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PubMed2003

The Arkansas River Valley Rural Health Cooperative: building a three-pronged approach to improved health and health care.

This paper describes the Arkansas River Valley Rural Health Cooperative (ARVRHC), one of the Arkansas networks jump-started with support from the Southern Rural Access Program (SRAP). The initial goal of the network was to develop a subsidized health insurance program to provide affordable medical services for the uninsured population (23%) in the 3-county service area. When planning efforts called for the network to address broader needs, the ARVRHC crafted a more comprehensive 3-pronged program model consisting of 3 interrelated programs: (1) the Health Care Access Program (HCAP), (2) the Health Education and Disease Management Program (HE&DMP), and 3) the Information and Assistance Program (I&AP). The HCAP is designed to address the financial barriers to access through a community-based health plan. The HE&DMP focuses on improving the health of individuals through education, counseling, and preventive care. The I&AP links low-income families to existing public assistance programs (e.g., Medicaid) and social support services. The Prescription Drug Assistance Program is one of the I&AP programs that helps individuals without prescription coverage obtain drugs at no cost. A key lesson learned is the importance of combining technical assistance with funding. The ARVRHC has been successful in leveraging funding, having received over $1.7 million in grant funds since 1999. A critical challenge facing the network today is the need for ongoing subsidy funding. Proposed legislation for a federal demonstration of the HCAP and similar programs would enable full implementation and evaluation of this model.

Arkansas↗
PubMed1986

Prediction and prevention of famine.

In general, famines have become less frequent and of decreasing magnitude in recent decades, a generalization to which sub-Saharan Africa is the striking exception. The underlying factors preventing famine continue to weaken in sub-Saharan Africa, while they grow stronger elsewhere. The basic elements of famine prevention are: a substantial surplus of agricultural production beyond the subsistence needs of the rural population; highly developed transportation systems within rural areas, between rural and related urban areas, and with the rest of the world; and a democratic form of government. The first makes a shortage of food and income to buy food less likely, the second makes it possible to deal with food and income shortages if they do occur, and the third ensures that necessary and feasible actions will be taken. In a democratic framework a free press brings attention to famine even in isolated areas, and public opinion refuses to countenance inaction by the bureaucracy. Once conditions of famine arise, market mechanisms concentrate food where the purchasing power exists, drawing food from the rural to the urban areas and from the poor to the rich. In such circumstances governments must take direct action to prevent starvation. Famine is predicted by successive years of poor crops, a rapid rise in food prices, a decline in the prices of goods that the poor sell (particularly including the livestock of pastoralists), and a decline in employment.

Africa↗
PubMed1994

Understanding physicians' decisions to practice in rural areas as a basis for developing recruitment and retention strategies.

The shortage of providers in rural areas is threatening the quality and availability of health care in many communities. The causes of the provider shortage are many and varied-from economic to social to personal. Government programs have addressed the issue of provider supply by offering scholarships and loan repayment programs for medical students who then must fulfil service obligations in underserved settings, among which are rural areas. Experience has shown that once providers complete their obligations under these grant programs, retention of providers in rural areas becomes an even more critical issue. Using focus group research, this study explores the practice setting choices of a group of physicians currently practicing in rural areas. The discussion reveals that personal values are one of the primary motivators for choosing to practice in rural settings while lack of availability of career opportunities for spouses and educational opportunities for children are major obstacles. The health care system poses barriers to success for providers in rural settings. The key rewards from rural practice are the ability to become integrated into the local community and the provider/patient relationships that develop in such settings. These findings are used as the basis for proposing recruitment and retention strategies for providers to improve access to medical care by patients in rural areas.

Career Choice↗
PubMed1990

Development and return migration to rural French Polynesia.

"In this article, a recent trend towards return migration to outer island French Polynesia is examined. Following a discussion of massive rural to urban migration throughout island Oceania, the regional and international factors responsible for reversing population movements in this French Territory are discussed. Finally, the impact of return migration on Tubuai, a rapidly developing outer island, is assessed specifically analyzing the manner in which returnees are reintegrated socially and economically into rural community life. The article concludes that returnees are development-oriented, but that increasing population growth in a context of fundamentally limited rural resources is not an economically viable process in the long term."

Acculturation↗
PubMed1992

A Community Health Education System to meet the health needs of Indo-Chinese women.

This paper presents a Community Health Education System which is cost-effective, sustainable, strongly community-based, and directed at improving the health status of rural women in Indo-china (Kampuchea, Laos and Vietnam). The system is developed through a series of steps which are concerned with the education of Community Health Education Units (in national ministries of health) and, at the village level, among community health workers, women's groups, and other women. The ultimate aim is the establishment of a community health education program in Indochinese villages.

Cambodia↗
PubMed2003

Rural health resource databases: a little nurturing goes a long way.

Access to rural health research information together with the type and availability of educational resources in rural areas, are important to rural health care providers, community members, researchers, students, planners and policy makers. The Rural Health Research Register (RHRR) focuses on current and recent research activity being undertaken in Australia in the field of rural health, while the Health Education Rural Remote Resources Database (HERRD) focuses on education courses and resources relevant to the practice and professional development of rural and remote health professionals throughout Australia. Early versions of these databases were established between 1992 and 1997, and in the period 1998-2001 both information resources were systematically updated through targeted promotion, registrations and the creation of web-accessible search facilities. They continue to be maintained and updated. Detailed information is available by searching the RHRR and HERRD databases via the web or by contacting the relevant coordinator. This article examines some of the issues in developing and maintaining these resources and demonstrates the usefulness of their contents to rural healthcare workers.

Journal Article↗
PubMed2001

Development of children from urban and rural areas of West Siberia.

Four hundred and twenty three Slavic children aged 4-9 were tested for age sex-tape related physiological features, the effects of residence (urban vs. rural), kindergarten or school establishments on physical development. The data obtained indicated that total body dimensions decreased in preschool and school age children from 1989-1999. Urban schoolchildren tended to be asthenic. Urban schoolchildren differed from the rural in their adaptation response to the standard step-test.

Anthropometry↗
PubMed1998

Nosocomial infections in a rural regional hospital in a developing country: infection rates by site, service, cost, and infection control practices.

OBJECTIVE: To assess the prevalence of nosocomial infections at a rural government hospital from 1992 to 1995. DESIGN: Retrospective review of data from 1992 to 1995 regarding rates of nosocomial infections, cost to government, and infection control practices. SETTING: 653-bed rural hospital providing primary and tertiary care. PATIENTS: Patients admitted to the hospital between 1992 and 1995 who were found with hospital-acquired infections during their stay. INTERVENTIONS: None. RESULTS: Over the 4-year period, 7,158 nosocomial infections were identified from 72,532 patients (10.0/100 admissions). High nosocomial infection rates were found on the intensive-care unit (67/100 admissions), urology (30/100 admissions), neurosurgery (29.5/100 admissions), and newborn nursery (28.4/100 admissions). Urinary tract infections (4.1/100 admissions) accounted for most nosocomial infections (42%), followed by postoperative wound infections (26.8%) with a rate of 2.6/100 admissions. Nosocomial pneumonias and bloodstream infections also were common with 13.2% and 8.0%, respectively. The highest rates occurred on the intensive-care unit for both pneumonia (26.4/100 admissions) and bloodstream infection (7.0/100 admissions). The cost to the government for nosocomial infections was estimated at US $697,000 annually (US $1=$6 Trinidad and Tobago). Poor infection control practices, inadequate handwashing facilities, lack of supplies, and nonexistent garbage cans on most wards were quite evident. CONCLUSIONS: Strict adherence to proper infection control practices, such as handwashing techniques, and improvement of facilities are crucial steps in preventing cross-infections in the hospital environment. Implementing these measures may substantially reduce the massive drain on the hospital budget in treating nosocomial infections. The saved revenue could go toward improvement of ward facilities and reduction of overcrowding, thus further reducing cross-infection.

Cross Infection↗
PubMed1991

Training Ph.D. psychologists for rural service: a report from Nebraska.

The Clinical Psychology Training Program at the University of Nebraska-Lincoln developed a rural mental health specialty to train psychologists to work in rural settings. Preliminary data indicate that the project was relatively successful in placing graduates in rural practice. But the needs for practitioners in rural communities clearly are greater than training programs can meet. Relying on doctoral psychologists for clinical work in rural communities may not be the best strategy in workforce planning.

Community Mental Health Services↗
PubMed2005

'Lost in translation'? Developing assessment criteria that value rural practice.

INTRODUCTION: Rural workforce preparation is often discussed in terms of specific interventions such as rural placements. More technical discussions of education matters seem to belong in the realm of education experts. However, this issues article argues that a focus on quality assessment techniques is important to the rural health agenda. Making connections between the medical education literature and the broader education literature, it explores elements of a qualitative decision-making model as an alternative to narrow competency-based and norm-referenced approaches. In the process it explores assessment techniques that may help educators better translate their intentions to value rural practice into the learning of students. BACKGROUND: Research suggests that, in Australia at least, many university educators have different and conflicting understanding of assessment criteria. At the same time, the literature on the development of assessment criteria is relatively small in a context in which the medical education literature takes a quantitative, reliability-driven approach. This has important implications for how we ensure that rural practice is given enough emphasis at the level of education that most strongly drives student learning-assessment. METHODS: This article explores such matters by examining the steps needed to develop assessment criteria in undergraduate medical education courses. It draws on key writings from the past, as well as current debates, in the medical education and broader education literature. It focuses on the detail of assessment techniques to show how the intention to value rural practice can be 'lost in translation' with narrow norm-referenced and competency-based assessment models. CONCLUSIONS: Rural health has a stake in technical debates about education in health sciences courses. Like other knowledge and skills, the knowledge and skills important to rural practice cannot be valued at the coalface of student learning if our assessment techniques subvert intentions. Developing the quality of assessment techniques involves scrutiny of not only the medical education literature, but also the broader education literature, including writings about working models of criteria-and-standards-based assessment. This scrutiny suggests assessment techniques are not equal in terms of how well they translate intentions. More than that, it suggests the value to rural health education of shifting from narrow norm-referenced models to best practice in criteria-and-standards-based assessment.

Australia↗
PubMed1993

Organizational and administrative factors influencing the adoption of consortia programs by rural hospitals.

This study was designed to assess the effects of various hospital and environmental characteristics on the involvement of rural hospitals in forming and governing consortia and adopting consortia programs. The study focused on the 127 hospitals that are members of the nine rural consortia developed by grants from the Robert Wood Johnson Foundation during 1989 under its Hospital-Based Rural Hospital Consortia Program. Hospital involvement in the formation and governance of the consortia was found to be far less than expected for these grass-roots organizations. Only 38 percent of the administrators said that their hospitals were involved in developing the consortia, and 44 percent said that they played a role in determining the program menu. Governing board and medical staff involvement was even more limited. Program adoption rates were found to be related to both the types of programs offered by the consortia and the characteristics of the hospitals. In general, greater involvement of physicians and governing board members in hospital decisions was found to enhance program adoption rates, but the influence varied by type of involvement in the hospital and program content.

Chief Executive Officers, Hospital↗
PubMed1992

[On the daily living and development of infants living in urban and rural regions].

Temporal pattern of daily living behavior and development in infants aged 3-6 yr were compared between urban and rural regions at Fukuoka-prefecture. The present study consisted of questionnaire on behavior of daily living and tests for development in intelligence and motor function. Rural infants got up and went to bed earlier than urban infants. Urban infants with less physical activity were inferior to rural infants in motor skill. It is suggested that manual dexterity and intelligence may be related.

Activities of Daily Living↗
PubMed2003

Performance evaluation of reverse osmosis desalination plants for rural water supply in a developing country--a case study.

Performance evaluation of two reverse osmosis (RO) desalination plants (DSP) at villages: Melasirupodhu (30 m3 day(-1)) and Sikkal (50 m3 day(-1)) in Ramanathpuram district, Tamil Nadu (India) were studied so as to bring out the state-of-art of their operation and maintenance (O&M). Detailed information on plant design and engineering, water quality, plant personnel, and cost of O&M was collected for a period of three years after commissioning of the two plants. Feed water was brackish, the TDS varied in the range of 6500-8500 mg L(-1) at Melasirupodhu and 5300-7100 mg L(-1) at Sikkal villages. The product water quality was observed to be gradually deteriorating as the salt rejection by the membranes decreased with time. The salt rejection was 97-99% at the time of commissioning of the plants, and came down to 89-90% at the end of 3 years of operation. Product water TDS soon after installation of the plants was excellent and within desirable limits of BIS. After three years of operation, few parameters exceeded the desirable limits, however, they were found to be within permissible limits of BIS. The analyses of the data showed that both plants were operated only at 30-36% of the design capacity. Plant shut-down due to inadequate and erratic power supply, and plant break-down and inherent delay in repairs due to lack of adequate infrastructure were found to be the major causes for the low utilization of the plants. Consequently the recurring cost of product water production enhanced to Rs. 25.0/m3 at Melasirupodhu and Rs. 17.5 m(-3) at Sikkal, as against the estimated cost of Rs. 15.0/m3 and Rs. 11.0/m3, respectively, as per the design. Over the years, the energy consumption for the product water output increased reflecting higher operational pressures needed with the aging of the membranes.

Conservation of Energy Resources↗