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This paper outlines a community development project in rural Somerset that was instituted in response to identified health needs in the area. Organisational changes meant that funding for the project was curtailed so that completion of the planned programme and full evaluation could not be carried out.
The author presents population projections for Bangladesh using data from the 1981 census, U.N. sources, and other official and nonofficial sources. "Confidence intervals for year 1986 and year 2001 populations for Bangladesh are developed. Rural-urban shifts in population are analyzed through Markov chains, and reveal a significant projected redistribution to urban areas. A study is presented of the actuarial cost of a potential social security program designed to meet the financial needs of an increasing set of urban dwellers.... Aggregate projected contributions and benefits for the years 1975, 2005, 2015, and 2025 illustrate the possible program."
Newfoundland and Labrador is the most easterly province of Canada (O'Loughlin et al., Figure 1) with a population of 537,000. Rural in nature, 50% of the population resides in widely-dispersed communities of less than 2500 people. The economy traditionally relied on the fishing industry, but with the closure of the once lucrative cod fishery in 1991, the poorest province in Canada faced a difficult economic climate with up to 20% unemployment rates. With little funding available to supplement or sustain expensive initiatives, the Demonstration Phase of the Newfoundland and Labrador Heart Health Program (1990-1996) focused on how community-based programs are developed and sustained, with a view to diffusion throughout the province. The whole province was defined as the demonstration site for the project, and a community mobilization strategy was used with extensive reliance on community health professionals and volunteer contributions.
This Act institutes the Comprehensive Agrarian Reform Program (CARP). CARP takes as its declared aim "the establishment of owner cultivatorship of economic-size farms as the basis of Philippine agriculture" (Section 2). It prohibits the retention by landowners of more than five hectares of land and, for each child of the landowner over 15 years old, an additional three hectares, providing he or she is personally cultivating that land (Section 6). That limit of three hectares is also the upper limit for the redistribution of land to "qualified beneficiaries." These may be agricultural lessees and share tenants, regular, seasonal, or other farm workers, actual tillers or occupants of public lands, or some others directly working on the land (Section 22). Where splitting up of the land is economically inappropriate, then it may be taken over by collectives or cooperatives of these categories of agricultural workers (Sections 25 and 29). The land reforms envisaged under CARP are scheduled to take place in three phases over a 10-year period. Land in the public domain held or leased by multinational corporations is scheduled for expropriation within three years of the passing of the Act (Section 8); land otherwise controlled to be redistributed during the first phase is generally scheduled for redistribution in order of the size of the landholdings: that is, the larger the holding, the earlier it is scheduled for redistribution. Land acquisition is to be carried out by means of the Department of Agrarian Reform (DAR) and the Land Bank of the Philippines (LBP). The level of compensation payable to the expropriated landowner is to be determined by the DAR, the LBP, and the landowner, according to the cost of acquisition and development of the land, current market values, the income it generates in the light of the sworn valuation of the owner, and any tax returns pertaining to it. If the landowner disagrees with the level of compensation offered, there is a right of appeal to the courts. Payment of compensation, carried out through the medium of the LBP, is to be partly in cash and partly in government bonds, or in credits for taxes or other government funded services such as education and hospitalization. For land in excess of 50 hectares, the proportion payable in cash is 25% and for land below 24 hectares in area, 35%. These amounts may be increased by 5% in cases where the landowner voluntarily puts the land forward for transfer under the Program.
STUDY OBJECTIVE: To evaluate a cost-optimized operative technique for outpatient laparoscopic hysterectomy in a rural ambulatory surgery center focusing on shortening hospital stay and substitution of expensive disposable laparoscopic instruments with standard surgical techniques. DESIGN: Prospective feasibility and observational study (Canadian Task Force classification II-3). SETTING: Rural ambulatory surgery center in Lamar, Alabama. PATIENTS: Fifty-two women. INTERVENTION: Outpatient laparoscopic hysterectomy. MEASUREMENTS AND MAIN RESULTS: From September 2001 through September 2003, 52 consecutive procedures with a modified classical intrafascial supracervical hysterectomy (CISH) technique without disposable instruments have been performed on patients with an average age of 42.2 years (range 25-62 years) and a follow-up of 12.5 months (range 0.4-23.6 months). Mean postoperative length of stay was 6 hours, 79 minutes (range 3 hours, 10 minutes-17 hours, 30 minutes), and overall length of stay was 11 hours, 37 minutes (range 6 hours, 45 minutes-22 hours, 50 minutes). Five patients (9.6%) stayed overnight, three for medical and two for social reasons. With an average of 2 hours, 14 minutes, the operating room time was about 1 hour longer than with disposable instruments. Health insurance reimbursement for the ambulatory surgery center was on average $1814.11. No complications occurred, and no readmission to the hospital was necessary. CONCLUSION: Outpatient laparoscopic hysterectomy is feasible and safe and can be performed cost effectively in ambulatory surgery centers, even in rural areas. Development of a protocol with patient selection, preoperative and postoperative patient teaching, caring family environment, and round-the-clock medical telephone backup is necessary.
This study was designed to examine the pattern of mother's milk consumption of infants from poor Mexican rural areas. A standardized sample of 17 mother-infant units was longitudinally studied in ad-libitum conditions, estimating milk volume by difference in body weights before and after feeding from the breast. Average total milk consumption during the 1st year of life was 183 +or- 23 liters. Daily milk consumption started low (423 +or- 85 ml), increased to a peak at 450 +or- 80 ml, and finally dropped to about 350 +or- 44 ml at 18 months. About 1/2 the cases reached the peak at 8 weeks and the rest at 24 weeks; this difference in presentation of the peak was connected to the mother's parity and nutritional status. Consumption seems to depend on mother's production since the baby keeps a high demand as evidenced by high feeding frequencies and too long sucking times. The gap resulting from decreasing milk production at a time when nutritional needs increase progressively affects the baby's development and nutritional status.
"This article proposes a model of Melanesian urbanization and associated forms of migration, both permanent and temporary/circular. The model describes four stages of urban development, spanning the arrival of capitalism to a futuristic city of the next century. The author links the future of circular migration in Melanesia to the relative strengths of the precapitalist and capitalist modes of production and associated social relations, particularly the wantok [kinship network]."
"International labour migration involves 20 million workers from 'middle income' and 'Third World' countries. The article reviews both theoretical propositions and empirical evidence on its effects on regional disparities in labour exporting countries. It shows the variety of ways in which the departure of emigrants affects the uneven development of rural and urban areas there by changing the volume and nature of production as well as welfare conditions. Regional patterns of production and welfare are further modified by the impact of emigrants' remittances and their eventual return."
To increase the number of residents choosing to practice in rural and underserved areas, the Medical College of Georgia in 1994 created the Office of Recruitment and Retention (ORR) for generalist physicians as part of its participation in The Robert Wood Johnson Foundation's Generalist Physician Initiative. Its major purpose is to increase the contact between generalist residents and practice opportunities, especially those in rural and underserved areas. The office has helped residents better understand the resources available in rural settings and has helped these communities better understand the needs of graduates in generalist residency programs. It became a point of contact for residents and communities. It also organized on-campus "practice opportunity fairs" that permitted community representatives to meet formally with generalist residents to provide information on practice opportunities and community resources. The office organized practice management sessions and provided legal consultation to residents desiring to enter private practice in rural settings. This program has already been instrumental in furthering contact between generalist residents and the rural communities they selected as clinical practice sites during training. Although it is too early to know the impact of these activities, communities increasingly use the office to recruit generalist physicians, and residents use it to identify appropriate practice sites.
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Vaccine preventable diseases have been reduced in the country since the routine immunisation programme started in 1978 as the Expanded Programme on Immunisation, then in 1985 renamed as Universal Immunisation Programme. Re-emergence of some vaccine preventable disease is a concern to all and the Government of India has launched a new multiyear plan to strengthen the routine immunisation. A number of recommendations was made to address the weaknesses in the programme. Some newer initiatives were also made under the multiyear plan and National Rural Health Mission to strengthen the routine immunisation. The general practitioners can play a positive role while immunising children as per Universal Immunisation Programme. Routine immunisation is one of the key components of polio eradication.
The field trial of home-based neonatal care was conducted in Gadchiroli, India during 1993 to 1998. Owing to its new approach and the success in reducing newborn mortality in a rural area, it has attracted considerable attention. In this article, we describe the background of the trial -- the situation in 1990, why the problems of neonatal mortality and neonatal infection were selected for research, the area -- Gadchiroli district -- where the study was conducted, and the background work and philosophy of the organization, SEARCH, which conducted the study. This history and background will help readers understand the origins and the context of the field trial and the subsequent research papers in this supplement. We also hope that sharing this will be of use to other researchers and program managers working with communities in developing countries.
End-of-life programs that provide an option for patients to die at home are available in most U.S. communities. However, Alaska Natives living in remote Alaska villages often die alone in hospitals and nursing homes hundreds of miles away from home. The Bristol Bay Area Health Corporation (BBAHC), a tribal organization, is the sole provider of comprehensive primary care services to 34 Alaska Native villages located within a 46,000 square mile area in southwest Alaska. The closest tertiary care hospital is 329 air miles away in Anchorage. Because of the high cost of, and difficulties encountered in trying to deliver end-of-life care services to remote communities, a village-focused, culturally sensitive, volunteer and primary care program combined with a regionally based physician and home health nurse to deliver multi-disciplinary palliative care was developed. The Helping Hands Program blends cultural practices with contemporary palliative care medicine to allow Alaska Natives and others living in remote communities to be cared for at home through the end of life. Since the program was implemented in 1999, the percentage of home deaths for selected causes has changed from 33% in 1997 to 77% in 2001. The Anchorage-based Alaska Native Tribal Health Consortium (ANTHC) and the Alaska Native Medical Center (ANMC) have recognized the importance and success of the BBAHC program and are investigating expanding the program to other parts of Alaska. Centralizing the program in Anchorage will allow staff trained in palliative care to travel to regional Alaska Native hospitals to help train health care professionals.
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The health care system in Mexico was built upon a western model in which curative rather than preventive medicine is emphasized. However, the incorporation of indigenous midwives into maternal and child care and family planning programs by several public health agencies is an exception to the governmental health policies. An analysis of midwife preferences among rural women indicates that primarily poor illiterate women with children, living in remote areas with difficult access, rely on midwives. The continued reliance on midwives by this sector of the population makes the government programs most important. These programs are a unique case in which the incorporation of traditional practitioners in the modern health system has occurred. However, in order to implement programs that have the capability to offer rural women the benefits of both health systems, the incorporation of the traditional midwives requires not only the upgrading of their skills in modern antiseptic techniques, but the recognition of the contributions of traditional health practices, and the research of elements and practices to foster its understanding.
INTRODUCTION: In order to improve health literacy in rural areas, the Hawaii/Pacific Basin AHEC and Ke 'Anuenue AHEC are working to connect rural communities via video teleconferencing. METHODS: Video teleconferencing connectivity has been established to 15 rural and underserved locations across Hawaii and to the Republic of the Marshall Islands. RESULTS: An average of 15 individuals participate in weekly facilitated health education sessions. DISCUSSION: Participants have reported lifestyle change as a result of sessions and attendance is significantly increasing. In some areas, mid level health care professionals attend in order to obtain information for their patients.
To test the hypothesis that malnutrition alters fertility, the reproductive pattern of a poor rural community with a high natality rate was studied. A late menarche age (15.5 +or- 1.5 years) and an early menopause (40.4 +or- 2.5 years) were found and resulted in a short reproductive period of 25 years. In all, there were 8.8 +or- 2.7 pregnancies and 7.9 +or- 2.9 deliveries during this period, but only 4.8 +or- 2.2 children reached adulthood. A longitudinal observation was made of 2 groups which were similar in all respects, except that one was supplemented and the other was not. Both groups lactated the entire time between pregnancies as well. The control group recovered fertility 14.0 +or- 4.0 months after delivery while the supplemented group did after only 7.5 +or- 2.6 months; this difference, as well as the difference in recovery times in the experimental group before and after supplementation, were highly significant (P0.001). It may be concluded that undernutrition reduced mothers' fertility in 2 potential ways. It may reduce a woman's reproductive life and it determines an increase in the period between deliveries of more than 40%. Therefore, the high natality rate in this community should not be explained by high individual fertility but rather by the sociocultural characteristics of the community.