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PubMed1983

Rural and urban population changes and the stages of economic development: a unified approach.

The long-term aspects of the process of economic development and urbanization are examined. A model is presented that shows the dynamics of economic development from the earliest to the more advanced stages. "The model is able to explain not only the occurrence of a downturn in the rural population after the initial phase of population growth both in rural and urban areas, but also the delayed occurrence of such a downturn in many present-day developing countries. The author then focuses [on] the later stages of economic development and explains two alternative courses of urbanization, namely, the reversal process and the continual-growth process, as special cases of the general model; which of the courses occurs depends on the value of the elasticity of urban agglomeration-economies."

Demography↗
PubMedDate not supplied

Preceptorship: a model to empower nurses in rural health settings.

Continuing education and staff development help nurses meet new needs and demands caused by rapid changes in society, demography, technology, politicoeconomic structure, and disease patterns. Rural nurses have a unique, generalist role within their practice but are disadvantaged in accessing professional development because of geographical and professional isolation. A preceptorship program was developed to empower individual nurses in rural health units in South Australia. This program equipped them with the knowledge, skills, and attitudes necessary to make changes in their health units. At the same time, it enabled participants to act as mentors to colleagues in collaborative partnerships designed to meet the complex health needs of their rural clients.

Curriculum↗
PubMed2002

Developing a public health training institute through public health improvement efforts: Montana's story.

This descriptive study describes the development of a public health training institute through statewide public health improvement planning. Efforts to design workforce development strategies in a rural setting with a decentralized state public health system are portrayed. Significant lessons learned in developing the training institute and other workforce development strategies are outlined.

Academies and Institutes↗
PubMed2001

New approaches to spatially analyse primary health care usage patterns in rural South Africa.

OBJECTIVE: To develop indices to quantitatively assess and understand the spatial usage patterns of health facilities in the Hlabisa district of South Africa. METHODOLOGY: We mapped and interviewed more than 23 000 homesteads (approximately 200 000 people) in Hlabisa district, South Africa and spatially analysed their modal primary health usage patterns using a geographical information system. We generated contour maps of health service use and quantified the relationship between clinic catchments and distance-defined catchments using inclusion and exclusion error. We propose the distance usage index (DUI) as an overall spatial measure of clinic usage. This index is the sum of the distances from clinic to all client homesteads divided by the sum of the distances from clinic to all homesteads within its distance-defined catchment. The index encompasses inclusion, exclusion, and strength of patient attraction for each clinic. RESULTS: Eighty-seven per cent of homesteads use the nearest clinic. Residents of homesteads travel an average Euclidean distance of 4.72 km to attend clinics. There is a significant logarithmic relationship between distance from clinic and their use by homesteads (r(2)=0.774, P < 0.0001). The DUI values range between 31 and 198% (mean=110%, SD=43.7) for 12 clinics and highlight clinic usage patterns across the district. CONCLUSIONS: The DUI is a powerful and informative composite measure of clinic usage. The results of the study have important implications for health care provision in developing countries.

Geography↗
PubMed2005

Update: health insurance and utilization of care among rural adolescents.

CONTEXT: Adolescence is critical for the development of adult health habits. Disparities between rural and urban adolescents and between minority and white youth can have life-long consequences. PURPOSE: To compare health insurance coverage and ambulatory care contacts between rural minority adolescents and white and urban adolescents. METHODS: Cross-sectional design using data from the 1999-2000 National Health Interview Survey, a nationally representative sample of US households. Analysis was restricted to white, black, and Hispanic children aged 12 through 17 (8,503 observations). Outcome measures included health insurance, ambulatory visit within past year, usual source of care (USOC), and well visit within past year. Independent variables included race, residence, demographics, facilitating/enabling characteristics, and need. RESULTS: Across races, rural adolescents were as likely to have insurance (86.8% vs 87.7%) but less likely to report a preventive visit (60.1% vs 65.5%) than urban children; residence did not affect the likelihood of a visit or a USOC. Minority rural adolescents were less likely than whites to be insured, report a visit, or have a USOC. Most race-based differences were not significant in multivariate analysis holding constant living situation, caretaker education, income, and insurance. Low caretaker English fluency, limited almost exclusively to Hispanics, was an impediment to all outcomes. CONCLUSIONS: Most barriers to care among rural and minority youth are attributable to factors originating outside the health care system, such as language, living situation, caretaker education, and income. A combination of outreach activities and programs to enhance rural schools and economic opportunities will be needed to improve coverage and utilization among adolescents.

Adolescent↗
PubMedDate not supplied

Development and use of an economic evaluation model to assess establishment of local centralized rural biogas plants in Greece.

An economic evaluation model was developed in the Laboratory of Agricultural Structures (LAS) of the Agricultural University of Athens-the Modified Basic Economic Evaluation Model (MBEEM). This model is an improved version of the original Basic Economic Evaluation Model, available in LAS, and it is used to assess the cost-effectiveness of biogas production systems. Because of the parameters involved, a computer model was developed to facilitate the application of the MBEEM. The model was used in this work to determine the cost-effective size of a local centralized biogas production system fed with pig wastes.

Animals↗
PubMed1988

Announcement and proposed criteria for rural health medical education demonstration projects--HRSA. Notice.

The Health Resources and Services Administration (HRSA) in coordination with the Health Care Financing Administration announces its intent to implement section 4038 of the Omnibus Budget Reconciliation Act of 1987 (Pub. L. 100-203) (the Act), authorizing Rural Health Medical Education Demonstration Projects. This is a demonstration to assist physicians to develop clinical experience in rural areas using reimbursement for graduate medical education under the Social Security Act. For the purposes of these projects, payments made for the indirect costs of graduate medical education, pursuant to section 1886(d)(5)(B) of the Social Security Act, for any part of a year that a resident works at a small rural hospital, shall be treated as if the resident was working at the sponsoring hospital on September 1 of that year, and shall not be treated as if the resident was working in the small rural hospital. Medicare's share of the direct graduate medical education costs of the sponsoring hospital will be increased for the duration of the project to meet any reasonable additional direct costs incurred for the education and training of resident physicians at the rural site. The sponsoring hospital will be required to separately accumulate the costs of the demonstration project. Medicare will reimburse the sponsoring hospital for Medicare's share of the additional costs the hospital incurs in connection with the project under the reasonable cost authority in section 1861(v) of the act. Reimbursement for these costs will be in addition to the hospital's payment under section 1886(h). It should be noted that direct costs may only be claimed once and will not be reimbursed under both section 1886(h) and 1861(v).(ABSTRACT TRUNCATED AT 250 WORDS)

Economics, Hospital↗
PubMed1994

Prevalence of hypertension and subtypes in an Indian rural population: clinical and electrocardiographic correlates.

The aims of this study were to determine the prevalence of hypertension (systolic > or = 140 and/or diastolic > or = 90 mmHg) and its subtypes such as borderline isolated systolic hypertension (systolic > or = 140, diastolic < 90 mmHg), definite isolated systolic hypertension (systolic > or = 160, diastolic < 90 mmHg), isolated diastolic hypertension (systolic < 160, diastolic > or = 90 mmHg) and definite hypertension (systolic > or = 160 and diastolic > or = 90 mmHg or hypertensives on treatment) in a rural population of a developing country. We have conducted a total community cross-sectional survey in a rural population of western India. 3148 persons (1982 males and 1166 females), aged > or = 20 years were examined in a cluster of three villages in Rajasthan. These were grouped into various subtypes of hypertension according to the US Fifth Joint National Committee and Framingham Study guidelines. The overall prevalence of hypertension and its subtypes was 24% in males and 17% in females. There was an age related increase in the prevalence of hypertension in both males and females. Only 7% males and 8% females were aware of their high BP. On subclassification of hypertensives it was seen that in males 12% had borderline isolated systolic hypertension, 2% had definite isolated systolic hypertension, 70% had isolated diastolic hypertension and 16% had definite hypertension. In females 18% had borderline isolated systolic hypertension, 2% had definite isolated systolic hypertension, 53% had isolated diastolic hypertension and 17% had definite hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Sole providers of hospital care in rural areas.

This study examines the possibility of developing alternative targeting criteria for identifying small rural hospitals that serve as the sole providers of hospital care in their market areas. Compared to facilities currently targeted under Medicare payment policies, high market share hospitals are larger, less isolated facilities that deliver more complex care to their patients than other rural hospitals. They do not appear to serve vulnerable patient populations. Most importantly, these facilities appear to be financially viable and are likely to continue to provide services to their patients. The results of the study suggest that appropriate targeting criteria for identifying essential access facilities for reimbursement policy should focus on both structural characteristics and utilization patterns.

Aged↗
PubMed1998

Health professions students as research partners in community oriented primary care.

This paper describes the process of involving health professions students in research in rural primary care and how their research has contributed to the development and expansion of a rural community health center. Since 1978 over 400 students have completed rotations at the center, and more than 200 have been health profession students, including medical, nursing, physician assistant, pharmacy, and health administration students. A total of 96 research projects were completed. These projects lie in two main areas: medical services and community outreach. Those related to medical services include measures of access to care, quality of care audits, clinical guideline development, practice patterns, prevalence studies, and qualitative research. Projects focusing on community outreach include community surveys, screening follow-ups, program evaluation, and program development. Principles that guide the selection and conduct of research projects include: Projects should be directly related to important work of the practice and reflect an interest of the student; projects are structured to include some or all of the following: literature search, data analysis, a visual display of quantitative information (table or graph), and application of relevant statistical tools; the student has a project supervisor; the student is a participant rather than an independent investigator; and a research flow sheet is used to orient students and NRHA staff to the larger research effort. Students are expected to present results, conclusions and recommendations to an appropriate group. Student research has made a significant contribution to both practice activities and practice policies.

Community Health Centers↗
PubMed2005

Community-based surveillance: a pilot study from rural Cambodia.

OBJECTIVE: This study seeks to assess the performance of a community-based surveillance system (CBSS), developed and implemented in seven rural communes in Cambodia from 2000 to 2002 to provide timely and representative information on major health problems and life events, and so permit rapid and effective control of outbreaks and communicable diseases in general. METHODS: Lay people were trained as Village Health Volunteers (VHVs) to report suspected outbreaks, important infectious diseases, and vital events occurring in their communities to local health staff who analysed the data and gave feedback to the volunteers during their monthly meetings. RESULTS: Over 2 years of its implementation, the system was able to detect outbreaks early, regularly monitor communicable disease trends, and to provide continuously updated information on pregnancies, births and deaths in the rural areas. In addition, the system triggered effective responses from both health staff and VHVs for disease control and prevention and in outbreaks. CONCLUSION: A CBSS can successfully fill the gaps of the current health facility-based disease surveillance system in the rapid detection of outbreaks, in the effective monitoring of communicable diseases, and in the notification of vital events in rural Cambodia. Its replication or adaptation for use in other rural areas in Cambodia and in other developing countries is likely to be beneficial and cost-effective.

Acute Disease↗
PubMed1992

The assessment of total energy expenditure of female farmers under field conditions.

The paper reviews methods, and their difficulties, in the measurement of the daily energy expenditure of rural women under field conditions in developing countries. Since all methods need to be validated against a reference method which is usually based on indirect calorimetry, examples of the use of this technique are given. The energy costs of most agricultural and daily tasks of rural women in developing countries have been measured. Large intra- and inter-individual variations in the cost of a single activity occur, so repeated measurements are needed to obtain a valid mean energy cost for a specific activity for a homogeneous group of individuals. Much work remains to be done on the assessment of the duration and the intensity of the physical activity of the rural adolescent and adult female population. Studies indicate that the workload of most rural women in developing countries is excessive and frequently associated with acute poverty.

Agriculture↗
PubMed2003

Organizing palliative care for rural populations: a systematic review of the evidence.

BACKGROUND: Palliative care services have developed mostly in urban areas. Rural areas typically are characterized by the lack of well-organized services, with primary care professionals, specifically GPs and community nurses, having to undertake most of the palliative care. Little is known, however, either of their views or of how best to organize palliative care in rural areas. OBJECTIVE: The aim of this study was to conduct a systematic literature review of studies that have examined the organization of rural palliative care and the views of professionals in rural areas. METHOD: Six electronic databases were searched for published studies between 1991 and 2001. Articles had to match against (i). MeSH or keyword terms relating to palliative, terminal or end of life care; and (ii). MeSH or keyword terms relating to rural. A data extraction framework was designed and used systematically by two reviewers to consider research question and method, sample characteristics, selection and size, study quality, summary results and implications. RESULTS: Twenty-six studies were identified. These were mostly questionnaire surveys and reports, and three qualitative studies. No randomized controlled studies or cohort studies were identified. Education and strategic issues were dominant research questions. Both the sample numbers and response rates in the surveys were variable. The qualitative studies had methodological strengths and elicited important views from nurses, carers and families. GPs were, however, unrepresented. Whilst the role of primary care emerged as an important theme, primary care professionals reported difficulties in obtaining education and training. There were also reported problems in symptom control and in the management of emotional issues such as bereavement counselling. Difficulties were also described in accessing specialist services such as hospices, and families were reported as having problems in accessing information. Developments in information technology such as telemedicine were seen as possible solutions to some of the problems. CONCLUSIONS: There is little published work on this topic. Most of the work identifies problems in the delivery of palliative care in rural areas. Whilst primary care professionals are seen as having a key role, there is a need to discover both their views and their needs in this field.

Attitude of Health Personnel↗
PubMed1999

Relationship Between Relative Risk of Developing Breast Cancer and Absolute Risk in a Population of Rural, Older African American Women.

Relative risks computed from known breast cancer risk factors can be used to quantitate a woman's individual risk of developing breast cancer. However, among older women the absolute risk of developing breast cancer over a specified time interval may be more useful in risk-benefit counseling. The objective of this investigation is to characterize the relationships between relative risks and absolute risks of breast cancer among a population of rural, older African American women. Among 224 African American women aged 50-91 years, relative risks were computed from historical information on age at menarche, number of previous biopsies, age at first birth, and number of first-degree relatives with breast cancer. These estimates, combined with the woman's current age, average remaining life expectancy, age-specific mortality, and breast cancer incidence rates, were used to estimate lifetime probabilities of developing breast cancer. Most women in the cohort (72.8%) had weak relative risks of 1.01-1.5 and only 3.5% of the women had relative risks of greater than 3.0. The majority of the women (87.5%) had lifetime probabilities of developing breast cancer that were less than 5%. Although there is a marked increase in age-specific breast cancer incidence with age, the probability of developing breast cancer in this population is low, primarily due to the low relative risks and the effects of competing mortality at older ages. Screening mammography should be directed toward women with high risks who are not receiving regular screening mammograms.

Journal Article↗
PubMed2002

Factors associated with maternal mortality in rural Guinea-Bissau. A longitudinal population-based study.

OBJECTIVE: To assess demographic and obstetric risk factors for pregnancy-related death in a multiethnic rural population in a developing country. DESIGN: A prospective survey of women in the fertile age-range. SETTING: Rural Guinea-Bissau. POPULATION: More than 15,000 women living in 100 clusters were visited at six-monthly intervals over a period of more than six years. A total of 10,931 pregnancies were registered prospectively; 85 of these pregnancies resulted in maternal or late maternal death. MAIN OUTCOME MEASURE: Maternal mortality ratio. METHOD: In the rural areas of Guinea-Bissau, we conducted a prospective survey of women in the fertile age range. More than 15,000 women living in 100 clusters were visited at 6-monthly intervals over a period of more than six years. An analysis of demographic, environmental and obstetric risk factors for maternal death was performed based on 10,931 prospectively registered pregnancies; 85 of these pregnancies resulted in maternal or late maternal death. RESULTS: In the adjusted model maternal mortality ratio increased with increasing distance from the regional hospital (OR>25 km = 7.4 [95% CI: 1.6-132]). Multiple pregnancy was found to increase the risk of maternal death (OR = 3.4 [95% CI: 1.3-7.5]). The risk of subsequent maternal death was increased if the fetus was stillborn (OR = 5.3 [95% CI: 2.8-9.4]). Women living in the region of Gabu had higher mortality than those living in Biombo (OR = 2.5 [95% CI: 1.3-5.1]). No category of age or parity were associated with an increased risk of maternal mortality. Predictive values did not exceed 3% for any of the significant risk factors. CONCLUSIONS: For the purpose of reducing maternal mortality, the screening approach of antenatal care is of limited value. Age and parity should not be used routinely as selection criteria for transfer of otherwise healthy pregnant women to higher-level health institutions. Twin pregnancy seems to be the only operational risk factor identified in this study. Stillbirth is associated with an increased risk of maternal death. Regional differences must be studied further. The distance to emergency obstetric care (EOC) may determine the outcome of a complicated delivery.

Adult↗
PubMed1986

The management of ruptured abdominal aortic aneurysms in rural Colorado. With a historical note on Kit Carson's death.

Kit Carson died of a ruptured aneurysm in rural Colorado in 1868. Since that time, techniques for management of aortic aneurysms have been developed and disseminated to rural areas with small hospitals. A survey of six Colorado rural hospitals' experience with ruptured abdominal aortic aneurysms is presented. Fifty-seven ruptured aneurysms had been managed during periods ranging from three to ten years. The average time to the operating room was 3.5 to 4.0 hours after hospital arrival and less than 45 minutes after diagnosis. Of those cases arriving with a systolic blood pressure less than 100 mm Hg, the mortality was 56%. The overall mortality was 53%. Groups are analyzed according to preoperative delay, occurrence of shock, and other risk factors. The results are compared with several series from metropolitan hospitals. Techniques of management that are of potential benefit in low-volume vascular case settings are discussed.

Aorta, Abdominal↗
PubMedDate not supplied

Impact of a community-based program on early childhood development.

To determine the impact of an integrated community-based program in rural villages on early childhood development, a controlled trial was conducted in the Nakhon Sawan province of Thailand. The program involved the cooperation of governmental agencies, nongovernmental agencies, academic institutions, and community organizations. At baseline, 3 control and 3 program villages were similar in terms of nutritional status, developmental performance and parental care. After 2 years of intervention in the program villages, improvements were noted in nutritional status, developmental performance, and intelligence quotient scores, as well as overall utilization of health care resources and parental attitude and involvement.

Child↗