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Organochlorine pesticides and polychlorinated biphenyls in foodstuffs from Asian and oceanic countries.

Public concern about the adverse environmental and human health impacts of organochlorine contaminants led to strict regulations on their use in developed nations two decades ago. Nevertheless, DDT and several other organochlorine insecticides are still being used for agriculture and public health programs in developing countries in Asia and the South Pacific. As a consequence, humans in this region are exposed to greater dietary levels of organochlorines. In this review, published information on organochlorine concentrations in foodstuffs from South and Southeast Asia and Oceanic countries has been compiled. Foodstuffs that contribute to human exposures and dietary intakes of organochlorines were examined, and the data compared with those reported from more developed nations. Among various developing countries in Asia, considerable information on organochlorines in foodstuffs has been available from India since the late 1960s. DDT and HCH were the major insecticides in Indian foodstuffs. Concentrations of these insecticides have declined more than two orders of magnitude in farm products, such as food grains and vegetables, in two decades. Milk and milk products are the major sources of dietary exposure to DDT and HCH in India. The residues of these insecticides in dairy products were close to or above the MRLs of the FAO/WHO. Dietary intake of DDT and HCH by Indians was > 100 fold that in more developed nations. Sporadic incidences of greater concentrations (> 1 microgram/g) of aldrin, dieldrin, and heptachlor have been measured in Indian vegetables. Untreated surface waters could be a potential source of DDT and HCH exposure. In most Southeast Asian countries DDT was the common contaminant in animal origin foodstuffs. The higher percentage of p,p'-DDT in meat and fish from Southeast Asian countries, except Japan and Korea, indicated the recent use of DDt in vector control operations. Dietary intakes of DDt and HCH in Southeast Asia were an order of magnitude less than those of Indians but 5- to 10 fold greater than in more developed nations. In addition to DDT, aldrin and dieldrin were prominent in meat collected from Thailand and Malaysia. Aquatic food products from more industrialized countries, such as Japan, South Korea, Hong Kong, and Taiwan, contained significant levels of PCBs. In South Pacific countries, particularly in Australia and New Zealand, chlordanes and PCBs were the most prevalent organochlorines in foodstuffs. Food contamination by DDT, HCH, aldrin, and dieldrin was less than in developing countries in Asia but greater than in the U.S. and Japan. Intake of PCBs in Australia was greater than in the U.S. Meat and fish were the major sources of organochlorine exposure by Australians. Human dietary intake of organochlorines has been declining more slowly in developing countries in Asia. Current intakes were at least 5- to 100 fold greater than those in more developed nations, suggesting a greater risk from organochlorine exposure. Factors such as malnutrition, common among rural poor in developing nations, can increase these risks. Of greatest concern is the magnitude of exposure to organochlorines to which infants and children are subjected through human and dairy milk. The estimated intake of DDT by infants was at least 100 fold greater than the ADI of the FAO/WHO. In addition to DDT, excessive exposures to HCH and dieldrin may cause potential health effects in infants because they are more vulnerable to toxic effects. The design and implementation of appropriate epidemiological studies and their integration with monitoring of human, food, and environmental samples would be a major step in assessing the risks of organochlorine residues in foods and controlling or eliminating them. With the continued globalization of trade in food products, and the concomitant risk that food contaminated through point-source pollution may be widely distributed, identification of sources and their control should be matters of

Asia↗

Rural interdisciplinary healthcare training in Hawaii: a cross-cultural project.

In 1993, a federally funded project began at the University of Hawaii to educate students from a variety of health professions (nursing, medicine, dental hygiene, psychology, public health, and social work) about the challenges of working as an interdisciplinary team in rural health settings. After nine months of study, this education culminated in students participating in interdisciplinary team projects in rural areas of Hawaii. The development and funding of interdisciplinary rural health projects across the United States reflects the growing awareness that limited resources and access to health in rural areas requires resource sharing, both physical and non-physical. Exposing students to information about rural health care, and then providing hands-on opportunities for teamwork with fellow students in a rural setting, can serve an additional and critical function: to recruit to rural areas healthcare workers who are already aware of the challenges and rewards of this type of practice.

Cross-Cultural Comparison↗

Effect of medicare payment on rural health care systems.

Medicare payments constitute a significant share of patient-generated revenues for rural providers, more so than for urban providers. Therefore, Medicare payment policies influence the behavior of rural providers and determine their financial viability. Health services researchers need to contribute to the understanding of the implications of changes in fee-for-service payment policy, prospects for change because of the payment to Medicare+Choice risk plans, and implications for rural providers inherent in any restructuring of the Medicare program. This article outlines the basic policy choices, implications for rural providers and Medicare beneficiaries, impacts of existing research, and suggestions for further research. Topics for further research include implications of the Critical Access Hospital program, understanding how changes in payment to rural hospitals affect patient care, developing improved formulas for paying rural hospitals, determining the payment-to-cost ratio for physicians, measuring the impact of changes in the payment methodology used to pay for services delivered by rural health clinics and federally qualified health centers, accounting for the reasons for differences in historical Medicare expenditures across rural counties and between rural and urban counties, explicating all reasons for Medicare+Choice plans withdrawing from some rural areas and entering others, measuring the rural impact of proposals to add a prescription drug benefit to the Medicare program, and measuring the impact of Medicare payment policies on rural economies.

Aged↗

The new rural health curriculum at Dunedin School of Medicine: how has it influenced the attitudes of medical students to a career in rural general practice?

AIM: To evaluate the effect of the new fifth-year rural health curriculum developed at Dunedin School of Medicine on the attitudes of students to a career in rural general practice. METHODS: A structured questionnaire was administered to all fifth-year medical students immediately before and after participation in the rural health curriculum at DSM during 2000 and 2001. RESULTS: There were statistically significant positive changes in the students' responses to each question regarding their attitudes towards rural general practice. Students identifying as being of rural origin were more likely to give positive answers both before and after the course. The numbers indicating that they will or probably will enter rural general practice increased from 1.1% (0% (n = 0) of urban and 6% (n = 1) of rural students) to 13% (10% (n = 6) of urban and 22% (n = 4) of rural), pre- to post-course. CONCLUSIONS: Students who identify their origins as rural are more likely to have a positive attitude towards rural general practice as a career choice. However, a rural curriculum can produce attitude changes in students, irrespective of origin. If medical schools wish to assist in addressing the needs of their rural communities they should consider selection of students from rural origin and ensure that rural health plays a significant part in the school curriculum.

Career Choice↗

Therapeutic massage: an education program for rural and remote workers in the palliative care field.

This paper, drawing upon data from a Rural Health, Support, Education and Training (RHSET) funded project, focuses on the evaluation of a massage education program developed specifically for rural and remote palliative care workers. An 8 week pilot massage education course was run for palliative care workers in the Albury-Wodonga area and, from this course, an instructional video education package on massage has been developed. The program was evaluated by using a questionnaire, journals and focus group interviews. Feedback from participants was incorporated into both the pilot course and final education package, which was consistent with the action research framework. The major findings of the project were that skill development in the therapeutic use of massage was attained and that job satisfaction was indeed achieved by palliative care workers.

Attitude of Health Personnel↗

Biomass fuel combustion and health.

Biomass fuels (wood, agricultural waste, and dung) are used by about half the world's population as a major, often the only, source of domestic energy for cooking and heating. The smoke emissions from these fuels are an important source of indoor air pollution, especially in rural communities in developing countries. These emissions contain important pollutants that adversely affect health-such as suspended particulate matter and polycyclic organic matter which includes a number of known carcinogens, such as benzo[a]pyrene, as well as gaseous pollutants like carbon monoxide and formaldehyde.Exposure to large amounts of smoke may present a health risk that is of a similar order of magnitude to the risk from tobacco smoke. The effects on health arising from exposure to air pollution are reviewed, based on what has been reported in the literature so far. Further and more detailed information on exposures and on the epidemiological aspects is urgently required.The persons most frequently affected are women who do the cooking for households in rural villages; they suffer from impaired health due to prolonged and repeated contact with these harmful pollutants. When they are pregnant, the developing fetus may also be exposed and this leads to the risk of excess deaths. In the developing countries, exposure to biomass fuel emissions is probably one of the most important occupational health hazards for women. A conservatively estimated 300-400 million people worldwide, mostly in the rural areas of developing countries, are affected by these problems.

Air Pollutants↗

Understanding of diseases and treatment-seeking pattern of childhood illnesses in rural Haryana, India.

Two hundred and sixty respondents were interviewed to know the causes of ten common childhood illnesses, in one community development block in rural Haryana. Chickenpox, measles and marasmus were attributed to supernatural causes by 27%, 28%, and 50% respondents respectively. Furthermore older age groups, illiterates, schedule caste and people living more than 5 km from a Government health post believe more in supernatural causation of disease. By and large, Registered Indigenous Medicine Practitioners (RIMP's) and traditional birth attendants were utilised for curative medicine and obstetric care.

Adolescent↗

Development of a local advanced practice nurse coalition.

PURPOSE: To describe the experiences of a group of advanced practice nurses (APNs) in a rural area in developing an APN Coalition. DATA SOURCES: Selective review of literature and documents from the newly developed organizational framework for the coalition. CONCLUSION: Professional connections can begin at the local level through the development of local APN coalitions and then expand to involvement in state and national organizations. IMPLICATIONS FOR PRACTICE: Guidelines for establishing the coalition organizational structure are included and can be used as a template by similar evolving APN coalitions.

Group Practice↗

Psychology and rural America. Current status and future directions.

Rural people constitute about one fourth of the U.S. population, and their special mental health needs have been largely neglected. For a variety of reasons psychologists have focused little attention on this group. Recent economic developments affecting agriculture, farm families, and rural communities have increased awareness of problems facing rural areas. Psychologists can respond to the unique challenges created by rural mental health needs through research on stress, psychopathology, and community well-being. Training programs should be encouraged to recognize rural concerns. Psychologists are needed to practice in rural areas and to help develop effective rural service models. They can also support the development of state and federal policies that address rural needs.

Community Mental Health Centers↗

Reproductive health indicators for China's rural areas.

We report community-based development of reproductive health indicators for China's rural areas. To generate these indicators, we sequenced two participatory techniques known as nominal group process and Delphi survey methodology. Nominal group process entailed grassroots reproductive health workers' generating indicators, followed by refinement and prioritization of these indicators through a consensus-building Delphi process among nationally and internationally known reproductive health experts. Major criteria for the indicators were practicality, feasibility, and measurability within China's rural areas. We explain the importance of establishing these indicators for application in rural China and other developing countries as a complement to the World Health Organization's reproductive health indicators for global monitoring; present the identified indicators; and describe lessons learned from field testing in low-, middle-, and high-income counties of China's countryside.

Adult↗

School-based rural case management: a model to prevent and reduce risk.

PURPOSE: To describe the development of the School-Based Rural Case Management: A Model to Prevent and Reduce Risk in a primary health care academic nursing center practice in West Virginia. DATA SOURCES: Selected nursing and anthropological literature, regional health planning documents, and case examples. CONCLUSIONS: The model guides identification of health risks and the provision of health service, health education, and support to students, families, and communities. IMPLICATIONS FOR PRACTICE: As primary health care services are developed within rural schools, a school-based case management system assists matching appropriate services to the client, as well as supports program success.

Adolescent↗

Rural health and labour supplies: empirical evidence from the World Bank Assisted Agricultural Development Project in the Kwara State of Nigeria.

The efforts made in this study are in two areas. First, an effort has been made to determine whether there are any health or labour supply differences between ADP and non-ADP households. Second, an effort has also been made to determine whether differences in health, housing and nutrition, if any, have an effect on labour supply. All the efforts are attempts to focus research attention on the Nigeria's resource endowment factor and at the same time assess the impact of rural infrastructure capital and thus the World Bank Assisted Agricultural Development Projects (ADP) on the rural Nigerian residents and their industry. Using 175 households, 50 from the ADP and 125 from the non-ADP areas, the discriptive statistic indicates strong mean significant differences for the descriptors of nutrition, housing and state of health among the two sample categories. The discriminant function strongly discriminates between the two sample groups while the multiple regression analysis establishes a causal relationship between the discriptors of rural healthy days and labour supply for the two sample data sets. The policy implication of the study is that the implementation of the ADP particularly the Ilorin, leads to the improvement of quality of life and greater infusion of high quality labour into the rural agricultural industry. Higher productivity and increased farm family income and enhanced rural life which results is a useful virile circle necessary for laying the bedrock for the rural development.

Agriculture↗

Cervical cancer: the Indian perspective. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer.

Cancer of the uterine cervix is the commonest gynaecologic cancer in India, with most women presenting with disease extending beyond the cervix. The majority of women belong to the lower socioeconomic status, are rural, aged between 35 and 64 years and highly noncompliant for complete treatment and follow-up. Opportunistic screening with cytology, colposcopy and test for Human Papilloma Virus and appropriate treatment are available on payment at urban private medical centres but are not available at urban and rural government health centres that are accessed by women of the lower socioeconomic status. The Government's investment in health is 0.9% of the GDP. Thus cytology screening as a government health measure is not feasible. The 'social vaccine' of health empowerment along with visual inspection and appropriate referral by the rural and urban health personnel (Department of Health and Family Welfare); with an additional input of health awareness and motivation by Anganwadi Workers (Department of Women and Child Development), elected women representatives in the Panchayats (Department of Rural Development and Panchayati Raj) and non-governmental development agencies could be a collaborative effort towards "downstaging" cervical cancer. This could lay the foundation for the introduction of cytology screening when resources are available.

Adolescent↗

A strategy for generating and testing models of migration and urban growth.

"In this paper, it is argued that to identify the appropriate conditions under which the traditional gravity-type migration model should be tested, it is necessary to consider the wider demographic-economic framework in which such models play an essential part. The traditional model and attempts to make it more realistic in an ad hoc way are first sketched, and then the model is embedded in a dynamic framework based on nonlinear differential equations of the logistic kind describing the growth of population and employment. The role of the gravity model in coupling these equations is then developed." A theoretical analysis of this framework is then presented using simulation. "The simplest possible two-region case involving urban and rural regions is developed and after preliminary simulations, a more realistic version involving urban core, suburb and rural hinterland is proposed. A number of variants of this model are tested using simulation and it is concluded that in devising an appropriate test for this type of migration model, attention should be switched from spatial to temporal variation in migration using highly polarized spatial situations such as city regions." (summary in FRE, GER)

Demography↗

Geoparasites in rural Dakahlia Governorate, a preliminary based study for development of the community-based intervention programs.

A prospective study was carried out to detect the rural prevalence and intensity of geoparasites in Dakahlia Governorate, Egypt. A total of 1070 soil samples were collected; 571 (53.4%) were infected with one or more parasites. Only 24% of samples were infected with one parasite, 16.4% and 13% with two, and more than two parasites respectively, and the difference was statistically significant. The geoparasites in a descending order of their prevalence were: E. histolytica cysts (9.2%), Toxocara eggs (9.1%), Giardia cysts (7.9%), Cryptosporidium oocysts (6.1%), Trichostrongylus eggs and larvae (5.6%), Isospora oocysts (4.3%), Acanathamoeba cysts (4.1%), Naegleria cysts (3.6%), Dust mites (2.7%), H. diminuta eggs (2.7%), Strongyloides free living adults, rhabditiform and filariform larvae (2.3%), H. nana eggs (1.7%), S. mansoni eggs (1.2%), Ascaris eggs (0.6%), Ancylostoma larvae (0.5%), Taenia eggs (0.4%), Trichocephalus eggs (0.4%) and F. gigantica eggs (0.2%). The prevalence of parasitic infections was significantly higher (P<0.001) in fields (63.4%) than streets (47.7%) and indoor-yards samples (35.3%). The intensity of infections was significantly higher (P< 0.001) in streets than fields and indoor-yards (18.1, 9.7 & 1 parasite/10 gm of soil respectively).

Animals↗

An evaluation of a network for professional development in child and adolescent mental health in rural and remote communities.

In 1998 a telemedicine network was established in South Australia and the Northern Territory to deliver educational material to professionals working in child and adolescent mental health in remote areas. The network involved a wide range of health professions, from psychiatrists to psychologists and social workers. The first 12 months of network activity were evaluated by quantitative and qualitative techniques. Four sources of data were used: an activity log, questionnaires, interviews and action research. A total of 36 telemedicine sessions were held, ranging in duration from 45 to 90 min (average 56 min) and involving a total of 45 different professionals, who participated an average of four times each (range 1-15). The most common types of session were case discussions (47%), followed by specialist seminars (36%) and administrative and introductory sessions (17%). The benefits of the network included: networking and peer support; improved efficiency and reduced travel costs; and improved efficiency of health services. The problems included: costs; lack of access to technical support; and the need for staff induction and training.

Adolescent↗