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PubMed2002

Health conditions in the tribal villages of South Bihar: an epidemiologic survey.

In order to understand and establish an effective approach toward sustainable rural health development in the tribal region of South Bihar, an extensive socio-medical survey on over 90% of the houses of four tribal villages was undertaken. Using both a family-based questionnaire and screening physical examinations, the vital statistics, disease prevalence rates, immunization rates, and use of maternal health services in this neglected and previously unstudied area were determined. Local health-related behaviours and attitudes as well as nutritional status and family dietary intake were also focused upon. The results indicate that disease prevalence and mortality rates are significantly higher than expected and that existing services are less effective than previously thought. More importantly, the survey offers evidence that the fundamental obstacle toward improved community health remains a vast lack of health awareness and education in the villages; specifically in the areas of nutrition, immunization, diarrhoea prevention and treatment, maternity care, and family planning. Surveys of this kind provide vital information to health professionals working in underserved areas in India and should be an integral part of any such developmental undertaking.

Anemia↗
PubMed2002

The impact of urinary incontinence in working women: a study in a production facility.

OBJECTIVES: The objectives of this study were to identify the impact of self-reported UI on working women, to describe urine loss symptoms, strategies used to control urine loss, and help-seeking behavior among full-time women working in a rural production facility. METHODS: A cross-sectional survey design was used and questionnaires were distributed to 500 women (response rate, 54%). Items elicited information on demographics, health, parity, symptoms and duration of urine loss, strategies to manage urine loss, effects of UI on work activities, level of knowledge about UI and treatment options, perceived importance of getting professional help, and actual help seeking behavior. RESULTS: Twenty-nine percent (n = 78) reported UI at least monthly. Incontinent women were older (44.8 years vs. 38.1 years) than continent women (t = -5.22, p < .001) and incontinent women had a significantly higher average body mass index (BMI) than continent women (t = -4.3, p < .001). More women reported urine loss with coughing, lifting, bending, and when hands were in water, and were more likely to use pads at work to control urine loss. Few women had reported UI to a health care provider (36%) and most wanted more information about UI (85%). CONCLUSIONS: UI is a prevalent problem for working women. Workplace programs designed to assist women with prevention, treatment, and management of UI are crucial.

Adolescent↗
PubMed1998

Effect of intestinal helminth infection on some nutritional parameters among rural villagers in Nepal.

We report the prevalence of intestinal helminthiasis and its impact on health of Nepalese in two different rural Village Development Committees (VDC) in Nepal. A total of 261 school children from Okharpauwa VDC in Nuwakot district (Central Region) and 242 inhabitants of Boya VDC in Bhojpur district (Eastern Region) in Nepal were included in this study. The overall prevalence in these two different districts were 57.5% and 55.4%, respectively. Altogether four types of helminths were detected. In both districts, Ascaris lumbricoides was the commonest helminth. Mixed helminth infection in both study areas accounted for less than 5.0%. All helminth infected subjects were treated with a single dose of albendazole. Heavy Trichuris trichiura infection needed a second dose. Blood hemoglobin and serum total protein level in school children in Okharpauwa VDC increased significantly after chemotherapy (P < 0.05). Eosinophil count (10.1%; SD 5.0325) returned to normal (4.8%; SD 4.6997). Helminth infection in Boya VDC was more common in children than in adults. Serum total protein, albumin, total cholesterol and triglycerides levels were not influenced by the presence or absence of helminths among the inhabitants of Boya VDC. In both districts, more than 80.0% of the household had no latrine. In Boya VDC, 94.0% of inhabitants interviewed were not aware of other intestinal parasite other than A. lumbricoides.

Adolescent↗
PubMedDate not supplied

The costs and coverage of a strategy to control schistosomiasis morbidity in non-enrolled school-age children in Egypt.

Schistosomiasis still constitutes a major public health problem in some endemic parts of rural Egypt, particularly in school-aged children. The school-based health programme for schistosomiasis control adopted by the Egyptian Ministry of Health and Population (MOHP) focuses on treating enrolled schoolchildren. Children who are not enrolled or who do not attend regularly (out-of-school) do not have access to this service, in spite of evidence that the prevalence and intensity of infection are higher in these children than among children who attend school regularly. The aim of the present study was to test an intervention to extend the existing routinely applied school-based treatment to the out-of-school children. This paper reports on the costs and the coverage obtained by the intervention under 2 alternative delivery strategies: selective versus mass chemotherapy for out-of-school children. The intervention reached 88.5% of the out-of-school children at a relatively low cost per infected child of 2.29 L.E. (US$0.67) and 2.02 L.E. (US$0.59) for selective and mass chemotherapy, respectively. The calculations also suggest that, if the government were to implement such a programme, it would be more efficient to offer mass than selective chemotherapy at observed levels of prevalence. Sensitivity analysis showed that selective chemotherapy would be more cost-effective in areas where the prevalence of infection in out-of-school children was < 43%.

Adolescent↗
PubMed2002

Assessment of mother's knowledge and practice in use of oral rehydration solution for diarrhea in rural Bangladesh.

OBJECTIVE: To assess mothers' knowledge, attitude and use of oral rehydration solution (ORS) for diarrhea management at home, and feeding practices during diarrhea for children under 5-years of age, in a rural Health Development Project, Bangladesh. METHODS: This was a cross-sectional survey. This study was carried out in Cox's Bazar district, South Bangladesh, over a 2-week period, during May 1994. A sample of 300 households in the project area and a similar one in a control area were randomly selected using a multistage stratified technique. Data was collected by interviewing mothers at home using a standard questionnaire and through practical demonstration of how to prepare and use ORS correctly. Project and control households were compared regarding differences in knowledge and practice. RESULTS: More mothers in the project area received information regarding ORS than in the control area (63% versus 59%). The majority of mothers in both project and control areas recognized ORS packets (97% versus 95%). A significantly higher proportion of mothers in the project area knew how to prepare ORS correctly (64% versus 55%). Mothers' skill of using ORS was significantly associated with having seen a packet of ORS and mothers' education. The ORS use rate was lower in the project area compared with the control area (74% versus 84%). No significant differences in feeding practices during diarrhea were detected. CONCLUSION: The study showed that a significantly higher proportion of mothers in the project area knew how to prepare and use ORS correctly. However, the ORS use rate was inadequate. Repeated health education of mothers regarding diarrhea management is needed. Oral rehydration solution should be made available at health posts and households.

Bangladesh↗
PubMed2002

Community-directed treatment with ivermectin in two Nigerian communities: an analysis of first year start-up processes, costs and consequences.

OBJECTIVES: To determine the start-up processes, costs and consequences of community-directed treatment with ivermectin (CDTI) in two onchocerciasis endemic rural towns of Southeast Nigeria; namely Achi and Nike. The other objectives were to discover the community-financing mechanisms, local ivermectin distribution strategies and communities' organisational capacity to handle the programme. METHODS: Structured questionnaires, informal interviews, observations, discussions with community members at general village assemblies and community outreach lectures were used at different stages of the study. RESULT: The towns had the organisational capacity to implement the programme. Coverage with ivermectin was between 31-73% in Achi (mean = 58.6%), and 36.6-72% in Nike (mean = 61.95%). The unit financial costs were $0.17 in Nike and $0.13 in Achi, but the unit aggregate cost was $0.37 in Nike and $0.39 in Achi. When research costs were removed, the unit aggregate cost was $0.22 in Achi and $0.20 in Nike. Provider's financial costs and communities' non-financial costs were the biggest contributors to the aggregate cost. The cost would decrease in subsequent years since the research cost and parts of the mobilisation and training costs would not be incurred after the first year. CONCLUSION: Governments and sponsors of CDTI should find means of continuously strengthening the programme and providing technical support to the communities. As both CDTI and communities are dynamic entities, continuous health education campaigns are needed to keep reminding the people of the benefit of long-term ivermectin distribution, together with the need for community ownership of the programme.

Anthelmintics↗
PubMed2006

The effectiveness of a nurse-managed perinatal smoking cessation program implemented in a rural county.

The present study (a) examined the effectiveness of a nurse-managed smoking cessation program, that was totally integrated into routine perinatal care, on the cessation rates of pregnant smokers in a rural community, and (b) assessed the subject characteristics associated with smoking cessation success. Data were collected from a convenience sample of 194 pregnant women who stated that they were smokers at the onset of their pregnancies. The study compared the effects of usual care (n = 93) versus the Smoke Free Baby & Me program (n = 101), which included the American Cancer Society's Make Yours a Fresh Start Family program. Smoking status was measured by self-report and urinary cotinine at four points during pregnancy and postpartum. At the postpartum visit, more women in the experimental group reported that they were not smoking compared with those in the control group (37.3% vs. 16.7%), Pearson's chi2 (n = 87) = 4.37, p = .037, and they had higher validated (urinary cotinine <200 ng/ml) smoking cessation rates (n = 80, t = 2.449, p = .017) if they had quit smoking by the first prenatal visit. Smoking cessation was positively associated with level of education and negatively associated with gravidity, parity, the number of smokers in the household, and the number of cigarettes smoked per day at the first prenatal visit. Significant discordance was found between self-report and urinary cotinine assays at all prevalence points, regardless of group. In conclusion, this nurse-delivered program integrated into perinatal care influenced the smoking behaviors of "recent quitters" but had no effect on those who reported smoking at the first prenatal visit. Implications for clinical practice are discussed.

Adult↗
PubMed2005

The Rural Physician Associate Program: successful outcomes in primary care and rural practice.

The Rural Physician Associate Program (RPAP) has trained 1063 medical students in rural communities for the past 34 years and produced 658 primary care physicians and 521 physicians who currently practice in rural communities. While the students' experience in this nine-month clerkship is primarily clinic-based, they see patients in the emergency room, assist in surgery, deliver babies, attend physician meetings and participate in community health education. They experience real continuity of care by following a patient from the clinic or emergency room to the operating room and throughout their recovery. They diagnose a pregnancy, deliver the baby and then do the well-child examination in the clinic. The students recognize the value of this experience, as expressed in their final essays. They value the mentoring of the physicians, the relationship with the patients and the experiences in health care in which they play integral part. While the trend toward primary care in medical education is decreasing, the outcome of the RPAP program is holding steady at approximately 80%. Selection is certainly a factor, because many of the students who apply for RPAP have already expressed an interest in primary care. Additionally, the mentoring relationship with their preceptor, professionally and personally, and the ability to observe the lives of other practising physicians provides a reality check that may guide decisions. The enthusiasm for teaching, and the significant engagement with and impact on the community of the physicians may be another factor in deciding on primary care. Practising alongside physicians who find intellectual challenge and rewarding relationships in primary care is essential in continuing to produce primary care physicians of future.

Career Choice↗
PubMed2006

Tuberculosis case-finding through a village outreach programme in a rural setting in southern Ethiopia: community randomized trial.

OBJECTIVE: To ascertain whether case-finding through community outreach in a rural setting has an effect on case-notification rate, symptom duration, and treatment outcome of smear-positive tuberculosis (TB). METHODS: We randomly allocated 32 rural communities to intervention or control groups. In intervention communities, health workers from seven health centres held monthly diagnostic outreach clinics at which they obtained sputum samples for sputum microscopy from symptomatic TB suspects. In addition, trained community promoters distributed leaflets and discussed symptoms of TB during house visits and at popular gatherings. Symptomatic individuals were encouraged to visit the outreach team or a nearby health facility. In control communities, cases were detected through passive case-finding among symptomatic suspects reporting to health facilities. Smear-positive TB patients from the intervention and control communities diagnosed during the study period were prospectively enrolled. FINDINGS: In the 1-year study period, 159 and 221 cases of smear-positive TB were detected in the intervention and control groups, respectively. Case-notification rates in all age groups were 124.6/10(5) and 98.1/10(5) person-years, respectively (P = 0.12). The corresponding rates in adults older than 14 years were 207/10(5) and 158/10(5) person-years, respectively (P = 0.09). The proportion of patients with >3 months' symptom duration was 41% in the intervention group compared with 63% in the control group (P<0.001). Pre-treatment symptom duration in the intervention group fell by 55-60% compared with 3-20% in the control group. In the intervention and control groups, 81% and 75%, respectively of patients successfully completed treatment (P = 0.12). CONCLUSION: The intervention was effective in improving the speed but not the extent of case finding for smear-positive TB in this setting. Both groups had comparable treatment outcomes.

Adolescent↗
PubMed2005

A community-based training program for eating disorders and its contribution to a provincial network of specialized services.

The Ontario Community Outreach Program for Eating Disorders is a pilot training project within the eating disorder programs at the University Health Network--Toronto General Hospital (TGH) and the Hospital for Sick Children. This system provides ongoing training, consultation, and research evaluation in areas ranging from prevention through to tertiary care, in the hopes of increasing the capacity of practitioners to respond to the healthcare pressures of those experiencing eating disorders. A total of 3,315 health care practitioners and educators in Ontario participated in community-based training workshops. A pre-post analysis of participants' self-report evaluations was conducted using chi-square analyses. The findings revealed that there was a statistically significant increase in participants' (a) knowledge of eating disorders and of body image issues and (b) level of comfort to either treat clients with eating disorders or teach a curriculum on body image. The contribution of the training program to the development of a provincial network of specialized eating disorder services, designed to promote the public's access to timely and appropriate care for the full spectrum of eating disorders, are discussed.

Adolescent↗
PubMed1993

Anxiety and autonomy in adolescence among father-orphaned kibbutz children.

The aim of the study was to measure levels of anxiety and autonomy in non-clinically referred kibbutz orphaned and non-orphaned adolescents. The performance of 28 kibbutz adolescents orphaned when aged 2-10 was compared to 42 non-orphaned kibbutz adolescents on the Manifest Anxiety Scale for Israeli Children, the Autonomy of the Child Test and on a general data questionnaire. Results showed that when total populations were considered, no significant differences were found on levels of manifest anxiety and levels of autonomy. When the groups were further broken down according to gender and age, it was found that older orphan girls manifested significantly greater anxiety than any group and significantly lower autonomy than older non-orphan girls. A rationale linking the vulnerability of older orphan girls to adolescent developmental theory is suggested.

Adolescent↗
PubMed1976

[Changes in delusional psychoses. A historical transcultural comparison (author's transl)].

A historical transcultural comparison of paranoid psychoses (ICD 295.3, 297. 0-9) was done by evaluating the data of 200 case histories (I: 100 from 1911, II: 100 from 1973). An interrater reliability test was performed. 1. Stable delusions were: delusions of reference, religious delusions, delusions of persecution. 2. There was a significant increase in hypochondriacal delusions. 3. Megalomania and erotomania decreased. 4. There is in the "old" and "new" group a significant correlation between megalomania and the male sex. 5. The significant correlation between erotomania and the female sex found in the "old" group could not be found in the "new" group. 6. Constancy and change of delusion is due to both sexes, differing in degree, in part contrarotating. 7. The decrease of "sex-specific" delusions (megalomania and erotomania) is due to the sex concerned. 8. With increasing age there is a reduction of delusion themes in group II: delusions of special descent, paranoid identity change, erotomania were not found after age 30. Querulant paranoia did not occur. In group I querulant paranoia did not appear before age 30. 9. There was a significant correlation between megalomania and the item "development in rural country". 10. In our material there was no correlation between delusion and intelligence and religious confession. 11. Paranoid ideas of hypochondriasis and persecution show changes in the thematics (organs, disease, means of persecution) subject to time. 12. A tendency to change of content of the main delusion is discussed.

Age Factors↗
PubMed2006

Local responses to inundation and de-farming in the reservoir region of the three gorges project (China).

Large-scale infrastructural developments in rural areas often impose significant direct and indirect impacts on environment and people. The Three Gorges Project to dam the Yangtze River in China will create a huge reservoir, inundate farmlands and villages, and incur large-scale resettlement. The concurrent de-farming program to reforest marginal farmlands on steep slopes imposes additional stresses on local people. This study evaluates the ecological and economic adjustments in rural areas affected by both projects, and explores villagers' knowledge, attitudes, perceptions, and expectations vis-à-vis the drastic changes. Eleven villages in Yunyang County in Sichuan Province, stratified into three zones based on topography and agriculture, were assessed by field studies, questionnaire surveys, maps, satellite imagery, and census and government reports. Multiple regressions identified predictors for 17 dependent variables. Spatial variations in the difficult terrain imposed zone-differentiated agricultural constraints, ecological impacts, and human responses. The dominant farming population--mainly young adults working as migrant laborers in cities--has adopted some nonagricultural work to supplement incomes. Expected per-capita standardized farmland (SF) exceeded threshold SF, which surpasses existing SF. Motivations to reclaim more farmlands, de-farm marginal lands, and become migrant laborers were explained by different multiple-regression predictors. Reduction in farmland stock by inundation and de-farming, aggravated by unwillingness towards nonlocal resettlement, would impose ecological pressures and stimulate demands for nonfarming incomes. Common anticipation of better future income and occupation has been subdued by unfavorable feedbacks from early relocatees. Future environmental and landscape changes are hinged upon changing human responses. Government policies could be informed by research findings to match economic, ecological, and social realities.

Agriculture↗
PubMed2005

Cultural universals and differences in male homosexuality: the case of a Brazilian fishing village.

This study investigated whether homosexually identified males in a small Brazilian fishing community are similar to homosexually identified males described in the international literature. In addition, it attempted to distinguish heterosexuals who have sex with homosexuals from other heterosexuals. A total of 41 men were classified into three sexual categories: paneleiros ("pan cabinets"), who have sex only with men, and invariably so in a bottom position; persistent heterosexuals, who have sex only with women; and paneleiro lovers, who have sex with women and with paneleiros, but invariably in a top position. There were significant differences in childhood play activities, sexual inclinations, and sports preferences between paneleiros and non-paneleiros; however, paneleiro lovers and persistent heterosexuals were not significantly different with regard to these variables or with regard to access to women. These findings add to the cross-cultural literature on childhood cross-gender behavior and homoerotic activities among non-homosexually identified males.

Adult↗
PubMed2006

Factorial structure of the parental bonding instrument (PBI) in Japan: a study of cultural, developmental, and gender influences.

This study explored the factorial structure of the Parental Bonding Instrument (PBI) in the Japanese population. Several differences between the structure model in the current study and Parker et al.'s original model were identified. We also examined the adaptability of the inventory to children currently being raised by parents. We also developed a structural equation model that takes into account the impacts of the respondents' generation and gender and the caregivers' gender. The cultural, developmental, generational, and gender influences on the factorial structure of the PBI as well as the implications for clinical settings were discussed.

Adolescent↗
PubMed1984

Dilemmas of modernization in primary health care in Western Samoa.

This paper examines the historical development of rural women's associations (komiti tumama) in Western Samoa under New Zealand's colonial administration. These associations came to be the backbone of public health programmes and played a crucial role in preventive medicine at the village level: they embodied all the principles now subsumed under the rubric 'primary health care'. The successful growth of a rural, self-help system of primary health care in Samoa resulted from the use of traditional institutions to promote new practices in sanitation and health care. The system rewarded and fostered village autonomy and enhanced the status of married women. This paper argues that a stagnation in community-based health programmes linked in part to an increasing unwillingness of rural women's associations to support such programmes has occurred most particularly in the past decade. It is proposed that this stagnation may be related to overall problems of modernization in the Western Samoan economy, professionalization and bureaucratization of the national health services, and the ritualization of certain key practices (such as the inspection of village sanitation) in preventive medicine by rural women. The consequences of the stagnation for rural people have been a greater dependence upon curative medical services, and a loss of clearly defined roles for women's institutions in primary health care. The historical drift has been away from rather than towards the PHC model as espoused today by the World Health Organization and as initiated by the New Zealand administration in colonial times.

Cultural Characteristics↗