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PubMed2002

The tropical triangle: a health education alliance for the Southwest Pacific.

INTRODUCTION: Few collaborations between universities in developed countries and medical schools in developing countries have been described in detail in the medical literature. We describe a collaboration between three medical schools, one in a developed country and two in developing countries based on shared challenges and missions. THE ALLIANCE: James Cook University School of Medicine (JCU), Fiji School of Medicine (FSM) and University of Papua New Guinea School of Medicine (UPNG) are all located within the tropical regions of the Southwest Pacific. All schools serve vast geographical areas where much of the population lives in rural and remote communities with limited access to medical care. JCU's first class started in 2000 as the only complete medical school in Tropical Australia and was founded with a mission to meet the health care needs of rural, remote and underserved populations in the region. FSM educates medical students from most English-speaking developing Pacific Island Nations. UPNG serves a predominantly rural developing nation where infectious diseases and other diseases of rural developing nations predominate. Based on their common challenges and goals, the three schools established an informal collaborative relationship called "the Tropical Triangle" in the late 1990s. OBJECTIVES, ACTIVITIES AND CHALLENGES: These very different institutions are committed to an effective partnership based on mutual understanding and knowledge of each other's day-to-day challenges. Faculty development seminars on medical education have already been carried out in Fiji by JCU staff. JCU has also offered several PhD scholarships to FSM staff, three of which are in the process of being taken up. JCU has offered to make available its online teaching resources to FSM and UPNG. Student exchanges are planned, and FSM and UPNG have exchanged examiners on several occasions for the MBBS and postgraduate programs. The possibilities for collaborative research on regional problems are being explored. CONCLUSION: The Tropical Triangle Alliance is a special and perhaps unique alliance based on equality and shared challenges. The benefits from this alliance flow both ways. The alliance may serve as a model for other collaborations between health education institutions in developed and developing countries.

Journal Article↗
PubMed2002

Developing, implementing, and evaluating a treatment protocol for rural substance abusers.

Substance abuse is a significant social and public health problem facing rural Americans. However, most treatment protocols have been developed in urban areas. This article describes the development, implementation, and evaluation of an innovative substance abuse treatment designed with the collaboration of rural professionals and consumers specifically for rural clients and delivered by rural clinicians. Results of the process evaluation of Structured Behavioral Outpatient Rural Therapy (SBORT) produced findings about the experiences of participating clients, clinicians, and program directors. Most clients perceived SBORT as a helpful learning process that used multiple treatment strategies and presented an alternative to 12-step programs. Clients also reported that treatment was stressful even when beneficial, and that clinician support was critical for remaining in treatment. Most clinicians found that SBORT challenged their "old" treatment frameworks, was demanding to learn and adopt, and that the training and supervision involved in the project implementation helped remedy rural isolation from the treatment community. Interestingly, agency approach to program implementation strongly influenced clinician responses to the innovation. Agency program directors' appraisals of SBORT included observations that the therapy was viable because of its rural-specific design and that most staff were able to adapt to the changes demanded by the manualized protocol. All three groups reported that they saw the emphasis and acceptance of motivation as an emergent process as important to the treatment. This project highlighted the challenge and importance of testing rural substance abuse treatment protocols in naturalistic settings.

Behavior Therapy↗
PubMed2002

Developing a cardiac rehabilitation education resource for rural health workers in Queensland: reviewing the process and outcomes.

The provision of cardiac rehabilitation services to people living in rural and remote areas is often limited to the nearest large hospital situated in urban coastal centres, leaving a gap in the rehabilitation of cardiac patients. This paper discusses the development, composition and the results of a process evaluation of a cardiac rehabilitation education resource for rural health workers. The development of the structure and content of the manual were informed by a review of current rehabilitation literature, the results of focus groups with 60 rural health workers in five Queensland rural centres, and survey results of 135 rural cardiac patients admitted to five Queensland hospitals. The draft manual was trialled by health workers in seven rural centres throughout Queensland by the National Heart Foundation (Queensland Division). The results of the process evaluation provided valuable feedback on the efficacy of the manual as an educational resource for rural health workers in the cardiac rehabilitation of their patients. Specific content in the educational resource was strengthened as a result of this evaluation. The limitations of the evaluation and suggestions for its improvement are also discussed. The paper highlights the importance of this level of evaluation in the development of health promotion education resources.

Australia↗
PubMed1977

Foreign medical graduates in rural primary care: the case of western New York State.

To determine whether foreign medical graduates (FMGs) provide a disproportionate and increasing share of primary care in some rural areas, changes in physician distribution in a rural section of upstate New York over a 20-year period (1953-1973) were evaluated by country of medical education and type of practice. A contiguous urban area was examined for comparison. In 1953, FMGs accounted for a higher proportion of primary care physicians in rural areas (11%) than in urban practice (6%) (p less than 0.01). By 1973, this distribution had increased to 26% rural and 14% urban (p less than 0.001). During the two decades, the number of U.S. medical graduates in primary care declined by 15% in the rural areas but increased by 13% in the urban center. The number of primary care FMGs in this same period increased 88% in the rural area. With a 10% decline in (rural) FMGs trained in developed countries, this net increase in FMGs was accounted for by physicians from developing countries. Primary care physicians trained in the U.S. or in developed countries increased more in the urban center, while physicians from developing countries increased more in rural (53%) than urban (47%) practices. Finally, by 1973, rural primary care physicians were more likely than urban primary care physicians to be from developing countries (p less than 0.001).

Developing Countries↗
PubMed2001

Monitoring beef cattle productivity as a measure of environmental health.

Domestic livestock have occasionally been used as sentinels of environmental health. Historically, these studies focused on measuring blood or tissue levels of a specific environmental contaminant. For many environmental exposures, however, there is no appropriate biomarker for exposure. The objective of this study was to examine productivity and health information from domestic livestock as one indicator of the potential long-term environmental impact of natural gas developments in a rural area. Intensive biological accounting methods were developed to measure the health and productivity of cow-calf herds surrounding a new sour natural gas processing plant. From the fall of 1991 through calving 1997, cow production records from 7040 recorded bull contacts were examined from seven area cow-calf herds. Detailed information was also collected on other risk factors known to influence beef herd productivity. The median risks for nonpregnancy, abortion, calving late, stillbirth, and calf mortality for local herds did not differ from those of other published reports. There was no significant change in the risk of nonpregnancy, abortion, calving late, stillbirth, or calf mortality.

Air Pollutants↗
PubMed2006

Sanitary and phytosanitary measures and food safety: challenges and opportunities for developing countries.

Because of fast-growing demand, export markets can absorb high value added products and offer high returns; for many developing countries export market development is thus a key requirement for rural income generation and rural growth. Although developing countries face increasingly strict sanitary and phytosanitary standards in their export markets, they can maintain and improve market access--and improve domestic food safety and agricultural productivity--by adopting a strategic approach to food safety, agricultural health and trade. High-income countries should increase development flows to help developing countries build the capacity to plan and execute the necessary strategies. The first proposal in this paper is to make two existing sets of guidelines widely available to interested parties, in particular through the World Bank and the World Organisation for Animal Health (OIE). The first covers the broad process of problem assessment, strategy development and action plan formulation; the second set deals with institutional analysis and training of staff of the official sanitary control services. The second proposal is that interested countries and donors should speed up the ongoing development of guidelines, computer software tools and training material to help countries quantify the importance and impact of food safety issues. The focus here is on a 'multipurpose agricultural data analysis and modelization system'. The third proposal is to carry out a case study to help demonstrate that a number of animal health issues related to food safety should be treated as relating to 'global public goods' and thus require intervention on a global scale. Possible candidates are foot and mouth disease and highly pathogenic avian influenza.

Agriculture↗
PubMed2002

Beneficial effects of a woman-focused development programme on child survival: evidence from rural Bangladesh.

This paper reports results from a prospective study of the impact of a woman-focused development programme on child survival in Matlab, a rural area of Bangladesh. The programme was targeted to households owning less than 50 decimals of land and members selling more than 100 days of labour for living in a year. Programme components included formation of women's groups for saving and credit, training on skill development, functional literacy including legal and social awareness, and technical and marketing support to projects undertaken with the loan money from the organization. A total of 13,549 children born alive during 1988-97 in the study area were included in the study. Hazards of mortality during pre- and post-intervention periods were compared among the programme participants and non-participants controlling the effects of other relevant variables. There has been a substantial reduction in mortality during the post-intervention period; however, the reduction was much greater for infants whose mothers participated in the development programme compared to infants of non-participant mothers from similar socioeconomic background. In a relative sense, there has been a 52% reduction of the pre-intervention level hazard of death of children during infancy of participant mothers compared to 31% reduction for the infants of non-participant mothers from similar socioeconomic background. There had also been a substantial reduction in hazard of death during childhood (1-4 year age group), however, the reduction was statistically similar for all groups of children irrespective of their mothers' participation in the development programmes.

Adult↗
PubMed2004

Measuring rural hospital quality.

CONTEXT: Increased interest in the measurement of hospital quality has been stimulated by accrediting bodies, purchaser coalitions, government agencies, and other entities. PURPOSE: This paper examines quality measurement for hospitals in rural settings. We seek to identify rural hospital quality measures that reflect quality in all hospitals and that are sensitive to the rural hospital context. METHODS: We develop a conceptual model for measuring rural hospital quality, with a focus on the special issues posed by the rural hospital context for quality measurement. With the assistance of a panel of rural hospital and hospital quality measurement experts, we review hospital quality measures from national and rural organizations for their fit to rural hospitals. FINDINGS: Based on this analysis, we recommend an initial core set of quality measures relevant for rural hospitals with less than 50 beds. This core set of 20 measures includes 11 core measures from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) related to community acquired pneumonia, heart failure, and acute myocardial infarction; 1 measure related to infection control; 3 measures related to medication dispensing and teaching; 2 procedure-related measures; 1 financial measure; and 2 other measures related to the use of advance directives and emergency department monitoring of trauma vital signs. CONCLUSION: Based on the special measurement needs posed by the rural hospital context, we suggest avenues for future quality measure development for core rural hospital functions (eg, triage, stabilization, and transfer, and emergency care) not considered in existing quality measurement sets.

Community-Acquired Infections↗
PubMedDate not supplied

Informal risk-sharing arrangements (IRSAs) in rural Burkina Faso: lessons for the development of community-based insurance (CBI).

In resource-poor environments, community-based insurance (CBI) is increasingly being propagated as a strategy to improve access of poor rural populations to modern health care. It has been repeatedly hypothesized that CBI schemes need to be grounded in national as well as local traditions of solidarity. This paper presents a typology of informal risk sharing arrangements (IRSAs) in a rural area of North-Western Burkina Faso and discusses their modus operandi as well as the underlying concepts of solidarity and reciprocity. The research was explicitly multi-disciplinary, combining anthropological and economic as well as qualitative and quantitative data collection methods. Focus group and interview data were complemented by a census of existing IRSAs. In addition to presenting the main features of existing institutions, the paper discusses whether IRSAs can serve as entry points for CBI schemes. In spite of the fact that existing IRSAs fulfil important solidarity functions in the rural Burkinian context, we conclude that they cannot serve as institutional models for more formalized CBI schemes. Community participation in a future CBI scheme will need to tap into existing notions of solidarity and mutuality. The CBI scheme itself, however, needs to be newly tailored.

Burkina Faso↗
PubMed1991

[Socio-hygienic characteristics of families from the rural regions of Uzbekistan].

For the purpose of obtaining a socio-economic characteristic of a rural family a complex survey has been conducted in three regions of the Uzbek Republic covering all families having children of early age. The findings showed that in rural areas of the republic women marry early and the birth spacing in 74-78 percent of women does not exceed 2 years. Rural women deliver babies during the whole period of reproductive age but when they reach the age of 28-30 the birth spacing increases. All rural families tend to have many children and there is no evidence that they might shift to having less children in the nearest years. About 60 percent of rural families have two babies under 3 years of age. Living and socio-economic conditions of most rural families are estimated as poor. Most of these families have many children, their health culture is poor and medical activity slow. Many of these families preserve old, at times negative traditions. The demographic development of a rural family does not correspond to the level of socio-economic development of the rural area. All this contributes to the formation of a slow dynamic lifestyle concentrated on narrow family interests. As a whole an average rural Uzbek family lags behind other such families from industrial regions of the country as far as their cultural and socio-economic development is concerned, and to overcome this backwardness it is necessary to create real conditions for more active involvement of population in different spheres of social and public activities.

Adult↗
PubMed2006

Development of an integrated and sustainable rural service for people with diabetes in the Scottish Highlands.

INTRODUCTION: The number of people with diabetes is increasing leading to a greater burden on health care services. The impact of the growing prevalence is accentuated by remote and rural demographic and geographic characteristics. Highland is a sparsely populated remote and rural area in the north of Scotland, characterised by poor access to health-care services and pockets of marked deprivation. Centralised policy developments demanding local implementation compounded the pressures on a system that already had waiting times of over 90 weeks for some people with diabetes. A regional review of services, engaging stakeholders from all disciplines and geographical locations was required to develop acceptable and sustainable solutions. This article describes the extensive mapping process involved, how solutions were derived, and suggests a new service structure to encompass remote health-care issues. METHODS: Health-care professionals with an interest in diabetes were identified and workshops were organised to include the remote areas of Highland. Patient and carers views were ascertained through workshops and supplemented by written submissions. Using the redesign methodology the patient pathway was mapped, noting service deficiencies and good practice. The information gathered was constructed into a service-level map representing the patient journey. A conference was organised to develop solutions to the issues raised during the mapping process. From these solutions a new service configuration was constructed. RESULTS: Over 300 health-care professionals patients and carers contributed. Fourteen workshops were held across the region including the remote areas, providing 15 local maps of the patient pathways subsequently amalgamated into a service-level map. The current patient pathway in Highland follows a traditional and dichotomous cycle of care in the primary and secondary care setting, partly reflecting the rural nature of healthcare in the Highlands. Four main areas for service improvement were identified: a reduction in waiting times for secondary care out patients; an improvement in communication between health-care professionals; further education for both health-care professionals and patients; and the use and role of allied health professionals. Seventeen solutions were recommended, including the introduction of a managed clinical network, use of an integrated IT system, use of a remote access consultation clinic, and web-based peer education and group sessions for allied health professionals. A new service configuration was proposed with the patient at the centre of a non-hierarchical system using standardised referral letters with a seamless flow of information. CONCLUSION: Local processes for the implementation of government directives are imposing pressures on relatively smaller organisations. These pressures develop as a result of attempts to ensure local ownership and in overcoming the difficulties unique to the remote and rural setting. Further evaluation of the implementation of initiatives to solve the issues of service planning in remote areas is needed to clarify their level of effectiveness.

Diabetes Mellitus↗
PubMed1994

Impact of new information technologies on training and continuing education for rural health professionals.

Recently developed and emerging information and communications technologies offer the potential to move the clinical training of physicians and other health professionals away from the resource intensive urban academic health center, with its emphasis on tertiary care, and into rural settings that may be better able to place emphasis on the production of badly needed primary care providers. These same technologies also offer myriad opportunities to enhance the continuing education of health professionals in rural settings. This article explores the effect of new technologies for rural tele-education by briefly reviewing the effect of technology on health professionals' education, describing ongoing applications of tele-education, and discussing the likely effect of new technological developments on the future of tele-education. Tele-education has tremendous potential for improving the health care of rural Americans, and policy-makers must direct resources to its priority development in rural communities.

CD-ROM↗
PubMed2003

AHEC in West Virginia: a case study. Area health education centers.

This case study describes the area health education centers (AHEC) program in West Virginia, spanning 30 years from a first-generation project at Charleston in 1972 (AHEC 1) to a newly funded statewide program (AHEC 2). The outcome is an evolving university-community partnership designed to meet changing work-force and community health needs in the heart of rural Appalachia. West Virginia University's (WVU's) application of the original Carnegie Commission AHEC recommendations (1970) resulted in the Charleston AHEC, now part of the Robert C. Byrd Health Sciences Center of WVU. AHEC today trains more than 135 residents and interns, and one-third of the third-year and fourth-year WVU medical students. Charleston offers clinical and continuing education for nurses, dentists, pharmacists, and allied health professionals. A health sciences library, distance learning, and a network of primary care clinics help define Charleston's unique AHEC role. This AHEC hub continues to meet the classic Carnegie goals of recruiting and retaining health professionals, and providing access to care in the original service area and statewide. Based on the Charleston experience, four new federally funded AHECs are being developed to link rural primary care residencies with the state-funded West Virginia rural health education partnerships. These rural consortia AHECs are applying the concept of community competency, a performance-based methodology, to integrate learning while achieving the goals of Healthy People 2010.

Academic Medical Centers↗
PubMed1992

Designing roles for assistive personnel in a rural hospital.

The role development of assistive personnel has become more important in rural hospitals because of the limited professional nursing supply. St. Mary's Hospital has fostered interdepartmental collaboration to reallocate duties to personnel who are best qualified to perform them. The dyad model, uniquely tailored to this hospital's needs, has resulted in the more efficient and effective use of personnel.

Hospitals, Rural↗
PubMed1991

Primary oral health care for developing countries.

A model for the delivery of oral health care in rural areas of developing countries has been derived from studies in Papua New Guinea and Thailand. It gives special attention to self-help and self-reliance at village level; it provides for training of each category of personnel, with a clearly defined career structure, and can be adapted to respond to diverse epidemiological, demographic, social and economic circumstances.

Adult↗
PubMed2003

Changing needs for appropriate excreta disposal and small wastewater treatment methodologies or The future technology of small wastewater treatment systems.

Recent developments will strongly influence the design and utilization of small wastewater treatment systems in the future, e.g. population increases in non-sewered rural areas and developing countries; increasing impairment of surface water quality; the construction of occupied high-rise buildings in metropolitan areas; the development of planned but somewhat isolated communities, growing shortages of water that mandate reuse of wastewaters. It is well known that there is a very strong linkage between wastewater disposal methods in rural areas and developing countries and the general health of the population. These problems could be greatly reduced or prevented by the utilization of well known excreta disposal and small wastewater treatment system technologies, but the development of more innovative on-site systems is needed. It is expected that future environmental and public health pressures in developed countries will require increasingly stringent effluent limitations for small and on-site wastewater disposal systems, based primarily on nutrient discharges. Both on-site and small-scale technologies are available for the more stringent requirements, but innovative and more economical designs are needed for wide-spread acceptance. Water reuse should be a consideration for the designs of these systems. Implementation and utilization of well known technologies are needed, but the obstacles are often more social and political than economical.

Conservation of Natural Resources↗