty accessing sufficient quantities of drinking water for all domestic uses. If the water must be treated for safety reasons, then treatment facilities and trained operating personnel and finances are always in short supply. Ideally, each solution should be sustainable within its own cultural, political and economic context, and preferably with local personnel and financial resources. Otherwise, the water supply will be continuously dependent on outside resources and thus will not be able to control its destiny, and its future will be questionable. The history of success in this regard has been inconsistent, particularly in less developed but also in some developed countries. The traditional and ideal solution in developing countries has been central water treatment and a piped distribution network, however, results have had a mixed history primarily due to high initial costs and operation and maintenance, inadequate access to training, management and finance sufficient to support a fairly complex system for the long term. These complete systems are also slow to be implemented so waterborne disease continues in the interim. Thus, non-traditional, creative, cost-effective practical solutions that can be more rapidly implemented are needed. Some of these options could involve: small package central treatment coupled with non piped distribution, e.g. community supplied bottled water; decentralized treatment for the home using basic filtration and/or disinfection; higher levels of technology to deal with chemical contaminants e.g. natural fluoride or arsenic. These technological options coupled with training, technical support and other essential elements like community commitment provide opportunities that should be explored both for rural small communities and in rapidly growing periurban areas in developing countries.

Developed Countries↗

Case studies of change--addressing family support needs of rural GPs.

The National Rural Faculty of the Royal Australian College of General Practitioners received commonwealth funding between 2000-2002 to develop a rural medical family support project. There were three elements to this project: a counselling and communication skills or mentoring workshop for rural GP spouses in each state. The development of a resource kit of existing rural medical family support strategies, and the piloting of a range of strategies designed to address family support needs in collaboration with rural GPs, registrars and their families. This article focusses on the last of these three elements.

Adult↗

Patients' rights in a Third World southern African country, with special reference to Bophuthatswana: is there any potential for privatisation?

Patients' rights to medical care, to inviolability without informed consent, and to medical screening tests, for example, are determined by the legal system to which they are subject. The interests of the individual must be weighed against the interests of the society to which he or she belongs, as this must be the criterion used to establish the extent of their rights, if any. The rights of an AIDS patient in a First World country and those of an AIDS patient in a Third World country are bound to differ in extent. The emphasis in the simultaneous duties of the state towards an individual AIDS patient and to society as a whole will differ from state to state. The First and Third World sectors are differentiated with reference to privatisation, and legal forms are touched upon.

Africa, Southern↗

Rural telemedicine: lessons from Alaska for developing regions.

Alaska shares many characteristics with other rural and remote regions of the Asia-Pacific, including a small population spread over a large area, lack of roads linking villages to hospitals, a significant indigenous population, and a shortage of doctors in rural areas. Communication with village health aides was originally by high frequency (HF) radio. Satellites brought reliable voice communication in the 1970s. Alaska has now introduced the first permanent upgrade to the voice satellite system, known as the Alaska Federal Health Care Access Network (AFHCAN). This satellite-based system is now the world's most extensive telemedicine network, linking 248 sites, including 158 village health centers. This paper examines the approach used to design the network, and includes preliminary findings on utilization of the network and associated cost-savings. It also discusses the U.S. Universal Service Fund subsidy for rural health care facilities. It concludes with lessons learned that could be applicable for other remote and isolated areas and developing regions.

Alaska↗

Farming exposure in childhood, exposure to markers of infections and the development of atopy in rural subjects.

BACKGROUND: Within the context of the hygiene hypothesis, we aimed to study the potential association between farming-related risk factors and Toxoplasma gondii (T. gondii) as well as Helicobacter pylori (H. pylori) seropositivity. METHODS: The study included questionnaire data and serum samples of 321 young adults living in a rural environment. Serum samples were analysed for specific IgE to a common panel of aeroallergens (SX1) as well as IgG against T. gondii and H. pylori. RESULTS: Regular contact with animal stables before the age of 3 years (odds ratio (OR) (95% confidence interval): 2.0 [1.0; 4.0]) and unpasteurized milk consumption at age 6 years (1.8 [1.0; 3.3]) were the strongest risk factors for T. gondii infection. None of the farming-related factors were significantly associated with H. pylori infection. Current consumption of raw farm milk was not significantly associated with H. pylori infection (2.1 [0.8; 5.3]). Regular contact with animal houses before the age of 7 years was the strongest predictor for atopy (0.49 [0.26-0.96]). The reduction in risk could not be further decreased by any other factor under consideration. After adjustment for animal house contact, the OR for atopy was decreased by raw milk consumption and H. pylori infection in an additive manner. CONCLUSION: Exposure to farming environments in childhood might predict T. gondii seropositivity in rural subjects. Nevertheless, the strongest predictor for atopy in rural subjects seems to be regular contact with farm animals. Whether T. gondii infection is an intermediate factor in the association between farm contact and atopy needs to be confirmed in larger studies.

Adult↗

Developing consumer involvement in rural HIV primary care programmes.

OBJECTIVES: As part of a broader medical and psychosocial needs assessment in a rural region of northern California, USA, five focus groups were conducted to explore innovative approaches to creating a system of consumer involvement in the delivery of HIV primary care services in the region. DESIGN: A total of five focus groups (n = 30) were conducted with clients from three of five counties in the region with the highest number of HIV patients receiving primary care. SETTING AND PARTICIPANTS: Participants were recruited by their HIV case managers. They were adults living with HIV, who were receiving health care, and who resided in a rural mountain region of northern California. VARIABLES STUDIED: Group discussions explored ideas for new strategies and examined traditional methods of consumer involvement, considering ways they could be adapted for a rural environment. RESULTS: Recommendations for consumer involvement included a multi-method approach consisting of traditional written surveys, a formal advisory group, and monthly consumer led social support/informal input groups. Specific challenges discussed included winter weather conditions, transportation barriers, physical limitations, confidentiality concerns, and needs for social support and education. CONCLUSIONS: A multiple-method approach would ensure more comprehensive consumer involvement in the programme planning process. It is also evident that methods for incorporating consumer involvement must be adapted to the specific context and circumstances of a given programme.

California↗