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PubMed2001

A current assessment of rurally linked exposures as potential risk factors for sarcoidosis.

PURPOSE: To identify and quantify the risk of developing sarcoidosis associated with specific rural exposures previously recognized as potential risk factors for this disease. METHODS: A matched case-control design was carried out with a 2-to-1 ratio of controls to cases. Case exposure histories were determine from a detailed questionnaire collecting self-reported information covering the period from birth through disease development and comparing that to exposure histories for the corresponding period in age-, race-, and gender-matched controls identified using Random Digit Dial survey methodology. Conditional logistic regression was used to analyze the matched data while controlling for several baseline variables. RESULTS: A number of exposures were found to be univariately associated with the development of sarcoidosis including: the use of wood stoves, the use of fireplaces, the use of nonpublic water supplies, and living or working on a farm. A dose-response gradient was detected from exposure to wood stoves and fireplaces continued to be significantly associated with sarcoidosis in multivariable models. CONCLUSIONS: The results of this study provide further support for the hypothesis that behaviors associated with rural living play some role in the development of sarcoidosis. This study further suggests that exposures involving the handling or burning of wood such as using wood stoves or fireplaces for home heating may, in part, explain this rural association.

Adult↗
PubMedDate not supplied

Development of a nurse case management service: a proposed business plan for rural hospitals.

The nurse case management service (NCMS) for rural hospitals is an entrepreneurial endeavor designed to provide rural patients with quality, cost-effective healthcare. This article describes the development of an NCMS. A detailed marketing and financial plan, a review of industry trends, and the legal structure and risks associated with the development of the venture are presented. The financial plan projects a minimum savings of 223,200 dollars for rural institutions annually. To improve quality and reduce cost for rural hospitals, the authors recommend implementation of an NCMS.

Case Management↗
PubMed2003

Wheezing, allergy, and parasite infection in children in urban and rural Ethiopia.

Epidemiological studies in developing countries suggest that intestinal parasite infection may reduce the risk of asthma. Because this evidence is all derived from adults and older children, we have investigated the relation between parasite infection, wheezing, and allergen skin sensitization in nested case-control studies drawn from a survey of 7,155 children aged 1 to 4 years living in urban and rural areas of Jimma, Ethiopia. Infection with parasites was common, predominantly with Trichuris (54%), Ascaris (38%), and hookworm (10%). Wheezing in the past year was significantly more prevalent in urban (4.4%) than rural children (2.0%), and was less prevalent in those infected with Ascaris (age, sex, and urban/rural adjusted odds ratio, 0.5; 95% confidence interval, 0.3 to 0.9), particularly in relation to high-intensity infection. Similar, although nonsignificant, associations were found for hookworm (adjusted odds ratio, 0.6; 95% confidence interval, 0.2 to 1.8), but there was no suggestion of any relation to Trichuris infection. Dermatophagoides pteronyssinus and cockroach (Blattella germanica) skin sensitization was more prevalent in rural than urban children, and was unrelated to wheeze. We conclude that Ascaris and possibly hookworm infection protects against wheeze in young Ethiopian children, and that this effect is not mediated by inhibition of allergen sensitization.

Age Distribution↗
PubMed2003

Understanding the experience of household food insecurity in rural Bangladesh leads to a measure different from that used in other countries.

This research aimed to gain in-depth understanding of the experience of household food insecurity in rural Bangladesh and to develop a direct measure of it from this understanding. Using naturalistic, emergent inquiry, in-depth interviews were conducted with 21 rural women living in diverse situations using a semistructured interview guide. Two analytic strategies classified households on food insecurity and elicited themes that were the basis for classification. Survey questions were developed to capture themes, and were revised after review, field testing, and ranking and pile-sorting exercises. Four gradations of severity of food insecurity resulted, based on nine themes: meals, cooking, rice, fish, perishable foods, snacks, festival food, other expenditures and management strategies. The emergent conceptualization of food insecurity differs from that found from naturalistic research in other countries. The developed food insecurity measure has 11 questions. This research affirms the value of gaining in-depth understanding of household food insecurity. In many situations, this approach, rather than translating questions developed elsewhere, may best lead to suitable experience-based measures of food insecurity.

Adult↗
PubMed1997

Sanitation for rural communities: first win the people's support.

A latrine project in an Indian village which failed because the inhabitants were scarcely brought into its planning and execution is contrasted with a moderately successful scheme in another village where a concerted effort was made to educate the community about the value of latrines and to obtain the people's participation.

Community Participation↗
PubMed2002

Rural-to-urban migration and cardiovascular disease risk factors in young Guatemalan adults.

BACKGROUND: Migration to cities may increase cardiovascular disease risk factors in developing countries. We examined rural and urban individuals who were born in the same villages and shared similar childhood experiences. METHODS: Blood lipids and glucose, blood pressure, anthropometry, body composition, physical activity, and food, tobacco and alcohol consumption were examined in 161 men and 193 women, 19-29 years old, living in their village of birth (76 commuted to work in Guatemala City), and in 76 men and 43 women living in the city. RESULTS: Rural and urban women had similar prevalence of overweight (28%), elevated body fat (29.8 +/- 6.1%) and low physical activity (83%). Compared to rural men, more urban men were sedentary (79 versus 27%), and they had higher body fat (15.3 +/- 5.3% versus 13.3 +/- 5.7%), serum cholesterol (4.27 +/- 0.75 versus 3.90 +/- 0.70 mmol/l [165 +/- 29 versus 151 +/- 27 mg/dl]), low density lipoprotein [LDL]-cholesterol (2.66 +/- 0.72 versus 2.30 +/- 0.62 mmol/l [103 +/- 28 versus 89 +/- 24 mg/dl]) and total cholesterol/high density lipoprotein [HDL]-cholesterol ratio (4.6 +/- 1.0 versus 4.1 +/- 0.9). Commuters showed intermediate values. Women had higher serum cholesterol (4.43 +/- 0.80 mmol/l [171 +/- 31 mg/dl]) than men in rural and urban areas. Urban residents ate/drank more saturated fats, red meat and sweetened beverages, and less legumes. CONCLUSIONS: High proportions of young Guatemalan women were overweight and sedentary. Migration to a city increased sedentarism and undesirable eating habits among men and women; men became fatter and their lipid profile worsened. Public health actions must address the prevention of emerging chronic diseases in countries still burdened by undernutrition and infections.

Adult↗
PubMed1998

Alaska Native community assessment: health care services, knowledge of health issues, and health education.

This project gathered information from 32 Alaska Native communities in Bristol Bay, located in southwestern Alaska, regarding use of health care services and knowledge of health care issues. It also educated residents about health care and their role in improving health status, enabling participants to feel that their involvement in planning health care services is important. In conjunction with the University of Washington Community Development Program and the Alaska Center for Rural Health, a household survey was developed. A coordinator in each community was trained, and packets of surveys and health education materials were delivered to each household or post-office box. Completed surveys were returned, confidentially, to the village clinic. An English/Yup'ik cassette tape explaining the project was also available. Results were analyzed by the University of Washington. The findings were determined to be accurate with a 95% confidence level. Of surveys delivered to households, there was a 66% return rate and an overall return rate of 45%.

Adult↗
PubMed2005

Barriers facing junior doctors in rural practice.

INTRODUCTION: Early postgraduate, or junior doctors, are still required to practise in rural and remote communities, and they continue to face numerous issues and difficulties. Within the hospital setting, exposure to rural practice appears to be very limited during internship, and also to some extent, during the second postgraduate year and beyond. This is a major issue for those required to undertake country relieving, rural terms or who will be bonded to rural and remote practice for several years after internship. This research investigated the current issues and difficulties faced by junior doctors, required to undertake rural and remote practice in Queensland, Australia. METHODS: An exploratory study was undertaken. Primary data were collected through semi-structured interviews held with key stakeholders. Stakeholders included: directors of clinical training; medical educators; junior doctors; rural practitioners; academic rural practitioners; and medical administrators. Of the 23 people approached, a total of 19 agreed to be interviewed. The response rate was 82.6%. RESULTS: Similar to the issues identified in the literature, there are currently a number of barriers influencing the ability of junior doctors to practise competently and confidently when undertaking practice in rural and remote communities. Minimal clinical experience, lack of supervision and on-site support, inadequate orientation and uninformed expectations, limited access to relevant education, and the influence of isolation, results in an overall lack of preparation both professionally and personally. When asked, respondents supported the identification of core skills and knowledge, and integration of these and other issues affecting rural practice, into their hospital-based programs. Current hospital-based education and training programs were not adequately preparing junior doctors for rural and remote practice. It was commented that orientation and education, with a rural emphasis, could assist junior doctors in their preparation for country relieving, rural terms and longer placements. CONCLUSIONS: Data collected in this study have confirmed that junior doctors are still being sent to undertake country relieving in their second postgraduate year. Hence, the issues remain for junior doctors when undertaking practice in rural or remote communities, including country relievers and scholarship holders. Results from this study suggest that prior recommendations have not been fully implemented. A recommendation is that initiatives at the undergraduate level, including increasing rural exposure and integration of rural context into training, be further developed at the early postgraduate level. Core rural competencies should be identified and realistic preparation and support strategies put in place in the hospital setting. This will further the effort to prepare junior doctors for rural practice and minimise some of the barriers currently experienced.

Attitude of Health Personnel↗
PubMedDate not supplied

Networking in a rural community focuses on at-risk children.

The need to integrate social and medical services to deal with the issues of child abuse prevention and treatment has been documented frequently. In rural areas, referral to the various programs developed to reach the at-risk child is hampered by lack of communication, personal contact, and understanding of the roles and functions among the staffs of the agencies involved. Networking provides an interdisciplinary team approach to foster communication and coordination among the agencies' staffs and increase the effectiveness of their efforts. A model for developing an interagency network in a rural area is presented, eliciting key liaison persons as coordinators.

California↗
PubMed1996

Mental health services for rural elderly: innovative service strategies.

This paper reviews issues in planning and delivering mental health services to rural dwelling elderly. First, comparative data on the prevalence of mental illness among rural elderly, and the availability and accessibility of mental health services in rural areas are presented to provide a basis for subsequent discussion. Next, several strategies for improving the development and delivery of geriatric mental health services to rural areas are discussed. These include: increasing the number and quality of rural mental health providers; adapting or developing diagnostic techniques to improve case identification among rural elderly; providing culturally sensitive mental health services; strengthening informal and formal care linkages in rural communities; developing innovative service delivery models building upon the strengths of rural settings; and emphasizing fluidity as well as continuity in treatment models.

Aged↗
PubMed1997

Neonatal resuscitation and newborn outcomes in rural Kenya.

Neonatal resuscitation methods vary in developing countries. This study describes the delivery experience at one rural Kenyan mission hospital, retrospectively analysing delivery data and newborn outcomes for a 12-month period, and prospectively characterizing neonatal resuscitation practices. Thirty-six of 878 newborns (4 per cent) suffered unfavourable outcomes, significantly associated with caesarean, breech, and vacuum deliveries (nine infants, P < 0.01) and birthweight of 2000 g or less (10 infants, P < 0.001). Observed neonatal resuscitation practices were inconsistent and notable for umbilical vein injections given in lieu of bag and mask ventilation. A basic neonatal resuscitation protocol was developed. It is concluded that at one Kenyan hospital, unfavourable newborn outcomes were significantly associated with delivery other than normal vaginal and with birthweights of 2000 g or less. Neonatal resuscitation methods could be modified for use in this setting, and might be most useful for term infants delivered by caesarean, breech, or vacuum deliveries.

Delivery, Obstetric↗
PubMed2006

Norms for mental health services in South Africa.

BACKGROUND: In the aftermath of apartheid, South Africa has inherited a fragmented, under-resourced and inequitable public sector mental health service. Attempts are being made to reform mental health services, in keeping with new health policy, which proposes the downscaling of psychiatric institutions and the development of community-based services. This study set out to develop a set of service norms for the care of people with severe psychiatric conditions (SPC) in South Africa, to assist the implementation of the new policy. METHODS: A national situation analysis of current public sector mental health services was conducted. A model was developed for estimating the mental health service resource needs of people with SPC. Following consultation with provincial stakeholders, a set of service norms were developed taking into account national indicators from the situation analysis (as a baseline level) and proposals of the model (as a target level). RESULTS: The study recommends an increase in the number of acute psychiatric beds in general hospitals; development of community-based residential care; redistribution of staff from hospital to community services, particularly in rural areas; and the development of information systems to monitor the transitions to community-based care. CONCLUSIONS: The norms proposals presented in this study express mental health service needs in terms of quantifiable service resource and utilisation levels. In doing so, the study attempts to make explicit the assumptions and values on which planning is based.

Community Mental Health Services↗
PubMed2000

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

BACKGROUND AND PURPOSE: We carried out a door-to-door survey in rural areas of the Cordillera Province, Santa Cruz Department, Bolivia. A cluster sample of 10 124 inhabitants was selected, and 9955 subjects were screened. The aim was to determine the prevalence of the most common neurological diseases (epilepsy, stroke, parkinsonism, and peripheral neuropathy) in this population. METHODS: We used a modified version of the World Health Organization screening instrument. On screening we found that 1130 subjects tested positive, and 1027 underwent a complete neurological examination. According to the World Health Organization guidelines, we defined stroke as "rapidly developing clinical signs of focal (or global) disturbance of cerebral functions, lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin." We considered only first stroke and excluded a possible stroke. RESULTS: We found 16 subjects (cases) who had experienced 1 complete stroke on prevalent day (November 1, 1994). The crude prevalence of stroke was 174/100 000 (322/100 000 age-adjusted to the world standard population) and 663/100 000 in subjects aged >/=35 years. Prevalence was >2-fold higher in men than in women (247/100 000 and 99/100 000, respectively) and increased rapidly with age. Seven cases were hospitalized and received specific treatment. CONCLUSIONS: Our crude prevalence is lower compared with rates from developed countries, probably because of a high case fatality rate. Our findings are comparable with those reported from other surveys carried out in rural developing countries.

Adolescent↗