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An exploration of when urban background medical students become interested in rural practice.

INTRODUCTION: While it is well recognized that rural background medical students are more likely to enter rural practice than urban background, students' research shows that 34% to 67% of rural doctors have urban backgrounds. This article explores the factors influencing urban background medical students' interest in rural practice. METHOD: The study used a qualitative design employing focus groups and semi-structured interviews. Data were collected at three Australian universities and a national student rural health conference, and the participants were 82 first and final year medical students who participated in focus groups, and 49 who were interviewed individually. Data were analysed using the N6 computer package to manage the data. Forty-three urban background students indicated an interest in rural practice and the data presented in this article relate to this group of students. RESULTS: This article presents an analysis of data from one part of a larger project conducted from 2002 to 2004 investigating medical student career choice. The students' level of interest in rural practice depends on an interaction between student and location factors and other external influences with students seeking to match their needs and interests with locations. Some are 'predisposed' to develop interest in rural practice via their familiarity with rural areas, level of altruism, interest in generalist work, and interest in certain leisure activities. Exposure to rural locations provides knowledge about different places. Students recognize differences between rural locations in relation to the size of town and the remoteness of the town, and they seek specific rural locations which will match their values and interests. Existing social relationships can be enabling or limiting factors in the student's ability to follow through their interest in rural practice and to enter rural practice, and are important in the students finding a match between themselves and an appropriate location. CONCLUSIONS: Exposure of urban background students to rural practice and a range of rural locations generates an interest in rural practice among many urban background students. This exposure may increase the number of students who become interested in rural practice and decide to enter rural practice. Further quantitative research is required to test the findings from this exploratory qualitative study.

Adolescent↗

Seasonal energy deficiency in Ethiopian rural women.

The purpose of the study was to establish the existence of seasonal exposure to energy deficiency in rural areas of developing countries and to investigate the sequence of appearance and the nature of energy-sparing mechanisms utilized under real life conditions. The body weight of a group of 226 rural Ethiopian women was measured repeatedly over a one year period, at 45 day intervals. On a sub-group of 22 non-pregnant women total energy intake, TEI, total energy expenditure, TEE, and basal metabolic rate, BMR were also measured by the precise weighing method and by indirect calorimetry (Kofranyi-Michaelis respirometer or Douglas bag) and activity diaries. Body weight was found to have a moderate but statistically significant seasonal trend, with an overall loss of 1.6 kg. Women with higher BMI had larger seasonal swings of their body weight. Seasonal fluctuations were also found for TEI (maximum difference 420 kcal/d, not significant), and for BMR (maximum difference 200 kcal/day, P less than 0.000). TEE (mean yearly value of 1909 kcal/d, 42 kcal/kg) was very stable over the year and did not show any seasonal fluctuation. The present findings suggest that, under the study circumstances, seasonal exposure to fluctuation in food availability caused a moderate weight loss which was sufficient to induce metabolic adaptations, but not to cause any detectable change in physical activity.

Adaptation, Physiological↗

REACH: clinical feasibility of a rural telestroke network.

BACKGROUND AND PURPOSE: Development of stroke networks is critical to bringing guideline-driven stroke care to rural, underserved areas. METHODS: A Web-based telestroke tool, REACH, was developed to provide a foundation for a rural stroke network that delivered acute stroke consults 24 hours per day 7 days per week to 8 rural community hospitals in Georgia. RESULTS: There were 194 acute stroke consults delivered. Thirty patients were treated with tissue plasminogen activator (tPA). The mean National Institutes of Health Stroke Score (NIHSS) was 15.4, and the median NIHSS was 12.5. The mean onset to treatment time (OTT) was 122 minutes. The OTT dropped from 143 minutes in the first 10 patients treated to 111 minutes in last 20 patients. Of the 30 patients treated with tPA, 23% (7) were treated in < or =90 minutes and 60% (18) were treated within 2 hours. There were no symptomatic intracerebral hemorrhages. CONCLUSIONS: The REACH telestroke system permits the rapid and safe use of tPA in rural community hospitals. Over time, the system became more efficient and OTT decreased.

Aged↗

Emotional illness in a paediatric population in Nigeria.

In a survey of 500 children aged between 5-15 years in a small rural community in Nigeria, 15.0% were found to suffer from mental morbidity. Disturbances of emotion and conduct disorder constituted 66.7% of total morbidity detected. Children from disrupted families (due to divorce, separation and widowhood) were found to be significantly more likely to suffer from psychiatric morbidity. The need to train primary health care worker and for them to work closely with families and school teachers in the provision of community mental health care services for children in the rural communities of developing countries was emphasized.

Adolescent↗

[Prophylaxis of hypertension and its complications considering biological, social, and cultural risk factors in rural population].

The authors developed system of mass prophylaxis of essential hypertension disease and its complications. It considers biological and socio-cultural risk factors of essential hypertension disease and its complications. This system is of particular interest by its realistic approach to real situation in health care and its efficiency resulted in decreasing the temporary disability, disablement and death rate caused by the disease.

Cultural Characteristics↗

Socio-biological factors influencing infertility in a rural Nigerian community.

An assessment of factors influencing infertility in a rural Nigerian community revealed a prevalence rate of 12.9% primary infertility. Secondary infertility among the subjects was 54.1%. Age, education and religion of respondents had statistically significant influence on infertility (P less than 0.05) but not income (P greater than 0.05). The correlation between age of respondents and infertility was statistically significant (P less than 0.05). Primary health care efforts aimed at implementing maternal and child health care should explore the traditional customs on infertility in rural areas of developing countries.

Adolescent↗

Income and dietary adequacy in an agricultural community.

Although many studies as well as conventional wisdom suggest that increases in income result in improved diet and nutritional status in rural areas of developing countries, several recent studies have failed to demonstrate such a relationship. In this paper the relationships between material wealth and income and dietary strategies are examined for an agricultural community in rural Mexico. A superficial examination focusing on summary indices of dietary adequacy frequently cited in the literature and indices of wealth and income demonstrates a positive relationship between them in this community. However, an examination of the same data emphasizing alternative dietary strategies to achieve nutritional adequacy shows a more complex picture. Increasing income is associated with consumption of purchased foods especially foods of animal origin, and is not associated with the consumption of staple foods produced within the household. Diets dependent on purchased foods do not necessarily meet nutritional needs more adequately than diets which rely on agricultural products and gathered foods. Among the implications of this research are a need for a method of analysis which focuses on alternative nutritional strategies available in particular settings, and a need to reassess the relative importance of income generating activities and subsistence agriculture in areas undergoing agricultural change.

Agriculture↗

Prevalence of epilepsy in rural Bolivia: a door-to-door survey.

OBJECTIVE: To carry out a door-to-door survey in rural areas of the Cordillera Province, Santa Cruz Department, Bolivia, to determine the prevalence of neurologic diseases (epilepsy, stroke, parkinsonism, and peripheral neuropathy) in a sample of approximately 10,000 inhabitants. METHODS: A team of nondoctor health workers administered a standard screening instrument for neurologic diseases-a slightly modified version of the World Health Organization protocol. All subjects found positive during the screening underwent a neurologic examination. RESULTS: On screening, the authors found 1,130 positive subjects, of whom 1,027 were then investigated by neurologists. On the basis of the definition proposed by the International League Against Epilepsy, we detected 124 epileptic patients (prevalence, 12.3/1,000), 112 of whom had active epilepsy (prevalence, 11.1/1,000) on the prevalence day (November 1, 1994). Peak age-specific prevalence occurred in the 15 to 24-year age group (20.4/1,000). Sex-specific prevalence was higher in women (13.1/1,000) than men (11.4/1,000). Eighty-nine patients (71.8%) underwent a standard EEG recording. Considering both EEG and clinical data, partial seizures were the most common type (53.2%) based on the classification of the International League Against Epilepsy. The mean age at onset was 20.7 years for partial seizures and 13.6 years for generalized seizures. Only 10.5% of patients had received specific treatment for more than 2 months of their life. CONCLUSION: This report on epilepsy prevalence in Bolivia confirms that epilepsy is a major health problem in rural areas of developing countries.

Adolescent↗

High prevalence of gynaecological diseases in rural Indian women.

A population-based cross-sectional study of gynaecological and sexual diseases in rural women was done in two Indian villages. Of 650 women who were studied, 55% had gynaecological complaints and 45% were symptom-free. 92% of all women were found to have one or more gynaecological or sexual diseases, and the average number of these diseases per woman was 3.6. Infections of the genital tract contributed half of this morbidity. Only 8% of the women had undergone gynaecological examination and treatment in the past. There was an association between presence of gynaecological diseases and use of female methods of contraception, but this could explain only a small fraction of the morbidity. In the rural areas of developing countries, gynaecological and sexual care should be part of primary health care.

Adolescent↗

Delayed skin hypersensitivity as indicator of T-cell function in three population groups.

Immunological differences between a rural under-developed black population with a low incidence of rheumatoid arthritis, and living according to old traditional ways have been compared with an urban black and urban Caucasian population with a high incidence of the disease. A delayed skin hypersensitivity test for cell-mediated immunity with seven antigens and control was used. The rural group showed a statistically significant inhibition of cell-mediated immunity with 37% showing an anergic response. A matched Caucasian group showed a more marked response while an urban black group occupied an intermediate position. The 37% anergic response in our rural group was seen despite the fact that they were very healthy and their immune systems resisted multiple parasitic and infective onslaughts. From this data interpretation of an anergic response to multiple skin antigen tests in peoples from under-developed populations must be approached with great caution. Whether this altered cell-mediated immunity plays a role in the low incidence of rheumatoid arthritis in under-developed peoples is still speculative.

Arthritis, Rheumatoid↗

Evaluating the accuracy of the benefit transfer method: a rural water supply application in the USA.

Due to declining federal, state, and local government budgets, there is an increasing need to analyze the benefits of government funded programs to determine where increasingly limited funds would best be spent. The benefits transfer technique is analyzed for the development of a rural water supply system and guidelines for successful benefits transfer are presented. Benefit transfer appears to provide reasonably accurate estimates of natural resource benefits if a broad based benefit model is used. The benefits-transfer-based estimates are accurate as long as a model based on data from a wide variety of conditions is used or the model is based on data from a very similar region. The wide-based data modeling approach has the greatest practical application. These findings are based upon contingent valuation data obtained from four sites in the western USA.

Conservation of Natural Resources↗

Adapting to old age in rural Britain.

The data on which this article is based were collected to inform and guide policy for rural social service provision. Over 500 elderly persons were interviewed in their own homes using a questionnaire schedule. Over the last two decades, the availability and support of the family for the elderly has remained in debate, some writers suggesting that urbanization and industrialization have led to the weakening of family support, others claiming that the family still functions well. At the same time, the ability of the elderly to change and adapt has been questioned. In rural and less developed regions concern has been expressed that the impact of reductions in or lack of services fall hardest on the elderly. This article looks at ways in which the elderly in a remote rural area of Britain adapt to the problems of sparsity, lack of adequate public transportation, migration in and out of the region and the reality of increasing age. It shows that the elderly are capable of adaptation and have a tolerance for isolation, and that changes in residence, household composition, and methods of access are made over time. The article presents evidence of commitment on the part of others towards the elderly and creative adaptations on the part of the elderly to provide necessary support.

Adaptation, Psychological↗

Total energy expenditure and physical activity level of lactating Mesoamerindians.

Energy-sparing mechanisms may be elicited to meet increased energy requirements imposed by lactation on women who reside in poor, rural communities in developing countries. The objectives of this study were to measure total energy expenditure and its components, basal and activity energy expenditure, and to investigate their relationships with lactation performance in a total of 40 rural Mesoamerindians stratified according to postpartum body mass index. Total energy expenditure and fat-free mass were measured by the doubly labeled water method, and basal metabolic rate was determined by indirect calorimetry at 3 and 6 mo postpartum. Physical activity level was taken as the ratio of total energy expenditure to basal metabolic rate. Milk energy output, which is not included in total energy expenditure, was computed from 24-h milk intake (test-weighing) and energy concentration of milk (bomb calorimetry). Anthropometric measurements revealed negligible mobilization of tissue stores. Mean (+/- SD) total energy expenditures were 8912 +/- 1296 kJ/d and 9253 +/- 1298 kJ/d for the lower and higher body mass index groups, respectively. Adjusted for fat-free mass, total energy expenditure was higher in the lower body mass index group (P = 0.05). Adjusted for fat-free mass, basal metabolic rate did not differ between groups. Physical activity level was significantly higher in the lower body mass index group (P = 0.03). Lactation performance did not differ between groups and was not associated with total energy expenditure or its components. Despite the maintenance of energy balance and heightened energy requirements of lactation, energy-sparing mechanisms were not evident in these lactating Mesoamerindians.

Adolescent↗

Women's participation in rural credit programmes in Bangladesh and their demand for formal health care: is there a positive impact?

Within the overall aim of poverty alleviation, development efforts have included credit and self-employment programmes. In Bangladesh, the major beneficiaries of such group-based credit programmes are rural women who use the loans to initiate small informal income-generating activities. This paper explores the benefits of women's participation in credit programmes on their own health seeking. Using data from a sample of 1798 households from rural Bangladesh, conducted in 1991-1992 through repeated random sampling of 87 districts covered by Grameen Bank, Bangladesh Rural Advancement Committee (BRAC) and Bangladesh Rural Development Board (BRDB), this paper addresses the question: does women's participation in credit programmes significantly affect their use of formal health care? A non-unitary household preference model is suggested to test the hypothesis that women's empowerment through participation in these programmes results in greater control of resources for their own demand for formal health care. The analysis controls for endogeneity due to self-selection and other unobserved village level factors through the use of a weighted two stage instrumental variable approach with village level fixed effects. The findings indicate a positive impact of women's participation in credit programmes on their demand for formal health care. The policy simulations on the results of this study highlight the importance of credit programmes as a health intervention in addition to being a mechanism for women's economic empowerment.

Adolescent↗

Daily average exposures to respirable particulate matter from combustion of biomass fuels in rural households of southern India.

Indoor air pollution resulting from combustion of biomass fuels in rural households of developing countries is now recognized as a major contributor to the global burden of disease. Accurate estimation of health risks has been hampered by a paucity of quantitative exposure information. In this study we quantified exposures to respirable particulate matter from biomass-fuel combustion in 436 rural homes selected through stratified random sampling from four districts of Tamil Nadu, India. The study households are a subset of a larger sample of 5,028 households from the same districts in which socioeconomic and health information has been collected. Results of measurements for personal exposures to respirable particulate matter during cooking were reported earlier. This has been extended to calculation of 24-hr exposures with the aid of additional measurements during noncooking times and the collection of time-activity records. Concentrations of respirable particulate matter ranged from 500 to 2,000 micro g/m(3) during cooking in biomass-using households, and average 24-hr exposures ranged from 90 +/- 21 micro g/m(3) for those not involved in cooking to 231 +/- 109 micro g/m(3) for those who cooked. The 24-hr exposures were around 82 +/- 39 micro g/m(3) for those in households using clean fuels (with similar exposures across household subgroups). Fuel type, type and location of the kitchen, and the time spent near the kitchen while cooking were the most important determinants of exposure across these households among other parameters examined, including stove type, cooking duration, and smoke from neighborhood cooking. These estimates could be used to build a regional exposure database and facilitate health risk assessments.

Adult↗

Conclusions and recommendations for policies on rural aging in the first decades of the 21st century.

The 2000 Forum on Rural Aging: Policy Debates was one of the main tracks of the first International Conference on Rural Aging held in Charleston, WVa., in June 2000. The 2000 Forum was a follow-up to the Expert Group Meeting on Rural Aging, which met at Shepherdstown, WVa., in May 1999. That group considered policy implications of the 1999 International Year of Older Persons for rural aging in four key areas: the situation of older people, multigenerational relationships, lifelong development, and the development and aging of rural populations. As a direct follow-up of the Shepherdstown Expert Group Meeting, the 2000 Forum on Rural Aging formulated the Conclusions and Recommendations for Policies on Rural Aging through a series of working groups. The Conclusions and Recommendations were endorsed by the Conference Plenary Session on June 11, 2000. The Draft Recommendations for Policies on Rural Aging were availablefor comments on the Internet in the remaining part of the year 2000. Many comments were received. Hana Hermanova and Sally Richardson incorporated the comments into the finalized version.

Aged↗

The changing face of rural Catholic hospitals.

Socioeconomic trends and developments within the U.S. healthcare system have challenged rural hospitals' ability to maintain adequate operating margins and offer needed services. However, some hospitals have fared better in this negative environment than have others. To clarify factors that distinguish the most viable rural Catholic hospitals from the least viable, our study identified a group of 30 "consistently sound" hospitals and 30 "adversely affected" hospitals based on profit margins and six other financial measures. As a group, rural hospitals suffered from declining inpatient utilization, increasing levels of indigency, and adverse reimbursement. However, the consistently sound hospitals' margins increased to 11 percent form 1985 to 1989, whereas margins at adversely affected hospitals fell nearly 8 percentage points during the same period. Adversely affected hospitals were less likely to belong to a system and had significantly fewer average staffed beds than did the consistently sound facilities. Their communities had significantly lower per capita income, and they devoted a greater percentage of their resources to care for the poor. Adversely affected hospitals also reduced the scope of available services more drastically than did consistently sound hospitals during the period under study.

Catholicism↗

The nurse anesthetist: issues in rural health care.

Nurse anesthetists in rural regions must find creative solutions to challenges. Patient abandonment and legal issues can be important for the rural anesthesia provider to consider in some emergencies. Rural hospitals must develop protocols to help nurses and nurse anesthetists deal with emergency situations.

Clinical Protocols↗