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PubMed1980

Rural out-migration and economic standing in a prairie setting.

"This study attempts to trace the determinants of rural out-migration for a typical portion of the Canadian Prairies, namely agricultural Manitoba. In concentrating on the 'push' factors responsible for gross out-migration over the period 1966-71, the study considers aspects of several dimensions: spatial, economic, social, ethnic and demographic. However, in order to explore the ramifications of interaction between migration and these multifaceted factors, a model is construed which dwells not only on the forces responsible for out-migration, per se, but also on those capable of regulating rural economic structure and agricultural welfare."

Americas↗
PubMed1993

Providing assertive community treatment for severely mentally ill patients in a rural area.

OBJECTIVE: The authors' goals were to describe an assertive community treatment program developed for patients in rural South Carolina and to evaluate the effect of the program on rates of hospital utilization and cost of care. METHODS: Twenty-three patients with chronic psychotic disorders living in rural areas of South Carolina were assigned to an assertive community treatment program. The patients' average number of days per year in the hospital, length of stay per admission, number of admissions per year, and estimated annual cost of care during the five years before assignment to the program and during a period from four to 26 months after assignment were compared. RESULTS: The intervention was associated with a 79 percent decrease in hospital days per year, a 64 percent decrease in the number of admissions per year, a 75 percent decrease in the average length of stay per admission, and a 52 percent reduction in estimated direct cost of care. CONCLUSIONS: Although the methods of assertive community treatment may need to be modified to suit the travel requirements and other characteristics of rural settings, the study results suggest that the model can be successfully used in rural areas.

Adult↗
PubMed2004

Palliative care in the Pueblo of Zuni.

The American Indian and Alaska Native population is aging and the leading causes of death for those aged 55 and older are chronic diseases such as cancer, heart disease, and the complications of diabetes. There are limited formal palliative care services available to rural and reservation dwelling American Indians and Alaska Natives. This collaboration between a tribally operated home health care agency and a federally operated Indian Health Service hospital, with the support of a palliative care center within an academic medical center, has established a palliative care program in the Pueblo of Zuni. The program is based in the tribal home health agency. Barriers to development included the rural setting with limited professional workforce, competing demands in a small agency, the need for coordination across distinct organizations, and the need to address the dying process in a culturally proficient manner. Family-focused interviews and other techniques were used to tailor the palliative care program to the unique cultural setting. The program has sought to integrate inpatient care of terminally ill patients at the Indian Health Service (IHS) hospital with outpatient hospice care. The initial goal of obtaining certification as a Medicare Hospice provider has not been met and remains a goal. Meanwhile alternative mechanisms for funding the services have been found. The experience of this collaboration suggests that a tribally based, culturally proficient palliative care program can be developed within an American Indian/Alaska Native community and that it can drive the local health system toward improved end-of-life care.

Cooperative Behavior↗
PubMed2004

[Using surveys of schoolchildren to evaluate coverage with and opportunity for vaccination in Costa Rica].

OBJECTIVE: To identify differences in the level of coverage of and opportunity for vaccination among schoolchildren in three areas in Costa Rica with different characteristics: an urban area (with the highest level of socioeconomic development of the three areas), a rural area (with a medium level of socioeconomic development), and a border area (a rural area in northern Costa Rica, on the border with Nicaragua, with the lowest level of socioeconomic development and the highest proportion of foreign immigrants). METHODOLOGY: Following selection of schools by proportional probability, surveys were used with children chosen at random from the first and second grades of elementary schools in the three areas: urban (961 students), rural (544 students), and border (811 students). The data on the vaccines that had been administered were obtained from the children's vaccination cards. Differences among the three areas were evaluated: (1) in the coverage with BCG; with three doses of diphtheria-tetanuspertussis vaccine (DTP3); with three doses of oral polio vaccine (OPV3); with the first dose of measles-mumps-rubella vaccine (MMR1); and with the second dose of MMR vaccine (MMR2) and (2) in the "opportunity" for the children having received DTP1 + OPV1 before 3 months of age, DTP3 + OPV3 before 7 months of age, and DTP4 + OPV4 + MMR1 before 24 months of age. RESULTS: Out of all the students who had been selected, 80% of them in the urban area had a vaccination card, 73% did in the rural area, and 72% did in the border area (P < 0.05). The coverage levels for BCG, DTP3, and OPV3 were each over 95% in both the urban area and the rural area; however, the coverage levels were significantly lower (P < 0.05) in the border area: BCG, 83%; OPV3, 88%; and DTP3, 88%. Coverage with MMR1 and MMR2 was similar in the three areas. The percentage of schoolchildren with two or more doses of measles vaccine was 98% in the urban area, 92% in the rural area, and 85% in the border area (P < 0.05). In terms of opportunity, 90% of the children had received DTP1 + OPV1 before 3 months of age in the urban area, 89% had in the rural area, and 80% had in the border area (P < 0.05). The percentage of application of the complete basic schedule (DTP4 + OPV4 + MMR1) before 24 months of age was 93% in the urban area, 95% in the rural area, and 84% in the border area (P < 0.05). CONCLUSIONS: The border area had lower coverage of and opportunity for the basic schedule of vaccines, except for MMR. Follow-up campaigns for measles eradication have increased the coverage of the initial and booster doses in all three areas, but the increase has been greatest in the urban area. A greater effort should be made to identify children with an incomplete schedule of vaccinations, with priority going to areas that have a high proportion of immigrants.

Adolescent↗
PubMed2004

Patterns of geohelminth infection, impact of albendazole treatment and re-infection after treatment in schoolchildren from rural KwaZulu-Natal/South-Africa.

BACKGROUND: Geohelminth infection is a major health problem of children from rural areas of developing countries. In an attempt to reduce this burden, the Department of Health of the province of KwaZulu-Natal (KZN) established in 1998 a programme for helminth control that aimed at regularly treating primary school children for schistosomiasis and intestinal helminths. This article describes the baseline situation and the effect of treatment on geohelminth infection in a rural part of the province. METHODS: Grade 3 schoolchildren from Maputaland in northern KZN were examined for infections with hookworm, Ascaris lumbricoides, and Trichuris trichiura, treated twice with 400 mg albendazole and re-examined several times over one year after the first treatment in order to assess the impact of treatment and patterns of infection and re-infection. RESULTS: The hookworm prevalence in the study population (83.2%) was considerably higher than in other parts of the province whereas T. trichiura and especially A. lumbricoides prevalences (57.2 and 19.4%, respectively) were much lower than elsewhere on the KZN coastal plain. Single dose treatment with albendazole was very effective against hookworm and A. lumbricoides with cure rates (CR) of 78.8 and 96.4% and egg reduction rates (ERR) of 93.2 and 97.7%, respectively. It was exceptionally ineffective against T. trichiura (CR = 12.7%, ERR = 24.8%). Re-infection with hookworm and A. lumbricoides over 29 weeks after treatment was considerable but still well below pre-treatment levels. CONCLUSION: High geohelminth prevalences and re-infection rates in the study population confirm the need for regular treatment of primary school children in the area. The low effectiveness of single course albendazole treatment against T. trichiura infection however demands consideration of alternative treatment approaches.

Albendazole↗
PubMed1989

Principles and problems of environmental pollution of groundwater resources with case examples from developing countries.

The principles and problems of environmental pollution and contamination are outlined. Emphasis is given to case examples from developing countries of Africa, Asia, and Latin America with a comparative analysis to developed countries. The problems of pollution/contamination are widespread in developed countries but are gradually spreading from the urban to rural areas in the developing countries. Great efforts in research and control programs to check pollution-loading into the environment have been made in the industrialized countries, but only negligible actions have been taken in developing countries. Pollutants emanate from both point and distributed sources and have adversely affected both surface water and groundwaters. The influences of the geologic and hydrologic cycles that exacerbate the incidences of pollution/contamination have not been well understood by environmental planners and managers. Professionals in the different areas of pollution control projects, particularly in developing countries, lack the integrated multiobjective approaches and techniques in problem solving. Such countries as Nigeria, Kenya, Brazil, and India are now menaced by pollution hazards. Appropriate methods of control are hereby suggested.

Africa↗
PubMedDate not supplied

[The state of the knowledge of the rural population about the importance of risk factors for the development of arterial hypertension].

Thanks to a special questionnaire awareness was studied in 203 villagers of the part risk factors play in the development of arterial hypertension. The study made showed that the rural country-folk, those aged 65 and older especially, as well as those patients suffering from arterial hypertension, were far from being fully aware of the above risk factors. Only one-third male respondents and one-half female ones of those taking in too much alcoholic drink habitually consider it to be a risk factor for arterial hypertension. Similar tendency is seen among those smoking tobacco and consuming too much common salt. The most commonly encountered reaction to stressful situation in male countryfolk is emotional excitement, in female ones emotional depression. Identified among patients with arterial hypertension were persons having been in the state of stress for more than 24 hours. Most respondents drew attention to inadequate prophylactic work that health workers carry on in rural population.

Adolescent↗
PubMed1997

Moving forward with university departments of rural health.

This paper outlines recent developments in relation to the proposed university departments of rural health, and highlights how the principles (articulated by the Commonwealth government) for the establishment of these departments are being addressed in Broken Hill. The approach taken by the Broken Hill centre is focused on providing practical, population-based training and education that should enable health professionals to apply their knowledge and skills in ways appropriate to the needs of remote communities.

Australia↗
PubMed2000

The use of community surveys for health planning: the experience of 56 northwest rural communities.

A rural health services development program of the University of Washington School of Medicine has worked for 15 years with communities throughout the five-state region of Alaska, Idaho, Montana, Washington and Wyoming to strengthen their health systems. In the course of that work, 56 communities were surveyed about their utilization and opinions of local health systems. This database allows the following generalizations to be made about rural Northwest communities: (1) People think highly of their local hospitals, physicians and other key components of the acute medical care system and want their hospitals to remain open. Older respondents are more satisfied than younger respondents; (2) the typical hospital market share is 36 percent, the typical physician market share is 50 percent (3) satisfaction with discrete, well-funded services such as pharmacy, ambulance and dentistry is quite high, whereas satisfaction with mental health and substance abuse treatment is significantly lower; (4) the most commonly cited serious problems in surveyed communities were "too few physicians or- services" and "care is too expensive"; and (5) there is great variation between communities in both satisfaction and utilization.

Alaska↗
PubMed2006

Rural-urban differentials of premature mortality burden in south-west China.

BACKGROUND: Yunnan province is located in south western China and is one of the poorest provinces of the country. This study examines the premature mortality burden from common causes of deaths among an urban region, suburban region and rural region of Kunming, the capital of Yunnan. METHODS: Years of life lost (YLL) rate per 1,000 and mortality rate per 100,000 were calculated from medical death certificates in 2003 and broken down by cause of death, age and gender among urban, suburban and rural regions. YLL was calculated without age-weighting and discounting rate. Rates were age-adjusted to the combined population of three regions. However, 3% discounting rate and a standard age-weighting function were included in the sensitivity analysis. RESULTS: Non-communicable diseases contributed the most YLL in all three regions. The rural region had about 50% higher premature mortality burden compared to the other two regions. YLL from infectious diseases and perinatal problems was still a major problem in the rural region. Among non-communicable diseases, YLL from stroke was the highest in the urban/suburban regions; COPD followed as the second and was the highest in the rural region. Mortality burden from injuries was however higher in the rural region than the other two regions, especially for men. Self-inflicted injuries were between 2-8 times more serious among women. The use of either mortality rate or YLL gives a similar conclusion regarding the order of priority. Reanalysis with age-weighting and 3% discounting rate gave similar results. CONCLUSION: Urban south western China has already engaged in epidemiological pattern of developed countries. The rural region is additionally burdened by diseases of poverty and injury on top of the non-communicable diseases.

Journal Article↗
PubMed1988

Measles in developing countries. Part II. The predicted impact of mass vaccination.

A mathematical model is developed to mimic the transmission dynamics of the measles virus in communities in the developing world with high population growth rates and high case fatality rates. The model is used to compare the impacts of different mass vaccination programmes upon morbidity and mortality arising from infection by measles virus. Analyses identify three conclusions of practical significance to the design of optimal vaccination programmes. First, there is no single optimum age at which to vaccinate children for all urban and rural communities in developing countries. For a given community the best age at which to vaccinate depends critically on the age distribution of cases of infection prior to the introduction of control measures. Second, numerical studies predict that the introduction of mass vaccination will induce a temporary phase of very low incidence of infection before the system settles to a new pattern of recurrent epidemics. Mass vaccination acts to lengthen the inter-epidemic period in the post-vaccination period when compared with that prevailing prior to control. Third, numerical simulations suggest that two-phase and two-stage vaccination programmes are of less benefit than one-stage programmes (achieving comparable coverage) aimed at young children. The paper ends with a discussion of the needs for: improved programmes of data collection; monitoring of the impact of current vaccination programmes; and the development of models that take account of viral transmission dynamics, host demography and economic factors.

Adolescent↗
PubMed2000

Use of a dry-plasma collection device to overcome problems with storage and transportation of blood samples for epidemiology studies in developing countries.

Studies are difficult in areas lacking modern facilities due to the inability to reliably collect, store, and ship samples. Thus, we sought to evaluate the use of a dry plasma collection device for seroepidemiology studies. Plasma was obtained by fingerstick using a commercial dry plasma collection device (Chemcard Plasma Collection Device) and serum (venipuncture) from individuals in Kazakhstan. Plasma samples were air dried for 15 min and then stored desiccated in foil zip-lock pouches at 4 to 6 degrees C and subsequently shipped to the United States by air at ambient temperature. Serum samples remained frozen at -20 degrees C until assayed. Helicobacter pylori status was determined by enzyme-linked immunosorbent assay (HM-CAP EIA) for the dry plasma and the serum samples. The results were concordant in 250 of the 289 cases (86.5%). In 25 cases (8.6%), the dry plasma samples gave indeterminate results and could not be retested because only one sample was collected. Five serum samples were positive, and the corresponding dry plasma samples were negative; one serum sample was negative, and the corresponding plasma sample was positive. The relative sensitivity and specificity of the Chemcard samples to serum were 97.6 and 97.9%, respectively, excluding those with indeterminate results. Repeated freeze-thawing had no adverse effect on the accuracy of the test. We found the dry plasma collection device to provide an accurate and practical alternative to serum when venipuncture may be difficult or inconvenient and sample storage and handling present difficulties, especially for seroepidemiologic studies in rural areas or developing countries and where freeze-thawing may be unavoidable.

Blood Preservation↗
PubMed1987

Emergency obstetric surgery performed by nurses in Zaïre.

In rural northwestern Zaïre nurses at Karawa and Wasolo hospitals were trained to do caesarean sections, laparotomies, and supracervical hysterectomies. In Karawa 278 of 321 caesarean sections were done by nurse-surgeons in 18 months, with two deaths. In Wasolo all 32 caesarean sections in 13 months were done by the nurse-surgeons, with 1 death. Of the 37 laparotomies done in both centres, 16 were by nurse-surgeons, and there were two deaths. Four of the five deaths were attributable to protracted labour with septicaemia (1), postoperative infection (2), and protracted labour with no blood pressure on admission (1). Obstetric operations could safely be performed by specially trained nurses in rural areas of developing countries and the high maternal mortality rate in such areas could thus be reduced.

Cesarean Section↗
PubMed1998

Primary health care meets the market in China and Vietnam.

China and Vietnam developed low cost rural health services between the 1950s and the mid-1970s. These services contributed to substantial improvements in health. Both countries have been liberalising their economies for a number of years. Partly as a result of these changes health facilities have become increasingly dependent on user charges, and they have gained considerable independence from political or bureaucratic control. There has also been a growth in private provision. This has given people a wider choice of health services, but costs have risen and there are greater differences in access to medical care. The Chinese and Vietnamese governments face fundamental questions about the future development of the health sector.

China↗
PubMed1976

[Community health technical personnel].

In this article the author describes his experience in training community health officers at the Community Health School of the State of Mexico. She presents her views on the training of this type of personnel to work in the rural areas of developing countries; described the fundamental characteristics of their training and the methods used; and indicates the difficulties encountered by the first graduates of the above-mentioned School when they took up their duties.

Community Health Services↗
PubMed2005

The progress of family health nursing in remote and rural Scotland.

Since 2001 the World Health Organization Europe's family health nurse (FHN) role has been developing in remote and rural areas of Scotland. In 2003, an independent evaluation identified a need for facilitation of the FHN role and family-health orientated approaches with local primary health care teams. The Scottish Executive Health Department appointed three part-time, regionally-based family health practice development facilitators (FHPDFs) in December 2003 to work over an 18-month period. This article presents findings from a small study which sought these FHPDFs' judgements on individual FHN autonomy and supportive colleague action at 24 sites where FHNs were practising. These judgements reveal a picture of mixed progress that is consistent with findings from other related research. This collective overview is presented in the form of a new typology and the resultant implications for future development of family health nursing are discussed.

Family Nursing↗
PubMedDate not supplied

Rural community health agencies as primary care clerkship sites for medical students.

BACKGROUND AND OBJECTIVES: This study describes a student-centered third-year clerkship involving student choice and on-site investigation of rural community health care agencies. The objective of the clerkship was student understanding of how to explore and use community agencies to enhance the care of patients. METHODS: The course was evaluated through pre- and postcourse surveys of attitudes about primary care, care of the socially disadvantaged, knowledge of social agencies, and specialty orientation. Also analyzed were student clerkship evaluation forms, student performance evaluations, and review by external consultants. RESULTS: Students reported statistically significant increases in knowledge about social agencies (P = .0001). Attitudes of social responsibility for health care and greater concern about patients' social well-being were reported but were not statistically significant. While students agreed with the philosophy of the experience, they felt the course would have been more valuable later in their training. Student performance exceeded faculty expectations in all cases. External evaluators felt the community agency contacts were crucial experiences for future caregivers. CONCLUSIONS: A student-centered clerkship using community-based agencies can provide a valid educational experience, even in remote rural areas. Students develop facility in contacting and using community resources. Participation can give new perspectives on patient care not achievable in other sites. The long-term benefits of this early community exposure remain to be investigated.

Clinical Clerkship↗