Spirit of Marshfield: celebrating 10 years of critical care transport excellence.
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Roof-collected rainwater is a common water source in subtropical regions and has not been associated with human illness. In Trinidad, the West Indies, a church group, attending a rural camp, developed gastrointestinal illness, caused by Salmonella arechevalata. This rare serotype was isolated from stool specimens of campers, foods eaten at the camp, and a water tap, which was supplied by a storage tank of roof-collected rainwater. The surface of the roof, used as water catchment, was covered with bird faeces. It is postulated that rainwater, falling on the roof, washed off animal excrement which contained S. arechevalata and led to the outbreak of salmonellosis through camper ingestion of contaminated food and water.
In a longitudinal study we investigated 5th- and 7th-grade children's perceptions of smokers and nonsmokers, changes in perceptions from 5th to 7th grades, and the degree to which these perceptions predict smoking in 9th grade. The participants were 1,663 students from 14 school districts in Washington state. The results showed large developmental shifts from 5th to 7th grade in children's perceptions of both smokers and nonsmokers: Students at 7th grade saw smokers in a much more positive light and nonsmokers in a much more negative light than they did at 5th grade. Children's positive perceptions at 5th grade of smokers predicted smoking 4 years later at 9th grade and were stronger predictors than positive perceptions at 7th grade. The results suggest that smoking prevention interventions must begin before 5th grade to counter perceptions predictive of subsequent smoking.
Priorities among the infectious diseases affecting the three billion people in the less developed world have been based on prevalence, morbidity, mortality and feasibility of control. With these priorities in mind a program of selective primary health care is compared with other approaches and suggested as the most cost-effective form of medical intervention in the least developed countries. A flexible program delivered by either fixed or mobile units might include measles and diphtheria-pertussis-tetanus vaccination, treatment for febrile malaria and oral rehydration for diarrhea in children, and tetanus toxoid and encouragement of breast feeding in mothers. Other interventions might be added on the basis of regional needs and new developments. For major diseases for which control measures are inadequate, research is an inexpensive approach on the basis of cost per infected person per year.
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In Uganda, the control of onchocerciasis by mass treatment with ivermectin (Mectizan) began in 1990 and has expanded greatly since 1992. The parties involved in the programme are the Uganda Ministry of Health and its National Onchocerciasis Task Force, the Mectizan Donation Programme, the African Programme for Onchocerciasis Control, a number of non-governmental development organizations and the communities where the disease is endemic. Their aim is to make the programme self-sustaining, without further outside aid, within a period of 12 years. The methodology of the ivermectin-distribution programme, based on community-directed treatment, is outlined; the constraints under which the four co-operating parties have to work are described and the effects of the social changes produced by community-directed distribution are discussed, all in terms of influence on the achievement of a programme that will be able to sustain itself without the need for outside aid.
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BACKGROUND: Most studies of the growth of Turkish schoolchildren are limited to large cities and to subjects from high socio-economic background. Very little is known about growth and development of rural, suburban and low socio-economic children in Turkey. AIM: The purpose of this study is to compare height and weight of school-aged children of low socio-economic background with available growth data from high socio-economic strata, and to verify the possible influences of three socio-demographic parameters on their growth. SUBJECTS AND METHODS: The sample consisted of 1,052 girls and 1,223 boys, aged between 7-17 years, living in the outskirts of Ankara, a suburban area of poor socio-economic background. Centile distributions for height and weight were estimated by the LMS-method. ANOVA and Student's t-test were used to compare mean z-scores for height and weight among the various categories of the socio-demographic parameters. RESULTS: Children living in the outskirts of Ankara have lower mean values for height and weight when compared with growth data of upper socio-economic strata children. The differences were most pronounced during adolescence. Skinfolds were higher in girls than in boys at all ages (largest p = 0.007). There was no clear relationship between growth and the number of siblings, the number of rooms in the house, the mother's and father's education, and the father's professional status (p > 0.05), except for the height of girls (p < 0.05). CONCLUSION: It is suggested that the lower growth status of children living in the outskirts of Ankara is attributable to the poor socio-economic status of this suburban population, which has not changed over the past decades. It is postulated that the growth impairment during adolescence might be due to a reduced tempo of growth in these children.
The recent unexplained increase in severe streptococcal diseases in the United States and Great Britain is compared to the 1825-1885 pandemic of fatal scarlet fever. Although scarlet fever may not be representative of all severe streptococcal disease, it was the only one reliably identified in the 19th century. The epidemiology of scarlet fever during the 19th century pandemic suggests the following features of the disease; cocirculation of both virulent and less-virulent streptococcal strains eliciting cross-immunity; circulation of hyperendemic prevalent strains in urban centers of developed nations, with periodic spillovers to rural areas and developing nations; and protection of infants from infection (but not from fatal disease once infection occurred) by the transfer of maternal antibodies via the placenta, breast milk, or both. The 19th century data suggest that efforts to prevent severe streptococcal diseases should begin with better characterization of the epidemiology of streptococcal disease, a task entailing identification of streptococcal virulence factors and measurement of their distribution among isolates from individuals with streptococcal diseases and in open populations.
During the winter of 1973-1974, 580 elderly recreational vehicle campers were interviewed in six private trailer parks and four public camping areas in southwestern Arizona and Southern California. The ten sites represented four different types of camping environment: (1) highly developed, relatively expensive urban private trailer parks, (2) moderately developed, relatively inexpensive, rural private trailer parks, (3) authorized, developed, free federal campgrounds, and (4) unauthorized, undeveloped, free public land camping areas. Analysis of variance was utilized to identify those respondent characteristics most strongly associated with the type of site selected for winter residence. The most important of these variables were per person annual income, woman's age, man's education, woman's total preretirement adult camping experience, value of mobile quarters and tow vehicle, and percentage of the year lived in a recreational vehicle. Several financial indicators and certain noneconomic characteristics of females were strongly associated with winter camping location.
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As internal medicine residency programs struggle to produce general internists in greater numbers and assure that they are adequately prepared for practice, it is imperative that the graduate medical education system have a clear picture of what competencies will be expected of those entering general internist careers. Feedback from the practicing community and large managed care organizations in Minnesota has made it clear that general internists in that state are functioning in a variety of positions requiring a wide range of skills depending on the practice description, choice of practice setting, and the complement of other primary care providers. General internists functioning in nontraditional careers have special curricular needs. It is imperative that training programs constantly monitor the changing practice environment and stay current on the variety of new generalist career choices to adequately prepare their residents for generalist careers. The graduate medical education enterprise needs to be involved in determining the best teaching strategies for the broad range of ambulatory general medicine competencies and in determining how best to preserve the richness of the medical subspecialty experience critical to the training of excellent general internists.
This article describes the evolution of a Community-Based Stroke Risk Screening and Education Program at a 400-bed regional medical center located in southeastern Alabama. The author outlines the implementation of a case management-oriented program developed to target the specific high-risk populations residing in this rural area. Retrospective chart reviews were used to identify a large discrepancy between patient-recognized onset of stroke symptoms and the actual time it took for the patient to present to the Emergency Department (ED). A performance improvement goal was initiated to increase community awareness of stroke warning signs, stroke risk, and prevention. Summaries of the research process, design, and outcome data overwhelmingly indicated a positive correlation between stroke education and ED presentation time.
A major concern of many rural and remote communities, as they struggle to cope with the impacts of social, economic and demographic changes, is the effect of government policies on health services. The National Rural Health Strategy has evolved as the key framework guiding action for improving health services for people in rural and remote Australia. The importance of maintaining an awareness of the 'big picture' of rural health remains paramount if interventions designed to bring about improved health status are to tackle the underlying causes of the problems, minimise problems associated with lack of co-ordination between health authorities, and avoid duplication of activity. Given the communality of rural health problems across Australia, close co-operation and collaboration among rural health groups is vital in developing appropriate national rural health policy. At the same time rural communities must continue to participate actively in the policy formulation and implementation process.
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OBJECTIVE: This study presents a set of concepts underpinning rural practice that could assist teaching health and medical students. OUTCOME: Five concepts, important in distinguishing rural health practice, are presented and discussed. These are rural-urban health differentials, access, confidentiality, cultural safety and team practice. Together these concepts impact the ways in which rural health professionals provide care, due to fewer services, greater distances, smaller populations, less choice of services and smaller workforce. CONCLUSION: These concepts introduce students to some of the positive and negative aspects of rural practice, as well as opportunities for rural practitioners to have a diverse practice, to become involved in all aspects of health and to initiate change. They provide an understanding of rurality from which health students can learn from their practical experiences during rural placements.