An Ethnographic Meta-Synthesis of Three Southwestern Rural Studies.

PubMed

Averill, Jennifer B

2016-01-01

The objectives were to synthesize cumulative findings across three critical ethnographic, community-partnered studies in the southwestern United States and to describe the process of meta-ethnography for that analysis. The meta-ethnography followed the design of Noblit and Hare for constructing an analysis of composite data, informed by community-based participatory research and Stringer's ethnographic strategies of Look-Think-Act. The three studies occurred in rural settings of Colorado and New Mexico, engaging 129 total participants, along with community organizations and agencies as partners. Methods consisted of detailed review of each original study, mapping of major concepts and themes, and general analysis, interpretation, and synthesis across the studies. Overall themes were: health is the capacity to care for oneself and do work, meaningful relationships are key in health care interactions, patterns of discrimination persist in rural settings, poor literacy and health literacy are barriers, and food insecurity is a growing concern for older rural adults. Resolutions involve practice, policy, and research and must incorporate all stakeholder groups in rural settings; a participatory approach is critical to prioritize and impact existing inequities; and work is needed to extend education and understanding of multiple cultures, groups, customs, and rural contexts. © 2015 Wiley Periodicals, Inc.

The Impact of the Built Environment on Young People’s Physical Activity Patterns: A Suburban-Rural Comparison Using GPS

PubMed Central

Collins, Peter; Al-Nakeeb, Yahya; Nevill, Alan; Lyons, Mark

2012-01-01

The built environment in which young people live has a significant influence on their physical activity (PA). However, little is known regarding how youth from suburban and rural settings utilise their surrounding environments to participate in free-living PA. 50 adolescents aged 13–14 years old (22 rural; 28 suburban) wore an integrated GPS and heart rate device during non-school hours and completed a daily PA diary over 7 days. Descriptive statistics and analyses of variance were used to explore differences in the amount and location of moderate-to-vigorous physical activity (MVPA) between genders and youth from different geographical settings. Suburban youth participated in significantly (p = 0.004) more daily PA (52.14 minutes MVPA) and were more extensive in their utilisation of their surroundings, compared to rural youth (26.61 minutes MVPA). Suburban youth visited more public recreational facilities and spent significantly more time outdoors and on local streets (109.71 minutes and 44.62 minutes, respectively) compared to rural youth (55.98 minutes and 17.15 minutes, respectively) during weekdays. Rural youth on average spent significantly more time within the home (350.69 minutes) during weekends compared to suburban youth (214.82 minutes). Rural females were the least active group of adolescents, participating in the least amount of daily PA (20.14 minutes MVPA) and spending the least amount of time outdoors (31.37 minutes) during weekdays. Time spent outdoors was positively associated with PA. The findings highlight the disparity in PA levels and the utilisation of the surrounding built environment between youth from two different geographical settings and possible environmental causes are discussed. The study supports the use of GPS (combined with other methods) in investigating geographical differences in young people’s PA and movement patterns. This method provides a wealth of information that may assist future policies and interventions in identifying environmental characteristics that promote PA in youth from different geographical settings. PMID:23202669

The impact of the built environment on young people's physical activity patterns: a suburban-rural comparison using GPS.

PubMed

Collins, Peter; Al-Nakeeb, Yahya; Nevill, Alan; Lyons, Mark

2012-08-24

The built environment in which young people live has a significant influence on their physical activity (PA). However, little is known regarding how youth from suburban and rural settings utilise their surrounding environments to participate in free-living PA. 50 adolescents aged 13-14 years old (22 rural; 28 suburban) wore an integrated GPS and heart rate device during non-school hours and completed a daily PA diary over 7 days. Descriptive statistics and analyses of variance were used to explore differences in the amount and location of moderate-to-vigorous physical activity (MVPA) between genders and youth from different geographical settings. Suburban youth participated in significantly (p = 0.004) more daily PA (52.14 minutes MVPA) and were more extensive in their utilisation of their surroundings, compared to rural youth (26.61 minutes MVPA). Suburban youth visited more public recreational facilities and spent significantly more time outdoors and on local streets (109.71 minutes and 44.62 minutes, respectively) compared to rural youth (55.98 minutes and 17.15 minutes, respectively) during weekdays. Rural youth on average spent significantly more time within the home (350.69 minutes) during weekends compared to suburban youth (214.82 minutes). Rural females were the least active group of adolescents, participating in the least amount of daily PA (20.14 minutes MVPA) and spending the least amount of time outdoors (31.37 minutes) during weekdays. Time spent outdoors was positively associated with PA. The findings highlight the disparity in PA levels and the utilisation of the surrounding built environment between youth from two different geographical settings and possible environmental causes are discussed. The study supports the use of GPS (combined with other methods) in investigating geographical differences in young people's PA and movement patterns. This method provides a wealth of information that may assist future policies and interventions in identifying environmental characteristics that promote PA in youth from different geographical settings.

Characteristics of the Residential Neighborhood Environment Differentiate Intimate Partner Femicide in Urban Versus Rural Settings

PubMed Central

Beyer, Kirsten M. M.; Layde, Peter M.; Hamberger, L. Kevin; Laud, Purushottam W.

2012-01-01

Purpose A growing body of work examines the association between neighborhood environment and intimate partner violence (IPV). As in the larger literature examining the influence of place context on health, rural settings are understudied and urban and rural residential environments are rarely compared. In addition, despite increased attention to the linkages between neighborhood environment and IPV, few studies have examined the influence of neighborhood context on intimate partner femicide (IPF). In this paper, we examine the role for neighborhood-level factors in differentiating urban and rural IPFs in Wisconsin, USA. Methods We use a combination of Wisconsin Violent Death Reporting System (WVDRS) data and Wisconsin Coalition Against Domestic Violence (WCADV) reports from 2004–2008, in concert with neighborhood-level information from the US Census Bureau and US Department of Agriculture, to compare urban and rural IPFs. Findings Rates of IPF vary based on degree of rurality, and bivariate analyses show differences between urban and rural victims in race/ethnicity, marital status, country of birth, and neighborhood characteristics. After controlling for individual characteristics, the nature of the residential neighborhood environment significantly differentiates urban and rural IPFs. Conclusions Our findings suggest a different role for neighborhood context in affecting intimate violence risk in rural settings, and that different measures may be needed to capture the qualities of rural environments that affect intimate violence risk. Our findings reinforce the argument that multilevel strategies are required to understand and reduce the burden of intimate violence, and that interventions may need to be crafted for specific geographical contexts. PMID:23802930

Postacute Stroke Rehabilitation Utilization: Are There Differences between Rural-Urban Patients and Taxonomies?

ERIC Educational Resources Information Center

Jia, Huanguang; Cowper, Diane C.; Tang, Yuhong; Litt, Eric; Wilson, Lauren

2012-01-01

Purpose: To assess the association between Veterans Affairs (VA) stroke patients' poststroke rehabilitation utilization and their residential settings by using 2 common rural-urban taxonomies. Methods: This retrospective study included all VA stroke inpatients in 2001 and 2002. Rehabilitation utilization referred to rehabilitation therapy received…

Methods for estimating annual exceedance-probability discharges and largest recorded floods for unregulated streams in rural Missouri.

DOT National Transportation Integrated Search

2014-01-01

Regression analysis techniques were used to develop a : set of equations for rural ungaged stream sites for estimating : discharges with 50-, 20-, 10-, 4-, 2-, 1-, 0.5-, and 0.2-percent : annual exceedance probabilities, which are equivalent to : ann...

Mapping the interprofessional education landscape for students on rural clinical placements: an integrative literature review.

PubMed

Walker, Lorraine; Cross, Merylin; Barnett, Tony

2018-05-01

Interprofessional collaboration and effective teamwork are core to optimising rural health outcomes; however, little is known about the opportunities available for interprofessional education (IPE) in rural clinical learning environments. This integrative literature review addresses this deficit by identifying, analysing and synthesising the research available about the nature of and potential for IPE provided to undergraduate students undertaking rural placements, the settings and disciplines involved and the outcomes achieved. An integrative review method was adopted to capture the breadth of evidence available about IPE in the rural context. This integrative review is based on a search of nine electronic databases: CINAHL, Cochrane Library, EMBASE, MEDLINE, ProQuest, PubMed, SCOPUS, Web of Science and Google Scholar. Search terms were adapted to suit those used by different disciplines and each database and included key words related to IPE, rurality, undergraduate students and clinical placement. The inclusion criteria included primary research and reports of IPE in rural settings, peer reviewed, and published in English between 2000 and mid-2016. This review integrates the results of 27 primary research studies undertaken in seven countries: Australia, Canada, USA, New Zealand, the Philippines, South Africa and Tanzania. Despite geographical, cultural and health system differences, all of the studies reviewed were concerned with developing collaborative, interprofessional practice-ready graduates and adopted a similar mix of research methods. Overall, the 27 studies involved more than 3800 students (range 3-1360) from 36 disciplinary areas, including some not commonly associated with interprofessional education, such as theology. Interprofessional education was provided in a combination of university and rural placement settings including hospitals, community health services and other rural venues. The education activities most frequently utilised were seminars, tutorial discussion groups (n=21, 84%), case presentations (n=11, 44%) and community projects (n=11, 44%) augmented by preliminary orientation and ongoing interaction with clinicians during placement. The studies reviewed demonstrate that rural clinical learning environments provide rich and varied IPE opportunities for students that increase their interprofessional understanding, professional respect for other roles, and awareness of the collaborative and interprofessional nature of rural practice. This review addresses the lack of attention given to understanding IPE in the rural context, provides Australian and international evidence that initiatives are being offered to diverse student groups undertaking placements in rural settings and proposes a research agenda to develop a relevant framework to support rural IPE. Rural clinical learning environments afford a rich resource whereby health professionals can conceptualise IPE creatively and holistically to construct transformative learning experiences for students. This review develops a case for supporting the development, trialling, evaluation and translation of IPE initiatives that harness the opportunities afforded by rural placements. Further research is required to examine the ways to optimise IPE opportunities in the rural clinical context, including the potential for simulation-based activities, the challenges to achieving sustainable programs, and to evaluate the impact of interprofessional education on collaboration and health outcomes.

Canadian Rural-urban Differences in End-of-life Care Setting Transitions

PubMed Central

Wilson, Donna M.; Thomas, Roger; Burns, Katharina Kovacs; Hewitt, Jessica A.; Jane, Osei-Waree; Sandra, Robertson

2012-01-01

Few studies have focused on the care setting transitions that occur in the last year of life. A three part mixed-methods study was conducted to gain an understanding of the number and implications or impact of care setting transitions in the last year of life for rural Canadians. Provincial health services utilization data, national online survey data, and local qualitative interview data were analyzed to gain general and specific information for consideration. Rural Albertans had significantly more healthcare setting transitions than urbanites in the last year of life (M=4.2 vs 3.3). Online family respondents reported 8 moves on average occurred for family members in the last year of life. These moves were most often identified (65%) on a likert-type scale as “very difficult,” with the free text information revealing these trips were often emotionally painful for themselves and physically painful for their ill family member. Eleven informants were then interviewed until data saturation, with constant-comparative data analysis conducted for a more in-depth understanding of rural transitions. Moving from place to place for needed care in the last year of life was identified as common and concerning for rural people and their families, with three data themes developing: (a) needed care in the last year of life is scattered across many places, (b) travelling is very difficult for terminally-ill persons and their caregivers, and (c) local rural services are minimal. These findings indicate planning is needed to avoid unnecessary end-of-life care setting transitions and to make needed moves for essential services in the last year of life less costly, stressful, and socially disruptive for rural people and their families. PMID:22980372

From the bush to the big smoke--development of a hybrid urban community based medical education program in the Northern Territory, Australia.

PubMed

Morgan, S; Smedts, A; Campbell, N; Sager, R; Lowe, M; Strasser, S

2009-01-01

The Northern Territory (NT) of Australia is a unique setting for training medical students. This learning environment is characterised by Aboriginal health and an emphasis on rural and remote primary care practice. For over a decade the NT Clinical School (NTCS) of Flinders University has been teaching undergraduate medical students in the NT. Community based medical education (CBME) has been demonstrated to be an effective method of learning medicine, particularly in rural settings. As a result, it is rapidly gaining popularity in Australia and other countries. The NTCS adopted this model some years ago with the implementation of its Rural Clinical School; however, urban models of CBME are much less well developed than those in rural areas. There is considerable pressure to better incorporate CBME into medical student teaching environment, particularly because of the projected massive increase in student numbers over the next few years. To date, the community setting of urban Darwin, the NT capital city, has not been well utilised for medical student training. In 2008, the NTCS enrolled its first cohort of students in a new hybrid CBME program based in urban Darwin. This report describes the process and challenges involved in development of the program, including justification for a hybrid model and the adaptation of a rural model to an urban setting. Relationships were established and formalised with key partners and stakeholders, including GPs and general practices, Aboriginal medical services, community based healthcare providers and other general practice and community organisations. Other significant issues included curriculum development and review, development of learning materials and the establishment of robust evaluation methods. Development of the CBME model in Darwin posed a number of key challenges. Although the experience of past rural programs was useful, a number of distinct differences were evident in the urban setting. Change leadership and inter-professional collaboration were key strengths in the implementation and ongoing evaluation of the program. The program will provide important information about medical student training in urban community settings, and help inform other clinical schools considering the adoption of similar models.

Cross-Sectional Study of Malnutrition and Associated Factors among School Aged Children in Rural and Urban Settings of Fogera and Libo Kemkem Districts, Ethiopia

PubMed Central

Herrador, Zaida; Sordo, Luis; Gadisa, Endalamaw; Moreno, Javier; Nieto, Javier; Benito, Agustín; Aseffa, Abraham; Cañavate, Carmen; Custodio, Estefania

2014-01-01

Introduction Little information is available on malnutrition-related factors among school-aged children ≥5 years in Ethiopia. This study describes the prevalence of stunting and thinness and their related factors in Libo Kemkem and Fogera, Amhara Regional State and assesses differences between urban and rural areas. Methods In this cross-sectional study, anthropometrics and individual and household characteristics data were collected from 886 children. Height-for-age z-score for stunting and body-mass-index-for-age z-score for thinness were computed. Dietary data were collected through a 24-hour recall. Bivariate and backward stepwise multivariable statistical methods were employed to assess malnutrition-associated factors in rural and urban communities. Results The prevalence of stunting among school-aged children was 42.7% in rural areas and 29.2% in urban areas, while the corresponding figures for thinness were 21.6% and 20.8%. Age differences were significant in both strata. In the rural setting, fever in the previous 2 weeks (OR: 1.62; 95% CI: 1.23–2.32), consumption of food from animal sources (OR: 0.51; 95% CI: 0.29–0.91) and consumption of the family's own cattle products (OR: 0.50; 95% CI: 0.27–0.93), among others factors were significantly associated with stunting, while in the urban setting, only age (OR: 4.62; 95% CI: 2.09–10.21) and years of schooling of the person in charge of food preparation were significant (OR: 0.88; 95% CI: 0.79–0.97). Thinness was statistically associated with number of children living in the house (OR: 1.28; 95% CI: 1.03–1.60) and family rice cultivation (OR: 0.64; 95% CI: 0.41–0.99) in the rural setting, and with consumption of food from animal sources (OR: 0.26; 95% CI: 0.10–0.67) and literacy of head of household (OR: 0.24; 95% CI: 0.09–0.65) in the urban setting. Conclusion The prevalence of stunting was significantly higher in rural areas, whereas no significant differences were observed for thinness. Various factors were associated with one or both types of malnutrition, and varied by type of setting. To effectively tackle malnutrition, nutritional programs should be oriented to local needs. PMID:25265481

A Qualitative Inquiry Into the Challenges of Medical Education for Retention of General Practitioners in Rural and Underserved Areas of Iran

PubMed Central

2016-01-01

Objectives General practitioners (GPs) retention in rural and underserved areas highly effects on accessibility of healthcare facilities across the country. Education seems to be a critical factor that affects GPs retention. Thus, the present study aimed at inquiry into medical education challenges that limit their retention in rural and underserved areas. Methods A qualitative approach was applied for the aim of this study. Data were gathered via 28 semi-structured interviews with experts at different levels of Iran’s health system as well as GPs who retained and refused to retain working in rural settings. Interviews mainly were performed face-to-face and in some cases via telephone during 2015 and then coded and analyzed using content analysis approach. Results Iran’s medical education is faced with several challenges that were categorized in four main themes including student selection, medical students’ perception about their field of study, education setting and approach, curriculum of medical education. According to experts this challenges could results in making GP graduates disinterested for practicing in rural and underserved areas. Conclusions Challenges that were found could have negative effects on retention. Modification in student’s perception about rural practice could be done via changing education setting and approach and curriculum. These modifications could improve GPs retention in rural and underserved areas. PMID:27951631

Influences on Children's Human Capital in Rural Malawi: Three Essays

ERIC Educational Resources Information Center

Appiah-Yeboah, Shirley Afua

2013-01-01

The circumstances that characterize poor, rural communities in Malawi suggest that children's health-wealth gradient can vary from other settings. This dissertation begins with a description of the methods used to create a household wealth variable using assets data in the Malawi Longitudinal Study of Families and Health project. By using a fixed…

Assessing Needs for Gerontological Education in Urban and Rural Areas of Ohio

ERIC Educational Resources Information Center

Van Dussen, Daniel J.; Leson, Suzanne M.; Emerick, Eric S.; Voytek, Joseph A.; Ewen, Heidi H.

2016-01-01

Purpose of the Study: This project surveyed health care professionals from both urban and rural care settings in Ohio and examined differences in professionals' needs and interests in continuing gerontological education. Design and Methods: The survey data were analyzed for 766 health care professionals descriptively, using cross-tabulations and…

Environmental Carcinogen Releases and Lung Cancer Mortality in Rural-Urban Areas of the United States

ERIC Educational Resources Information Center

Luo, Juhua; Hendryx, Michael

2011-01-01

Purpose: Environmental hazards are unevenly distributed across communities and populations; however, little is known about the distribution of environmental carcinogenic pollutants and lung cancer risk across populations defined by race, sex, and rural-urban setting. Methods: We used the Toxics Release Inventory (TRI) database to conduct an…

Programa de fortalecimiento de capacidades: reflections on a case study of community-based teacher education set in rural northern Peru

NASA Astrophysics Data System (ADS)

Alsop, Steve; Ames, Patricia; Arroyo, Graciela Cordero; Dippo, Don

2010-12-01

This article explores distinctive features of a 5-year international education development project set in rural northern Peru (PROMEB, the Proyecto de Mejoramiento de la Educación Básica). Grounded within a partnership between teacher educators from Peru, Mexico and Canada, and rural Peruvian teachers, students and their communities, we offer reflections on a teacher education initiative which sought to support action-orientated inquiries as a mechanism for school/community development. Set against a background of poverty, hunger, isolation and an "educational crisis", we outline our pedagogy and describe two projects. We then reflect on the influences of our engagements and on associated tensions and ambiguities in our methods. We hope that such discussions might offer insights for others involved in international school/community development projects of this type.

Barriers in implementing evidence-informed health decisions in rural rehabilitation settings: a mixed methods pilot study.

PubMed

Prakash, V; Hariohm, K; Balaganapathy, M

2014-08-01

Literature on the barriers to implementing research findings into physiotherapy practice are often urban centric, using self report based on the hypothetical patient scenario. The objective of this study was to investigate the occurrence of barriers, encountered by evidence informed practice-trained physiotherapists in the management of "real world" patients in rural rehabilitation settings. A mixed-methods research design was used. Physiotherapists working in rural outpatient rehabilitation settings participated in the study. In the first phase, we asked all participants (N = 5) to maintain a log book for a 4-week period to record questions that arose during their routine clinical encounters and asked them also to follow first four of the five steps of evidence-informed practice (ask, access, appraise and apply). In the second phase (after 4 weeks), we conducted a semistructured, direct interviews with the participants exploring their experiences involved in the process of implementing evidence-informed clinical decisions made during the study period. At the end of 4 weeks, 30 questions were recorded. For 17 questions, the participants found evidence but applied that evidence into their practice only in 9 instances. Being generalist practitioners, lack of outcomes specific to the patients were reported as barriers more so than time constraints in implementing evidence-informed practice. Practice setting, lack of patient-centered research and evidence-informed practice competency of physiotherapists can be significant barriers to implementing evidence-informed health decisions in rural rehabilitation setting. © 2014 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd.

Communication, Respect, and Leadership: Interprofessional Collaboration in Hospitals of Rural Ontario.

PubMed

Morris, Diane; Matthews, June

2014-12-01

Health care professionals are expected to work collaboratively across diverse settings. In rural hospitals, these professionals face different challenges from their urban colleagues; however, little is known about interprofessional practice in these settings. Eleven health care professionals from 2 rural interprofessional teams were interviewed about collaborative practice. The data were analyzed using a constant comparative method. Common themes included communication, respect, leadership, benefits of interprofessional teams, and the assets and challenges of working in small or rural hospitals. Differences between the cases were apparent in how the members conceptualized their teams, models of which were then compared with an "Ideal Interprofessional Team". These results suggest that many experienced health care professionals function well in interprofessional teams; yet, they did not likely receive much education about interprofessional practice in their training. Providing interprofessional education to new practitioners may help them to establish this approach early in their careers and build on it with additional experience. Finally, these findings can be applied to address concerns that have arisen from other reports by exploring innovative ways to attract health professionals to communities in rural, remote, and northern areas, as there is a constant need for dietitians and other health care professionals in these practice settings.

Rural Doctors’ Views on and Experiences with Evidence-Based Medicine: The FrEEDoM Qualitative Study

PubMed Central

Hisham, Ranita; Liew, Su May; Ng, Chirk Jenn; Mohd Nor, Kamaliah; Osman, Iskandar Firzada; Ho, Gah Juan; Hamzah, Nurazira; Glasziou, Paul

2016-01-01

Background Evidence-based medicine is the integration of individual clinical expertise, best external evidence and patient values which was introduced more than two decades ago. Yet, primary care physicians in Malaysia face unique barriers in accessing scientific literature and applying it to their clinical practice. Aim This study aimed to explore the views and experiences of rural doctors’ about evidence-based medicine in their daily clinical practice in a rural primary care setting. Methods Qualitative methodology was used. The interviews were conducted in June 2013 in two rural health clinics in Malaysia. The participants were recruited using purposive sampling. Four focus group discussions with 15 medical officers and three individual in-depth interviews with family medicine specialists were carried out. All interviews were conducted using a topic guide and were audio-recorded, transcribed verbatim, checked and analyzed using a thematic approach. Results Key themes identified were: (1) doctors viewed evidence-based medicine mainly as statistics, research and guidelines, (2) reactions to evidence-based medicine were largely negative, (3) doctors relied on specialists, peers, guidelines and non-evidence based internet sources for information, (4) information sources were accessed using novel methods such as mobile applications and (5) there are several barriers to evidence-based practice, including doctor-, evidence-based medicine-, patient- and system-related factors. These included inadequacies in knowledge, attitude, management support, time and access to evidence-based information sources. Participants recommended the use of online services to support evidence-based practice in the rural settings. Conclusion The level of evidence-based practice is low in the rural setting due to poor awareness, knowledge, attitude and resources. Doctors use non-evidence based sources and access them through new methods such as messaging applications. Further research is recommended to develop and evaluate interventions to overcome the identified barriers. PMID:27031700

Does increased emergency medical services prehospital time affect patient mortality in rural motor vehicle crashes? A statewide analysis.

PubMed

Gonzalez, Richard P; Cummings, Glenn R; Phelan, Herbert A; Mulekar, Madhuri S; Rodning, Charles B

2009-01-01

Fatality rates from rural vehicular trauma are almost double those found in urban settings. It has been suggested that increased prehospital time is a factor that adversely affects fatality rates in rural vehicular trauma. By linking and analyzing Alabama's statewide prehospital data, emergency medical services (EMS) prehospital time was assessed for rural and urban vehicular crashes. An imputational methodology permitted linkage of data from police motor vehicle crash (MVC) and EMS records. MVCs were defined as rural or urban by crash location using the United States Census Bureau criteria. Areas within Alabama that fell outside the Census Bureau definition of urban were defined as rural. Prehospital data were analyzed to determine EMS response time, scene time, and transport time in rural and urban settings. Over a 2-year period from January 2001 through December 2002, data were collected from EMS Patient Care Reports and police crash reports for the entire state of Alabama. By using an imputational methodology and join specifications, 45,763 police crash reports were linked to EMS Patient Care Reports. Of these, 34,341 (75%) were injured in rural settings and 11,422 (25%) were injured in urban settings. A total of 714 mortalities were identified, of which 611 (1.78%) occurred in rural settings and 103 (.90%) occurred in urban settings (P < .0001). When mortalities occurred, the mean EMS response time in rural settings was 10.67 minutes and 6.50 minutes in urban settings (P < .0001). When mortalities occurred, the mean EMS scene time in rural settings was 18.87 minutes and 10.83 minutes in urban settings (patients who were dead on scene and extrication patients were excluded from both settings) (P < .0001). When mortalities occurred, the mean EMS transport time in rural settings was 12.45 minutes and 7.43 minutes in urban settings (P < .0001). When mortalities occurred, the overall mean prehospital time in rural settings was 42.0 minutes and 24.8 minutes in urban settings (P < .0001). The mean EMS response time for rural MVCs with survivors was 8.54 minutes versus a mean of 10.67 minutes with mortalities (P < .0001). The mean EMS scene time for rural MVCs with survivors was 14.81 minutes versus 18.87 minutes with mortalities (patients who were dead on scene and extrication patients were excluded) (P = .0014). Based on this statewide analysis of MVCs, increased EMS prehospital time appears to be associated with higher mortality rates in rural settings.

Rural Doctors' Views on and Experiences with Evidence-Based Medicine: The FrEEDoM Qualitative Study.

PubMed

Hisham, Ranita; Liew, Su May; Ng, Chirk Jenn; Mohd Nor, Kamaliah; Osman, Iskandar Firzada; Ho, Gah Juan; Hamzah, Nurazira; Glasziou, Paul

2016-01-01

Evidence-based medicine is the integration of individual clinical expertise, best external evidence and patient values which was introduced more than two decades ago. Yet, primary care physicians in Malaysia face unique barriers in accessing scientific literature and applying it to their clinical practice. This study aimed to explore the views and experiences of rural doctors' about evidence-based medicine in their daily clinical practice in a rural primary care setting. Qualitative methodology was used. The interviews were conducted in June 2013 in two rural health clinics in Malaysia. The participants were recruited using purposive sampling. Four focus group discussions with 15 medical officers and three individual in-depth interviews with family medicine specialists were carried out. All interviews were conducted using a topic guide and were audio-recorded, transcribed verbatim, checked and analyzed using a thematic approach. Key themes identified were: (1) doctors viewed evidence-based medicine mainly as statistics, research and guidelines, (2) reactions to evidence-based medicine were largely negative, (3) doctors relied on specialists, peers, guidelines and non-evidence based internet sources for information, (4) information sources were accessed using novel methods such as mobile applications and (5) there are several barriers to evidence-based practice, including doctor-, evidence-based medicine-, patient- and system-related factors. These included inadequacies in knowledge, attitude, management support, time and access to evidence-based information sources. Participants recommended the use of online services to support evidence-based practice in the rural settings. The level of evidence-based practice is low in the rural setting due to poor awareness, knowledge, attitude and resources. Doctors use non-evidence based sources and access them through new methods such as messaging applications. Further research is recommended to develop and evaluate interventions to overcome the identified barriers.

Factors Affecting Utilization of Family Planning Services in a Post-Conflict Setting, South Sudan: A Qualitative Study

PubMed Central

Ahmed, Waled Amen Mohammed; Shokai, Sara Boutros; Abduelkhair, Insaf Hassan; Boshra, Amira Yahia

2015-01-01

This study aims to explore and examine the conjectures surrounding the utilization of family planning services among currently married couples of childbearing age in Renk County. This study has adopted a qualitative method to collect data on factors affecting the utilization of family planning services through focus group discussions and in-depth interviews, in rural and urban areas of Renk County. It targeted married women, men as well as unmarried men and women. The researchers conducted nine focus group discussions and nine interviews at both Jelhak (rural setting) and Renk (urban setting). The results suggested that the people of Renk County prefer to have large families and therefore choose not to use family planning methods. The data collected was analyzed by means of thematic analysis. This included the construction of a thematic framework, coding, editing and categorization of available data as well as the creation of sub-themes. The result also suggested that perception is a main factor that affects utilization of family planning services with a majority of the people in Renk and Jelhak preferring to have many children in order to increase the family size for some reasons. These are linked to religion, social stigma and taboo that are attached to childless people or users of family planning methods for birth control purposes. The responses revealed some variation in perception between rural (Jelhak) and urban (Renk) areas. Respondents from Renk area reported that some people use family planning services for economic reasons that involve alleviation of financial difficulties and provision of better education when the family size is small. On the other hand, rural people from Jelhak perceive family planning to be socially un-acceptable. Furthermore, men and women of Jelhak reported that after each birth of a child, married couples avoid sexual relationship for a period of two years as means of family planning. Women of both Urban and Rural settings reported intentions to use conventional methods of family planning without the knowledge of their spouses. PMID:29546129

Factors Affecting Utilization of Family Planning Services in a Post-Conflict Setting, South Sudan: A Qualitative Study.

PubMed

Ahmed, Waled Amen Mohammed; Shokai, Sara Boutros; Abduelkhair, Insaf Hassan; Boshra, Amira Yahia

2015-01-01

This study aims to explore and examine the conjectures surrounding the utilization of family planning services among currently married couples of childbearing age in Renk County. This study has adopted a qualitative method to collect data on factors affecting the utilization of family planning services through focus group discussions and in-depth interviews, in rural and urban areas of Renk County. It targeted married women, men as well as unmarried men and women. The researchers conducted nine focus group discussions and nine interviews at both Jelhak (rural setting) and Renk (urban setting). The results suggested that the people of Renk County prefer to have large families and therefore choose not to use family planning methods. The data collected was analyzed by means of thematic analysis. This included the construction of a thematic framework, coding, editing and categorization of available data as well as the creation of sub-themes. The result also suggested that perception is a main factor that affects utilization of family planning services with a majority of the people in Renk and Jelhak preferring to have many children in order to increase the family size for some reasons. These are linked to religion, social stigma and taboo that are attached to childless people or users of family planning methods for birth control purposes. The responses revealed some variation in perception between rural (Jelhak) and urban (Renk) areas. Respondents from Renk area reported that some people use family planning services for economic reasons that involve alleviation of financial difficulties and provision of better education when the family size is small. On the other hand, rural people from Jelhak perceive family planning to be socially un-acceptable. Furthermore, men and women of Jelhak reported that after each birth of a child, married couples avoid sexual relationship for a period of two years as means of family planning. Women of both Urban and Rural settings reported intentions to use conventional methods of family planning without the knowledge of their spouses.

Transactional sex risk across a typology of rural and urban female sex workers in Indonesia: a mixed methods study.

PubMed

Puradiredja, Dewi Ismajani; Coast, Ernestina

2012-01-01

Context-specific typologies of female sex workers (FSWs) are essential for the design of HIV intervention programming. This study develops a novel FSW typology for the analysis of transactional sex risk in rural and urban settings in Indonesia. Mixed methods include a survey of rural and urban FSWs (n=310), in-depth interviews (n=11), key informant interviews (n=5) and ethnographic assessments. Thematic analysis categorises FSWs into 5 distinct groups based on geographical location of their sex work settings, place of solicitation, and whether sex work is their primary occupation. Multiple regression analysis shows that the likelihood of consistent condom use was higher among urban venue-based FSWs for whom sex work is not the only source of income than for any of the other rural and urban FSW groups. This effect was explained by the significantly lower likelihood of consistent condom use by rural venue-based FSWs (adjusted OR: 0.34 95% CI 0.13-0.90, p=0.029). The FSW typology and differences in organisational features and social dynamics are more closely related to the risk of unprotected transactional sex, than levels of condom awareness and availability. Interventions need context-specific strategies to reach the different FSWs identified by this study's typology.

Improving spine surgical access, appropriateness and efficiency in metropolitan, urban and rural settings

PubMed Central

Zarrabian, Mohammad; Bidos, Andrew; Fanti, Caroline; Young, Barry; Drew, Brian; Puskas, David; Rampersaud, Raja

2017-01-01

Background The Inter-professional Spine Assessment and Education Clinics (ISAEC) were developed to improve primary care assessment, education and management of patients with persistent or recurrent low back pain–related symptoms. This study aims to determine the effect of ISAEC on access for surgical assessment, referral appropriateness and efficiency for patients meeting a priori referral criteria in rural, urban and metropolitan settings. Methods We conducted a retrospective review of prospective data from networked ISAEC clinics in Thunder Bay, Hamilton and Toronto, Ontario. For patients meeting surgical referral criteria, wait times for surgical assessment, surgical referral–related magnetic resonance imaging (MRI) scans and appropriateness of referral were recorded. Results Overall 422 patients, representing 10% of all ISAEC patients in the study period, were referred for surgical assessment. The average wait times for surgical assessment were 5.4, 4.3 and 2.2 weeks at the metropolitan, urban and rural centres, respectively. Referral MRI usage for the group decreased by 31%. Of the patients referred for formal surgical assessment, 80% had leg-dominant pain and 96% were deemed appropriate surgical referrals. Conclusion Contrary to geographic concentration of health care resources in metropolitan settings, the greatest decrease in wait times was achieved in the rural setting. A networked, shared-cared model of care for patients with low back pain–related symptoms significantly improved access for surgical assessment despite varying geographic practice settings and barriers. The greatest reductions were noted in the rural setting. In addition, significant improvements in referral appropriateness and efficiency were achieved compared with historical reports across all sites.

Social Capital and Health Outcomes among Older Adults in China: The Urban-Rural Dimension

ERIC Educational Resources Information Center

Norstrand, Julie A.; Xu, Qingwen

2012-01-01

Purpose: This study examines different types of individual-level social capital (bonding, bridging, and linking) and their relationships with physical and emotional health among older Chinese living in urban and rural settings. Design and Methods: Using the 2005 China General Social Survey, physical and emotional health were regressed on social…

Effects of School-Based Point-of-Testing Counselling on Health Status Variables among Rural Adolescents

ERIC Educational Resources Information Center

Murimi, Mary W.; Chrisman, Matthew S.; Hughes, Kelly; Taylor, Chris; Kim, Yeonsoo; McAllister, Tiffany L.

2015-01-01

Objective: Rural areas may suffer from a lack of access to health care and programmes to promote behaviours such as healthy eating and physical activity. Point-of-testing counselling is a method of promoting a healthy lifestyle during an individual's most "teachable moment". Design/Setting: This longitudinal study examined the effects of…

Geospatial methods provide timely and comprehensive urban forest information

Treesearch

Kathleen T. Ward; Gary R. Johnson

2007-01-01

Urban forests are unique and highly valued resources. However, trees in urban forests are often under greater stress than those in rural or undeveloped areas due to soil compaction, restricted growing spaces, high temperatures, and exposure to air and water pollution. In addition, conditions change more quickly in urban as opposed to rural and undeveloped settings....

A Spanish Language Narrative Simulation to Prevent Horseback Riding Head Injury among Rural Youth

ERIC Educational Resources Information Center

Arrowsmith, Heather E.; Cole, Henry P.; Mazur, Joan M.

2009-01-01

Objective: A Spanish language version of an exercise about adolescent horseback riders' exposure to traumatic brain injuries was integrated into the Spanish curriculum in a rural Kentucky high school. Design: An exploratory case study design with two groups of students. Setting and Method: Thirty-eight students, enrolled in intermediate Spanish IV…

Delayed treatment of tuberculosis patients in rural areas of Yogyakarta province, Indonesia

PubMed Central

Mahendradhata, Yodi; Syahrizal, Bobby M; Utarini, Adi

2008-01-01

Background In year 2000, the entire population in Indonesia was 201 million and 57.6 percent of that was living in rural areas. This paper reports analyses that address to what extent the rural structure influence the way TB patients seek care prior to diagnosis by a DOTS facility. Methods We documented healthcare utilization pattern of smear positive TB patients prior to diagnosis and treatment by DOTS services (health centre, chest clinic, public and private hospital) in Yogyakarta province. We calculated the delay in treatment as the number of weeks between the onset of symptoms and the start of DOTS treatment. Statistical analysis was carried out with Epi Info version 3.3 (October 5, 2004). Results The only factor which was significantly associated with total delay was urban-rural setting (p = < 0.0001). The median total delay for TB patients in urban districts was 8 (1st Quartile = 4; 3rd Quartile = 12) weeks compared to 12 (1st Quartile = 7; 3rd Quartile = 23) weeks for patients in rural districts. Multivariate analysis suggested no confounding between individual factors and urban-rural setting remained as the main factor for total delay (p = < 0.0001). Primary health centre was the first choice provider for most (38.7%) of these TB patients. Urban-rural setting was also the only factor which was significantly associated with choice of first provider (p = 0.03). Conclusion Improving access to DOTS services in rural areas is an area of vital importance in aiming to make progress toward achieving TB control targets in Indonesia. PMID:19036164

Urban-Rural Differences in Suicide in the State of Maryland: The Role of Firearms.

PubMed

Nestadt, Paul S; Triplett, Patrick; Fowler, David R; Mojtabai, Ramin

2017-10-01

To assess whether the use of firearms explains rural-urban differences in suicide rates. We performed a retrospective analysis on all 6196 well-characterized adult suicides in Maryland from 2003 through 2015. We computed rate ratios by using census data and then stratified by sex, with adjustment for age and race. Suicide rates were higher in rural compared with urban counties. However, the higher rural suicide rates were limited to firearm suicides (incident rate ratio [IRR] = 1.66; 95% confidence interval [CI] = 1.20, 2.31). Nonfirearm suicide rates were not significantly higher in rural settings. Furthermore, 89% of firearm suicides occurred in men and the higher rural firearm suicide rate was limited to men (IRR = 1.36; 95% CI = 1.09, 1.69). Women were significantly less likely to complete suicide in rural areas (IRR = 0.63; 95% CI = 0.43, 0.94), regardless of method. Male firearm use drives the increased rate of suicide in rural areas. The opposite associations between urbanicity and suicide in men and women may be driven by the male preference for firearms as a method for committing suicide.

Development of a Rural Health Framework: Implications for Program Service Planning and Delivery

PubMed Central

White, Deanna

2013-01-01

Purpose: To describe the development and application of an evidence-based Rural Health Framework to guide rural health program, policy and service planning. Methods: A literature review of rural health programs, focusing on health promotion, chronic disease prevention and population health, was conducted using several bibliographic databases. Findings: Thirty papers met the criteria for review, describing chronic disease interventions and public health policies in rural settings. Twenty-one papers demonstrated effective intervention programs and highlighted potential good practices for rural health programs, which were used to define key elements of a Rural Health Framework. Conclusions: The Rural Health Framework was applied to an influenza immunization program to demonstrate its utility in assisting public health providers to increase uptake of the vaccine. This Rural Health Framework provides an opportunity for program planners to reflect on the key issues facing rural communities to ensure the development of policies and strategies that will prudently and effectively meet population health needs. PMID:23968625

Selecting, Adapting, and Implementing Evidence-based Interventions in Rural Settings: An Analysis of 70 Community Examples.

PubMed

Smith, Tina Anderson; Adimu, Tanisa Foxworth; Martinez, Amanda Phillips; Minyard, Karen

2016-01-01

This paper explores how communities translate evidence-based and promising health practices to rural contexts. A descriptive, qualitative analysis was conducted using data from 70 grantees funded by the Federal Office of Rural Health Policy to implement evidence-based health practices in rural settings. Findings were organized using The Interactive Systems Framework for Dissemination and Implementation. Grantees broadly interpreted evidence-based and promising practices, resulting in the implementation of a patchwork of health-related interventions that fell along a spectrum of evidentiary rigor. The cohort faced common challenges translating recognized practices into rural community settings and reported making deliberate modifications to original models as a result. Opportunities for building a more robust rural health evidence base include investments to incentivize evidence-based programming in rural settings; rural-specific research and theory-building; translation of existing evidence using a rural lens; technical assistance to support rural innovation; and prioritization of evaluation locally.

Human Health Risk Assessment Applied to Rural Populations Dependent on Unregulated Drinking Water Sources: A Scoping Review.

PubMed

Ford, Lorelei; Bharadwaj, Lalita; McLeod, Lianne; Waldner, Cheryl

2017-07-28

Safe drinking water is a global challenge for rural populations dependent on unregulated water. A scoping review of research on human health risk assessments (HHRA) applied to this vulnerable population may be used to improve assessments applied by government and researchers. This review aims to summarize and describe the characteristics of HHRA methods, publications, and current literature gaps of HHRA studies on rural populations dependent on unregulated or unspecified drinking water. Peer-reviewed literature was systematically searched (January 2000 to May 2014) and identified at least one drinking water source as unregulated (21%) or unspecified (79%) in 100 studies. Only 7% of reviewed studies identified a rural community dependent on unregulated drinking water. Source water and hazards most frequently cited included groundwater (67%) and chemical water hazards (82%). Most HHRAs (86%) applied deterministic methods with 14% reporting probabilistic and stochastic methods. Publications increased over time with 57% set in Asia, and 47% of studies identified at least one literature gap in the areas of research, risk management, and community exposure. HHRAs applied to rural populations dependent on unregulated water are poorly represented in the literature even though almost half of the global population is rural.

Human Health Risk Assessment Applied to Rural Populations Dependent on Unregulated Drinking Water Sources: A Scoping Review

PubMed Central

Ford, Lorelei; Bharadwaj, Lalita; McLeod, Lianne; Waldner, Cheryl

2017-01-01

Safe drinking water is a global challenge for rural populations dependent on unregulated water. A scoping review of research on human health risk assessments (HHRA) applied to this vulnerable population may be used to improve assessments applied by government and researchers. This review aims to summarize and describe the characteristics of HHRA methods, publications, and current literature gaps of HHRA studies on rural populations dependent on unregulated or unspecified drinking water. Peer-reviewed literature was systematically searched (January 2000 to May 2014) and identified at least one drinking water source as unregulated (21%) or unspecified (79%) in 100 studies. Only 7% of reviewed studies identified a rural community dependent on unregulated drinking water. Source water and hazards most frequently cited included groundwater (67%) and chemical water hazards (82%). Most HHRAs (86%) applied deterministic methods with 14% reporting probabilistic and stochastic methods. Publications increased over time with 57% set in Asia, and 47% of studies identified at least one literature gap in the areas of research, risk management, and community exposure. HHRAs applied to rural populations dependent on unregulated water are poorly represented in the literature even though almost half of the global population is rural. PMID:28788087

Comparison of Program Costs for Parent-Only and Family-Based Interventions for Pediatric Obesity in Medically Underserved Rural Settings

ERIC Educational Resources Information Center

Janicke, David M.; Sallinen, Bethany J.; Perri, Michael G.; Lutes, Lesley D.; Silverstein, Janet H.; Brumback, Babette

2009-01-01

Purpose: To compare the costs of parent-only and family-based group interventions for childhood obesity delivered through Cooperative Extension Services in rural communities. Methods: Ninety-three overweight or obese children (aged 8 to 14 years) and their parent(s) participated in this randomized controlled trial, which included a 4-month…

What Do You Use Mobile Phones For? A Creative Method of Thematic Drawing with Adolescents in Rural China

ERIC Educational Resources Information Center

Hong, Jiachun

2016-01-01

This study sets out to explore Chinese adolescents' subjectivities toward the use of mobile phones, and reveal the dynamic relationship among students, parents, and school concerning mobile phone usage in rural China. Twenty-one high school students were recruited, and asked to draw a painting that expresses their perceptions of mobile phones in…

Strategies Pregnant Rural Women Employ to Deal with Intimate Partner Violence

ERIC Educational Resources Information Center

Bhandari, Shreya; Bullock, Linda F. C.; Sharps, Phyllis W.

2013-01-01

This study explored strategies from the Intimate Partner Violence Strategy Index (IPVSI) that a sub-set of 20 rural, low-income, abused women of a larger, multi-site, mixed-method study employed to deal with Intimate Partner Violence (IPV) during the perinatal period. We conducted 32 in-depth interviews with women who were pregnant (N = 12) and/or…

Low prevalence of methicillin-resistant Staphylococcus aureus nasal carriage in urban and rural community settings in Bolivia and Peru.

PubMed

Bartoloni, Alessandro; Pallecchi, Lucia; Fernandez, Connie; Mantella, Antonia; Riccobono, Eleonora; Magnelli, Donata; Mannini, Dario; Strohmeyer, Marianne; Bartalesi, Filippo; Segundo, Higinio; Monasterio, Joaquin; Rodriguez, Hugo; Cabezas, César; Gotuzzo, Eduardo; Rossolini, Gian Maria

2013-05-01

To investigate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage in rural and urban community settings of Bolivia and Peru. MRSA nasal carriage was investigated in 585 individuals living in rural and urban areas of Bolivia and Peru (one urban area, one small rural village, and two native communities, one of which was highly isolated). MRSA isolates were subjected to molecular analysis for the detection of virulence genes, characterization of the staphylococcal cassette chromosome mec (SCCmec), and genotyping (multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE)). An overall very low prevalence of MRSA nasal carriage was observed (0.5%), with MRSA carriers being detected only in a small rural village of the Bolivian Chaco. The three MRSA isolates showed the characteristics of community-associated MRSA (being susceptible to all non-beta-lactam antibiotics and harboring the SCCmec type IV), were clonally related, and belonged to ST1649. This study provides an insight into the epidemiology of MRSA in community settings of Bolivia and Peru. Reliable, time-saving, and low-cost methods should be implemented to encourage continued surveillance of MRSA dissemination in resource-limited countries. Copyright © 2012 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Understanding low uptake of contraceptives in resource-limited settings: a mixed-methods study in rural Burundi.

PubMed

Ndayizigiye, M; Fawzi, M C Smith; Lively, C Thompson; Ware, N C

2017-03-15

Family planning can reduce deaths, improve health, and facilitate economic development in resource-limited settings. Yet, modern contraceptive methods are often underused. This mixed-methods study, conducted in rural Burundi, sought to explain low uptake of contraceptives by identifying utilization barriers. Results may inform development of family planning interventions in Burundi and elsewhere. We investigated uptake of contraceptives among women of reproductive age in two rural districts of Burundi, using an explanatory sequential, mixed-methods research design. We first assessed availability and utilization rates of modern contraceptives through a facility-based survey in 39 health clinics. Barriers to uptake of contraceptives were then explored through qualitative interviews (N = 10) and focus groups (N = 7). Contraceptives were generally available in the 39 clinics studied, yet uptake of family planning averaged only 2.96%. Greater uptake was positively associated with the number of health professionals engaged and trained in family planning service provision, and with the number of different types of contraceptives available. Four uptake barriers were identified: (1) lack of providers to administer contraception, (2) lack of fit between available and preferred contraceptive methods, (3) a climate of fear surrounding contraceptive use, and (4) provider refusal to offer family planning services. Where resources are scarce, availability of modern contraceptives alone will likely not ensure uptake. Interventions addressing multiple uptake barriers simultaneously have the greatest chance of success. In rural Burundi, examples are community distribution of contraceptive methods, public information campaigns, improved training for health professionals and community health workers, and strengthening of the health infrastructure.

Effects of the built environment on physical activity of adults living in rural settings.

PubMed

Frost, Stephanie S; Goins, R Turner; Hunter, Rebecca H; Hooker, Steven P; Bryant, Lucinda L; Kruger, Judy; Pluto, Delores

2010-01-01

To conduct a systematic review of the literature to examine the influence of the built environment (BE) on the physical activity (PA) of adults in rural settings. Key word searches of Academic Search Premier, PubMed, CINAHL, Web of Science, and Sport Discus were conducted. Studies published prior to June 2008 were included if they assessed one or more elements of the BE, examined relationships between the BE and PA, and focused on rural locales. Studies only reporting descriptive statistics or assessing the reliability of measures were excluded. Objective(s), sample size, sampling technique, geographic location, and definition of rural were extracted from each study. Methods of assessment and outcomes were extracted from the quantitative literature, and overarching themes were identified from the qualitative literature. Key characteristics and findings from the data are summarized in Tables 1 through 3. Twenty studies met inclusion and exclusion criteria. Positive associations were found among pleasant aesthetics, trails, safety/crime, parks, and walkable destinations. Research in this area is limited. Associations among elements of the BE and PA among adults appear to differ between rural and urban areas. Considerations for future studies include identifying parameters used to define rural, longitudinal research, and more diverse geographic sampling. Development and refinement of BE assessment tools specific to rural locations are also warranted.

Rural long-term care work, gender, and restructuring.

PubMed

Leach, Belinda; Joseph, Gillian

2011-06-01

Restructuring--the introduction of changes that alter the way health care is delivered for maximum efficiency and least cost--layered with rurality and with rural gender ideologies and practices, results in rural long-term care settings that have particular consequences for the women working in them, and for the residents and communities that they serve. This research investigated how rurality affects the implementation of patient classification in Ontario long-term care homes. Methods involved interviews and focus groups with front-line long-term care workers, administrators, and key participants. The findings revealed that rural long-term care delivery takes place when a restructured work environment intersects with gender ideologies and practices that take on particular characteristics when developed and sustained in a rural context. These factors shape the labor market and working conditions for rural women. We argue that this produces a uniquely rural experience for long-term care workers and conclude that those implementing classification systems must consider contextual factors as well as practical and financial exigencies.

Quality and rural-urban comparison of tuberculosis care in Rivers State, Nigeria

PubMed Central

Tobin-West, Charles Ibiene; Isodje, Anastasia

2016-01-01

Introduction Nigeria ranks among countries with the highest burden of tuberculosis. Yet evidence continues to indicate poor treatment outcomes which have been attributed to poor quality of care. This study aims to identify some of the systemic problems in order to inform policy decisions for improved quality of services and treatment outcomes in Nigeria. Methods A comparative assessment of the quality of TB care in rural and urban health facilities was carried out between May and June 2013, employing the Donabedian model of quality assessment. Data was analysed using the SPSS software package version 20.0. The level of significance was set at p < 0.05. Results Health facility infrastructures were more constrained in the urban than rural settings. Both the urban and rural facilities lacked adequate facilities for infection control such as, running water, air filter respirators, hand gloves and extractor fans. Health education and HIV counselling and testing (HCT) were limited in rural facilities compared to urban facilities. Although anti-TB drugs were generally available in both settings, the DOTS strategy in patient care was completely ignored. Finally, laboratory support for diagnosis and patient monitoring was limited in the rural facilities. Conclusion The study highlights suboptimal quality of TB care in Rivers State with limitations in health education and HCT of patients for HIV as well as laboratory support for TB care in rural health facilities. We, therefore, recommend that adequate infection control measures, strict observance of the DOTS strategy and sufficient laboratory support be provided to TB clinics in the State. PMID:27642401

Transactional Sex Risk across a Typology of Rural and Urban Female Sex Workers in Indonesia: A Mixed Methods Study

PubMed Central

Puradiredja, Dewi Ismajani; Coast, Ernestina

2012-01-01

Context-specific typologies of female sex workers (FSWs) are essential for the design of HIV intervention programming. This study develops a novel FSW typology for the analysis of transactional sex risk in rural and urban settings in Indonesia. Mixed methods include a survey of rural and urban FSWs (n = 310), in-depth interviews (n = 11), key informant interviews (n = 5) and ethnographic assessments. Thematic analysis categorises FSWs into 5 distinct groups based on geographical location of their sex work settings, place of solicitation, and whether sex work is their primary occupation. Multiple regression analysis shows that the likelihood of consistent condom use was higher among urban venue-based FSWs for whom sex work is not the only source of income than for any of the other rural and urban FSW groups. This effect was explained by the significantly lower likelihood of consistent condom use by rural venue-based FSWs (adjusted OR: 0.34 95% CI 0.13–0.90, p = 0.029). The FSW typology and differences in organisational features and social dynamics are more closely related to the risk of unprotected transactional sex, than levels of condom awareness and availability. Interventions need context-specific strategies to reach the different FSWs identified by this study's typology. PMID:23285205

Results of a Test and Win Contest to Raise Radon Awareness in Urban and Rural Settings

ERIC Educational Resources Information Center

Hahn, Ellen J.; Rayens, Mary Kay; Kercsmar, Sarah E.; Robertson, Heather; Adkins, Sarah M.

2014-01-01

Background: Radon is a leading cause of lung cancer, but few test their homes to determine radon levels. Purpose: The study assessed feasibility and success of a Test and Win Contest to promote radon testing in rural and urban communities. Methods: The prospective, quasi-experimental study tested a novel contest to raise radon awareness. Paid and…

Rural Health Networks and Care Coordination: Health Care Innovation in Frontier Communities to Improve Patient Outcomes and Reduce Health Care Costs

PubMed Central

Conway, Pat; Favet, Heidi; Hall, Laurie; Uhrich, Jenny; Palcher, Jeanette; Olimb, Sarah; Tesch, Nathan; York-Jesme, Margaret; Bianco, Joe

2017-01-01

Rural residents’ health is challenged by high health care costs, chronic diseases, and policy decisions affecting rural health care. This single-case, embedded design study, guided by community-based participatory research principles and using mixed methods, describes outcomes of implementation of a community care team (CCT) and care coordination to improve outcomes of patients living in a frontier community. Seventeen organizations and 165 adults identified as potential care coordination candidates constituted the target populations. Following CCT development, collaboration and cohesion increased among organizations. Patients who participated in care coordination reported similar physical and lower emotional health quality of life than national counterparts; emergency department use decreased following care coordination. Key components identified as successful in urban settings seem applicable in rural settings, with emphasis on the key role of team facilitators; need for intense care coordination for people with complex health needs, especially behavioral health needs; and access to specialty care through technology. PMID:27818417

Teleconsultation: The use of technology to improve evidence-based practices in rural communities.

PubMed

Bice-Urbach, Brittany J; Kratochwill, Thomas R

2016-06-01

Problem-solving consultation in schools has been found to be an effective method of service delivery to support teachers who are struggling to address student social-emotional behavioral (SEB) concerns. Despite its benefits, a number of barriers (e.g., lack of time and limited access to trained professionals) restrict the use of consultation within schools, especially in rural settings. The purpose of the study was to examine the impact of teleconsultation designed to improve behavior support to students living in rural communities. Both student outcomes and teacher perceptions were evaluated. Results indicated that (a) student disruptive behaviors improved through the implementation of an individualized behavior support plan developed through teleconsultation, and (b) teachers found the teleconsultation experience acceptable and feasible. As the demands placed on psychologists and the quality of videoconferencing continue to increase, teleconsultation is becoming a viable option for service delivery within rural school settings. Copyright © 2016 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

Effects of a Pedometer-Based Telephone Coaching Intervention on Physical Activity Among People with Cardiac Disease in Urban, Rural and Semi-Rural Settings: A Replication Study.

PubMed

Sangster, Janice; Furber, Susan; Phongsavan, Philayrath; Redfern, Julie; Mark, Andrew; Bauman, Adrian

2017-04-01

This study aimed to determine the replicability of a pedometer-based telephone coaching intervention by comparing the outcomes of a study conducted in rural and urban settings to a study that previously found the same intervention effective in a semi-rural setting. Replication studies are conducted to assess whether an efficacious intervention is effective in multiple different settings. This study compared the outcomes of a pedometer-based coaching intervention implemented in urban and rural settings (replication study) with the same intervention implemented in a semi-rural setting (reference study) on physical activity levels. Improvements in total weekly physical activity time in the replication study were significant from baseline to six weeks (p<0.001 urban, p=0.006 rural) and remained significant at six months (p=0.029 urban, p=0.005 rural). These increases were comparable to those achieved in the original efficacy trial conducted in a semi-rural setting. The pedometer-based telephone coaching intervention increases physical activity levels of people with cardiac disease referred to a CR program in diverse settings. This replication study indicates the suitability of this minimal contact, low-cost intervention for further scaling-up to address unmet need in community-dwelling cardiac patients. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.

Comparative study on perceived abuse and social neglect among rural and urban geriatric population

PubMed Central

Kaur, Jaspreet; Kaur, Jasbir; Sujata, N.

2015-01-01

Context: Elder abuse and social neglect are unrecognized problem. Many forms of elder abuse exist including physical, psychological, financial, sexual and social neglect. Social neglect is experienced by elderly through loss of friends and family members. Aim: Comparison of perceived abuse and social neglect among elderly residing in selected rural and urban areas. Settings and Design: Study setting was a rural area Pohir and urban area Jamalpur of district Ludhiana. Subjects and Methods: A sample of 200 subjects (100 subjects each from rural and urban area respectively) of age 60 years and above was drawn by cluster sampling technique and interview method was used to collect data by using Likert scale. Statistical Analysis: Descriptive and inferential statistics were carried out with SPSS package. Results: Results of the present study revealed that perceived physical abuse (25%) was higher among elderly residing in rural and it was found significantly higher among female elderly who were illiterate, widow/widower and partially dependent on caregiver whereas perceived psychological abuse (71%), financial abuse (37%) and social neglect (74%) were higher among elderly residing in urban. A significant association was found between psychological abuse and educational status, which inferred that as the level of education increases perception of psychological abuse also increases. The perceived financial abuse was significantly higher among male elderly who were financially independent. Conclusion: It was concluded that social neglect was most common, followed by psychological abuse and financial abuse among elderly residing in urban whereas physical abuse was more prevalent among elderly residing in rural. PMID:26816425

Methods for Adjusting U.S. Geological Survey Rural Regression Peak Discharges in an Urban Setting

USGS Publications Warehouse

Moglen, Glenn E.; Shivers, Dorianne E.

2006-01-01

A study was conducted of 78 U.S. Geological Survey gaged streams that have been subjected to varying degrees of urbanization over the last three decades. Flood-frequency analysis coupled with nonlinear regression techniques were used to generate a set of equations for converting peak discharge estimates determined from rural regression equations to a set of peak discharge estimates that represent known urbanization. Specifically, urban regression equations for the 2-, 5-, 10-, 25-, 50-, 100-, and 500-year return periods were calibrated as a function of the corresponding rural peak discharge and the percentage of impervious area in a watershed. The results of this study indicate that two sets of equations, one set based on imperviousness and one set based on population density, performed well. Both sets of equations are dependent on rural peak discharges, a measure of development (average percentage of imperviousness or average population density), and a measure of homogeneity of development within a watershed. Average imperviousness was readily determined by using geographic information system methods and commonly available land-cover data. Similarly, average population density was easily determined from census data. Thus, a key advantage to the equations developed in this study is that they do not require field measurements of watershed characteristics as did the U.S. Geological Survey urban equations developed in an earlier investigation. During this study, the U.S. Geological Survey PeakFQ program was used as an integral tool in the calibration of all equations. The scarcity of historical land-use data, however, made exclusive use of flow records necessary for the 30-year period from 1970 to 2000. Such relatively short-duration streamflow time series required a nonstandard treatment of the historical data function of the PeakFQ program in comparison to published guidelines. Thus, the approach used during this investigation does not fully comply with the guidelines set forth in U.S. Geological Survey Bulletin 17B, and modifications may be needed before it can be applied in practice.

Does the Universal Health Insurance Program Affect Urban-Rural Differences in Health Service Utilization among the Elderly? Evidence from a Longitudinal Study in Taiwan

ERIC Educational Resources Information Center

Liao, Pei-An; Chang, Hung-Hao; Yang, Fang-An

2012-01-01

Purpose: To assess the impact of the introduction of Taiwan's National Health Insurance (NHI) on urban-rural inequality in health service utilization among the elderly. Methods: A longitudinal data set of 1,504 individuals aged 65 and older was constructed from the Survey of Health and Living Status of the Elderly. A difference-in-differences…

Nurses who work in rural and remote communities in Canada: a national survey.

PubMed

MacLeod, Martha L P; Stewart, Norma J; Kulig, Judith C; Anguish, Penny; Andrews, Mary Ellen; Banner, Davina; Garraway, Leana; Hanlon, Neil; Karunanayake, Chandima; Kilpatrick, Kelley; Koren, Irene; Kosteniuk, Julie; Martin-Misener, Ruth; Mix, Nadine; Moffitt, Pertice; Olynick, Janna; Penz, Kelly; Sluggett, Larine; Van Pelt, Linda; Wilson, Erin; Zimmer, Lela

2017-05-23

In Canada, as in other parts of the world, there is geographic maldistribution of the nursing workforce, and insufficient attention is paid to the strengths and needs of those providing care in rural and remote settings. In order to inform workforce planning, a national study, Nursing Practice in Rural and Remote Canada II, was conducted with the rural and remote regulated nursing workforce (registered nurses, nurse practitioners, licensed or registered practical nurses, and registered psychiatric nurses) with the intent of informing policy and planning about improving nursing services and access to care. In this article, the study methods are described along with an examination of the characteristics of the rural and remote nursing workforce with a focus on important variations among nurse types and regions. A cross-sectional survey used a mailed questionnaire with persistent follow-up to achieve a stratified systematic sample of 3822 regulated nurses from all provinces and territories, living outside of the commuting zones of large urban centers and in the north of Canada. Rural workforce characteristics reported here suggest the persistence of key characteristics noted in a previous Canada-wide survey of rural registered nurses (2001-2002), namely the aging of the rural nursing workforce, the growth in baccalaureate education for registered nurses, and increasing casualization. Two thirds of the nurses grew up in a community of under 10 000 people. While nurses' levels of satisfaction with their nursing practice and community are generally high, significant variations were noted by nurse type. Nurses reported coming to rural communities to work for reasons of location, interest in the practice setting, and income, and staying for similar reasons. Important variations were noted by nurse type and region. The proportion of the rural nursing workforce in Canada is continuing to decline in relation to the proportion of the Canadian population in rural and remote settings. Survey results about the characteristics and practice of the various types of nurses can support workforce planning to improve nursing services and access to care.

Financial performance monitoring of the technical efficiency of critical access hospitals: a data envelopment analysis and logistic regression modeling approach.

PubMed

Wilson, Asa B; Kerr, Bernard J; Bastian, Nathaniel D; Fulton, Lawrence V

2012-01-01

From 1980 to 1999, rural designated hospitals closed at a disproportionally high rate. In response to this emergent threat to healthcare access in rural settings, the Balanced Budget Act of 1997 made provisions for the creation of a new rural hospital--the critical access hospital (CAH). The conversion to CAH and the associated cost-based reimbursement scheme significantly slowed the closure rate of rural hospitals. This work investigates which methods can ensure the long-term viability of small hospitals. This article uses a two-step design to focus on a hypothesized relationship between technical efficiency of CAHs and a recently developed set of financial monitors for these entities. The goal is to identify the financial performance measures associated with efficiency. The first step uses data envelopment analysis (DEA) to differentiate efficient from inefficient facilities within a data set of 183 CAHs. Determining DEA efficiency is an a priori categorization of hospitals in the data set as efficient or inefficient. In the second step, DEA efficiency is the categorical dependent variable (efficient = 0, inefficient = 1) in the subsequent binary logistic regression (LR) model. A set of six financial monitors selected from the array of 20 measures were the LR independent variables. We use a binary LR to test the null hypothesis that recently developed CAH financial indicators had no predictive value for categorizing a CAH as efficient or inefficient, (i.e., there is no relationship between DEA efficiency and fiscal performance).

Field-based random sampling without a sampling frame: control selection for a case-control study in rural Africa.

PubMed

Crampin, A C; Mwinuka, V; Malema, S S; Glynn, J R; Fine, P E

2001-01-01

Selection bias, particularly of controls, is common in case-control studies and may materially affect the results. Methods of control selection should be tailored both for the risk factors and disease under investigation and for the population being studied. We present here a control selection method devised for a case-control study of tuberculosis in rural Africa (Karonga, northern Malawi) that selects an age/sex frequency-matched random sample of the population, with a geographical distribution in proportion to the population density. We also present an audit of the selection process, and discuss the potential of this method in other settings.

Suicide in Castellon, 2009-2015: Do sociodemographic and psychiatric factors help understand urban-rural differences?

PubMed

Suso-Ribera, Carlos; Mora-Marín, Rafael; Hernández-Gaspar, Carmen; Pardo-Guerra, Lidón; Pardo-Guerra, María; Belda-Martínez, Adela; Palmer-Viciedo, Ramón

Studies have pointed to rurality as an important factor influencing suicide. Research so far suggests that several sociodemograpic and psychiatric factors might influence urban-rural differences in suicide. Also, their contribution appears to depend on sex and age. Unfortunately, studies including a comprehensive set of explanatory variables altogether are still scare and most studies have failed to present their analyses split by sex and age groups. Also, urban-rural differences in suicide in Spain have been rarely investigated. The present study aimed at explaining rural-urban differences in suicidality in the province of Castellon (Spain). A comprehensive set of sociodemographic and psychiatric factors was investigated and analyses were split by sex and age. The sample comprised all suicides recorded in the province of Castellon from January 2009 to December 2015 (n=343). Sociodemographic data included sex, age, and suicide method. Psychiatric data included the history of mental health service utilization, psychiatric diagnosis, suicide attempts, and psychiatric hospitalization. Consistent with past research, suicide rates were highest in rural areas, especially in men and older people. We also found that urban-rural differences in sociodemographic and psychiatric variables were sensitive to sex and age. Our results indicated that specialized mental health service use and accessibility to suicide means might help understand urban-rural differences in suicide, especially in men. When exploring urban-rural differences as a function of age, general practitioner visits for psychiatric reasons were more frequent in the older age group in rural areas. Study implications for suicide prevention strategies in Spain are discussed. Copyright © 2017 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.

Understanding Rural-Urban Differences in Depressive Symptoms Among Older Adults in China

PubMed Central

Li, Lydia W.; Liu, Jinyu; Xu, Hongwei; Zhang, Zhenmei

2016-01-01

Objectives Studies have reported that rural elders in China have higher levels of depression than their urban peers. We aimed to examine the extent to which four sets of factors (socioeconomic status (SES), healthcare access, health status, social support and participation) account for such rural-urban differences. Methods Cross-sectional data from the 2011 China Health and Retirement Longitudinal Study were analyzed. A representative sample (N = 5,103) of older Chinese (age 60+) was included. Depressive symptoms were measured by the CESD-10. Multilevel linear regression was conducted. Results Rural elders had more depressive symptoms than urban elders. When SES at the individual-, household- and community-level was simultaneously controlled, the rural-urban difference lost its statistical significance. Health status, social support and social participation accounted for some, whereas healthcare access explained almost none, of the rural-urban difference. Discussion Results suggest that SES is the predominant factor accounting for the rural-urban depression gap in China. PMID:26100620

Patterns of Home and School Behavior Problems in Rural and Urban Settings

PubMed Central

Hope, Timothy L; Bierman, Karen L

2009-01-01

This study examined the cross-situational patterns of behavior problems shown by children in rural and urban communities at school entry. Behavior problems exhibited in home settings were not expected to vary significantly across urban and rural settings. In contrast, it was anticipated that child behavior at school would be heavily influenced by the increased exposure to aggressive models and deviant peer support experienced by children in urban as compared to rural schools, leading to higher rates of school conduct problems for children in urban settings. Statistical comparisons of the patterns of behavior problems shown by representative samples of 89 rural and 221 urban children provided support for these hypotheses, as significant rural-urban differences emerged in school and not in home settings. Cross-situational patterns of behavior problems also varied across setting, with home-only patterns of problems characterizing more children at the rural site and school-only, patterns of behavior problems characterizing more children at the urban sites. In addition, whereas externalizing behavior was the primary school problem exhibited by urban children, rural children displayed significantly higher rates of internalizing problems at school. The implications of these results are discussed for developmental models of behavior problems and for preventive interventions. PMID:19834584

Economic Impact of Dyspepsia in Rural and Urban Malaysia: A Population-Based Study

PubMed Central

Yadav, Hematram; Everett, Simon M; Goh, Khean-Lee

2012-01-01

Background/Aims The economic impact of dyspepsia in regions with a diverse healthcare system remains uncertain. This study aimed to estimate the costs of dyspepsia in a rural and urban population in Malaysia. Methods Economic evaluation was performed based on the cost-of-illness method. Resource utilization and quality of life data over a specific time frame, were collected to determine direct, indirect and intangible costs related to dyspepsia. Results The prevalences of dyspepsia in the rural (n = 2,000) and urban (n = 2,039) populations were 14.6% and 24.3% respectively. Differences in socioeconomic status and healthcare utilisation between both populations were considerable. The cost of dyspepsia per 1,000 population per year was estimated at USD14,816.10 and USD59,282.20 in the rural and urban populations respectively. The cost per quality adjusted life year for dyspepsia in rural and urban adults was USD16.30 and USD69.75, respectively. Conclusions The economic impact of dyspepsia is greater in an urban compared to a rural setting. Differences in socioeconomic status and healthcare utilisation between populations are thought to contribute to this difference. PMID:22323987

Recruitment and retention of rural physicians: outcomes from the rural physician associate program of Minnesota.

PubMed

Halaas, Gwen Wagstrom; Zink, Therese; Finstad, Deborah; Bolin, Keli; Center, Bruce

2008-01-01

Founded in 1971 with state funding to increase the number of primary care physicians in rural Minnesota, the Rural Physician Associate Program (RPAP) has graduated 1,175 students. Third-year medical students are assigned to primary care physicians in rural communities for 9 months where they experience the realities of rural practice with hands-on participation, mentoring, and one-to-one teaching. Students complete an online curriculum, participate in online discussion with fellow students, and meet face-to-face with RPAP faculty 6 times during the 9-month rotation. Projects designed to bring value to the community, including an evidence-based practice and community health assessment, are completed. To examine RPAP outcomes in recruiting and retaining rural primary care physicians. The RPAP database, including moves and current practice settings, was examined using descriptive statistics. On average, 82% of RPAP graduates have chosen primary care, and 68% family medicine. Of those currently in practice, 44% have practiced in a rural setting all of the time, 42% in a metropolitan setting and 14% have chosen both, with more than 50% of their time in rural practice. Rural origin has only a small association with choosing rural practice. RPAP data suggest that the 9-month longitudinal experience in a rural community increases the number of students choosing primary care practice, especially family medicine, in a rural setting.

Studying Educational Effectiveness in Rural Settings: A Guide for Researchers

ERIC Educational Resources Information Center

Sheridan, Susan; Dynarski, Mark; Bovaird, James

2017-01-01

This guide provides experienced education researchers with suggestions for conducting high-quality effectiveness studies to overcome research challenges common to rural settings. The guide addresses four factors that researchers must consider when conducting educational effectiveness research in rural settings: (1) study design, (2) recruitment of…

How health professionals conceive and construct interprofessional practice in rural settings: a qualitative study

PubMed Central

2013-01-01

Background Although interprofessional practice (IPP) offers the potential to enhance rural health services and provide support to rural clinicians, IPP may itself be problematic due to workforce limitations and service fragmentation. Differing socioeconomic and geographic characteristics of rural communities means that the way that IPP occurs in rural contexts will necessarily differ from that occurring in metropolitan contexts. The aim of this study was to investigate the factors contributing to effective IPP in rural contexts, to examine how IPP happens and to identify barriers and enablers. Methods Using Realistic Evaluation as a framework, semi-structured interviews were conducted with health professionals in a range of rural healthcare contexts in NSW, Australia. Independent thematic analysis was undertaken by individual research team members, which was then integrated through consensus to achieve a qualitative description of rural IPP practice. Results There was clear evidence of diversity and complexity associated with IPP in the rural settings that was supported by descriptions of collaborative integrated practice. There were instances where IPP doesn’t and could happen. There were a number of characteristics identified that significantly impacted on IPP including the presence of a shared philosophical position and valuing of IPP and recognition of the benefits, funding to support IPP, pivotal roles, proximity and workforce resources. Conclusions The nature of IPP in rural contexts is diverse and determined by a number of critical factors. This study goes some of the way towards unravelling the complexity of IPP in rural contexts, highlighting the strong motivating factors that drive IPP. However, it has also identified significant structural and relational barriers related to workload, workforce, entrenched hierarchies and ways of working and service fragmentation. Further research is required to explicate the mechanisms that drive successful IPP across a range of diverse rural contexts in order to inform the implementation of robust flexible strategies that will support sustainable models of rural IPP. PMID:24289815

Stated Preferences of Doctors for Choosing a Job in Rural Areas of Peru: A Discrete Choice Experiment

PubMed Central

Miranda, J. Jaime; Diez-Canseco, Francisco; Lema, Claudia; Lescano, Andrés G.; Lagarde, Mylene; Blaauw, Duane; Huicho, Luis

2012-01-01

Background Doctors’ scarcity in rural areas remains a serious problem in Latin America and Peru. Few studies have explored job preferences of doctors working in underserved areas. We aimed to investigate doctors’ stated preferences for rural jobs. Methods and Findings A labelled discrete choice experiment (DCE) was performed in Ayacucho, an underserved department of Peru. Preferences were assessed for three locations: rural community, Ayacucho city (Ayacucho’s capital) and other provincial capital city. Policy simulations were run to assess the effect of job attributes on uptake of a rural post. Multiple conditional logistic regressions were used to assess the relative importance of job attributes and of individual characteristics. A total of 102 doctors participated. They were five times more likely to choose a job post in Ayacucho city over a rural community (OR 4.97, 95%CI 1.2; 20.54). Salary increases and bonus points for specialization acted as incentives to choose a rural area, while increase in the number of years needed to get a permanent post acted as a disincentive. Being male and working in a hospital reduced considerably chances of choosing a rural job, while not living with a partner increased them. Policy simulations showed that a package of 75% salary increase, getting a permanent contract after two years in rural settings, and getting bonus points for further specialisation increased rural job uptake from 21% to 77%. A package of 50% salary increase plus bonus points for further specialisation would also increase the rural uptake from 21% to 52%. Conclusions Doctors are five times more likely to favour a job in urban areas over rural settings. This strong preference needs to be overcome by future policies aimed at improving the scarcity of rural doctors. Some incentives, alone or combined, seem feasible and sustainable, whilst others may pose a high fiscal burden. PMID:23272065

Cross-sectional study of malnutrition and associated factors among school aged children in rural and urban settings of Fogera and Libo Kemkem districts, Ethiopia.

PubMed

Herrador, Zaida; Sordo, Luis; Gadisa, Endalamaw; Moreno, Javier; Nieto, Javier; Benito, Agustín; Aseffa, Abraham; Cañavate, Carmen; Custodio, Estefania

2014-01-01

Little information is available on malnutrition-related factors among school-aged children ≥5 years in Ethiopia. This study describes the prevalence of stunting and thinness and their related factors in Libo Kemkem and Fogera, Amhara Regional State and assesses differences between urban and rural areas. In this cross-sectional study, anthropometrics and individual and household characteristics data were collected from 886 children. Height-for-age z-score for stunting and body-mass-index-for-age z-score for thinness were computed. Dietary data were collected through a 24-hour recall. Bivariate and backward stepwise multivariable statistical methods were employed to assess malnutrition-associated factors in rural and urban communities. The prevalence of stunting among school-aged children was 42.7% in rural areas and 29.2% in urban areas, while the corresponding figures for thinness were 21.6% and 20.8%. Age differences were significant in both strata. In the rural setting, fever in the previous 2 weeks (OR: 1.62; 95% CI: 1.23-2.32), consumption of food from animal sources (OR: 0.51; 95% CI: 0.29-0.91) and consumption of the family's own cattle products (OR: 0.50; 95% CI: 0.27-0.93), among others factors were significantly associated with stunting, while in the urban setting, only age (OR: 4.62; 95% CI: 2.09-10.21) and years of schooling of the person in charge of food preparation were significant (OR: 0.88; 95% CI: 0.79-0.97). Thinness was statistically associated with number of children living in the house (OR: 1.28; 95% CI: 1.03-1.60) and family rice cultivation (OR: 0.64; 95% CI: 0.41-0.99) in the rural setting, and with consumption of food from animal sources (OR: 0.26; 95% CI: 0.10-0.67) and literacy of head of household (OR: 0.24; 95% CI: 0.09-0.65) in the urban setting. The prevalence of stunting was significantly higher in rural areas, whereas no significant differences were observed for thinness. Various factors were associated with one or both types of malnutrition, and varied by type of setting. To effectively tackle malnutrition, nutritional programs should be oriented to local needs.

Coping with Rural Poverty: Economic Survival and Moral Capital in Rural America

ERIC Educational Resources Information Center

Sherman, Jennifer

2006-01-01

The experience of rural poverty is in many ways unique from that of urban poverty. In the rural setting, social cohesion creates pressure on the poor to behave in ways that are consistent with local values. This paper, based on qualitative research done in an isolated, rural Northern California community, argues that in this setting the survival…

Comparison of two approaches for measuring household wealth via an asset-based index in rural and peri-urban settings of Hunan province, China

PubMed Central

2010-01-01

Background There are growing concerns regarding inequities in health, with poverty being an important determinant of health as well as a product of health status. Within the People's Republic of China (P.R. China), disparities in socio-economic position are apparent, with the rural-urban gap of particular concern. Our aim was to compare direct and proxy methods of estimating household wealth in a rural and a peri-urban setting of Hunan province, P.R. China. Methods We collected data on ownership of household durable assets, housing characteristics, and utility and sanitation variables in two village-wide surveys in Hunan province. We employed principal components analysis (PCA) and principal axis factoring (PAF) to generate household asset-based proxy wealth indices. Households were grouped into quartiles, from 'most wealthy' to 'most poor'. We compared the estimated household wealth for each approach. Asset-based proxy wealth indices were compared to those based on self-reported average annual income and savings at the household level. Results Spearman's rank correlation analysis revealed that PCA and PAF yielded similar results, indicating that either approach may be used for estimating household wealth. In both settings investigated, the two indices were significantly associated with self-reported average annual income and combined income and savings, but not with savings alone. However, low correlation coefficients between the proxy and direct measures of wealth indicated that they are not complementary. We found wide disparities in ownership of household durable assets, and utility and sanitation variables, within and between settings. Conclusion PCA and PAF yielded almost identical results and generated robust proxy wealth indices and categories. Pooled data from the rural and peri-urban settings highlighted structural differences in wealth, most likely a result of localized urbanization and modernization. Further research is needed to improve measurements of wealth in low-income and transitional country contexts. PMID:20813070

A new inter-professional course preparing learners for life in rural communities.

PubMed

Medves, Jennifer; Paterson, Margo; Chapman, Christine Y; Young, John H; Tata, Elizabeth; Bowes, Denise; Hobbs, Neil; McAndrews, Brian; O'Riordan, Anne

2008-01-01

The 'Professionals in Rural Practice' course was developed with the aim of preparing students enrolled in professional programs in Canada to become better equipped for the possible eventuality of professional work in a rural setting. To match the reality of living and working in a rural community, which by nature is interprofessional, the course designers were an interprofessional teaching team. In order to promote group cohesiveness the course included the participation of an interprofessional group of students and instructors from the disciplines of medicine, nursing, occupational therapy, physical therapy, teacher education, and theology. The format of the course included three-hour classes over an eight-week period and a two-day field experience in a rural community. The course utilized various experiential and interactive teaching and learning methods, along with a variety of assessment methods. Data were collected from student participants over two iterations of the course using a mixed methods approach. Results demonstrate that students value the interprofessional and experiential approach to learning and viewed this course as indispensable for gaining knowledge of other professions and preparation for rural practice. The data reveal important organizational and pedagogical considerations specific to interprofessional education, community based action research, and the unique interprofessional nature of training for life and work in a rural community. This study also indicates the potential value of further longitudinal study of participants in this course. Key words: Canada, community based action research, education, interdisciplinary, interprofessional.

Engaging rural women in healthy lifestyle programs: insights from a randomized controlled trial.

PubMed

Kozica, Samantha L; Harrison, Cheryce L; Teede, Helena J; Ng, Sze; Moran, Lisa J; Lombard, Catherine B

2015-09-16

The obesity epidemic is well established, particularly in rural settings. Programs promoting healthy lifestyles for rural women are urgently needed; however, participant engagement is challenging. In the context of a large randomized controlled trial targeting the prevention of weight gain in rural women, we explored successful recruitment strategies and aimed to understand participants' barriers, enablers and reasons for program participation. We recruited women (aged 18-55 years) from the general rural Australian population. A mixed-methods approach was applied to explore factors that influenced program participation, including quantitative questionnaires for all participants (n = 649) and qualitative semi-structured interviews conducted for a subgroup of participants (n = 45). Data were collected at three time points: baseline, 6 and 12 months post program commencement. We recruited 649 rural women through a community communication and partnering strategy, a program marketing campaign and mobilization of social networks. Program participants were diverse across education and income levels and were representative of the wider Australian regional population. Factors that influenced program engagement were divided into personal (perceived program benefits and program accessibility) and social (peer persuasion and support). Identified enablers included convenience of the program location, perceived program utility, such as weight management and optimization of lifestyle choices, as well as attending the program with peer support. Barriers to engagement, which are likely exacerbated in rural communities included lack of anonymity, self-consciousness and segregated social networks in rural settings. Participants reported that eliciting local support and maximizing publicity is fundamental to improving future program engagement. Multiple program promotion strategies including communication, marketing and partnering, as well as mobilization of social networks and peer persuasion, enabled engagement of rural women into a healthy lifestyle program. These recruitment strategies are consistent with successful strategies utilized previously to recruit urban-dwelling women into lifestyle programs. Future engagement efforts in rural settings could be enhanced by hosting multiple sessions within existing socio-cultural networks and assuring participants that they will not need to share their personal health information with others in their community. Australia & New Zealand Clinical Trial Registry. Trial number ACTRN12612000115831. Date of registration 24 January 2012.

Instrumental and socioemotional communications in doctor-patient interactions in urban and rural clinics

PubMed Central

2013-01-01

Background Location of practice, such as working in a rural or urban clinic, may influence how physicians communicate with their patients. This exploratory pilot study examines the communication styles used during doctor-patient interactions in urban and rural family practice settings in Western Canada. Methods We analyzed observation and interview data from four physicians practicing in these different locations. Using a grounded theory approach, communications were categorized as either instrumental or socioemotional. Instrumental communication refers to “cure-oriented interactions” and tends to be more task-oriented focusing on the patient’s health concerns and reason for the appointment. In contrast, socioemotional communication refers to more “care-oriented interactions” that may make the patient feel comfortable, relieve patient anxiety and build a trusting relationship. Results The physicians in small, rural towns appear to know their patients and their families on a more personal level and outside of their office, and engage in more socioemotional communications compared to those practicing in suburban clinics in a large urban centre. Knowing patients outside the clinic seems to change the nature of the doctor-patient interaction, and, in turn, the doctor-patient relationship itself. Interactions between urban doctors and their patients had a mixture of instrumental and socioemotional communications, while interactions between rural doctors and their patients tended to be highly interpersonal, often involving considerable socioemotional communication and relationship-building. Conclusions Despite the different ways that doctors and patients communicate with each other in the two settings, rural and urban doctors spend approximately the same amount of time with their patients. Thus, greater use of socioemotional communication by rural doctors, which may ease patient anxiety and increase patient trust, did not appear to add extra time to the patient visit. Research suggests that socioemotional communication may ultimately lead to better patient outcomes, which implies that health differences between rural and urban settings could be linked to differences in doctor-patient communication styles. PMID:23835062

The epidemiology of regional and widespread musculoskeletal pain in rural versus urban settings in those ≥55 years

PubMed Central

Docking, Rachael E; Beasley, Marcus; Steinerowski, Artur; Jones, Elizabeth A; Farmer, Jane; Macfarlane, Gary J

2015-01-01

Objectives: To examine whether the prevalence of regional and chronic widespread pain (CWP) varies with rurality and to determine the characteristics of persons in rural locations in whom pain is found to be in excess. Methods: Participants, aged ≥55 years, from participating general practices in seven different geographical locations in Scotland were sent a postal questionnaire. The 1-month prevalence of 10 regional pain conditions plus CWP was identified using body manikins. Differences in the prevalence of pain with differing rurality were examined using Chi2 test for trend. Thereafter, among the rural population, the relationships between pain and putative risk factors were examined using Poisson regression. Thus, results are described as risk ratios. Results: There was some evidence to suggest that the prevalence of CWP increased with increasing rurality, although the magnitude of this was slight. No large or significant differences were observed with any regional pain conditions. Factors associated with the reporting of CWP included poor general health, feeling downhearted most of the time and selected measures of social contact. Factors independently associated with CWP included female gender (risk ratio: 1.24; 95% confidence interval (CI): 0.997–1.55), poor self-rated health (risk ratio: 3.50; 95% CI: 1.92–6.39) and low mood (risk ratio: 1.54; 95% CI: 1.07–2.20). Also, having fewer than 10 people to turn to in a crisis was associated with a decrease in the risk of CWP – risk ratio: 0.68 (95% CI: 0.50–0.93) and 0.78 (95% CI: 0.60–1.02) for those with 5–10 and <5 people, respectively. Conclusions: This study provides no evidence that the prevalence of regional musculoskeletal pain is increased in rural settings, although there is some evidence of a modest increase in CWP. Risk factors for CWP are similar to those seen in the urban setting, including markers of general health, mental health and also aspects of social contact. It may be, however, that social networks are more difficult to maintain in rural settings, and clinicians should be aware of the negative effect of perceived social isolation on pain in rural areas. PMID:26516563

Multidisciplinary chronic pain management in a rural Canadian setting.

PubMed

Burnham, Robert; Day, Jeremiah; Dudley, Wallace

2010-01-01

Chronic pain is prevalent, complex and most effectively treated by a multidisciplinary team, particularly if psychosocial issues are dominant. The limited access to and high costs of such services are often prohibitive for the rural patient. We describe the development and 18-month outcomes of a small multidisciplinary chronic pain management program run out of a physician's office in rural Alberta. The multidisciplinary team consisted of a family physician, physiatrist, psychologist, physical therapist, kinesiologist, nurse and dietician. The allied health professionals were involved on a part-time basis. The team triaged referral information and patients underwent either a spine or medical care assessment. Based on the findings of the assessment, the team managed the care of patients using 1 of 4 methods: consultation only, interventional spine care, supervised medication management or full multidisciplinary management. We prospectively and serially recorded self-reported measures of pain and disability for the supervised medication management and full multidisciplinary components of the program. Patients achieved clinically and statistically significant improvements in pain and disability. Successful multidisciplinary chronic pain management services can be provided in a rural setting.

Where the Wild Things Are: The Evolving Iconography of Rural Fauna

ERIC Educational Resources Information Center

Buller, Henry

2004-01-01

This paper explores the changing relationship between "nature" and rurality through an examination of the shifting iconography of animals, and particularly "wild" animals, in a rural setting. Drawing upon a set of examples, the paper argues that the faunistic icons of rural areas are evolving as alternative conceptions of the countryside, of…

The experience of intimate partner violence in the context of the rural setting

NASA Astrophysics Data System (ADS)

Roush, karen

Intimate partner violence (IPV) against women is a pervasive health and social problem in the United States; one in three women report being abused by an intimate partner at least once in their lifetime. IPV presents unique challenges to women living in rural areas that increase their vulnerability, limit their options for safety, and hamper efforts to leave an abusive relationship. Yet there is little research examining the lived experience of WV in a general population of women in the rural setting. Also, though there is a large body of research on TV screening and health care providers' attitudes and beliefs, little is known about rural providers specifically. A mixed methods study exploring the lived experience of IPV in women in the context of the rural setting was conducted. Along with qualitative interviews with women with experience of IPV, I conducted a survey to examine the TV-related knowledge, attitudes, beliefs and behaviors of the health care providers who interact with the women. The results from this study form a picture of the lives of women who experience IPV in the rural setting as one of isolation, fear, and uncertainty tempered by determination to understand and overcome the violence. Six major themes were identified, 1) living with violence, 2) protect self, 3) isolation, 4) search for understanding, 5) system level abuse, and 6) creating a new life. In contrast to earlier studies, health care providers demonstrated good overall knowledge and judicious attitudes about IPV and beliefs congruent with available evidence related to IPV. When looked at together the knowledge, attitudes, beliefs, and behaviors of the health care providers were aligned with the experiences voiced by the women participating in the interviews. The results of this study highlight the need for an interprofessional, public health approach that addresses the complex web of individual, social, cultural, economic, and political factors that create and feed the problem.

Concordance of Patient-Physician Obesity Diagnosis and Treatment Beliefs in Rural Practice Settings

ERIC Educational Resources Information Center

Ely, Andrea Charbonneau; Greiner, K. Allen; Born, Wendi; Hall, Sandra; Rhode, Paula C.; James, Aimee S.; Nollen, Nicole; Ahluwalia, Jasjit S.

2006-01-01

Context: Although clinical guidelines recommend routine screening and treatment for obesity in primary care, lack of agreement between physicians and patients about the need for obesity treatment in the primary care setting may be an unexplored factor contributing to the obesity epidemic. Purpose and Methods: To better understand this dynamic, we…

Rural Oregon community perspectives: introducing community-based participatory research into a community health coalition.

PubMed

Young-Lorion, Julia; Davis, Melinda M; Kirks, Nancy; Hsu, Anna; Slater, Jana Kay; Rollins, Nancy; Aromaa, Susan; McGinnis, Paul

2013-01-01

The Community Health Improvement Partnership (CHIP) model has supported community health development in more than 100 communities nationally. In 2011, four rural Oregon CHIPs collaborated with investigators from the Oregon Rural Practice-based Research Network (ORPRN), a component of the Oregon Clinical and Translational Research Institute (OCTRI), to obtain training on research methods, develop and implement pilot research studies on childhood obesity, and explore matches with academic partners. This article summarizes the experiences of the Lincoln County CHIP, established in 2003, as it transitioned from CHIP to Community Health Improvement and Research Partnership (CHIRP). Our story and lessons learned may inform rural community-based health coalitions and academicians who are engaged in or considering Community-based participatory research (CBPR) partnerships. Utilizing existing infrastructure and relationships in community and academic settings provides an ideal starting point for rural, bidirectional research partnerships.

Developing a framework for community-based sexual health interventions for youth in the rural setting: protocol for a participatory action research study

PubMed Central

Heslop, Carl William; Burns, Sharyn; Lobo, Roanna; McConigley, Ruth

2017-01-01

Introduction There is limited research examining community-based or multilevel interventions that address the sexual health of young people in the rural Australian context. This paper describes the Participatory Action Research (PAR) project that will develop and validate a framework that is effective for planning, implementing and evaluating multilevel community-based sexual health interventions for young people aged 16–24 years in the Australian rural setting. Methods and analysis To develop a framework for sexual health interventions with stakeholders, PAR will be used. Three PAR cycles will be conducted, using semistructured one-on-one interviews, focus groups, community mapping and photovoice to inform the development of a draft framework. Cycle 2 and Cycle 3 will use targeted Delphi studies to gather evaluation and feedback on the developed draft framework. All data collected will be reviewed and analysed in detail and coded as concepts become apparent at each stage of the process. Ethics and dissemination This protocol describes a supervised doctoral research project. This project seeks to contribute to the literature regarding PAR in the rural setting and the use of the Delphi technique within PAR projects. The developed framework as a result of the project will provide a foundation for further research testing the application of the framework in other settings and health areas. This research has received ethics approval from the Curtin University Human Research and Ethics Committee (HR96/2015). PMID:28559453

Low Dietary Diversity and Intake of Animal Source Foods among School Aged Children in Libo Kemkem and Fogera Districts, Ethiopia

PubMed Central

Herrador, Zaida; Perez-Formigo, Jesus; Sordo, Luis; Gadisa, Endalamaw; Moreno, Javier; Benito, Agustin; Aseffa, Abraham; Custodio, Estefania

2015-01-01

Background A low dietary diversity score (DDS) and low consumption of food from animal sources (ASF) are among the factors related to malnutrition in school-aged children living in Libo Kemkem and Fogera (Ethiopia). Objectives This study aimed to identify associated determinants for low dietary diversity and lack of consumption of ASF. Methods In 2009, a cross-sectional survey was carried out in May, at the end of the lean season. Socio-demographic characteristics and diet habits were collected from 886 school-aged children. Additionally, 516 children from rural sites were followed up in the post-harvest season, in December of the same year. Bivariate and multivariable statistical methods were employed to assess low DDS and ASF intake and their association with different factors. Results Up to 80% and 60% of school-aged children living in rural and urban sites, respectively, ate ≤ 3 food groups the day before the survey. The percentage of children consuming ASF was significantly higher in urban settings (64% vs 18%). In the rural areas, if the head of the household was male (OR: 1.91; 95%CI: 1.00-3.65) and older than 40 years (OR: 1.56; 95%CI: 1.02-2.38) the child had a lower DDS in the lean season, while differences by socioeconomic indexes were observed in the post-harvest season. Males took more ASF than females in rural settings (OR: 1.73; 95%CI: 1.14-2.62) and differences by socioeconomic indexes were observed in both settings in the lean season, though not in post-harvest survey. Conclusions The findings of this study revealed that the diet among school-aged children in Libo Kemkem and Fogera districts lacked diversity, and that the intake of foods from animal sources was low, especially among rural girls. To effectively tackle malnutrition, dietary diversification strategies oriented to the local needs are recommended. PMID:26203904

Community-based field implementation scenarios of a short message service reporting tool for lymphatic filariasis case estimates in Africa and Asia.

PubMed

Mableson, Hayley E; Martindale, Sarah; Stanton, Michelle C; Mackenzie, Charles; Kelly-Hope, Louise A

2017-01-01

Lymphatic filariasis (LF) is a neglected tropical disease (NTD) targeted for global elimination by 2020. Currently there is considerable international effort to scale-up morbidity management activities in endemic countries, however there remains a need for rapid, cost-effective methods and adaptable tools for obtaining estimates of people presenting with clinical manifestations of LF, namely lymphoedema and hydrocele. The mHealth tool ' MeasureSMS-Morbidity ' allows health workers in endemic areas to use their own mobile phones to send clinical information in a simple format using short message service (SMS). The experience gained through programmatic use of the tool in five endemic countries across a diversity of settings in Africa and Asia is used here to present implementation scenarios that are suitable for adapting the tool for use in a range of different programmatic, endemic, demographic and health system settings. A checklist of five key factors and sub-questions was used to determine and define specific community-based field implementation scenarios for using the MeasureSMS-Morbidity tool in a range of settings. These factors included: (I) tool feasibility (acceptability; community access and ownership); (II) LF endemicity (high; low prevalence); (III) population demography (urban; rural); (IV) health system structure (human resources; community access); and (V) integration with other diseases (co-endemicity). Based on experiences in Bangladesh, Ethiopia, Malawi, Nepal and Tanzania, four implementation scenarios were identified as suitable for using the MeasureSMS-Morbidity tool for searching and reporting LF clinical case data across a range of programmatic, endemic, demographic and health system settings. These include: (I) urban, high endemic setting with two-tier reporting; (II) rural, high endemic setting with one-tier reporting; (III) rural, high endemic setting with two-tier reporting; and (IV) low-endemic, urban and rural setting with one-tier reporting. A decision-making framework built from the key factors and questions, and the resulting four implementation scenarios is proposed as a means of using the MeasureSMS-Morbidity tool. This framework will help national LF programmes consider appropriate methods to implement a survey using this tool to improve estimates of the clinical burden of LF. Obtaining LF case estimates is a vital step towards the elimination of LF as a public health problem in endemic countries.

Eliciting health care priorities in developing countries: experimental evidence from Guatemala.

PubMed

Font, Joan Costa; Forns, Joan Rovira; Sato, Azusa

2016-02-01

Although some methods for eliciting preferences to assist participatory priority setting in health care in developed countries are available, the same is not true for poor communities in developing countries whose preferences are neglected in health policy making. Existing methods grounded on self-interested, monetary valuations that may be inappropriate for developing country settings where community care is provided through 'social allocation' mechanisms. This paper proposes and examines an alternative methodology for eliciting preferences for health care programmes specifically catered for rural and less literate populations but which is still applicable in urban communities. Specifically, the method simulates a realistic collective budget allocation experiment, to be implemented in both rural and urban communities in Guatemala. We report evidence revealing that participatory budget-like experiments are incentive compatible mechanisms suitable for revealing collective preferences, while simultaneously having the advantage of involving communities in health care reform processes. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Opioid Overdose Experience, Risk Behaviors, and Knowledge in Drug Users from a Rural versus an Urban Setting.

PubMed

Dunn, Kelly E; Barrett, Frederick S; Yepez-Laubach, Claudia; Meyer, Andrew C; Hruska, Bryce J; Petrush, Kathy; Berman, Suzan; Sigmon, Stacey C; Fingerhood, Michael; Bigelow, George E

2016-12-01

Opioid use is highly prevalent in the United States and there has been an increased incidence in the rate of opioid-related overdose. While evidence suggests there are substantial differences in opioid use among rural versus urban settings, the rate of overdose and corresponding frequency of opioid overdose risk behaviors and overdose knowledge between rural and urban settings have not been examined. Individuals with opioid use disorder from rural (N=98) and urban (N=247) settings completed a self-report survey regarding their lifetime history of overdose and overdose risk behaviors. Participants also completed the Brief Opioid Overdose Knowledge (BOOK) questionnaire, a 12-item self-report measure of opioid overdose knowledge. Overall, 35.6% of participants had experienced an overdose, and prevalence of overdose was significantly higher (p<.01) among rural (45.9%) vs. urban (31.6%) participants, though fewer rural participants reported past 30-day risk behaviors. There were few differences observed between the subset of rural and urban participants who had experienced an overdose, and fewer rural participants with a history of overdose reported past 30-day risk behaviors. Both rural and urban participants performed poorly on the BOOK, though the percent of correct responses was lowest among rural participants with a history of overdose. Results demonstrate higher rates of overdose among rural opioid users, though rural participants were less likely to report recent risk behaviors. Results also suggest that knowledge regarding key factors related to opioid overdose is severely lacking, particularly among rural opioid users, which could be a potential target for future intervention efforts.

The leisure style of Canadian rural recreation participants: An analysis based on three different rural leisure settings

Treesearch

Paul Heintzman; Don Dawson

2012-01-01

This study was a secondary analysis of data from a previous study of 248 Canadians on four dimensions of leisure style: time use, leisure setting, leisure activity participation, and leisure motivation. Correlation analyses were conducted to determine if frequency of participation in three rural leisure settings were related to other leisure style dimensions.

A pilot study evaluating alternative approaches of academic detailing in rural family practice clinics

PubMed Central

2012-01-01

Background Academic detailing is an interactive, convenient, and user-friendly approach to delivering non-commercial education to healthcare clinicians. While evidence suggests academic detailing is associated with improvements in prescribing behavior, uncertainty exists about generalizability and scalability in diverse settings. Our study evaluates different models of delivering academic detailing in a rural family medicine setting. Methods We conducted a pilot project to assess the feasibility, effectiveness, and satisfaction with academic detailing delivered face-to-face as compared to a modified approach using distance-learning technology. The recipients were four family medicine clinics within the Oregon Rural Practice-based Research Network (ORPRN). Two clinics were allocated to receive face-to-face detailing and two received outreach through video conferencing or asynchronous web-based outreach. Surveys at midpoint and completion were used to assess effectiveness and satisfaction. Results Each clinic received four outreach visits over an eight month period. Topics included treatment-resistant depression, management of atypical antipsychotics, drugs for insomnia, and benzodiazepine tapering. Overall, 90% of participating clinicians were satisfied with the program. Respondents who received in person detailing reported a higher likelihood of changing their behavior compared to respondents in the distance detailing group for five of seven content areas. While 90%-100% of respondents indicated they would continue to participate if the program were continued, the likelihood of participation declined if only distance approaches were offered. Conclusions We found strong support and satisfaction for the program among participating clinicians. Participants favored in-person approaches to distance interactions. Future efforts will be directed at quantitative methods for evaluating the economic and clinical effectiveness of detailing in rural family practice settings. PMID:23276303

Bipolar Disorder Center for Pennsylvanians: Implementing an Effectiveness Trial to Improve Treatment for At-Risk Patients

PubMed Central

Kupfer, David J.; Friedman, Edward S.; Reynolds, Charles F.; Axelson, David A.; Grochocinski, Victoria J.; Stofko, Mary G.; Birmaher, Boris; Houck, Patricia R.; Swartz, Holly A.; Brown, Charlotte; Kilbourne, Amy M.; Thase, Michael E.; Curet, David E.; Mulsant, Benoit H.; Turkin, Scott R.; Fagiolini, Andrea; Pollock, Bruce G.; Whyte, Ellen M.; Frank, Ellen

2012-01-01

Objective Adolescents, elderly persons, African Americans, and rural residents with bipolar disorder are less likely than their middle-aged, white, urban counterparts to be diagnosed, receive adequate treatment, remain in treatment once identified, and have positive outcomes. The Bipolar Disorder Center for Pennsylvanians (BDCP) study was designed to address these disparities. This report highlights the methods used to recruit, screen, and enroll a cohort of difficult-to-recruit individuals with bipolar disorder. Methods Study sites included three specialty clinics for bipolar disorder in a university setting and a rural behavioral health clinic. Study operations were standardized, and all study personnel were trained in study procedures. Several strategies were used for recruitment. Results It was possible to introduce the identical assessment and screening protocol in settings regardless of whether they had a history of implementing research protocols. This protocol was also able to be used across the age spectrum, in urban and rural areas, and in a racially diverse cohort of participants. Across the four sites 515 individuals with bipolar disorder were enrolled as a result of these methods (69 African Americans and 446 non–African Americans). Although clinical characteristics at study entry did not differ appreciably between African Americans and non–African Americans, the pathways into treatment differed significantly. Conclusions Rigorous recruitment and assessment procedures can be successfully introduced in different settings and with different patient cohorts, thus facilitating access to high-quality treatment for individuals who frequently do not receive appropriate care for bipolar disorder. PMID:19564218

Is Western Australia's rural surgical workforce going to sustain the future? A quantitative and qualitative analysis.

PubMed

Shanmugakumar, Sharanyaa; Playford, Denese; Burkitt, Tessa; Tennant, Marc; Bowles, Tom

2017-03-01

Objective Despite public interest in the rural workforce, there are few published data on the geographical distribution of Australia's rural surgeons, their practice skill set, career stage or work-life balance (on-call burden). Similarly, there has not been a peer-reviewed skills audit of rural training opportunities for surgical trainees. The present study undertook this baseline assessment for Western Australia (WA), which has some of the most remote practice areas in Australia. Methods Hospital staff from all WA Country Health Service hospitals with surgical service (20 of 89 rural health services) were contacted by telephone. A total of 18 of 20 provided complete data. The study questionnaire explored hospital and practice locations of practicing rural surgeons, on-call rosters, career stage, practice skill set and the availability of surgical training positions. Data were tabulated in excel and geographic information system geocoded. Descriptive statistics were calculated in Excel. Results Of the seven health regions for rural Western Australia, two (28.6%) were served by resident surgeons at a ratio consistent with Royal Australasian College of Surgeons (RACS) guidelines. General surgery was offered in 16 (89%) hospitals. In total, 16 (89%) hospitals were served by fly-in, fly-out (FIFO) surgical services. Two hospitals with resident surgeons did not use FIFO services, but all hospitals without resident surgeons were served by FIFO surgical specialists. The majority of resident surgeons (62.5%) and FIFO surgeons (43.2%) were perceived to be mid-career by hospital staff members. Three hospitals (16.7%) offered all eight of the identified surgical skill sets, but 16 (89%) offered general surgery. Conclusions Relatively few resident rural surgeons are servicing large areas of WA, assisted by the widespread provision of FIFO surgical services. The present audit demonstrates strength in general surgical skills throughout regional WA, and augers well for the training of general surgeons. What is known about the topic? A paper published in 1998 suggested that Australia's rural surgeons were soon to reach retirement age. However, there have been no published peer-reviewed papers on Australia's surgical workforce since then. More recent workforce statistics released from the RACS suggest that the rural workforce is in crisis. What does this paper add? This paper provides up-to-date whole-of-state information for WA, showing where surgical services are being provided and by whom, giving a precise geographical spread of the workforce. It shows the skill set and on-call rosters of these practitioners. What are the implications for practitioners? The present study provides geographical workforce data, which is important to health planners, the general public and surgeons considering where to practice. In particular, these data are relevant to trainees considering their rural training options.

Does living in urban or rural settings affect aspects of physical fitness in children? An allometric approach

PubMed Central

Tsimeas, P; Tsiokanos, A; Koutedakis, Y; Tsigilis, N; Kellis, S

2005-01-01

Objective: The aim of this study was to investigate physical fitness in relation to fatness in urban and rural Greek children by means of allometric scaling. Methods: The sample consisted of 360 (189 urban and 171 rural; age 12.3±0.42 years) boys and 247 (125 urban and 122 rural; age 12.3±0.43 years) girls. The sample was highly representative (32–64%) of all 12 year old children registered in the prefecture of Trikala, Greece. All volunteers were assessed for BMI and % body fat, as well as sit and reach, basketball throw (BT), vertical jump (VJ), handgrip strength (HG), 40 m sprint, agility run, and 20 m shuttle run. To correct for possible associations between fatness and fitness, a single cause allometric scaling was employed using the natural logarithms (ln) of fitness parameters that were significantly correlated with the ln body fat. Results: Independent-samples t tests revealed that VJ (p<0.05) was significantly higher in boys living in urban settings compared to their rural counterparts. Similarly, BT was found to be significantly better (p<0.05) in urban girls, whereas HG was significantly higher (p<0.05) in rural girls. Conclusion: Considering that (a) only three out of the 14 possible cases (seven fitness parameters for boys and seven for girls) were significantly different between urban and rural children, and (b) these differences were not uniformly distributed in children living in either urban or rural environments, it is concluded that the place of residence has no clear impact on physical fitness as studied herein. PMID:16118308

Multilevel Effects of Wealth on Women's Contraceptive Use in Mozambique

PubMed Central

Dias, José G.; de Oliveira, Isabel Tiago

2015-01-01

Objective This paper analyzes the impact of wealth on the use of contraception in Mozambique unmixing the contextual effects due to community wealth from the individual effects associated with the women's situation within the community of residence. Methods Data from the 2011 Mozambican Demographic and Health Survey on women who are married or living together are analyzed for the entire country and also for the rural and urban areas separately. We used single level and multilevel probit regression models. Findings A single level probit regression reveals that region, religion, age, previous fertility, education, and wealth impact contraceptive behavior. The multilevel analysis shows that average community wealth and the women’s relative socioeconomic position within the community have significant positive effects on the use of modern contraceptives. The multilevel framework proved to be necessary in rural settings but not relevant in urban areas. Moreover, the contextual effects due to community wealth are greater in rural than in urban areas and this feature is associated with the higher socioeconomic heterogeneity within the richest communities. Conclusion This analysis highlights the need for the studies on contraceptive behavior to specifically address the individual and contextual effects arising from the poverty-wealth dimension in rural and urban areas separately. The inclusion in a particular community of residence is not relevant in urban areas, but it is an important feature in rural areas. Although the women's individual position within the community of residence has a similar effect on contraceptive adoption in rural and urban settings, the impact of community wealth is greater in rural areas and smaller in urban areas. PMID:25786228

Measuring teamwork and taskwork of community-based “teams” delivering life-saving health interventions in rural Zambia: a qualitative study

PubMed Central

2013-01-01

Background The use of teams is a well-known approach in a variety of settings, including health care, in both developed and developing countries. Team performance is comprised of teamwork and task work, and ascertaining whether a team is performing as expected to achieve the desired outcome has rarely been done in health care settings in resource-limited countries. Measuring teamwork requires identifying dimensions of teamwork or processes that comprise the teamwork construct, while taskwork requires identifying specific team functions. Since 2008 a community-based project in rural Zambia has teamed community health workers (CHWs) and traditional birth attendants (TBAs), supported by Neighborhood Health Committees (NHCs), to provide essential newborn and continuous curative care for children 0–59 months. This paper describes the process of developing a measure of teamwork and taskwork for community-based health teams in rural Zambia. Methods Six group discussions and pile-sorting sessions were conducted with three NHCs and three groups of CHW-TBA teams. Each session comprised six individuals. Results We selected 17 factors identified by participants as relevant for measuring teamwork in this rural setting. Participants endorsed seven functions as important to measure taskwork. To explain team performance, we assigned 20 factors into three sub-groups: personal, community-related and service-related. Conclusion Community and culturally relevant processes, functions and factors were used to develop a tool for measuring teamwork and taskwork in this rural community and the tool was quite unique from tools used in developed countries. PMID:23802766

Culture of rural nursing practice: a critical theoretical analysis of determinants of power in nursing.

PubMed

Gibb, Heather; Forsyth, Katreena; Anderson, Judith

This paper investigates the culture of workplace learning within a study of eight small hospitals in rural New South Wales (NSW), Australia. The study used a focus group method of data collection, undertaken before then after a series of interventions designed to nurture a culture that supports learning within the rural health care setting. Student AINs, AINs, ENs and RNs from any of the eight hospitals. Framed within a critical social perspective it applies a theory of culture to understand the determinants of social divisiveness that was occurring between different levels of the nursing workforce. These results are further analysed within a theoretical discussion of culture and power in nursing.

County-level poverty is equally associated with unmet health care needs in rural and urban settings.

PubMed

Peterson, Lars E; Litaker, David G

2010-01-01

Regional poverty is associated with reduced access to health care. Whether this relationship is equally strong in both rural and urban settings or is affected by the contextual and individual-level characteristics that distinguish these areas, is unclear. Compare the association between regional poverty with self-reported unmet need, a marker of health care access, by rural/urban setting. Multilevel, cross-sectional analysis of a state-representative sample of 39,953 adults stratified by rural/urban status, linked at the county level to data describing contextual characteristics. Weighted random intercept models examined the independent association of regional poverty with unmet needs, controlling for a range of contextual and individual-level characteristics. The unadjusted association between regional poverty levels and unmet needs was similar in both rural (OR = 1.06 [95% CI, 1.04-1.08]) and urban (OR = 1.03 [1.02-1.05]) settings. Adjusting for other contextual characteristics increased the size of the association in both rural (OR = 1.11 [1.04-1.19]) and urban (OR = 1.11 [1.05-1.18]) settings. Further adjustment for individual characteristics had little additional effect in rural (OR = 1.10 [1.00-1.20]) or urban (OR = 1.11 [1.01-1.22]) settings. To better meet the health care needs of all Americans, health care systems in areas with high regional poverty should acknowledge the relationship between poverty and unmet health care needs. Investments, or other interventions, that reduce regional poverty may be useful strategies for improving health through better access to health care. © 2010 National Rural Health Association.

The spatial pattern of suicide in the US in relation to deprivation, fragmentation and rurality.

PubMed

Congdon, Peter

2011-01-01

Analysis of geographical patterns of suicide and psychiatric morbidity has demonstrated the impact of latent ecological variables (such as deprivation, rurality). Such latent variables may be derived by conventional multivariate techniques from sets of observed indices (for example, by principal components), by composite variable methods or by methods which explicitly consider the spatial framework of areas and, in particular, the spatial clustering of latent risks and outcomes. This article considers a latent random variable approach to explaining geographical contrasts in suicide in the US; and it develops a spatial structural equation model incorporating deprivation, social fragmentation and rurality. The approach allows for such latent spatial constructs to be correlated both within and between areas. Potential effects of area ethnic mix are also included. The model is applied to male and female suicide deaths over 2002–06 in 3142 US counties.

The Koorie Men's Health Day: an innovative model for early detection of mental illness among rural Aboriginal men.

PubMed

Isaacs, Anton; Lampitt, Berwyn

2014-02-01

To describe the design, implementation and outcomes of an innovative model for the early detection of mental illness among rural Aboriginal men. Through a collaborative effort between a University' Department of Rural and Indigenous Health, an Aboriginal organisation and a regional mental health service, an all-male team was set up which consisted of a doctor, a mental health nurse and four key individuals from the local Aboriginal community. Invitations to attend a Koorie Men's Health Day were distributed via flyers and posters. Using an assembly line technique and avoiding any reference to the term 'mental', all participants underwent a complete medical examination, a blood test for diabetes and a psychological assessment using the Kessler-10 schedule. The event was attended by 20 men. Of the 17 participants whose data were available, seven scored significantly (25 or higher) on the psychological assessment and were offered follow-up. When conducted on a regular basis, the Koorie Men's Health Day could be a useful method for the early detection of mental illness among rural Aboriginal men in Australia. Further research is needed to study the feasibility and sustainability of the model in different settings.

Rural-urban disparities in child nutrition in Bangladesh and Nepal

PubMed Central

2013-01-01

Background The persistence of rural-urban disparities in child nutrition outcomes in developing countries alongside rapid urbanisation and increasing incidence of child malnutrition in urban areas raises an important health policy question - whether fundamentally different nutrition policies and interventions are required in rural and urban areas. Addressing this question requires an enhanced understanding of the main drivers of rural-urban disparities in child nutrition outcomes especially for the vulnerable segments of the population. This study applies recently developed statistical methods to quantify the contribution of different socio-economic determinants to rural-urban differences in child nutrition outcomes in two South Asian countries – Bangladesh and Nepal. Methods Using DHS data sets for Bangladesh and Nepal, we apply quantile regression-based counterfactual decomposition methods to quantify the contribution of (1) the differences in levels of socio-economic determinants (covariate effects) and (2) the differences in the strength of association between socio-economic determinants and child nutrition outcomes (co-efficient effects) to the observed rural-urban disparities in child HAZ scores. The methodology employed in the study allows the covariate and coefficient effects to vary across entire distribution of child nutrition outcomes. This is particularly useful in providing specific insights into factors influencing rural-urban disparities at the lower tails of child HAZ score distributions. It also helps assess the importance of individual determinants and how they vary across the distribution of HAZ scores. Results There are no fundamental differences in the characteristics that determine child nutrition outcomes in urban and rural areas. Differences in the levels of a limited number of socio-economic characteristics – maternal education, spouse’s education and the wealth index (incorporating household asset ownership and access to drinking water and sanitation) contribute a major share of rural-urban disparities in the lowest quantiles of child nutrition outcomes. Differences in the strength of association between socio-economic characteristics and child nutrition outcomes account for less than a quarter of rural-urban disparities at the lower end of the HAZ score distribution. Conclusions Public health interventions aimed at overcoming rural-urban disparities in child nutrition outcomes need to focus principally on bridging gaps in socio-economic endowments of rural and urban households and improving the quality of rural infrastructure. Improving child nutrition outcomes in developing countries does not call for fundamentally different approaches to public health interventions in rural and urban areas. PMID:23767425

Intra-Facility Linkage of HIV-Positive Mothers and HIV-Exposed Babies into HIV Chronic Care: Rural and Urban Experience in a Resource Limited Setting

PubMed Central

Mugasha, Christine; Kigozi, Joanita; Kiragga, Agnes; Muganzi, Alex; Sewankambo, Nelson; Coutinho, Alex; Nakanjako, Damalie

2014-01-01

Introduction Linkage of HIV-infected pregnant women to HIV care remains critical for improvement of maternal and child outcomes through prevention of maternal-to-child transmission of HIV (PMTCT) and subsequent chronic HIV care. This study determined proportions and factors associated with intra-facility linkage to HIV care and Early Infant Diagnosis care (EID) to inform strategic scale up of PMTCT programs. Methods A cross-sectional review of records was done at 2 urban and 3 rural public health care facilities supported by the Infectious Diseases Institute (IDI). HIV-infected pregnant mothers, identified through routine antenatal care (ANC) and HIV-exposed babies were evaluated for enrollment in HIV clinics by 6 weeks post-delivery. Results Overall, 1,025 HIV-infected pregnant mothers were identified during ANC between January and June, 2012; 267/1,025 (26%) in rural and 743/1,025 (74%) in urban facilities. Of these 375/1,025 (37%) were linked to HIV clinics [67/267(25%) rural and 308/758(41%) urban]. Of 636 HIV-exposed babies, 193 (30%) were linked to EID. Linkage of mother-baby pairs to HIV chronic care and EID was 16% (101/636); 8/179 (4.5%)] in rural and 93/457(20.3%) in urban health facilities. Within rural facilities, ANC registration <28 weeks-of-gestation was associated with mothers' linkage to HIV chronic care [AoR, 2.0 95% CI, 1.1–3.7, p = 0.019] and mothers' multi-parity was associated with baby's linkage to EID; AoR 4.4 (1.3–15.1), p = 0.023. Stigma, long distance to health facilities and vertical PMTCT services affected linkage in rural facilities, while peer mothers, infant feeding services, long patient queues and limited privacy hindered linkage to HIV care in urban settings. Conclusion Post-natal linkage of HIV-infected mothers to chronic HIV care and HIV-exposed babies to EID programs was low. Barriers to linkage to HIV care vary in urban and rural settings. We recommend targeted interventions to rapidly improve linkage to antiretroviral therapy for elimination of MTCT. PMID:25546453

A Persistent Disparity: Smoking in Rural Sexual and Gender Minorities.

PubMed

Bennett, Keisa; McElroy, Jane A; Johnson, Andrew O; Munk, Niki; Everett, Kevin D

2015-03-01

Sexual and gender minorities (SGM) smoke cigarettes at higher rates than the general population. Historically, research in SGM health issues was conducted in urban populations and recent population-based studies seldom have sufficient SGM participants to distinguish urban from rural. Given that rural populations also tend to have a smoking disparity, and that many SGM live in rural areas, it is vitally important to understand the intersection of rural residence, SGM identity, and smoking. This study analyzes the patterns of smoking in urban and rural SGM in a large sample. We conducted an analysis of 4280 adult participants in the Out, Proud, and Healthy project with complete data on SGM status, smoking status, and zip code. Surveys were conducted at 6 Missouri Pride Festivals and online in 2012. Analysis involved descriptive and bivariate methods, and multivariable logistic regression. We used GIS mapping to demonstrate the dispersion of rural SGM participants. SGM had higher smoking proportion than the non-SGM recruited from these settings. In the multivariable model, SGM identity conferred 1.35 times the odds of being a current smoker when controlled for covariates. Rural residence was not independently significant, demonstrating the persistence of the smoking disparity in rural SGM. Mapping revealed widespread distribution of SGM in rural areas. The SGM smoking disparity persists among rural SGM. These communities would benefit from continued research into interventions targeting both SGM and rural tobacco control measures. Recruitment at Pride Festivals may provide a venue for reaching rural SGM for intervention.

Changing trends in the prevalence of blindness and visual impairment in a rural district of India: Systematic observations over a decade

PubMed Central

Khanna, Rohit C; Marmamula, Srinivas; Krishnaiah, Sannapaneni; Giridhar, Pyda; Chakrabarti, Subhabrata; Rao, Gullapalli N

2012-01-01

Context: Globally, limited data are available on changing trends of blindness from a single region. Aims: To report the changing trends in the prevalence of blindness, visual impairment (VI), and visual outcomes of cataract surgery in a rural district of Andhra Pradesh, India, over period of one decade. Settings and Design: Rural setting; cross-sectional study. Materials and Methods: Using a validated Rapid Assessment of Cataract Surgical Services (RACSS) method, population-based, cross-sectional survey was done in a rural district in the state of Andhra Pradesh, India. Two-stage sampling procedure was used to select participants ≥50 years of age. Further, a comparative analysis was done with participants ≥50 years from the previously concluded Andhra Pradesh Eye Disease Study (APEDS) study, who belonged to the same district. Statistical Analysis: Done using 11th version of Stata. Results: Using RACSS, 2160/2300 (93.9%) participants were examined as compared with the APEDS dataset (n=521). Age and sex adjusted prevalence of blindness in RACSS and APEDS was 8% (95% CI, 6.9–9.1%) and 11% (95% CI, 8.3–13.7%), while that of VI was 13.6% (95% CI, 12.2–15.1%) and 40.3% (95% CI, 36.1–44.5%), respectively. Cataract was the major cause of blindness in both the studies. There was a significant reduction in blindness following cataract surgery as observed through RACSS (17.3%; 95% CI, 13.5–21.8%) compared with APEDS (34%; 95% CI, 20.9–49.3%). Conclusion: There was a significant reduction in prevalence of blindness and VI in this rural district of India over a decade. PMID:22944766

Changing trends in the prevalence of blindness and visual impairment in a rural district of India: systematic observations over a decade.

PubMed

Khanna, Rohit C; Marmamula, Srinivas; Krishnaiah, Sannapaneni; Giridhar, Pyda; Chakrabarti, Subhabrata; Rao, Gullapalli N

2012-01-01

Context : Globally, limited data are available on changing trends of blindness from a single region. Aims : To report the changing trends in the prevalence of blindness, visual impairment (VI), and visual outcomes of cataract surgery in a rural district of Andhra Pradesh, India, over period of one decade. Settings and Design : Rural setting; cross-sectional study. Materials and Methods : Using a validated Rapid Assessment of Cataract Surgical Services (RACSS) method, population-based, cross-sectional survey was done in a rural district in the state of Andhra Pradesh, India. Two-stage sampling procedure was used to select participants ≥50 years of age. Further, a comparative analysis was done with participants ≥50 years from the previously concluded Andhra Pradesh Eye Disease Study (APEDS) study, who belonged to the same district. Statistical Analysis : Done using 11 th version of Stata. Results : Using RACSS, 2160/2300 (93.9%) participants were examined as compared with the APEDS dataset (n=521). Age and sex adjusted prevalence of blindness in RACSS and APEDS was 8% (95% CI, 6.9-9.1%) and 11% (95% CI, 8.3-13.7%), while that of VI was 13.6% (95% CI, 12.2-15.1%) and 40.3% (95% CI, 36.1-44.5%), respectively. Cataract was the major cause of blindness in both the studies. There was a significant reduction in blindness following cataract surgery as observed through RACSS (17.3%; 95% CI, 13.5-21.8%) compared with APEDS (34%; 95% CI, 20.9-49.3%). Conclusion : There was a significant reduction in prevalence of blindness and VI in this rural district of India over a decade.

Rural women caregivers in Canada.

PubMed

Crosato, Kay E; Leipert, Beverly

2006-01-01

Informal caregiving within rural contexts in Canada is increasing. This is due in part to a number of factors related to the restructuring of the Canadian health care system, the regionalization of services to urban locations, the increased population of people 65 years and older, and the desire of this population to age within their rural homes. Most often, the informal caregiving role is assumed by rural women. Women tend to fall into the role of informal caregiver to elders because of the many societal and gender expectations and values that are present within the rural culture. The purpose of this literature review is to identify the context in which women provide care for an elder in rural Canada. Illustrating these issues will help to uncover challenges and barriers rural women face when providing care and highlight recommendations and implications for rural women caregivers and nurses employed within rural settings. Many rural women share similar caregiving experiences as urban informal caregivers, but rural women are faced with additional challenges in providing quality care for an elder. Rural women caregivers are faced with such issues as limited access to adequate and appropriate healthcare services, culturally incongruent health care, geographical distance from regionalized centers and health services, transportation challenges, and social/geographical isolation. In addition to these issues, many rural women are faced with the multiple role demands that attend being a wife, mother, caregiver and employee. The pile up of these factors leaves rural women caregivers susceptible to additional stresses and burn out, with limited resources on which to depend. Through reviewing pertinent literature, appropriate implications and recommendations can be made that may assist rural women caregivers and rural nurses. Nurses working within rural communities are in ideal settings to work collaboratively in building supportive relationships with rural women in order to promote the health and wellbeing of caregivers, as well as the elders for which they provide care. More research is needed regarding rural women and their caregiving experiences of elders. In addition, rural and remote courses and practicums should be made available to nursing students in order to encourage them and to support them in nursing careers in rural settings, thereby providing rural women caregivers with additional appropriate and consistent healthcare services. Also, governments and policy makers should consider the rural context and the challenges that are associated with providing care to an elder in a rural setting to ensure that rural women caregivers and their care recipients are well supported within their rural communities.

Report on the International Workshop on Drug Prevention and Treatment in Rural Settings Organized by United Nation Office on Drugs and Crime (UNODC) and World Health Organization (WHO).

PubMed

Milano, Giulia; Saenz, Elizabeth; Clark, Nicolas; Busse, Anja; Gale, John; Campello, Giovanna; Mattfeld, Elizabeth; Maalouf, Wadih; Heikkila, Hanna; Martelli, Antonietta; Morales, Brian; Gerra, Gilberto

2017-11-10

Very little evidence has been reported in literature regarding the misuse of substances in rural areas. Despite the common perception of rural communities as a protective and risk-mitigating environment, the scientific literature demonstrated the existence of many risk factors in rural communities. The Drug Prevention and Health Branch (DHB) of the United Nations Office on Drugs and Crime (UNODC), and the World Health Organization (WHO), in June 2016, organized a meeting of experts in treatment and prevention of SUDs in rural settings. The content presented during the meeting and the related discussion have provided materials for the preparation of an outline document, which is the basis to create a technical tool on SUDs prevention and treatment in rural settings. The UNODC framework for interventions in rural settings is a technical tool aimed to assist policy makers and managers at the national level. This paper is a report on UNODC/WHO efforts to improve the clinical conditions of people affected by SUDs and living in rural areas. The purpose of this article is to draw attention on a severe clinical and social problem in a reality forgotten by everyone.

Peer mentoring supports the learning needs of nurses providing palliative care in a rural acute care setting.

PubMed

Rabbetts, Lyn

2017-06-02

A specific set of assessment scales can underpin the management of distressing symptoms of patients requiring palliative care. A research assistant supported nurses working in a rural hospital setting during the introduction of these scales. A secondary analysis was conducted to further explore the qualitative data of a previously reported mixed-method study. In particular, the experiences of nurses working alongside a research assistant in the facilitation of using a new assessment form. Purposeful sampling was employed: participating nurses were invited to attend one of three focus group meetings. Data analysis revealed three main themes: a contact person, coach/mentor and extra help initiatives. Three to four subthemes corresponded with each main theme. Findings suggest nurses benefit from having someone to assist in learning about new documentation. Nurses respond positively to mentorship and practical guidance when integrating a new assessment form into routine evidence-based practice.

A home calendar and recall method of last menstrual period for estimating gestational age in rural Bangladesh: a validation study.

PubMed

Gernand, Alison D; Paul, Rina Rani; Ullah, Barkat; Taher, Muhammad A; Witter, Frank R; Wu, Lee; Labrique, Alain B; West, Keith P; Christian, Parul

2016-10-21

The best method of gestational age assessment is by ultrasound in the first trimester; however, this method is impractical in large field trials in rural areas. Our objective was to assess the validity of gestational age estimated from prospectively collected date of last menstrual period (LMP) using crown-rump length (CRL) measured in early pregnancy by ultrasound. As part of a large, cluster-randomized, controlled trial in rural Bangladesh, we collected dates of LMP by recall and as marked on a calendar every 5 weeks in women likely to become pregnant. Among those with a urine-test confirmed pregnancy, a subset with gestational age of <15 weeks (n = 353) were enrolled for ultrasound follow-up to measure CRL. We compared interview-assessed LMP with CRL gestational age estimates and classification of preterm, term, and post-term births. LMP-based gestational age was higher than CRL by a mean (SD) of 2.8 (10.7) days; differences varied by maternal education and preterm birth (P < 0.05). Lin's concordance correlation coefficient was good at ultrasound [0.63 (95 % CI 0.56, 0.69)] and at birth [0.77 (95 % CI 0.73, 0.81)]. Validity of classifying preterm birth was high but post-term was lower, with specificity of 96 and 89 % and sensitivity of 86 and 67 %, respectively. Results were similar by parity. Prospectively collected LMP provided a valid estimate of gestational age and preterm birth in a rural, low-income setting and may be a suitable alternative to ultrasound in programmatic settings and large field trials. ClinicalTrials.gov NCT00860470.

An Ecological Approach to Exploring Rural Food Access and Active Living for Families With Preschoolers.

PubMed

Buro, Brandy; Gold, Abby; Contreras, Dawn; Keim, Ann L; Mobley, Amy R; Oscarson, Renee; Peters, Paula; Procter, Sandy; Smathers, Carol

2015-01-01

To identify factors using the Ecological Model of Childhood Overweight related to accessing nutritious foods and physical activity opportunities from the perspectives of rural parents of preschoolers. A mixed-methods study using a quantitative survey (Active Where?) and qualitative interviews. Analyzed interview themes provided context to the survey results. The setting was Head Start centers, county human service offices, and Women, Infants, and Children Program sites in rural counties in the Midwest. Rural parents (n = 377) of preschoolers took part in the survey in 7 Midwestern states; 15 similar participants were interviewed from 1 of the states. Transcribed interviews were coded. Frequencies and chi-square tests were computed; significance was set at P < .05. The Active Where? survey and interviews revealed that close proximity to recreation spaces and traffic safety issues influenced physical activity. For food access, close proximity to full service grocery stores did not influence access to healthy foods because respondents traveled to urban communities to purchase healthy foods. Public transportation solutions and enhanced neighborhood safety are potential community-wide obesity prevention strategies in rural communities. However, interventions should be tailored to the community's stage of readiness. Strong social networks should be considered an asset for community change in these regions. Copyright © 2015 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Clinical decision-making of rural novice nurses.

PubMed

Seright, T J

2011-01-01

Nurses in rural settings are often the first to assess and interpret the patient's clinical presentations. Therefore, an understanding of how nurses experience decision-making is important in terms of educational preparation, resource allocation to rural areas, institutional cultures, and patient outcomes. Theory development was based on the in-depth investigation of 12 novice nurses practicing in rural critical access hospitals in a north central state. This grounded theory study consisted of face-to-face interviews with 12 registered nurses, nine of whom were observed during their work day. The participants were interviewed a second time, as a method of member checking, and during this interview they reviewed their transcripts, the emerging themes and categories. Directors of nursing from both the research sites and rural hospitals not involved in the study, experienced researchers, and nurse educators facilitated triangulation of the findings. 'Sociocentric rationalizing' emerged as the central phenomenon and referred to the sense of belonging and agency which impacted the decision-making in this small group of novice nurses in rural critical access hospitals. The observed consequences, which were conceptualized during the axial coding process and were derived from observations and interviews of the 12 novice nurses in this study include: (1) gathering information before making a decision included assessment of: the credibility of co-workers, patients' subjective and objective data, and one's own past and current experiences; (2) conferring with co-workers as a direct method of confirming/denying decisions being made was considered more realistic and expedient than policy books and decision trees; (3) rural practicum clinical experiences, along with support after orientation, provide for transition to the rural nurse role; (4) involved directors of nursing served as both models and protectors of novice nurses placed in high accountability positions early in their careers. These novice nurses were often working with a limited staff, while managing an ever-changing census and acuity of patients. The significance of interdependence and welcoming relationships with their co-workers and directors of nursing was pivotal in the clinical decision-making process. Despite access to a number of resources at their disposal (including policy books, decision trees, standing orders, textbooks, and in some cases internet resources), the 12 nurses in this study indicated collaboration with co-workers was a major means of facilitating their decision-making. Rural novice nurses require facilitation of social skills as much as critical thinking skills both within their programs of nursing and during their new employee orientation; however, decision-making must be guided by more experienced nurses who are willing to mentor novice nurses and advise them to to reflect upon their decisions as they care for patients using evidenced based practice. In a rural setting, this is especially important because novice nurses are tasked early in their career with decision-making, which often involves ill-structured problems set in dynamic and changing environments, in high-stakes situations where patient safety is a concern.

Screening mammography uptake within Australia and Scotland in rural and urban populations

PubMed Central

Leung, Janni; Macleod, Catriona; McLaughlin, Deirdre; Woods, Laura M.; Henderson, Robert; Watson, Angus; Kyle, Richard G.; Hubbard, Gill; Mullen, Russell; Atherton, Iain

2015-01-01

Objective To test the hypothesis that rural populations had lower uptake of screening mammography than urban populations in the Scottish and Australian setting. Method Scottish data are based upon information from the Scottish Breast Screening Programme Information System describing uptake among women residing within the NHS Highland Health Board area who were invited to attend for screening during the 2008 to 2010 round (N = 27,416). Australian data were drawn from the 2010 survey of the 1946–51 cohort of the Australian Longitudinal Study on Women's Health (N = 9890 women). Results Contrary to our hypothesis, results indicated that women living in rural areas were not less likely to attend for screening mammography compared to women living in urban areas in both Scotland (OR for rural = 1.17, 95% CI = 1.06–1.29) and Australia (OR for rural = 1.15, 95% CI = 1.01–1.31). Conclusions The absence of rural–urban differences in attendance at screening mammography demonstrates that rurality is not necessarily an insurmountable barrier to screening mammography. PMID:26844118

Oviposition ecology and species composition of Aedes spp. and Aedes aegypti dynamics in variously urbanized settings in arbovirus foci in southeastern Côte d'Ivoire.

PubMed

Zahouli, Julien B Z; Utzinger, Jürg; Adja, Maurice A; Müller, Pie; Malone, David; Tano, Yao; Koudou, Benjamin G

2016-09-29

Aedes mosquito-transmitted outbreaks of dengue and yellow fever have been reported from rural and urban parts of Côte d'Ivoire. The present study aimed at assessing Aedes spp. oviposition ecology in variously urbanized settings within arbovirus foci in southeastern Côte d'Ivoire. Aedes spp. eggs were sampled using a standard ovitrap method from January 2013 to April 2014 in different ecosystems of rural, suburban and urban areas. Emerged larvae were reared until the adult stage for species identification. Aedes spp. oviposition ecology significantly varied from rural-to-urban areas and according to the ecozones and the seasons. Species richness of Aedes spp. gradually decreased from rural (eight species) to suburban (three species) and urban (one species) areas. Conversely, emerged adult Aedes spp. mean numbers were higher in the urban (1.97 Aedes/ovitrap/week), followed by the suburban (1.44 Aedes/ovitrap/week) and rural (0.89 Aedes/ovitrap/week) areas. Aedes aegypti was the only species in the urban setting (100 %), and was also the predominant species in suburban (85.5 %) and rural (63.3 %) areas. The highest Ae. aegypti mean number was observed in the urban (1.97 Ae. aegypti/ovitrap/week), followed by the suburban (1.20 Ae. aegypti/ovitrap/week) and rural (0.57 Ae. aegypti/ovitrap/week) areas. Aedes africanus (9.4 %), Ae. dendrophilus (8.0 %), Ae. metallicus (1.3 %) in the rural, and Ae. vittatus (6.5 %) and Ae. metallicus (1.2 %) in the suburban areas each represented more than 1 % of the total Aedes fauna. In all areas, Aedes species richness and abundance were higher in the peridomestic zones and during the rainy season, with stronger variations in species richness in the rural and in abundance in the urban areas. Besides, the highest Culex quinquefasciatus abundance was found in the urban areas, while Eretmapodites chrysogaster was restricted to the rural areas. Urbanization correlates with a substantially higher abundance in Aedes mosquitoes and a regression of the Aedes wild species towards a unique presence of Ae. aegypti in urban areas. Aedes wild species serve as bridge vectors of arboviruses in rural areas, while Ae. aegypti amplifies arbovirus transmission in urban areas. Our results have important ramifications for dengue and yellow fever vector control and surveillance strategies in arbovirus foci in southeastern Côte d'Ivoire.

Providing sex education to adolescents in rural Bangladesh: experiences from BRAC.

PubMed

Rashid, S F

2000-07-01

In 1995, the Bangladesh Rural Advancement Committee set up an Adolescent Reproductive Health Education (ARHE) program to provide information about reproductive health to adolescents in rural areas. This article explores the impact of the ARHE on adolescent girls and boys, their parents, and community members among rural areas in Bangladesh. Drawing on data from the field research conducted among the target audience, it is noted that ARHE has mobilized the community. It helped break the silence and shame about sensitive topics, such as menstruation, family planning methods, sexually transmitted diseases and HIV/AIDS. Subsequently, these developments have affected relationships between adolescents and their parents, and among adolescents themselves. Moreover, the diffusion of knowledge as a result of the ARHE is occurring in the context of a wider process affecting rural areas of Bangladesh, involving the media, books, exposure to urban and nontraditional ways of life, and schooling. The need for additional research, with a greater focus on adolescents who participate in the program and go on to marry, is highlighted.

Antibiotic sales in rural and urban pharmacies in northern Vietnam: an observational study

PubMed Central

2014-01-01

Background The irrational overuse of antibiotics should be minimized as it drives the development of antibiotic resistance, but changing these practices is challenging. A better understanding is needed of practices and economic incentives for antibiotic dispensing in order to design effective interventions to reduce inappropriate antibiotic use. Here we report on both quantitative and qualitative aspects of antibiotic sales in private pharmacies in northern Vietnam. Method A cross-sectional study was conducted in which all drug sales were observed and recorded for three consecutive days at thirty private pharmacies, 15 urban and 15 rural, in the Hanoi region in 2010. The proportion of antibiotics to total drug sales was assessed and the revenue was calculated for rural and urban settings. Pharmacists and drug sellers were interviewed by a semi-structured questionnaire and in-depth interviews to understand the incentive structure of antibiotic dispensing. Results In total 2953 drug sale transactions (2083 urban and 870 rural) were observed. Antibiotics contributed 24% and 18% to the total revenue of pharmacies in urban and rural, respectively. Most antibiotics were sold without a prescription: 88% in urban and 91% in rural pharmacies. The most frequent reported reason for buying antibiotics was cough in the urban setting (32%) and fever in the rural area (22%). Consumers commonly requested antibiotics without having a prescription: 50% in urban and 28% in rural area. The qualitative data revealed that drug sellers and customer’s knowledge of antibiotics and antibiotic resistance were low, particularly in rural area. Conclusion Over the counter sales of antibiotic without a prescription remains a major problem in Vietnam. Suggested areas of improvement are enforcement of regulations and pricing policies and educational programs to increase the knowledge of drug sellers as well as to increase community awareness to reduce demand-side pressure for drug sellers to dispense antibiotics inappropriately. PMID:24555709

HIV-positive pregnant women attending the prevention of mother-to-child transmission of HIV/AIDS (PMTCT) services in Ethiopia: economic productivity losses across urban-rural settings.

PubMed

Zegeye, Elias Asfaw; Mbonigaba, Josue; Kaye, Sylvia Blanche

2018-06-01

HIV/AIDS impacts significantly on pregnant women and on children in Ethiopia. This impact has a multiplier effect on household economies and on productivity losses, and is expected to vary across rural and urban settings. Applying the human capital approach to data collected from 131 respondents, this study estimated productivity losses per HIV-positive pregnant woman-infant pair across urban and rural health facilities in Ethiopia, which in turn were used to estimate the national productivity loss. The study found that the annual productivity loss per woman-infant pair was Ethiopian birr (ETB) 7,433 or United States dollar (US$) 378 and ETB 625 (US$ 32) in urban and rural settings, respectively. The mean patient days lost per year due to inpatient admission at hospitals/health centres was 11 in urban and 22 in rural health facilities. On average, urban home care-givers spent 20 (SD = 21) days annually providing home care services, while their rural counterparts spent 23 days (SD = 26). The productivity loss accounted for 16% and 7% of household income in urban and rural settings, respectively. These high and varying productivity losses require preventive interventions that are appropriate to each setting to ensure the welfare of women and children in Ethiopia.

Rural-Urban Differences in Consumer Governance at Community Health Centers

PubMed Central

Wright, David Bradley

2017-01-01

Context Community health centers (CHCs) are primary care clinics that serve mostly low-income patients in rural and urban areas. They are required to be governed by a consumer majority. What little is known about the structure and function of these boards in practice, suggests that CHC boards in rural areas may look and act differently than CHC boards in urban areas. Purpose To identify differences in the structure and function of consumer governance at CHCs in rural and urban areas. Methods Semi-structured telephone interviews were conducted with 30 CHC board members from 14 different states. Questions focused on board members’ perceptions of board composition and the role of consumers on the board. Findings CHCs in rural areas are more likely to have representative boards, are better able to convey confidence in the organization, and are better able to assess community needs than CHCs in urban areas. However, CHCs in rural areas often have problems achieving objective decision-making, and may have fewer means for objectively evaluating quality of care due to the lack of patient board member anonymity. Conclusions Consumer governance is implemented differently in rural and urban communities, and the advantages and disadvantages in each setting are unique. PMID:23551642

Are the CMS Hospital Outpatient Quality Measures Relevant for Rural Hospitals?

ERIC Educational Resources Information Center

Casey, Michelle M.; Prasad, Shailendra; Klingner, Jill; Moscovice, Ira

2012-01-01

Context: Quality measures focused on outpatient settings are of increasing interest to policy makers, but little research has been conducted on hospital outpatient quality measures, especially in rural settings. Purpose: To evaluate the relevance of Centers for Medicare and Medicaid Services' (CMS) outpatient quality measures for rural hospitals,…

Training MA Psychologists for Work in Rural Settings: Issues and Models.

ERIC Educational Resources Information Center

Keller, Peter A.

Despite the assumptions some have naively made about various stresses and the quality of life associated with rural settings, most who have studied people residing in rural areas would acknowledge the strong need for mental health services. However psychologists, like most other health care professionals prefer the amenities of more metropolitan…

Rural Compared to Urban Home Community Settings as Predictors of First-Year Students' Adjustment to University

ERIC Educational Resources Information Center

Ames, Megan E.; Wintre, Maxine G.; Prancer, S. Mark; Pratt, Michael W.; Birnie-Lefcovitch, Shelly; Polivy, Janet; Adams, Gerald R.

2014-01-01

Undergraduates (N = 2,823) at 6 universities were surveyed longitudinally to examine the relevance of student home setting on the transition to university. Preliminary results indicated that rural students seem less likely to attend large, ethnically diverse universities. Hierarchical linear models revealed that "proximal rural" students…

Toward Integrated Family Services in Rural Settings: A Summary of Research and Practice. Program Report.

ERIC Educational Resources Information Center

Stoops, Jack W.; Hull, Janis L.

This report synthesizes research findings with observations of three Pacific Northwest sites attempting service integration in rural settings. At case-study sites in Washington and Oregon, rural schools, communities, and service providers collaborate to deliver services to students and community members suffering from high unemployment, alcohol…

Monitoring HIV Drug Resistance Early Warning Indicators in Cameroon: A Study Following the Revised World Health Organization Recommendations

PubMed Central

Fokam, Joseph; Elat, Jean-Bosco N.; Billong, Serge C.; Kembou, Etienne; Nkwescheu, Armand S.; Obam, Nicolas M.; Essiane, André; Torimiro, Judith N.; Ekanmian, Gatien K.; Ndjolo, Alexis; Shiro, Koulla S.; Bissek, Anne C. Z-K.

2015-01-01

Background The majority (>95%) of new HIV infection occurs in resource-limited settings, and Cameroon is still experiencing a generalized epidemic with ~122,638 patients receiving antiretroviral therapy (ART). A detrimental outcome in scaling-up ART is the emergence HIV drug resistance (HIVDR), suggesting the need for pragmatic approaches in sustaining a successful ART performance. Methods A survey was conducted in 15 ART sites of the Centre and Littoral regions of Cameroon in 2013 (10 urban versus 05 rural settings; 8 at tertiary/secondary versus 7 at primary healthcare levels), evaluating HIVDR-early warning indicators (EWIs) as-per the 2012 revised World Health Organization’s guidelines: EWI1 (on-time pill pick-up), EWI2 (retention in care), EWI3 (no pharmacy stock-outs), EWI4 (dispensing practices), EWI5 (virological suppression). Poor performance was interpreted as potential HIVDR. Results Only 33.3% (4/12) of sites reached the desirable performance for “on-time pill pick-up” (57.1% urban versus 0% rural; p<0.0001) besides 25% (3/12) with fair performance. 69.2% (9/13) reached the desirable performance for “retention in care” (77.8% urban versus 50% rural; p=0.01) beside 7.7% (1/13) with fair performance. Only 14.4% (2/13) reached the desirable performance of “no pharmacy stock-outs” (11.1% urban versus 25% rural; p=0.02). All 15 sites reached the desirable performance of 0% “dispensing mono- or dual-therapy”. Data were unavailable to evaluate “virological suppression” due to limited access to viral load testing (min-max: <1%-15%). Potential HIVDR was higher in rural (57.9%) compared to urban (27.8%) settings, p=0.02; and at primary (57.9%) compared to secondary/tertiary (33.3%) healthcare levels, p=0.09. Conclusions Delayed pill pick-up and pharmacy stock-outs are major factors favoring HIVDR emergence, with higher risks in rural settings and at primary healthcare. Retention in care appears acceptable in general while ART dispensing practices are standard. There is need to support patient-adherence to pharmacy appointments while reinforcing the national drug supply system. PMID:26083364

The need for a standard approach to assessing the functionality of rural community water supplies

NASA Astrophysics Data System (ADS)

Bonsor, Helen; MacDonald, Alan; Casey, Vincent; Carter, Richard; Wilson, Paul

2018-03-01

The Sustainable Development Goals have set an agenda for transformational change in water access, aiming for secure household connections globally. Despite this goal, communal groundwater supplies are likely to remain the main source of improved water supplies for many rural areas in Africa and South Asia for decades to come. Understanding the poor functionality of existing communal supplies remains, therefore, a priority. A critical first step is to establish a sector-wide definition of borehole supply functionality and a standard method of its assessment.

Trend differences in men and women in rural and urban U.S. settings.

PubMed

Cepeda-Benito, A; Doogan, N J; Redner, R; Roberts, M E; Kurti, A N; Villanti, A C; Lopez, A A; Quisenberry, A J; Stanton, C A; Gaalema, D E; Keith, D R; Parker, M A; Higgins, S T

2018-04-05

Smoking prevalence is declining at a slower rate in rural than urban settings in the United States (U.S.), and known predictors of smoking do not readily account for this trend difference. Given that socioeconomic and psychosocial determinants of health disparities accumulate in rural settings and that life-course disadvantages are often greater in women than men, we examined whether smoking trends are different for rural and urban men and women. We used yearly cross-sectional data (n = 303,311) from the U.S. National Survey on Drug Use and Health (NSDUH) from 2007 through 2014 to compare cigarette smoking trends in men and women across rural and urban areas. Current smoking status was modelled using logistic regression controlling for confounding risk factors. Regression derived graphs predicting unadjusted prevalence estimates and 95% confidence bands revealed that whereas the smoking trends of rural men, urban men, and urban women significantly declined from 2007 to 2014, the trend for rural women was flat. Controlling for demographic, socioeconomic and psychosocial predictors of smoking did not explain rural women's significantly different trend from those of the other three groups. Rural women lag behind rural men, urban men and urban women in decreasing smoking, a health disparity finding that supports the need for tobacco control and regulatory policies and interventions that are more effective in reducing smoking among rural women. Copyright © 2018 Elsevier Inc. All rights reserved.

Bassett healthcare rural surgery experience.

PubMed

Borgstrom, David C; Heneghan, Steven J

2009-12-01

The surgical training at Bassett is naturally broader than in many university settings, with a survey showing that nearly 70% of graduates who practice general surgery remain in a rurally designated area. Rural surgery experience falls into 3 categories: undergraduate, graduate, and postgraduate. The general surgery training program has no competing fellowships or subspecialty residencies; residents get significant experience with endoscopy; ear, nose, and throat; plastic and hand surgery; and obstetrics and gynecology. The rural setting lifestyle is valued by the students, residents, and fellows alike. It provides an ideal setting for recognizing the specific nuances of small-town American life, with a high-quality education and surgical experience.

Rural and Urban Living in Persons with Spinal Cord Injury and Comparing Environmental Barriers, Their Health, and Quality-of-Life Outcomes.

PubMed

Glennie, R Andrew; Batke, Juliet; Fallah, Nader; Cheng, Christiana L; Rivers, Carly S; Noonan, Vanessa K; Dvorak, Marcel F; Fisher, Charles G; Kwon, Brian K; Street, John T

2017-10-15

There is worldwide geographic variation in the epidemiology of traumatic spinal cord injury (tSCI). The aim of this study was to determine whether environmental barriers, health status, and quality-of-life outcomes differ between patients with tSCI living in rural or urban settings, and whether patients move from rural to urban settings after tSCI. A cohort review of the Rick Hansen SCI Registry (RHSCIR) was undertaken from 2004 to 2012 for one province in Canada. Rural/urban setting was determined using postal codes. Outcomes data at 1 year in the community included the Short Form-36 Version 2 (SF36v2™), Life Satisfaction Questionnaire, Craig Hospital Inventory of Environmental Factors-Short Form (CHIEF-SF), Functional Independent Measure ® Instrument, and SCI Health Questionnaire. Statistical methodologies used were t test, Mann-Whitney U test, and Fisher's exact or χ 2 test. In the analysis, 338 RHSCIR participants were included; 65 lived in a rural setting and 273 in an urban setting. Of the original patients residing in a rural area at discharge,10 moved to an urban area by 1 year. Those who moved from a rural to urban area reported a lower SF-36v2™ Mental Component Score (MCS; p = 0.04) and a higher incidence of depression at 1 year (p = 0.04). Urban patients also reported a higher incidence of depression (p = 0.02) and a lower CHIEF-SF total score (p = 0.01) indicating fewer environmental barriers. No significant differences were found in other outcomes. Results suggest that although the patient outcomes are similar, some patients move from rural to urban settings after tSCI. Future efforts should target screening mental health problems early, especially in urban settings.

Rural and Urban Living in Persons with Spinal Cord Injury and Comparing Environmental Barriers, Their Health, and Quality-of-Life Outcomes

PubMed Central

Batke, Juliet; Fallah, Nader; Cheng, Christiana L.; Rivers, Carly S.; Noonan, Vanessa K.; Dvorak, Marcel F.; Fisher, Charles G.; Kwon, Brian K.; Street, John T.

2017-01-01

Abstract There is worldwide geographic variation in the epidemiology of traumatic spinal cord injury (tSCI). The aim of this study was to determine whether environmental barriers, health status, and quality-of-life outcomes differ between patients with tSCI living in rural or urban settings, and whether patients move from rural to urban settings after tSCI. A cohort review of the Rick Hansen SCI Registry (RHSCIR) was undertaken from 2004 to 2012 for one province in Canada. Rural/urban setting was determined using postal codes. Outcomes data at 1 year in the community included the Short Form-36 Version 2 (SF36v2™), Life Satisfaction Questionnaire, Craig Hospital Inventory of Environmental Factors-Short Form (CHIEF-SF), Functional Independent Measure® Instrument, and SCI Health Questionnaire. Statistical methodologies used were t test, Mann-Whitney U test, and Fisher's exact or χ2 test. In the analysis, 338 RHSCIR participants were included; 65 lived in a rural setting and 273 in an urban setting. Of the original patients residing in a rural area at discharge,10 moved to an urban area by 1 year. Those who moved from a rural to urban area reported a lower SF-36v2™ Mental Component Score (MCS; p = 0.04) and a higher incidence of depression at 1 year (p = 0.04). Urban patients also reported a higher incidence of depression (p = 0.02) and a lower CHIEF-SF total score (p = 0.01) indicating fewer environmental barriers. No significant differences were found in other outcomes. Results suggest that although the patient outcomes are similar, some patients move from rural to urban settings after tSCI. Future efforts should target screening mental health problems early, especially in urban settings. PMID:28462633

Tracking rural-to-urban migration in China: Lessons from the 2005 inter-census population survey.

PubMed

Ebenstein, Avraham; Zhao, Yaohui

2015-01-01

We examined migration in China using the 2005 inter-census population survey, in which migrants were registered at both their place of original (hukou) residence and at their destination. We find evidence that the estimated number of internal migrants in China is extremely sensitive to the enumeration method. We estimate that the traditional destination-based survey method fails to account for more than a third of migrants found using comparable origin-based methods. The 'missing' migrants are disproportionately young, male, and holders of rural hukou. We find that origin-based methods are more effective at capturing migrants who travel short distances for short periods, whereas destination-based methods are more effective when entire households have migrated and no remaining family members are located at the hukou location. We conclude with a set of policy recommendations for the design of population surveys in countries with large migrant populations.

Seasonal and Geographical Variation of Dengue Vectors in Narathiwat, South Thailand

PubMed Central

Boonklong, Ornanong; Bhumiratana, Adisak

2016-01-01

Using GIS-based land use map for the urban-rural division (the relative ratio of population density adjusted to relatively Aedes-infested land area), we demonstrated significant independent observations of seasonal and geographical variation of Aedes aegypti and Aedes albopictus vectors between Muang Narathiwat district (urban setting) and neighbor districts (rural setting) of Narathiwat, Southern Thailand, based on binomial distribution of Aedes vectors in water-holding containers (water storage containers, discarded receptacles, miscellaneous containers, and natural containers). The distribution of Aedes vectors was influenced seasonally by breeding outdoors rather than indoors in all 4 containers. Accordingly, both urban and rural settings elicited significantly seasonal (wet versus dry) distributions of Ae. aegypti larvae observed in water storage containers (P = 0.001 and P = 0.002) and natural containers (P = 0.016 and P = 0.015), whereas, in rural setting, the significant difference was observed in discarded receptacles (P = 0.028) and miscellaneous containers (P < 0.001). Seasonal distribution of Ae. albopictus larvae in any containers in urban setting was not remarkably noticed, whereas, in rural setting, the significant difference was observed in water storage containers (P = 0.007) and discarded receptacles (P < 0.001). Moreover, the distributions of percentages of container index for Aedes-infested households in dry season were significantly lower than that in other wet seasons, P = 0.034 for urban setting and P = 0.001 for rural setting. Findings suggest that seasonal and geographical variation of Aedes vectors affect the infestation in those containers in human inhabitations and surroundings. PMID:27437001

Information technology and hospice palliative care: social, cultural, ethical and technical implications in a rural setting.

PubMed

Kuziemsky, Craig; Jewers, Heather; Appleby, Brenda; Foshay, Neil; Maccaull, Wendy; Miller, Keith; Macdonald, Madonna

2012-01-01

There is a need to better understand the specific settings in which health information technology (HIT) is used and implemented. Factors that will determine the successful implementation of HIT are context-specific and often reside not at the technical level but rather at the process and people level. This paper provides the results of a needs assessment for HIT to support hospice palliative care (HPC) delivery in rural settings. Roundtable discussions using the nominal group technique were done to identify priority issues regarding HIT usage to support rural HPC delivery. Qualitative content analysis was then used to identify sociotechnical themes from the roundtable data. Twenty priority issues were identified at the roundtable session. Content analysis grouped the priority issues into one central theme and five supporting themes to form a sociotechnical framework for patient-centered care in rural settings. There are several sociotechnical themes and associated issues that need to be considered prior to implementing HIT in rural HPC settings. Proactive evaluation of these issues can enhance HIT implementation and also help to make ethical aspects of HIT design more explicit.

Increasing interest in rural mental health work: the impact of a short term program to orientate allied health and nursing students to employment and career opportunities in a rural setting.

PubMed

Sutton, Keith P; Patrick, Kent; Maybery, Darryl; Eaton, Kaytlyn

2015-01-01

Ongoing workforce shortages affect the provision of mental health services to rural and remote communities. This article examines the immediate impact of a novel recruitment strategy that aims to increase the number of mental health professionals commencing their careers in a rural area of Australia. This study utilised a sequential confirmatory mixed methods design which included both online pre- and post-program surveys and semi-structured individual interviews. Statistical analyses compared participants' pre- and post-program survey interest in rural work/career, mental health work/career and rural mental health work/career. Content analysis was undertaken to explore interview transcripts for data that confirmed, contradicted or added depth to the quantitative findings. Comparison of pre- and post-program surveys indicated a significant increase in participants' interest in rural work/career and rural mental health work/career. The qualitative findings provided depth to and supported the change in interest toward working in a rural environment. Despite qualitative evidence that the program has increased participants' knowledge and understanding of the mental health sector as a whole, overt support for the changes in interest toward mental health work was not evident. The study provides evidence that a short-term program can change allied health and nursing students' interest in rural mental health work. The findings have important implications for the recruitment of mental health practitioners to underserved rural areas.

A pilot study of the impact of bovine spongiform encephalopathy on the futures of rural youth and Canadian farming.

PubMed

Cook, Trevor M; Brook, Ryan K; Sindhwani, Madhu; Thurston, Wilfreda E

2011-01-01

There is an abundance of literature examining the economic impact of Canada's bovine spongiform encephalopathy (BSE) outbreak, but few studies examined the impact of such a crisis on health at the individual, family, or community levels. In particular, rural youth represent an under-researched population despite being at risk for a unique set of social and health concerns. In this pilot study, our objectives were to explore how rural youth responded to Canada's BSE crisis and how they perceived themselves, their families, and their communities to have been impacted. Seven youths (n = 7), recruited from within a university setting using a snowball sampling method, were interviewed. They represent a segment of rural, agriculturally based youth who are resilient due to good parental support. Although they reported high stress in their families during the immediate crisis in 2003, they did not report lasting high levels of stress or negative health effects due to BSE. They did report a decline in rural community health, identifying a reduction in community activities and in the participation of families in community activities. Participants identified elements that discourage youth from pursuing farming as a career and expressed concern for the future of family farming. The results are discussed in terms of the ability of agriculturally based youth to make the transition to adulthood. The implications have importance for future research and policy that addresses the structural supports for choice making, the long-term success for rural youth in transitioning to adult status, and the future of agriculture.

Translating evidence into practice in low resource settings: cervical cancer screening tests are only part of the solution in rural India.

PubMed

Isaac, Rita; Finkel, Madelon; Olver, Ian; Annie, I K; Prashanth, H R; Subhashini, J; Viswanathan, P N; Trevena, Lyndal J

2012-01-01

The majority of women in rural India have poor or no access to cervical cancer screening services, although one-quarter of all cervical cancers in the world occur there. Several large trials have proven the efficacy of low-tech cervical cancer screening methods in the Indian context but none have documented the necessary components and processes of implementing this evidence in a low-resource setting. This paper discusses a feasible model of implementation of cervical cancer screening programme in low-resource settings developed through a pilot research project carried out in rural Tamilnadu, India. The programme used visual inspection of cervix after acetic acid application (VIA) as a screening tool, nurses in the primary care centres as the primary screeners and peer educators within Self-Help Women groups to raise community awareness. The uptake of screening was initially low despite the access to a screening programme. However, the programme witnessed an incremental increase in the number of women accessing screening with increasing community awareness. The investigators recommend 4 key components to programme implementation in low-resource setting: 1) Evidence-based, cost-effective test and treatment available within the reach of the community; 2) Appropriate referral pathways; 3) Skilled health workers and necessary equipment; and 4) Optimisation of health literacy, beliefs, attitudes of the community.

Rural Stress: Myths and Realities.

ERIC Educational Resources Information Center

Hansen, Thomas D.; McIntire, Walter G.

A comparison between the common myths of "rural existence" and the documented realities of rural living explodes the myth that rural living is generally stress free, shows that life stress in rural settings can have deleterious effects on the function of individual and family, and provides a basis for exploring some implications of rural stress…

Improvement Efforts in Rural Schools: Experiences of Nine Schools Receiving School Improvement Grants

ERIC Educational Resources Information Center

Rosenberg, Linda; Christianson, Megan Davis; Hague Angus, Megan

2015-01-01

Low-performing schools in rural settings can face challenges common to all struggling schools, such as low student motivation and maintaining a qualified teaching staff. However, aspects of rural schools' settings, such as the distance from urban areas and the commute between the schools and the students' and teachers' homes, can exacerbate the…

49 CFR 195.12 - What requirements apply to low-stress pipelines in rural areas?

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 3 2011-10-01 2011-10-01 false What requirements apply to low-stress pipelines in... low-stress pipelines in rural areas? (a) General. This Section sets forth the requirements for each category of low-stress pipeline in a rural area set forth in paragraph (b) of this Section. This Section...

Self-Reported Health among Older Bangladeshis: How Good a Health Indicator Is It?

ERIC Educational Resources Information Center

Rahman, M. Omar; Barsky, Arthur J.

2003-01-01

Purpose: This study examines the value of self-reported health (SRH) as an indicator of underlying health status in a developing country setting. Design and Methods: Logistic regression methods with adjustments for multistage sampling are used to examine the factors associated with SRH in 2,921 men and women aged 50 and older in rural Bangladesh.…

Detecting the changes in rural communities in Taiwan by applying multiphase segmentation on FORMOSA-2 satellite imagery

NASA Astrophysics Data System (ADS)

Huang, Yishuo

2015-09-01

Agricultural activities mainly occur in rural areas; recently, ecological conservation and biological diversity are being emphasized in rural communities to promote sustainable development for rural communities, especially for rural communities in Taiwan. Therefore, since 2005, many rural communities in Taiwan have compiled their own development strategies in order to create their own unique characteristics to attract people to visit and stay in rural communities. By implementing these strategies, young people can stay in their own rural communities and the rural communities are rejuvenated. However, some rural communities introduce artificial construction into the community such that the ecological and biological environments are significantly degraded. The strategies need to be efficiently monitored because up to 67 rural communities have proposed rejuvenation projects. In 2015, up to 440 rural communities were estimated to be involved in rural community rejuvenations. How to monitor the changes occurring in those rural communities participating in rural community rejuvenation such that ecological conservation and ecological diversity can be satisfied is an important issue in rural community management. Remote sensing provides an efficient and rapid method to achieve this issue. Segmentation plays a fundamental role in human perception. In this respect, segmentation can be used as the process of transforming the collection of pixels of an image into a group of regions or objects with meaning. This paper proposed an algorithm based on the multiphase approach to segment the normalized difference vegetation index, NDVI, of the rural communities into several sub-regions, and to have the NDVI distribution in each sub-region be homogeneous. Those regions whose values of NDVI are close will be merged into the same class. In doing so, a complex NDVI map can be simplified into two groups: the high and low values of NDVI. The class with low NDVI values corresponds to those regions containing roads, buildings, and other manmade construction works and the class with high values of NDVI indicates that those regions contain vegetation in good health. In order to verify the processed results, the regional boundaries were extracted and laid down on the given images to check whether the extracted boundaries were laid down on buildings, roads, or other artificial constructions. In addition to the proposed approach, another approach called statistical region merging was employed by grouping sets of pixels with homogeneous properties such that those sets are iteratively grown by combining smaller regions or pixels. In doing so, the segmented NDVI map can be generated. By comparing the areas of the merged classes in different years, the changes occurring in the rural communities of Taiwan can be detected. The satellite imagery of FORMOSA-2 with 2-m ground resolution is employed to evaluate the performance of the proposed approach. The satellite imagery of two rural communities (Jhumen and Taomi communities) is chosen to evaluate environmental changes between 2005 and 2010. The change maps of 2005-2010 show that a high density of green on a patch of land is increased by 19.62 ha in Jhumen community and conversely a similar patch of land is significantly decreased by 236.59 ha in Taomi community. Furthermore, the change maps created by another image segmentation method called statistical region merging generate similar processed results to multiphase segmentation.

Prevalence of Arthritis in Africa: A Systematic Review and Meta-Analysis

PubMed Central

Usenbo, Anthony; Kramer, Veronika; Young, Taryn; Musekiwa, Alfred

2015-01-01

Objective In this systematic review, we estimate the prevalence of six types of arthritis in Africa; namely rheumatoid arthritis, osteoarthritis, juvenile arthritis, psoriatic arthritis, gout, and ankylosing spondylitis. Methods We comprehensively searched literature on 31 August 2014 in MEDLINE, EMBASE, Web of Science and the Cochrane Library to identify eligible studies from 1975 up to 31 July 2014. Two review authors independently selected studies, extracted data, and appraised studies. We carried out random effects meta-analysis of prevalence of arthritis and assessed heterogeneity through subgroup analyses. We performed separate analyses for population- and hospital-based studies, as well as rural and urban settings. Main Findings We included 27 cross-sectional studies (20 population-based and 7 hospital-based) from Africa reporting on the prevalence of arthritis. The majority of the studies were from South Africa (44.4%, 12/27). Rheumatoid arthritis in urban settings ranged from 0.1% in Algeria, 0.6% in the DRC, to a meta-analysis overall prevalence of 2.5% in South Africa, and in rural settings ranged from a meta-analysis overall prevalence of 0.07% in South Africa, 0.3% in Egypt, to 0.4% in Lesotho. Osteoarthritis was the most prevalent form of arthritis and in urban settings it was 55.1% in South Africa and in rural settings, all in South Africa, ranged from 29.5%, 29.7%, up to 82.7% among adults aged over 65 years. Other results include highest prevalence of 33.1% for knee osteoarthritis in rural South Africa, 0.1% for ankylosing spondylitis in rural South Africa, 4.4% for psoriatic arthritis in urban South Africa, 0.7% for gout in urban South Africa, and 0.3% for juvenile idiopathic arthritis in urban Egypt. A third of the included studies had a low risk of bias (33.3%, 9/27), 40.8% (11/27) moderate risk, and 25.9% (7/27) had a high risk of bias. Conclusions In this systematic review, we have identified the paucity of latest prevalence data on arthritis in Africa. More studies are needed to address the prevalence and the true burden of this disease in Africa. PMID:26241756

Ice and the outback: Patterns and prevalence of methamphetamine use in rural Australia.

PubMed

Roche, Ann; McEntee, Alice

2017-08-01

This study investigated whether lifetime and recent methamphetamine use (including crystal methamphetamine) differed among city, regional and rural residents and whether particular subpopulations were more at-risk. Secondary analyses of the last three National Drug Strategy Household Surveys and corresponding Alcohol and Other Drug Treatment Services National Minimum Data Sets (AODTS NMDS). Australian general population. Australians who completed the 2007 (n = 22 519), 2010 (n = 25 786) and 2013 (n = 23 512) NDSHS (aged 14 + ); and treatment episodes where the principal drug of concern was recorded in the 2006/2007 (n = 139 808), 2009/2010 (n = 139 608) and 2012/2013 (n = 154 489) AODTS NMDS. To determine whether rural Australians were more likely to use methamphetamine than non-rural counterparts. Lifetime and recent methamphetamine and recent crystal methamphetamine use were significantly higher among rural than other Australians. Significantly more rural men and employed rural Australians used methamphetamine than their city, regional or Australian counterparts. Rural Australians aged 18-24 and 25-29 years were significantly more likely to have used methamphetamine in their lifetime than city or Australian residents. Rural Australians aged 18-24 years were significantly more likely to have recently used crystal methamphetamine. Interventions tailored to address the specific and unique circumstances of rural settings are required to reduce and prevent methamphetamine use, particularly crystal methamphetamine. Scope exists to focus prevention efforts on rural workplaces and primary care settings. Greater understanding of the higher prevalence of methamphetamine use in rural areas is required, plus implementation of comprehensive strategies and optimised treatment utilisation. © 2016 National Rural Health Alliance Inc.

Developing a research agenda for cardiovascular disease prevention in high-risk rural communities.

PubMed

Melvin, Cathy L; Corbie-Smith, Giselle; Kumanyika, Shiriki K; Pratt, Charlotte A; Nelson, Cheryl; Walker, Evelyn R; Ammerman, Alice; Ayala, Guadalupe X; Best, Lyle G; Cherrington, Andrea L; Economos, Christina D; Green, Lawrence W; Harman, Jane; Hooker, Steven P; Murray, David M; Perri, Michael G; Ricketts, Thomas C

2013-06-01

The National Institutes of Health convened a workshop to engage researchers and practitioners in dialogue on research issues viewed as either unique or of particular relevance to rural areas, key content areas needed to inform policy and practice in rural settings, and ways rural contexts may influence study design, implementation, assessment of outcomes, and dissemination. Our purpose was to develop a research agenda to address the disproportionate burden of cardiovascular disease (CVD) and related risk factors among populations living in rural areas. Complementary presentations used theoretical and methodological principles to describe research and practice examples from rural settings. Participants created a comprehensive CVD research agenda that identified themes and challenges, and provided 21 recommendations to guide research, practice, and programs in rural areas.

Developing a Research Agenda for Cardiovascular Disease Prevention in High-Risk Rural Communities

PubMed Central

Corbie-Smith, Giselle; Kumanyika, Shiriki K.; Pratt, Charlotte A.; Nelson, Cheryl; Walker, Evelyn R.; Ammerman, Alice; Ayala, Guadalupe X.; Best, Lyle G.; Cherrington, Andrea L.; Economos, Christina D.; Green, Lawrence W.; Harman, Jane; Hooker, Steven P.; Murray, David M.; Perri, Michael G.; Ricketts, Thomas C.

2013-01-01

The National Institutes of Health convened a workshop to engage researchers and practitioners in dialogue on research issues viewed as either unique or of particular relevance to rural areas, key content areas needed to inform policy and practice in rural settings, and ways rural contexts may influence study design, implementation, assessment of outcomes, and dissemination. Our purpose was to develop a research agenda to address the disproportionate burden of cardiovascular disease (CVD) and related risk factors among populations living in rural areas. Complementary presentations used theoretical and methodological principles to describe research and practice examples from rural settings. Participants created a comprehensive CVD research agenda that identified themes and challenges, and provided 21 recommendations to guide research, practice, and programs in rural areas. PMID:23597371

The provision of neuropsychological services in rural/regional settings: professional and ethical issues.

PubMed

Allott, Kelly; Lloyd, Susan

2009-07-01

Despite rapid growth of the discipline of clinical neuropsychology during recent times, there is limited information regarding the identification and management of professional and ethical issues associated with the practice of neuropsychology within rural settings. The aim of this article is to outline the characteristics unique to practicing neuropsychology in rural communities and to describe the potential professional and ethical dilemmas that might arise. Issues are illustrated using examples from neuropsychological practice in a rural/regional setting in Victoria, Australia. Relative to urban regions, there is an inequality in the distribution of psychologists, including neuropsychologists, in rural areas. The unique characteristics of rural and regional communities that impact on neuropsychological practice are: 1) limited resources in expertise, technology, and community services, 2) greater travel distances and costs, 3) professional isolation, and 4) beliefs about psychological services. These characteristics lower the threshold for particular ethical issues. The ethical issues that require anticipation and careful management include: 1) professional competence, 2) multiple relationships, and 3) confidentiality. Through increased awareness and management of rural-specific professional and ethical issues, rural neuropsychologists can experience their work as rewarding and enjoyable. Specific guidelines for identifying, managing, and resolving ethically and professionally challenging situations that may arise during rural practice are provided.

Consumers’ experiences of back pain in rural Western Australia: access to information and services, and self-management behaviours

PubMed Central

2012-01-01

Background Coordinated, interdisciplinary services, supported by self-management underpin effective management for chronic low back pain (CLBP). However, a combination of system, provider and consumer-based barriers exist which limit the implementation of such models into practice, particularly in rural areas where unique access issues exist. In order to improve health service delivery for consumers with CLBP, policymakers and service providers require a more in depth understanding of these issues. The objective of this qualitative study was to explore barriers experienced by consumers in rural settings in Western Australia (WA) to accessing information and services and implementing effective self-management behaviours for CLBP. Methods Fourteen consumers with a history of CLBP from three rural sites in WA participated. Maximum variation sampling was employed to ensure a range of experiences were captured. An interviewer, blinded to quantitative pain history data, conducted semi-structured telephone interviews using a standardised schedule to explore individuals’ access to information and services for CLBP, and self-management behaviours. Interviews were digitally recorded and transcribed verbatim. Inductive analysis techniques were used to derive and refine key themes. Results Five key themes were identified that affected individuals’ experiences of managing CLBP in a rural setting, including: 1) poor access to information and services in rural settings; 2) inadequate knowledge and skills among local practitioners; 3) feelings of isolation and frustration; 4) psychological burden associated with CLBP; and 5) competing lifestyle demands hindering effective self-management for CLBP. Conclusions Consumers in rural WA experienced difficulties in knowing where to access relevant information for CLBP and expressed frustration with the lack of service delivery options to access interdisciplinary and specialist services for CLBP. Competing lifestyle demands such as work and family commitments were cited as key barriers to adopting regular self-management practices. Consumer expectations for improved health service coordination and a workforce skilled in pain management are relevant to future service planning, particularly in the contexts of workforce capacity, community health services, and enablers to effective service delivery in primary care. PMID:23057669

Contribution of military psychology in supporting those in rural and remote work environments.

PubMed

Deans, Carolyn L; Little, Emma L

2016-01-01

This article explores the relevance of the body of military psychology knowledge to the management and support of those living and working in rural/remote industries and locations, particularly within Australia. For those who live and work in rural/remote settings, there are social, occupational, health and environmental challenges. Some of these are shared with families and individuals who are associated with military life. The published literature on the shared attributes between military and rural/remote work environments rarely makes a direct link. However, looking at both areas suggests opportunities for the application of psychological knowledge in the well-developed field of military psychology to the rural/remote setting. This article focuses on application of psychological knowledge in the areas of occupational performance, fatigue, mental health, family care and in the training of psychologists to work in rural/remote areas. The cross-pollination of knowledge between those working with military personnel and family and those working in rural/remote settings should allow practitioners greater opportunities to improve health and wellbeing outcomes in these communities.

Well water quality in rural Nicaragua using a low-cost bacterial test and microbial source tracking.

PubMed

Weiss, Patricia; Aw, Tiong Gim; Urquhart, Gerald R; Galeano, Miguel Ruiz; Rose, Joan B

2016-04-01

Water-related diseases, particularly diarrhea, are major contributors to morbidity and mortality in developing countries. Monitoring water quality on a global scale is crucial to making progress in terms of population health. Traditional analytical methods are difficult to use in many regions of the world in low-resource settings that face severe water quality issues due to the inaccessibility of laboratories. This study aimed to evaluate a new low-cost method (the compartment bag test (CBT)) in rural Nicaragua. The CBT was used to quantify the presence of Escherichia coli in drinking water wells and aimed to determine the source(s) of any microbial contamination. Results indicate that the CBT is a viable method for use in remote rural regions. The overall quality of well water in Pueblo Nuevo, Nicaragua was deemed unsafe, and results led to the conclusion that animal fecal wastes may be one of the leading causes of well contamination. Elevation and depth of wells were not found to impact overall water quality. However rope-pump wells had a 64.1% reduction in contamination when compared with simple wells.

Complementary and alternative medicine (CAM) use by african american (AA) and caucasian american (CA) older adults in a rural setting: a descriptive, comparative study

PubMed Central

Cuellar, Norma; Aycock, Teresa; Cahill, Bridgett; Ford, Julie

2003-01-01

Background The use of CAM is at an all time high. There is very little research that compares the use of CAM in elders by ethnicity in rural settings. The purpose of the study was to determine if there was a difference between African American and Caucasian American rural elders on use of CAM and self-reported satisfaction with CAM. Methods The design was a descriptive, comparative study of 183 elders who reported the number of CAM used and satisfaction with CAM. A convenience sample was recruited through community service organizations in the state of Mississippi. The availability of elders through the support groups, sampling bias, subject effect, and self-report were limitations of the study. Results The commonest examples of CAM used by rural elders were prayer, vitamins, exercise, meditation, herbs, chiropractic medicine, glucosamine, and music therapy. Significant findings on SES and marital status were calculated. Differences on ethnicity and demographic variables were significant for age, education, and the use of glucosamine. Conclusions Health care providers must be aware that elders are using CAM and are satisfied with their use. Identifying different uses of CAM by ethnicity is important for health care practitioners, impacting how health care is provided. PMID:14622445

Investigating Rural Teachers' Professional Development, Instructional Knowledge, and Classroom Practice

ERIC Educational Resources Information Center

Glover, Todd A.; Nugent, Gwen C.; Chumney, Frances L.; Ihlo, Tanya; Shapiro, Edward S.; Guard, Kirra; Koziol, Natalie; Bovaird, Jim

2016-01-01

Teachers Speak was a national survey study designed to investigate the characteristics of rural elementary school teachers' existing professional development; differences in professional development practices between rural and non-rural settings; and the potential influence of professional development characteristics on rural teachers' knowledge,…

The application of a biometric identification technique for linking community and hospital data in rural Ghana

PubMed Central

Odei-Lartey, Eliezer Ofori; Boateng, Dennis; Danso, Samuel; Kwarteng, Anthony; Abokyi, Livesy; Amenga-Etego, Seeba; Gyaase, Stephaney; Asante, Kwaku Poku; Owusu-Agyei, Seth

2016-01-01

Background The reliability of counts for estimating population dynamics and disease burdens in communities depends on the availability of a common unique identifier for matching general population data with health facility data. Biometric data has been explored as a feasible common identifier between the health data and sociocultural data of resident members in rural communities within the Kintampo Health and Demographic Surveillance System located in the central part of Ghana. Objective Our goal was to assess the feasibility of using fingerprint identification to link community data and hospital data in a rural African setting. Design A combination of biometrics and other personal identification techniques were used to identify individual's resident within a surveillance population seeking care in two district hospitals. Visits from resident individuals were successfully recorded and categorized by the success of the techniques applied during identification. The successes of visits that involved identification by fingerprint were further examined by age. Results A total of 27,662 hospital visits were linked to resident individuals. Over 85% of those visits were successfully identified using at least one identification method. Over 65% were successfully identified and linked using their fingerprints. Supervisory support from the hospital administration was critical in integrating this identification system into its routine activities. No concerns were expressed by community members about the fingerprint registration and identification processes. Conclusions Fingerprint identification should be combined with other methods to be feasible in identifying community members in African rural settings. This can be enhanced in communities with some basic Demographic Surveillance System or census information. PMID:26993473

The application of a biometric identification technique for linking community and hospital data in rural Ghana.

PubMed

Odei-Lartey, Eliezer Ofori; Boateng, Dennis; Danso, Samuel; Kwarteng, Anthony; Abokyi, Livesy; Amenga-Etego, Seeba; Gyaase, Stephaney; Asante, Kwaku Poku; Owusu-Agyei, Seth

2016-01-01

The reliability of counts for estimating population dynamics and disease burdens in communities depends on the availability of a common unique identifier for matching general population data with health facility data. Biometric data has been explored as a feasible common identifier between the health data and sociocultural data of resident members in rural communities within the Kintampo Health and Demographic Surveillance System located in the central part of Ghana. Our goal was to assess the feasibility of using fingerprint identification to link community data and hospital data in a rural African setting. A combination of biometrics and other personal identification techniques were used to identify individual's resident within a surveillance population seeking care in two district hospitals. Visits from resident individuals were successfully recorded and categorized by the success of the techniques applied during identification. The successes of visits that involved identification by fingerprint were further examined by age. A total of 27,662 hospital visits were linked to resident individuals. Over 85% of those visits were successfully identified using at least one identification method. Over 65% were successfully identified and linked using their fingerprints. Supervisory support from the hospital administration was critical in integrating this identification system into its routine activities. No concerns were expressed by community members about the fingerprint registration and identification processes. Fingerprint identification should be combined with other methods to be feasible in identifying community members in African rural settings. This can be enhanced in communities with some basic Demographic Surveillance System or census information.

Rural Active Living: A Call to Action.

PubMed

Umstattd Meyer, M Renée; Moore, Justin B; Abildso, Christiaan; Edwards, Michael B; Gamble, Abigail; Baskin, Monica L

2016-01-01

Rural residents are less physically active than their urban counterparts and disproportionately affected by chronic diseases and conditions associated with insufficient activity. While the ecological model has been successful in promoting and translating active living research in urban settings, relatively little research has been conducted in rural settings. The resulting research gap prohibits a comprehensive understanding and application of solutions for active living in rural America. Therefore, the purpose of this article was to assess the evidence base for an ecological model of active living for rural populations and outline key scientific gaps that inhibit the development and application of solutions. Specifically, we reexamined the 4 domains conceptualized by the model and suggest that there is a dearth of research specific to rural communities across all areas of the framework. Considering the limited rural-specific efforts, we propose areas that need addressing to mobilize rural active living researchers and practitioners into action.

Rural Active Living: A Call to Action

PubMed Central

Meyer, M. Renée Umstattd; Moore, Justin B.; Abildso, Christiaan; Edwards, Michael B.; Gamble, Abigail; Baskin, Monica L.

2015-01-01

Rural residents are less physically active than their urban counterparts and disproportionately affected by chronic diseases and conditions associated with insufficient activity. While the ecological model has been successful in promoting and translating active living research in urban settings, relatively little research has been conducted in rural settings. The resulting research gap prohibits a comprehensive understanding and application of solutions for active living in rural America. Therefore, the purpose of this paper was to assess the evidence-base for an ecological model of active living for rural populations and outline key scientific gaps that inhibit the development and application of solutions. Specifically, we reexamined the four domains conceptualized by the model and suggest there is a dearth of research specific to rural communities across all areas of the framework. Considering the limited rural-specific efforts, we propose areas that need addressing in order to mobilize rural active living researchers and practitioners into action. PMID:26327514

Influence of Risk and Community Setting on Kindergarten Children's Development. R2Ed Working Paper 2015-2

ERIC Educational Resources Information Center

Holmes, Shannon R.; Sheridan, Susan M.; Witte, Amanda L.; Bhatia, Sonya A.; Coutts, Michael J.

2015-01-01

This study examined differences in kindergarten children's behavioral functioning across rural and non-rural communities, as well as explored the effect of risk in each setting (i.e., rural, nonrural) on these children's behavior. Data from 116 kindergarten students and their parents and teachers was analyzed. Multileveling modeling was used to…

Doing More with Less: Innovative Program Building in ABA and Special Education in a Rural Setting

ERIC Educational Resources Information Center

Bethune, Keri S.; Kiser, Ansley

2017-01-01

There is a need for both special education teachers and Board Certified Behavior Analysts (BCBAs) who are trained to work in rural school settings with students with disabilities and problem behaviors. The specific challenges presented by rural communities, such as diminished access to resources and fewer community partners, can make it difficult…

Does Context Matter? An Analysis of Training in Multicultural Assessment, Consultation, and Intervention between School Psychologists in Urban and Rural Contexts

ERIC Educational Resources Information Center

Newell, Markeda; Looser, Joshua

2018-01-01

The purpose of this study was to analyze the extent of training in multicultural assessment, intervention, and consultation of school psychologists in urban and rural contexts. Although there is greater cultural and sociodemographic diversity in urban settings as compared to rural settings, it is unknown whether school psychologists in urban…

Programa de Fortalecimiento de Capacidades: Reflections on a Case Study of Community-Based Teacher Education Set in Rural Northern Peru

ERIC Educational Resources Information Center

Alsop, Steve; Ames, Patricia; Arroyo, Graciela Cordero; Dippo, Don

2010-01-01

This article explores distinctive features of a 5-year international education development project set in rural northern Peru (PROMEB, the "Proyecto de Mejoramiento de la Educacion Basica"). Grounded within a partnership between teacher educators from Peru, Mexico and Canada, and rural Peruvian teachers, students and their communities,…

Rural and Urban/Suburban Families' Use of a Web-Based Mental Health Intervention

PubMed Central

Davidson, Tatiana M.; Dewey, Daniel; Price, Matthew; Ruggiero, Kenneth J.

2017-01-01

Abstract Background/Introduction: Access to mental healthcare among rural residents is a national concern because unique barriers (e.g., fewer providers, distance to services) create significant challenges for the 60 million Americans who live in these settings. There is now a large body of literature demonstrating the efficacy of a wide range of Internet-based interventions. However, little is known about the extent to which individuals in rural settings will use these approaches and find them acceptable. Research with youths and their caregivers within this scope is particularly limited and, therefore, of great importance. Methods: We examined access and completion of a Web-based disaster mental health intervention in a population-based sample of 1,997 rural (n = 676) and urban/suburban (n = 1,321) adolescents and their caregivers who were affected by the Spring 2011 tornadoes that touched down in parts of Missouri and Alabama. Results: Results indicated no differences in the rate of access or completion of Web-based modules based on geographical location. Furthermore, for those who did not access the Web-based resource, no differences were observed with respect to reasons for not accessing modules based on geographical location. Discussion: These data have promising implications for the reach of Web-based resources to both rural and urban/suburban communities, as well as the willingness of adolescents and their caregivers to access and complete such resources, regardless of geographical location. PMID:27753542

[Human rights violations among people with mental illness; rural vs. urban comparison].

PubMed

Poreddi, Vijayalakshmi; Ramachandra; Nagarajaiah; Konduru, Reddemma; Badamath, Suresh

2013-01-01

Human rights violations are commonly reported against people with mental illness and have remained a major research issue in recent times. The present study was aimed to compare psychiatric patients' perceptions of human rights needs between rural and urban settings. A descriptive study design was carried out among 100 recovered psychiatric patients based on the Clinical Global Impression-Improvement Scale (CGI-I scale), at a tertiary care center. Participants were selected through a random sampling method. Data was collected through face to face interviews, using a structured questionnaire. Data was analyzed and interpreted using descriptive and inferential statistics. The present study highlighted the significant differences in meeting their basic human rights needs in a physical needs dimension i.e. availability of hot water for bathing (c2=8.305, p<0.40) and provision of clean clothes to wear (c2=8.229, p<0.42) were rated higher in rural participants than participants from those in an urban setting. Similarly, in the ethical needs dimension, merely 13% of the rural participants reported that they never/rarely experienced sexual advances by family members (c2=9.949, p> .019). Our findings revealed that human rights violations among mentally ill are evident across rural and urban environments. Thus, there is an urgent need to change the attitude of the general population towards people with mental illness through awareness campaign. In addition, educating the public about the human rights of mentally ill is also essential.

Does proximity of women to facilities with better choice of contraceptives affect their contraceptive utilization in rural Ethiopia?

PubMed Central

Spigt, Mark; Seme, Assefa; Amogne, Ayanaw; Skrøvseth, Stein; Desta, Selamawit; Radloff, Scott; GeertJan, Dinant

2017-01-01

Background There is limited evidence of the linkage between contraceptive use, the range of methods available and level of contraceptive stocks at health facilities and distance to facility in developing countries. The present analysis aims at examining the influence of contraceptive method availability and distance to the nearby facilities on modern contraceptive utilization among married women in rural areas in Ethiopia using geo-referenced data. Methods We used data from the first round of surveys of the Performance Monitoring & Accountability 2020 project in Ethiopia (PMA2020/Ethiopia-2014). The survey was conducted in a sample of 200 enumeration areas (EAs) where for each EA, 35 households and up to 3 public or private health service delivery points (SDPs) were selected. The main outcome variable was individual use of a contraceptive method for married women in rural Ethiopia. Correlates of interest include distance to nearby health facilities, range of contraceptives available in facilities, household wealth index, and the woman’s educational status, age, and parity and whether she recently visited a health facility. This analysis primarily focuses on stock provision at public SDPs. Results Overall complete information was collected from 1763 married rural women ages 15–49 years and 198 SDPs in rural areas (97.1% public). Most rural women (93.9%) live within 5 kilometers of their nearest health post while a much lower proportion (52.2%) live within the same distance to the nearest health centers and hospital (0.8%), respectively. The main sources of modern contraceptive methods for married rural women were health posts (48.8%) and health centers (39.0%). The mean number of the types of contraceptive methods offered by hospitals, health centers and health posts was 6.2, 5.4 and 3.7 respectively. Modern contraceptive use (mCPR) among rural married women was 27.3% (95% CI: 25.3, 29.5). The percentage of rural married women who use modern contraceptives decreased as distance from the nearest SDP increased; 41.2%, 27.5%, 22.0%, and 22.6% of women living less than 2 kilometers, 2 to 3.9kilometers, 4 to 5.9 kilometers and 6 or more kilometers, respectively (p-value<0.01). Additionally, women who live close to facilities that offer a wider range of contraceptive methods were significantly more likely to use modern contraceptives. The mCPR ranged from 42.3% among women who live within 2 kilometers of facilities offering 3 or more methods to 22.5% among women living more than 6 kilometers away from the nearest facility with the same number (3 or more methods) available after adjusting for observed covariates. Conclusions Although the majority of the Ethiopian population lives within a relatively close distance to lower level facilities (health posts), the number and range of methods available (method choice) and proximity are independently associated with contraceptive utilization. By demonstrating the extent to which objective measures of distance (of relatively small magnitude) explain variation in contraceptive use among rural women, the study fills an important planning gap for family planning programs operating in resource limited settings. PMID:29131860

Nonlinear Differential Equations and Feedback Control Design for the Urban-Rural Resident Pension Insurance in China

NASA Astrophysics Data System (ADS)

Wang, Lijian

2015-12-01

Facing many problems of the urban-rural resident pension insurance system in China, one should firstly make sure that this system can be optimized. This paper, based on the modern control theory, sets up differential equations as models to describe the urban-rural resident pension insurance system, and discusses the globally asymptotic stability in the sense of Liapunov for the urban-rural resident pension insurance system in the new equilibrium point. This research sets the stage for our further discussion, and it is theoretically important and convenient for optimizing the urban-rural resident pension insurance system.

Rural Women Family Physicians: Strategies for Successful Work-Life Balance

PubMed Central

Phillips, Julie; Hustedde, Carol; Bjorkman, Sarah; Prasad, Rupa; Sola, Orlando; Wendling, Andrea; Bjorkman, Kurt; Paladine, Heather

2016-01-01

PURPOSE Women family physicians experience challenges in maintaining work-life balance while practicing in rural communities. We sought to better understand the personal and professional strategies that enable women in rural family medicine to balance work and personal demands and achieve long-term career satisfaction. METHODS Women family physicians practicing in rural communities in the United States were interviewed using a semistructured format. Interviews were recorded, professionally transcribed, and analyzed using an immersion and crystallization approach, followed by detailed coding of emergent themes. RESULTS The 25 participants described a set of strategies that facilitated successful work-life balance. First, they used reduced or flexible work hours to help achieve balance with personal roles. Second, many had supportive relationships with spouses and partners, parents, or other members of the community, which facilitated their ability to be readily available to their patients. Third, participants maintained clear boundaries around their work lives, which helped them to have adequate time for parenting, recreation, and rest. CONCLUSIONS Women family physicians can build successful careers in rural communities, but supportive employers, relationships, and patient approaches provide a foundation for this success. Educators, employers, communities, and policymakers can adapt their practices to help women family physicians thrive in rural communities. PMID:27184995

Neighbourhood-level socio-environmental factors and incidence of first episode psychosis by place at onset in rural Ireland: The Cavan–Monaghan First Episode Psychosis Study [CAMFEPS]☆

PubMed Central

Omer, Sami; Kirkbride, James B.; Pringle, Dennis G.; Russell, Vincent; O'Callaghan, Eadbhard; Waddington, John L.

2014-01-01

Background Little is known about associations between the social environment and risk for psychosis within rural settings. This study sought to investigate whether such associations exist within a rural context using a prospective dataset of unusual epidemiological completeness. Method Using the Cavan–Monaghan First Episode Psychosis Study database of people aged 16 years and older, both ecological analyses and multilevel modelling were applied to investigate associations between incidence of psychosis by place at onset and socio-environmental risk factors of material deprivation, social fragmentation and urban–rural classification across electoral divisions. Results The primary finding was an association between more deprived social contexts and higher rates of psychotic disorder, after adjustment for age and sex [all psychoses: incidence rate ratio (IRR) = 1.12, 95% CI (1.03–1.23)]. Conclusions These findings support an association between adverse socio-environmental factors and increase in risk for psychosis by place at onset within a predominantly rural environment. This study suggests that social environmental characteristics may have an impact on risk across the urban–rural gradient. PMID:24342585

Rural jail telepsychiatry: a pilot feasibility study.

PubMed

Manfredi, Luisa; Shupe, Joann; Batki, Steven L

2005-10-01

New York State has a large rural population, and many of the jails in rural areas have minimal or no psychiatric services available on site. Cost of transport to off-site psychiatric services and the safety issues related to moving inmates from a secure building may limit inmate access to appropriate psychiatric services. This feasibility study describes a project that provided telepsychiatric consultation to increase access to psychiatric treatment in an underserved rural jail in upstate New York. Subjects were consenting jail inmates who requested or were found to be in need of psychiatric care. The project provided interactive two-way audio-video communication between the psychiatrist located in an urban university medical center and subjects who were incarcerated 182 miles away. During the project period, 15 inmates were assessed and treated in 37 consultations. Subjects were predominantly young white males with anxiety, mood, and substance use disorders. Services were readily accepted by inmates and staff. Telepsychiatric examination and treatment appears to be a feasible method to increase access to mental health care in rural jails. Future advocacy for increased mental health services in rural areas in criminal justice setting is likely to depend on further evidence of favorable cost benefit.

Strengthening training in rural practice in Germany: new approach for undergraduate medical curriculum towards sustaining rural health care.

PubMed

Holst, Jens; Normann, Oliver; Herrmann, Markus

2015-01-01

After decades of providing a dense network of quality medical care, Germany is facing an increasing shortage of medical doctors in rural areas. Current graduation rates of generalists do not counterbalance the loss due to retirement. Informed by international evidence, different strategies to ensure rural medical care are under debate, including innovative teaching approaches during undergraduate training. The University of Magdeburg in Saxony-Anhalt was the first medical school in Germany to offer a rural elective for graduate students. During the 2014 summer semester, 14 medical students attended a two-weekend program in a small village in Northern Saxony-Anhalt that allowed them to become more familiar with a rural community and rural health issues. The elective course raised a series of relevant topics for setting up rural practice and provided students with helpful insight into living and working conditions in rural practice. Preliminary evaluations indicate that the rural medicine course allowed medical students to reduce pre-existing concerns and had positive impact on their willingness to set up a rural medical office after graduation. Even short-term courses in rural practice can help reduce training-related barriers that prevent young physicians from working in rural areas. Undergraduate medical training is promising to attenuate the emerging undersupply in rural areas.

Implementing and Evaluating Environmental and Policy Interventions for Promoting Physical Activity in Rural Schools

ERIC Educational Resources Information Center

Baker, Elizabeth A.; Elliott, Michael; Barnidge, Ellen; Estlund, Amy; Brownson, Ross C.; Milne, Anne; Kershaw, Freda; Hashimoto, Derek

2017-01-01

Background: Schools are an important setting for improving behaviors associated with obesity, including physical activity. However, within schools there is often a tension between spending time on activities promoting academic achievement and those promoting physical activity. Methods: A community-based intervention provided administrators and…

The buck stops here: midwives and maternity care in rural Scotland.

PubMed

Harris, Fiona M; van Teijlingen, Edwin; Hundley, Vanora; Farmer, Jane; Bryers, Helen; Caldow, Jan; Ireland, Jillian; Kiger, Alice; Tucker, Janet

2011-06-01

To explore and understand what it means to provide midwifery care in remote and rural Scotland. Qualitative interviews with 72 staff from 10 maternity units, analysed via a case study approach. Remote and rural areas of Scotland. Predominantly midwives, with some additional interviews with paramedics, general surgeons, anaesthetists and GPs. Remote and rural maternity care includes a range of settings and models of care. However, the impact of rural geographies on decision-making and risk assessment is common to all settings. Making decisions and dealing with the implications of these decisions is, in many cases, done without onsite specialist support. This has implications for the skills and competencies that are needed to practice midwifery in remote and rural settings. Whereas most rural midwives reported that their skills in risk assessment and decisions to transfer were well developed and appropriate to practising in their particular settings, they perceived these decisions to be under scrutiny by urban-based colleagues and felt the need to stress their competence in the face of what they imagined to be stereotypes of rural incompetence. This study shows that skills in risk assessment and decision-making are central to high quality remote and rural midwifery care. However, linked to different perspectives on care, there is a risk that these skills can be undermined by contact with colleagues in large urban units, particularly when staff do not know each other well. There is a need to develop a professional understanding between midwives in different locations. It is important for the good working relationships between urban and rural maternity units that all midwives understand the importance of contextual knowledge in both decisions to transfer from rural locations and the position of midwives in receiving units. Multiprofessional CPD courses have been effective in bringing together teams around obstetric emergencies; we suggest that a similar format may be required in considering issues of transfer. Copyright © 2010 Elsevier Ltd. All rights reserved.

Examining the Specific Effects of Context on Adaptive Behavior and Achievement in a Rural African Community: Six Case Studies from Rural Areas of Southern Province, Zambia

ERIC Educational Resources Information Center

Tan, Mei; Reich, Jodi; Hart, Lesley; Thuma, Philip E.; Grigorenko, Elena L.

2014-01-01

Generally accepted as universal, the construct of adaptive behavior differs in its manifestations across different cultures and settings. The Vineland-II (Sparrow et al. in "Vineland Adaptive Behavior Scales, Second edn." AGS Publishing, Circle Pines, MN, 2005) was translated into Chitonga and adapted to the setting of rural Southern…

What do medical residents learn on a rural Japanese island?

PubMed Central

Ohta, Ryuichi; Son, Daisuke

2018-01-01

Objective: Community-based medical education (CBME) serves as a complement to university medical education, and it is practiced in several urban undergraduate and postgraduate curriculums. However, there are few reports on CBME learning content in rural Japanese settings. Materials and Methods: This research aimed to clarify learning content through semi-structured interviews and qualitative analysis of second-year residents who studied on a remote, rural island located 400 km from the mainland of Okinawa, Japan. Analysis was based on Steps for Coding and Theorization (SCAT). Results: Fifteen concepts were extracted, and four categories were generated: a strong connection among the islanders, the necessary abilities for rural physicians, islander-centered care, and the differences between rural and hospital medicine. In contrast to hospital medicine, various kinds of learning occurred in deep relationships with the islanders. Conclusion: Through CBME on a remote island, the residents learned not only about medical aspects, but also the importance of community health through the social and cultural aspects, whole-person medical care in a remote location, and the importance of reflection in their self-directed learning. PMID:29875892

Technology use by rural and urban oldest old

PubMed Central

Calvert, James F.; Kaye, Jeffrey; Leahy, Marjorie; Hexem, Kari; Carlson, Nichole

2010-01-01

Objectives Technologies designed to optimally maintain older people as they age in their desired places of residence are proliferating. An important step in designing and deploying such technologies is to determine the current use and familiarity with technology in general among older people. The goal of this study was to determine the extent that community-dwelling elderly at highest risk of losing independence, the oldest old, use common electronic devices found in residential urban or rural settings. Methods We surveyed 306 nondemented elderly age 85 or over; 144 were part of a rural aging study, the Klamath Exceptional Aging Project, and 181 were from an urban aging cohort in Portland. Results The most frequently used devices were televisions, microwave ovens, and answering machines. Persons with mild cognitive impairment were less likely to use all devices than those with no impairment. Higher socioeconomic status and education were associated with use of more complicated devices. Urban respondents were more likely than rural ones to use most devices. Conclusion Technology use by very old community-dwelling elderly is common. There are significant differences in use between rural and urban elderly. PMID:19478400

The rural community care gerontologic nurse entrepreneur: role development strategies.

PubMed

Caffrey, Rosalie A

2005-10-01

Rural elderly individuals are an underserved population with limited access to health care. There is an increasing need for independent community care nurses to provide assistance to home-based elderly individuals with chronic illnesses to prevent unnecessary medical and placement decisions and, thus, allow them to maintain independence and quality of life. This article describes the rural setting and why community care nurses are needed, and explores strategies for implementing the role of the independent nurse entrepreneur in caring for community-based elderly individuals in rural settings.

Does proximity of women to facilities with better choice of contraceptives affect their contraceptive utilization in rural Ethiopia?

PubMed

Shiferaw, Solomon; Spigt, Mark; Seme, Assefa; Amogne, Ayanaw; Skrøvseth, Stein; Desta, Selamawit; Radloff, Scott; Tsui, Amy; GeertJan, Dinant

2017-01-01

There is limited evidence of the linkage between contraceptive use, the range of methods available and level of contraceptive stocks at health facilities and distance to facility in developing countries. The present analysis aims at examining the influence of contraceptive method availability and distance to the nearby facilities on modern contraceptive utilization among married women in rural areas in Ethiopia using geo-referenced data. We used data from the first round of surveys of the Performance Monitoring & Accountability 2020 project in Ethiopia (PMA2020/Ethiopia-2014). The survey was conducted in a sample of 200 enumeration areas (EAs) where for each EA, 35 households and up to 3 public or private health service delivery points (SDPs) were selected. The main outcome variable was individual use of a contraceptive method for married women in rural Ethiopia. Correlates of interest include distance to nearby health facilities, range of contraceptives available in facilities, household wealth index, and the woman's educational status, age, and parity and whether she recently visited a health facility. This analysis primarily focuses on stock provision at public SDPs. Overall complete information was collected from 1763 married rural women ages 15-49 years and 198 SDPs in rural areas (97.1% public). Most rural women (93.9%) live within 5 kilometers of their nearest health post while a much lower proportion (52.2%) live within the same distance to the nearest health centers and hospital (0.8%), respectively. The main sources of modern contraceptive methods for married rural women were health posts (48.8%) and health centers (39.0%). The mean number of the types of contraceptive methods offered by hospitals, health centers and health posts was 6.2, 5.4 and 3.7 respectively. Modern contraceptive use (mCPR) among rural married women was 27.3% (95% CI: 25.3, 29.5). The percentage of rural married women who use modern contraceptives decreased as distance from the nearest SDP increased; 41.2%, 27.5%, 22.0%, and 22.6% of women living less than 2 kilometers, 2 to 3.9kilometers, 4 to 5.9 kilometers and 6 or more kilometers, respectively (p-value<0.01). Additionally, women who live close to facilities that offer a wider range of contraceptive methods were significantly more likely to use modern contraceptives. The mCPR ranged from 42.3% among women who live within 2 kilometers of facilities offering 3 or more methods to 22.5% among women living more than 6 kilometers away from the nearest facility with the same number (3 or more methods) available after adjusting for observed covariates. Although the majority of the Ethiopian population lives within a relatively close distance to lower level facilities (health posts), the number and range of methods available (method choice) and proximity are independently associated with contraceptive utilization. By demonstrating the extent to which objective measures of distance (of relatively small magnitude) explain variation in contraceptive use among rural women, the study fills an important planning gap for family planning programs operating in resource limited settings.

Establishing and delivering pulmonary rehabilitation in rural and remote settings: The opinions, attitudes and concerns of health care professionals.

PubMed

Johnston, Catherine L; Maxwell, Lyndal J; Alison, Jennifer A

2016-04-01

Pulmonary rehabilitation is recommended for people with chronic lung disease however access remains limited in rural and remote settings. The aim of this project was to explore the perspectives of rural and remote health care professionals regarding the establishment and delivery of pulmonary rehabilitation. Rural (NSW) and remote (NT) Australian healthcare settings. Health care professionals (n = 25) who attended a training program focussing on the delivery of pulmonary rehabilitation. Surveys with open written questions were completed by participants following the training program. Key informants also participated in face-to-face interviews. Thematic analysis was undertaken of data collected on participant opinions, attitudes and concerns regarding the establishment and delivery of pulmonary rehabilitation in their individual situation. Participating health care professionals (predominantly nurses and physiotherapists) identified a number of issues relating to establishing and delivering pulmonary rehabilitation; including staffing, time and case load constraints, patient and community attitudes, lack of professional knowledge and confidence and inability to ensure sustainability. The practicalities of delivering pulmonary rehabilitation, particularly exercise prescription and training, were also important concerns raised. Lack of health care professional staffing, knowledge and confidence were reported to be factors impacting the establishment and delivery of pulmonary rehabilitation. This study has facilitated a greater understanding of the issues surrounding the establishment and delivery of pulmonary rehabilitation in rural and remote settings. Further research is required to investigate the contribution of health professional training and associated factors to improving the availability and delivery of pulmonary rehabilitation in rural and remote settings. © 2015 National Rural Health Alliance Inc.

Influence of parental education on Honduran medical students' labour perspectives: rural work and emigration.

PubMed

Zambrano, Lysien I; Pereyra-Elías, Reneé; Reyes-García, Selvin Z; Fuentes, Itzel; Mayta-Tristán, Percy

2015-01-01

We sought to evaluate the intentions of Honduran medical students to emigrate or to work in a rural setting, and their association with parental education. We performed a cross-sectional, analytic study at a Honduran medical school. Student participants completed a structured questionnaire, which assessed their intentions to emigrate or work in a rural setting after finishing medical school and the highest level of education achieved by their parents. We calculated crude and adjusted prevalence ratios with their respective 95% confidence intervals. Of 868 surveys distributed, 564 were completed. The mean age of the participants was 21 (standard deviation 3) years, and 62.2% were female. Of the respondents, 16.6% intended to emigrate to work and 11.2% intended to work in a rural setting. Higher paternal education (i.e., technical, university and postgraduate training) was associated with a higher rate of intention to emigrate. Students whose fathers underwent postgraduate education were less likely to intend to work in a rural setting. For maternal education, only the postgraduate level was associated with the outcomes in some of the tested models. The frequency of students intending to emigrate was relatively low. However, the frequency of students being willing to work in rural settings was also low. Students whose parents had higher levels of education were more likely to intend to work abroad and less likely to intend to work in a rural area. These factors should be considered in medical schools' selection processes to improve retention and ensure adequate distribution of physicians.

Rural Food and Physical Activity Assessment Using an Electronic Tablet-Based Application, New York, 2013–2014

PubMed Central

Morgan, Emily H.; Connor, Leah M.; Garner, Jennifer A.; King, Abby C.; Sheats, Jylana L.; Winter, Sandra J.; Buman, Matthew P.

2015-01-01

Introduction A community’s built environment can influence health behaviors. Rural populations experience significant health disparities, yet built environment studies in these settings are limited. We used an electronic tablet-based community assessment tool to conduct built environment audits in rural settings. The primary objective of this qualitative study was to evaluate the usefulness of the tool in identifying barriers and facilitators to healthy eating and active living. The second objective was to understand resident perspectives on community features and opportunities for improvement. Methods Participants were recruited from 4 rural communities in New York State. Using the tool, participants completed 2 audits, which consisted of taking pictures and recording audio narratives about community features perceived as assets or barriers to healthy eating and active living. Follow-up focus groups explored the audit experience, data captured, and opportunities for change. Results Twenty-four adults (mean age, 69.4 y [standard deviation, 13.2 y]), 6 per community, participated in the study. The most frequently captured features related to active living were related to roads, sidewalks, and walkable destinations. Restaurants, nontraditional food stores, and supermarkets were identified in the food environment in relation to the cost, quality, and selection of healthy foods available. In general, participants found the assessment tool to be simple and enjoyable to use. Conclusion An electronic tablet–based tool can be used to assess rural food and physical activity environments and may be useful in identifying and prioritizing resident-led change initiatives. This resident-led assessment approach may also be helpful for informing and evaluating rural community-based interventions. PMID:26133645

Measuring the burden of herpes zoster and post herpetic neuralgia within primary care in rural Crete, Greece

PubMed Central

2011-01-01

Background Research has indicated that general practitioners (GPs) have good clinical judgment in regards to diagnosing and managing herpes zoster (HZ) within clinical practice in a country with limited resources for primary care and general practice. The objective of the current study was to assess the burden of HZ and post herpetic neuralgia (PHN) within rural general practices in Crete, Greece. Methods The current study took place within a rural setting in Crete, Greece during the period of November 2007 to November 2009 within the catchment area in which the Cretan Rural Practice-based Research Network is operating. In total 19 GP's from 14 health care units in rural Crete were invited to participate, covering a total turnover patient population of approximately 25, 000 subjects. For the purpose of this study an electronic record database was constructed and used as the main tool for monitoring HZ and PHN incidence. Stress related data was also collected with the use of the Short Anxiety Screening Test (SAST). Results The crude incidence rate of HZ was 1.4/1000 patients/year throughout the entire network of health centers and satellite practices, while among satellite practices alone it was calculated at 1.3/1000 patients/year. Additionally, the standardised incidence density within satellite practices was calculated at 1.6/1000 patients/year. In regards to the stress associated with HZ and PHN, the latter were found to have lower levels of anxiety, as assessed through the SAST score (17.4 ± 3.9 vs. 21.1 ± 5.7; p = 0.029). Conclusions The implementation of an electronic surveillance system was feasible so as to measure the burden of HZ and PHN within the rural general practice setting in Crete. PMID:22145678

Factors associated with intended and effective settlement of nursing students and newly graduated nurses in a rural setting after graduation: a mixed-methods review.

PubMed

Trépanier, Amélie; Gagnon, Marie-Pierre; Mbemba, Gisèle Irène Claudine; Côté, José; Paré, Guy; Fortin, Jean-Paul; Duplàa, Emmanuel; Courcy, François

2013-03-01

To identify factors that influence the initial plan and final decision to choose a rural area as first employment location in final-year nursing students or newly graduated nurses. We conducted a mixed-methods review of the literature, including both published and gray literature, using established criteria. Two reviewers performed data extraction of relevant information independently. We retrieved empirical studies from the following databases: PubMED, Embase, CINAHL (EBSCO), Web of Science (SCI and SSCI), The Cochrane Library, Business Source Premier (EBSCO), ERIC, Proquest and PsychInfo. We also searched for empirical studies in the technical and gray literature and reviewed journals related to rural health. Additionally, we conducted searches in websites such as the Center for Health Workforce Planning and Analysis, as well as Google and Google Scholar search engines. Of the 523 studies thus screened, 15 were included for data extraction. We identified more than 40 factors associated with initial plans and final decision to settle in a rural area among nursing graduates. Only limited literature is currently available on the factors associated with the intention of nursing students or newly graduated nurses of practicing in rural areas and on the relationship between intention and effective behavior. This review highlights the needs for further research in this field. Copyright © 2012 Elsevier Ltd. All rights reserved.

Hospital-based emergency nursing in rural settings.

PubMed

Brown, Jennifer F

2008-01-01

In 2006, the Institute of Medicine (IOM) released a series of reports that highlighted the urgent need for improvements in the nation's emergency health services. This news has provided new energy to a growing body of research about the development and implementation of best practices in emergency care. Despite evidence of geographical disparities in health services, relatively little attention has been focused on rural emergency services to identify environmental differences. The purpose of this chapter is to summarize the contributions of nursing research to the rural emergency services literature. The research resembles a so-called shotgun effect as the exploratory and interventional studies cover a wide range of topics without consistency or justification. Emergency nursing research has been conducted primarily in urban settings, with small samples and insufficient methodological rigor. This chapter will discuss the limitations of the research and set forth an agenda of critical topics that need to be explored related to emergency nursing in rural settings.

Comparing the validity of the payment card and structured haggling willingness to pay methods: The case of a diabetes prevention program in rural Kenya.

PubMed

Kangethe, Anne; Franic, Duska M; Corso, Phaedra S

2016-11-01

The objective of this study was to compare the theoretical validity of two willingness-to-pay (WTP) methods, the commonly used payment card (PC) and the recently developed structured haggling (SH), for estimating the potential benefits of a diabetes prevention program in rural Kenya. A convenience sample of adult residents from a rural county in Kenya (Kiambu), with no history of diabetes, was randomly assigned to one of two WTP methods, PC or SH, using structured face-to-face interviews from December 2011 to February 2012. A total of 376 respondents completed the interviews using PC (n = 185) or SH (n = 191). More than 95% of respondents were willing to pay something for program access. The study showed that both methods were feasible in rural Kenya. SH resulted in a higher annual mean WTP than PC, Ksh504.05 (US$7.25) versus Ksh619.95 (US$5.90), respectively (p < 0.01). Based on theory, it was hypothesized that certain predisposing factors would result in greater WTP. Greater socio-economic status (measured using income proxies) resulted in greater unconditional WTP for both the PC and SH groups (t-tests and bivariate correlations) and conditional WTP (GLM models). GLM for PC showed being male, employed and having distant relatives with diabetes were significant predictors for WTP, while for SH being educated, employed and owning a vehicle were significant predictors. Both PC and SH showed theoretical validity in rural Kenya. However, the use of SH over PC in rural Kenya may be the better choice given that SH more closely mirrors marketplace transactions in this setting and the use of SH resulted in more significant variables in the GLM models. Copyright © 2016 Elsevier Ltd. All rights reserved.

Expanding rural primary care training by employing information technologies: the need for participation by medical reference librarians.

PubMed

Coggan, J M; Crandall, L A

1995-01-01

The use of rural sites to train badly needed primary care providers requires access to sophisticated medical information not traditionally available outside of academic health centers. Medical reference librarians can play a key role in the development of primary care training sites in rural settings. Electronic information technologies, with proactive support from medical reference librarians, can provide current and detailed information without concern for distance from the health science center library. This paper discusses recent developments in technology, describes current challenges to the application of this technology in rural settings, and provides policy recommendations for medical reference librarians to enhance rural primary care training.

Rural-urban disparities in child nutrition in Bangladesh and Nepal.

PubMed

Srinivasan, Chittur S; Zanello, Giacomo; Shankar, Bhavani

2013-06-14

The persistence of rural-urban disparities in child nutrition outcomes in developing countries alongside rapid urbanisation and increasing incidence of child malnutrition in urban areas raises an important health policy question - whether fundamentally different nutrition policies and interventions are required in rural and urban areas. Addressing this question requires an enhanced understanding of the main drivers of rural-urban disparities in child nutrition outcomes especially for the vulnerable segments of the population. This study applies recently developed statistical methods to quantify the contribution of different socio-economic determinants to rural-urban differences in child nutrition outcomes in two South Asian countries - Bangladesh and Nepal. Using DHS data sets for Bangladesh and Nepal, we apply quantile regression-based counterfactual decomposition methods to quantify the contribution of (1) the differences in levels of socio-economic determinants (covariate effects) and (2) the differences in the strength of association between socio-economic determinants and child nutrition outcomes (co-efficient effects) to the observed rural-urban disparities in child HAZ scores. The methodology employed in the study allows the covariate and coefficient effects to vary across entire distribution of child nutrition outcomes. This is particularly useful in providing specific insights into factors influencing rural-urban disparities at the lower tails of child HAZ score distributions. It also helps assess the importance of individual determinants and how they vary across the distribution of HAZ scores. There are no fundamental differences in the characteristics that determine child nutrition outcomes in urban and rural areas. Differences in the levels of a limited number of socio-economic characteristics - maternal education, spouse's education and the wealth index (incorporating household asset ownership and access to drinking water and sanitation) contribute a major share of rural-urban disparities in the lowest quantiles of child nutrition outcomes. Differences in the strength of association between socio-economic characteristics and child nutrition outcomes account for less than a quarter of rural-urban disparities at the lower end of the HAZ score distribution. Public health interventions aimed at overcoming rural-urban disparities in child nutrition outcomes need to focus principally on bridging gaps in socio-economic endowments of rural and urban households and improving the quality of rural infrastructure. Improving child nutrition outcomes in developing countries does not call for fundamentally different approaches to public health interventions in rural and urban areas.

Access to primary health care for acute vascular events in rural low income settings: a mixed methods study.

PubMed

Ahmed, Shyfuddin; Chowdhury, Muhammad Ashique Haider; Khan, Md Alfazal; Huq, Nafisa Lira; Naheed, Aliya

2017-01-18

Cardiovascular diseases (CVDs) are the leading cause of global mortality. Among the CVDs, acute vascular events (AVE) mainly ischemic heart diseases and stroke are the largest contributors. To achieve 25% reduction in preventable deaths from CVDs by 2025, health systems need to be equipped with extended service coverage in order to provide person-centered care. The overall goal of this proposed study is to assess access to health care in-terms of service availability, care seeking patterns and barriers to access care after AVE in rural Bangladesh. We will consider myocardial infarction (MI) and stroke as acute vascular events. We will conduct a mixed methods study in rural Matlab, Bangladesh. This study will comprise of a) health facility survey, b) structured questionnaire interview and c) qualitative study. We will assess service availabilities by creating an inventory of public and private health facilities. Readiness of the facilities to deliver services for AVE will be assessed through a health facility survey using 'service availability and readiness assessment' (SARA) tools of the World Health Organization (WHO). We will interview survivors of AVE and caregivers (present and accompanied the person during the event) of person who died from AVE for exploring patterns of care seeking during an AVE. For exploring barriers to access care for AVE, we will conduct in-depth interview with survivors of AVE and caregivers of the person who died from AVE. We will also conduct key informant interviews with the service providers at primary health care (PHC) facilities and government high level officials at central health administration of Bangladesh. This study will provide a comprehensive picture of access to primary health care services during acute cardiovascular events as stroke & MI in rural context of Bangladesh. It will explore available service facilities in rural area for management, utilization of services and barriers to access care during an acute emergency. This study will help to generate hypothesis, develop programs and policies for better access to care for AVE in similar rural settings considering barriers of access and improving utilization.

Students Setting out to Alleviate "Poverty of Spirit" in Rural China Found Themselves Transformed: Self-Organized Volunteerism among University Students for Rural Development

ERIC Educational Resources Information Center

Geng, Diane

2008-01-01

Most university students in China have their sights firmly set on future job and study opportunities in urban cities and abroad. However, a network of student volunteers felt compelled to join the cause of rural development and villager empowerment, reminiscent of efforts promoted forty years ago by Chairman Mao who sent "educated youth"…

Rural Development: Problems and Advantages of Rural Locations for Industrial Plants.

ERIC Educational Resources Information Center

Bishop, C. E.; And Others

The problems and advantages of locating industry in a rural setting were discussed in this conference report. The 10 individual speeches covered: changes in employment and the labor force; problems and advantages of rural locations, rural labor, and site selection; the importance of involving the Black community; the nature of the food processing…

Better Country: A Strategy for Rural Development in the 1980's.

ERIC Educational Resources Information Center

Department of Agriculture, Washington, DC.

The report of the 25-member National Advisory Council on Rural Development, appointed by the Secretary of Agriculture, defines rural needs and sets forth strategies for rural development in the 1980's. A review of the decade between 1970 and 1980 discusses rapid economic growth of rural areas, social progress, and changes in public service, and…

Rural Schools, Rural Communities: An Alternative View of the Future. Keynote Address.

ERIC Educational Resources Information Center

Nachtigal, Paul M.

The urbanization and industrialization of a society based on commercial competitiveness has resulted in the marginalization of rural communities and the disempowerment of rural people. An alternative view of the future is needed, and rural schools have a part to play in creating it. Four sets of forces are driving society toward a different…

The Biofuels Revolution: Understanding the Social, Cultural and Economic Impacts of Biofuels Development on Rural Communities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Selfa, Theresa L; Goe, Richard; Kulcsar, Laszlo

2013-02-11

The aim of this research was an in-depth analysis of the impacts of biofuels industry and ethanol plants on six rural communities in the Midwestern states of Kansas and Iowa. The goal was to provide a better understanding of the social, cultural, and economic implications of biofuels development, and to contribute to more informed policy development regarding bioenergy.Specific project objectives were: 1. To understand how the growth of biofuel production has affected and will affect Midwestern farmers and rural communities in terms of economic, demographic, and socio-cultural impacts; 2. To determine how state agencies, groundwater management districts, local governments andmore » policy makers evaluate or manage bioenergy development in relation to competing demands for economic growth, diminishing water resources, and social considerations; 3. To determine the factors that influence the water management practices of agricultural producers in Kansas and Iowa (e.g. geographic setting, water management institutions, competing water-use demands as well as producers attitudes, beliefs, and values) and how these influences relate to bioenergy feedstock production and biofuel processing; 4. To determine the relative importance of social-cultural, environmental and/or economic factors in the promotion of biofuels development and expansion in rural communities; The research objectives were met through the completion of six detailed case studies of rural communities that are current or planned locations for ethanol biorefineries. Of the six case studies, two will be conducted on rural communities in Iowa and four will be conducted on rural communities in Kansas. A multi-method or mixed method research methodology was employed for each case study.« less

Paediatric case mix in a rural clinical school is relevant to future practice.

PubMed

Wright, Helen M; Maley, Moira A L; Playford, Denese E; Nicol, Pam; Evans, Sharon F

2017-11-29

Exposure to a representative case mix is essential for clinical learning, with logbooks established as a way of demonstrating patient contacts. Few studies have reported the paediatric case mix available to geographically distributed students within the same medical school. Given international interest in expanding medical teaching locations to rural contexts, equitable case exposure in rural relative to urban settings is topical. The Rural Clinical School of Western Australia locates students up to 3500 km from the urban university for an academic year. There is particular need to examine paediatric case mix as a study reported Australian graduates felt unprepared for paediatric rotations. We asked: Does a rural clinical school provide a paediatric case mix relevant to future practice? How does the paediatric case mix as logged by rural students compare with that by urban students? The 3745 logs of 76 urban and 76 rural consenting medical students were categorised by presenting symptoms and compared to the Australian Institute of Health and Welfare (AIHW) database Major Diagnostic Categories (MDCs). Rural and urban students logged core paediatric cases, in similar order, despite the striking difference in geographic locations. The pattern of overall presenting problems closely corresponded to Australian paediatric hospital admissions. Rural students logged 91% of cases in secondary healthcare settings; urban students logged 90% of cases in tertiary settings. The top four presenting problems were ENT/respiratory, gastrointestinal/urogenital, neurodevelopmental and musculoskeletal; these made up 60% of all cases. Rural and urban students logged similar proportions of infants, children and adolescents, with a variety of case morbidity. Rural clinical school students logged a mix of core paediatric cases relevant to illnesses of Australian children admitted to public hospitals, with similar order and pattern by age group to urban students, despite major differences in clinical settings. Logged cases met the curriculum learning outcomes of graduates. Minor variations were readily addressed via recommendations about logging. This paper provides evidence of the legitimacy of student logs as useful tools in affirming appropriate paediatric case mix. It validates the rural clinical school context as appropriate for medical students to prepare for future clinical paediatric practice.

Intra-individual variation in urinary iodine concentration: effect of statistical correction on population distribution using seasonal three-consecutive-day spot urine in children

PubMed Central

Ji, Xiaohong; Liu, Peng; Sun, Zhenqi; Su, Xiaohui; Wang, Wei; Gao, Yanhui; Sun, Dianjun

2016-01-01

Objective To determine the effect of statistical correction for intra-individual variation on estimated urinary iodine concentration (UIC) by sampling on 3 consecutive days in four seasons in children. Setting School-aged children from urban and rural primary schools in Harbin, Heilongjiang, China. Participants 748 and 640 children aged 8–11 years were recruited from urban and rural schools, respectively, in Harbin. Primary and secondary outcome measures The spot urine samples were collected once a day for 3 consecutive days in each season over 1 year. The UIC of the first day was corrected by two statistical correction methods: the average correction method (average of days 1, 2; average of days 1, 2 and 3) and the variance correction method (UIC of day 1 corrected by two replicates and by three replicates). The variance correction method determined the SD between subjects (Sb) and within subjects (Sw), and calculated the correction coefficient (Fi), Fi=Sb/(Sb+Sw/di), where di was the number of observations. The UIC of day 1 was then corrected using the following equation: Results The variance correction methods showed the overall Fi was 0.742 for 2 days’ correction and 0.829 for 3 days’ correction; the values for the seasons spring, summer, autumn and winter were 0.730, 0.684, 0.706 and 0.703 for 2 days’ correction and 0.809, 0.742, 0.796 and 0.804 for 3 days’ correction, respectively. After removal of the individual effect, the correlation coefficient between consecutive days was 0.224, and between non-consecutive days 0.050. Conclusions The variance correction method is effective for correcting intra-individual variation in estimated UIC following sampling on 3 consecutive days in four seasons in children. The method varies little between ages, sexes and urban or rural setting, but does vary between seasons. PMID:26920442

Domestic and Environmental Factors of Chikungunya-affected Families in Thiruvananthapuram (Rural) District of Kerala, India

PubMed Central

Anish, TS; Vijayakumar, K; Leela, Itty Amma KR

2011-01-01

Background: The world is experiencing a pandemic of chikungunya which has swept across Indian Ocean and the Indian subcontinent. Kerala the southernmost state of India was affected by the chikungunya epidemic twice, first in 2006 and then in 2007. Kerala has got geography and climate which are highly favorable for the breeding of Aedes albopictus, the suspected vector. Aim: The aim of the study was to highlight the various domestic and environmental factors of the families affected by chikungunya in 2007 in Thiruvananthapuram district (rural) of Kerala. Settings and design:This is a cross-sectional survey conducted in Thiruvananthapuram (rural) district during November 2007. Settings and design: This is a cross-sectional survey conducted in Thiruvananthapuram (rural) district during November 2007 Materials and Methods: Samples were selected from field area under three Primary Health Centers.These areas represent the three terrains of the district namely the highland, midland, and lowland. The sample size was estimated to be 134 houses from each study area.The field area of health workers was selected as clusters and six subcenters from each primary health center were randomly selected (lot method). Results and Conclusions: The proportion of population affected by chikungunya fever is 39.9% (38.9-40.9%). The investigators observed water holding containers in the peri-domestic area of 95.6% of the houses. According to regression (binary logistic) analysis, the area of residence [adjusted odds ratio (OR) = 8.01 (6.06-14.60)], residing in a non-remote area [adjusted OR=0.25 (0.16-0.38)], perceived mosquito menace [adjusted OR=3.07 (2.31-4.64)], and containers/tires outside the house [adjusted OR=5.61 (2.74-27.58)] were the independent predictors of the occurrence of chikungunya in households. PMID:21572606

Patterns and risk factors of helminthiasis and anemia in a rural and a peri-urban community in Zanzibar, in the context of helminth control programs.

PubMed

Knopp, Stefanie; Mohammed, Khalfan A; Stothard, J Russell; Khamis, I Simba; Rollinson, David; Marti, Hanspeter; Utzinger, Jürg

2010-05-11

The control of helminth infections and prevention of anemia in developing countries are of considerable public health importance. The purpose of this study was to determine patterns and risk factors of helminth infections and anemia in a rural and a peri-urban community of Zanzibar, Tanzania, in the context of national helminth control programs. We carried out a community-based cross-sectional study in 454 individuals by examining at least two stool samples with different methods for soil-transmitted helminths (Ascaris lumbricoides, hookworm, Strongyloides stercoralis, and Trichuris trichiura) and one urine sample for Schistosoma haematobium. Finger-prick blood was taken to estimate anemia levels and to detect antibody reactions against ascariasis, strongyloidiasis and schistosomiasis, using an enzyme-linked immunosorbent assay (ELISA) approach. Parasitological methods determined a helminth prevalence of 73.7% in the rural, and 48.9% in the peri-urban setting. Most helminth infections were of light intensity with school-aged children showing the highest intensities. Multiple helminth species infections were pervasive in rural dwellers regardless of age. More than half of the participants were anemic, with a particularly high prevalence in the peri-urban setting (64.7%). Risk factors for helminth infections were age, sex, consumption of raw vegetables or salad, recent travel history, and socio-economic status. After several years of chemotherapy-based morbidity control efforts in Zanzibar, helminth prevalences are still high and anemia is common, but helminth infection intensities are low. Hence, chemotherapy should be continued, and complemented with improved access to clean water, adequate sanitation, and health education, along with poverty alleviation measures for a more enduring impact.

Management of Cold Water-induced Hypothermia: A Simulation Scenario for Layperson Training Delivered via a Mobile Tele-simulation Unit

PubMed Central

Parsons, Michael

2017-01-01

Newfoundland and Labrador (NL) has one of the highest provincial drowning rates in Canada, largely due to the many rural communities located near bodies of water. Factor in the province’s cold climate (average NL’s freshwater temperature is below 5.4°C)and the prevalence of winter recreational activities among the population, there exists an inherent risk of ice-related injuries and subsequent hypothermia. Oftentimes, these injuries occur in remote/rural settings where immediate support from Emergency Medical Services (EMS) may not be available. During this critical period, it frequently falls on individuals without formal healthcare training to provide lifesaving measures until help arrives. Training individuals in rural communities plays an important role in ensuring public safety. In recent years, simulation-based education has become an essential tool in medical, marine and first aid training. It provides learners with a safe environment to hone their skills and has been shown to be superior to traditional clinical teaching methods. The following case aims to train laypeople from rural settings in the immediate management of an individual who becomes hypothermic following immersion into cold water. However, reaching these individuals to provide training can be a challenge in a province with such a vast geography. To assist with overcoming this, the development of a simulation center that is portable between communities (or Mobile Tele-Simulation Unit) has occurred. By utilizing modern technology, this paper also proposes an innovative method of connecting with learners in more difficult to reach regions. PMID:29503784

Levels, Trends and Disparities in Public-Health-Related Indicators among Reproductive-Age Women in Bangladesh by Urban-Rural and Richest-Poorest Groups, 1993-2011

PubMed Central

Khan, Md. Mobarak Hossain; Zanuzdana, Arina; Kraemer, Alexander

2013-01-01

Background And Objectives Although Bangladesh has already achieved noticeable progress in the field of development and health, disparities in public health indicators for several markers are still reported. To assess public health development in Bangladesh during the last two decades, firstly, we analysed levels, trends and disparities in public-health-related indicators by rural versus urban as well as by the richest versus poorest group of women who have ever been married. Secondly, using the most recent data set we performed multiple analyses to check whether urban-rural and richest-poorest disparities were still significant. Methods The analysis was based on six nationally representative data sets from the Bangladesh Demographic and Health Surveys (BDHS) conducted in 1993-94 (n=9,640), 1996-1997 (n=9,127), 1999-2000 (n=10,544), 2004 (n=11,440), 2007 (n=10,996) and 2011 (n=17,749). The outcome variables were six selected public-health-related indicators. We performed various types of analyses, including multiple logistic regressions. Results The trend of all indicators except being overweight (1993-2011) displayed gradual improvements for both markers. However, the urban and richest groups revealed a better situation than their counterparts in both simple and multiple analyses. Disparities between richest-poorest groups were more pronounced than urban-rural disparities. For instance, the prevalence of delivery at any healthcare facility in 2011 was 20.4% in rural areas and 46.5% in urban areas, whereas it was 9.1% in the poorest group and 57.6% in the richest group. Conclusion The public health sector in Bangladesh has achieved some successes over the last two decades. However, urban-rural and richest-poorest disparities are still considerable and therefore more public health strategies and efforts are clearly needed for the rural and poorest groups of women in order to reduce these gaps further. PMID:24086485

[Discipline: Three Views.

ERIC Educational Resources Information Center

Turnbaugh, Ann

1986-01-01

This resource bulletin provides an overview of creative disciplinary programs in rural, suburban, and urban school settings through interviews conducted with administrators in 1986. Principals interviewed in urban settings expressed concern about student gangs and safety. In rural schools, administrators stated that community cohesion and…

Characteristics of Pesticide Poisoning in Rural and Urban Settings in Uganda.

PubMed

Pedersen, Bastian; Ssemugabo, Charles; Nabankema, Victoria; Jørs, Erik

2017-01-01

Pesticide poisoning is a significant burden on health care systems in many low-income countries. This study evaluates cases of registered pesticide poisonings treated in selected rural (N = 101) and urban (N = 212) health facilities in Uganda from January 2010 to August 2016. In the urban setting, pesticides were the most prevalent single poison responsible for intoxications (N = 212 [28.8%]). Self-harm constituted a significantly higher proportion of the total number of poisonings in urban (63.3%) compared with rural areas (25.6%) where unintentional poisonings prevailed. Men were older than women and represented a majority of around 60% of the cases in both the urban and rural settings. Unintentional cases were almost the only ones seen below the age of 10, whereas self-harm dominated among adolescents and young persons from 10 to 29 years of age. Organophosphorus insecticides accounted for 73.0% of the poisonings. Urban hospitals provided a more intensive treatment and had registered fever complications than rural health care settings. To minimize self-harm with pesticides, a restriction of pesticide availability as shown to be effective in other low-income countries is recommended. Training of health care workers in proper diagnosis and treatment of poisonings and improved equipment in the health care settings should be strengthened.

Characteristics of Pesticide Poisoning in Rural and Urban Settings in Uganda

PubMed Central

Pedersen, Bastian; Ssemugabo, Charles; Nabankema, Victoria; Jørs, Erik

2017-01-01

Pesticide poisoning is a significant burden on health care systems in many low-income countries. This study evaluates cases of registered pesticide poisonings treated in selected rural (N = 101) and urban (N = 212) health facilities in Uganda from January 2010 to August 2016. In the urban setting, pesticides were the most prevalent single poison responsible for intoxications (N = 212 [28.8%]). Self-harm constituted a significantly higher proportion of the total number of poisonings in urban (63.3%) compared with rural areas (25.6%) where unintentional poisonings prevailed. Men were older than women and represented a majority of around 60% of the cases in both the urban and rural settings. Unintentional cases were almost the only ones seen below the age of 10, whereas self-harm dominated among adolescents and young persons from 10 to 29 years of age. Organophosphorus insecticides accounted for 73.0% of the poisonings. Urban hospitals provided a more intensive treatment and had registered fever complications than rural health care settings. To minimize self-harm with pesticides, a restriction of pesticide availability as shown to be effective in other low-income countries is recommended. Training of health care workers in proper diagnosis and treatment of poisonings and improved equipment in the health care settings should be strengthened. PMID:28615953

Preferred delivery method and acceptability of Wheat-Soy Blend (WSB++) as a daily complementary food supplement in northwest Bangladesh.

PubMed

Shamim, Abu Ahmed; Hanif, Abu A M; Merrill, Rebecca D; Campbell, Rebecca K; Kumkum, Mehnaz Alam; Shaikh, Saijuddin; de Pee, Saskia; Ahmed, Tahmeed; Parveen, Monira; Mehra, Sucheta; Klemm, Rolf D W; Labrique, Alain B; West, Keith P; Christian, Parul

2015-01-01

Fortified blended foods (FBFs) are widely used to prevent undernutrition in early childhood in food-insecure settings. We field tested enhanced Wheat Soy Blend (WSB++)-a FBF fortified with micronutrients, milk powder, sugar, and oil-in preparation for a complementary food supplement (CFS) trial in rural northwestern Bangladesh. Formative work was conducted to determine the optimal delivery method (cooked vs. not) for this CFS, to examine mothers' child feeding practices with and acceptance of the WSB++, and to identify potential barriers to adherence. Our results suggest WSB++ is an acceptable CFS in rural Bangladesh and the requirement for mothers to cook WSB++ at home is unlikely to be a barrier to its daily use as a CFS in this population.

Changing Communities, Community Satisfaction, and Quality of Life: A View of Multiple Perceived Indicators

ERIC Educational Resources Information Center

Matarrita-Cascante, David

2010-01-01

The relationship between a community's services and conditions, satisfaction, and overall quality of life were examined in this study. As these relationships respond to specific contextual and cultural settings, qualitative methods were used to account for their complexity and depth. Key informant interviews were conducted in two rural communities…

Are Written Instructions Enough? Efficacy of Male Condom Packaging Leaflets among College Students

ERIC Educational Resources Information Center

Lindemann, Dana F.; Harbke, Colin R.

2013-01-01

Objective: To evaluate whether or not written condom use instructions successfully inform correct condom use skills. Design: Between-subjects, two-group design. Setting: Public university located in rural Midwestern region of the United States. Method: Participants were randomly assigned to either a control condition (read physical exercise…

Ethical Issues of Ethnography Method: A Comparative Approach to Subaltern, Self, and the Others

ERIC Educational Resources Information Center

Odeyemi, Christo

2013-01-01

Using urban and rural community settings, this review article focuses on ethical issues associated with ethnographer-participant interaction and draws from the ethnographic accounts of Bronislaw Malinowski and Susan Krieger. As such, the following sections intend to illuminate the issue of ethics in ethnography research. As case studies, the…

Destination Unknown? Study Choices and Graduate Destinations of Hungarian Youth in Slovakia

ERIC Educational Resources Information Center

Pásztor, Adél

2018-01-01

Focusing on Hungarian minority youth in a rural Slovakian setting, this article analyses their higher education aspirations and choices amidst significant economic, political and educational reforms. Relying on mixed methods and a longitudinal design, the research follows a cohort of high school students from their last year of secondary school…

Safety of Rural Nursing Home-to-Emergency Department Transfers: Improving Communication and Patient Information Sharing Across Settings.

PubMed

Tupper, Judith B; Gray, Carolyn E; Pearson, Karen B; Coburn, Andrew F

2015-01-01

The "siloed" approach to healthcare delivery contributes to communication challenges and to potential patient harm when patients transfer between settings. This article reports on the evaluation of a demonstration in 10 rural communities to improve the safety of nursing facility (NF) transfers to hospital emergency departments by forming interprofessional teams of hospital, emergency medical service, and NF staff to develop and implement tools and protocols for standardizing critical interfacility communication pathways and information sharing. We worked with each of the 10 teams to document current communication processes and information sharing tools and to design, implement, and evaluate strategies/tools to increase effective communication and sharing of patient information across settings. A mixed methods approach was used to evaluate changes from baseline in documentation of patient information shared across settings during the transfer process. Study findings showed significant improvement in key areas across the three settings, including infection status and baseline mental functioning. Improvement strategies and performance varied across settings; however, accurate and consistent information sharing of advance directives and medication lists remains a challenge. Study results demonstrate that with neutral facilitation and technical support, collaborative interfacility teams can assess and effectively address communication and information sharing problems that threaten patient safety.

Factors influencing interest in recreational sports participation and its rural-urban disparity

PubMed Central

Chen, Chiehfeng; Tsai, Liang-Ting; Lin, Ching-Feng; Huang, Chun-Ching; Chang, Yao-Tsung; Chen, Ruey-Yu; Lyu, Shu-Yu

2017-01-01

Objectives Recreational sports are important leisure activities. However, most studies investigating barrier factors and motivation for participation in recreational sports have been limited to specific areas (e.g., a city or school) or demographic groups (e.g., adolescents). Therefore, this study set out to gain a more comprehensive understanding of the behavioral and socioeconomic factors influencing interest in recreational sports participation in Taiwan, as well as to evaluate the effect of any urban-rural divide. Methods This study analyzed data collected by the “Taiwan Social Change Survey” (program five, wave 3) “Leisure Life” questionnaire. We used hierarchical linear modeling to assess respondent interest in recreational sports participation and evaluated the influence of behavioral factors, socioeconomic factors, and residence location (urban/rural). Results Of the 2,146 participants in this study, 50.3% were male, and the average age was 43.9 years. Location of residence (urban/rural) accounted for 35.3% of the variation in interest in recreational sports participation, while the remaining 64.7% came from the individual level. Participants who lived in rural settings were less interested in recreational sports than their urban counterparts. Gender, educational attainment, participation frequency, health-motivated interest, and appearance-motivated interest were also associated with interest in recreational sports participation. Conclusions Different communication strategies may be needed to effectively reach different demographic groups. We suggest that future public health campaigns aiming to increase recreational sports participation include tailored interventions and messages to effectively encourage leisure physical activities among all, regardless of demographic boundaries. PMID:28542455

Cost Effective Delivery Strategies in Rural Areas: Programs for Young Handicapped Children. Vol. I. Making It Work in Rural Communities. A Rural Network Monograph.

ERIC Educational Resources Information Center

Black, Talbot, Ed.; Hutinger, Patricia, Ed.

Using a common format outlining program settings, agencies, children/families served, staff, services, delivery strategies, and program costs, descriptions of four cost-effective rural service delivery programs for young handicapped children provide evidence that good rural programs are affordable. The Early Lifestyle Program at King's Daughters'…

A Logic Model for Coaching Experienced Rural Leaders: Lessons from Year One of a Pilot Program

ERIC Educational Resources Information Center

Lindle, Jane Clark; Della Sala, Matthew R.; Reese, Kenyae L.; Klar, Hans W.; Knoeppel, Robert Charles; Buskey, Frederick C.

2017-01-01

Rural schools dominate the United States, yet scant research exists on rural school leaders' development. Urban districts can transfer leaders to different locations, but rural districts, with few school sites, need leaders who stay and adapt to changing conditions. Mid-career rural leaders require a refreshed set of skills to carry school…

Rural and urban park visits and park-based physical activity.

PubMed

Shores, Kindal A; West, Stephanie T

2010-01-01

A physical activity disparity exists between rural and urban residents. Community parks are resources for physical activity because they are publicly provided, available at a low cost, and accessible to most residents. We examine the use of and physical activity outcomes associated with rural and urban parks. Onsite observations were conducted using the System for Observing Play and Recreation in Communities (SOPARC) at four rural and four urban parks. Momentary sampling scans were conducted four times per day for seven days at each site. A total of 6,545 park visitors were observed. Both rural and urban park visitors were observed more often at larger parks with paved trails and attended most often on weekends. Rural park visits were more frequent than urban park visits but rural visits were less physically active. Although similarities were observed between rural and urban park visits, differences suggest that findings from park and physical activity studies in urban areas should not be considered representative of their rural counterparts. Given that the majority of existing park and physical activity research has been undertaken in urban settings, the need for complementary research in rural settings has been made evident through this presentation of baseline descriptive data.

Nurses' experiences providing palliative care to individuals living in rural communities: aspects of the physical residential setting.

PubMed

Kaasalainen, S; Brazil, K; Williams, A; Wilson, D; Willison, K; Marshall, D; Taniguchi, A; Phillips, C

2014-01-01

Efforts are needed to improve palliative care in rural communities, given the unique characteristics and inherent challenges with respect to working within the physical aspects of residential settings. Nurses who work in rural communities play a key role in the delivery of palliative care services. Hence, the purpose of this study was to explore nurses' experiences of providing palliative care in rural communities, with a particular focus on the impact of the physical residential setting. This study was grounded in a qualitative approach utilizing an exploratory descriptive design. Individual telephone interviews were conducted with 21 community nurses. Data were analyzed by thematic content analysis. Nurses described the characteristics of working in a rural community and how it influences their perception of their role, highlighting the strong sense of community that exists but how system changes over the past decade have changed the way they provide care. They also described the key role that they play, which was often termed a 'jack of all trades', but focused on providing emotional, physical, and spiritual care while trying to manage many challenges related to transitioning and working with other healthcare providers. Finally, nurses described how the challenges of working within the physical constraints of a rural residential setting impeded their care provision to clients who are dying in the community, specifically related to the long distances that they travel while dealing with bad weather. These study findings contribute to our understanding of the experiences of nurses working in rural communities in terms of the provision of palliative care and the influence of the physical residential setting that surrounds them. These findings are important since nurses play a major role in caring for community-dwelling clients who are dying, but they are confronted with many obstacles. As such, these results may help inform future decisions about how to best improve access to important services and ways to support them while providing palliative care to rural individuals.

A descriptive study of access to services in a random sample of Canadian rural emergency departments

PubMed Central

Fleet, Richard; Poitras, Julien; Maltais-Giguère, Julie; Villa, Julie; Archambault, Patrick

2013-01-01

Objective To examine 24/7 access to services and consultants in a sample of Canadian rural emergency departments (EDs). Design Cross-sectional study—mixed methods (structured interview, survey and government data bases) with random sampling of hospitals. Setting Canadian rural EDs (rural small town (RST) definition—Statistics Canada). Participants 28% (95/336) of Canadian rural EDs providing 24/7 physician coverage located in hospitals with acute care hospitalisation beds. Main outcome measures General characteristics of the rural EDs, information about 24/7 access to consultants, equipment and services, and the proportion of rural hospitals more than 300 km from levels 1 and 2 trauma centres. Results Of the 336 rural EDs identified, 122 (36%) were randomly selected and contacted. Overall, 95 EDs participated in the study (participation rate, 78%). Hospitals had, on an average, 23 acute care beds, 7 ED stretchers and 13 500 annual ED visits. The proportion of rural hospitals with local access to the following 24/7 services was paediatrician, 5%; obstetrician, 10%; psychiatrist, 11%; internist, 12%; intensive care unit, 17%; CT scanner, 20%; surgeon, 26%; ultrasound, 28%; basic X-ray, 97% and laboratory services, 99%. Forty-four per cent and 54% of the RST EDs were more than 300 km from a level 1 and level 2 trauma centre, respectively. Conclusions This is the first study describing the services available in Canadian rural EDs. Apart from basic laboratory and X-ray services, most rural EDs have limited access to consultants, advanced imaging and critical care services. A detailed study is needed to evaluate the impact of these limited services on patient outcomes, costs and interfacility transport demands. PMID:24285633

Behavioral and Community Correlates of Adolescent Pregnancy and Chlamydia Rates in Rural Counties in Minnesota1

PubMed Central

Kozhimannil, Katy B.; Enns, Eva; Blauer-Peterson, Cori; Farris, Jill; Kahn, Judith; Kulasingam, Shalini

2014-01-01

Purpose Identifying co-occurring community risk factors, specific to rural communities, may suggest new strategies and partnerships for addressing sexual health issues among rural youth. We conducted an ecological analysis to identify the county-level correlates of pregnancy and chlamydia rates among adolescents in rural (nonmetropolitan) counties in Minnesota. Methods Pregnancy and chlamydia infection rates among 15–19 year-old females were compared across Minnesota’s 87 counties, stratified by rural/urban designations. Regression models for rural counties (n=66) in Minnesota were developed based on publicly available, county-level information on behaviors and risk exposures to identify associations with teen pregnancy and chlamydia rates in rural settings. Findings Adolescent pregnancy rates were higher in rural counties than in urban counties. Among rural counties, factors independently associated with elevated county-level rates of teen pregnancy included inconsistent contraceptive use by 12th-grade males, fewer 12th graders reporting feeling safe in their neighborhoods, more 9th graders reporting feeling overweight, fewer 12th graders reporting 30 min of physical activity daily, high county rates of single parenthood, and higher age-adjusted mortality (P < .05 for all associations). Factors associated with higher county level rates of chlamydia among rural counties were inconsistent condom use reported by 12th-grade males, more 12th graders reporting feeling overweight, and more 12th graders skipping school in the past month because they felt unsafe. Conclusions This ecologic analysis suggests that programmatic approaches focusing on behavior change among male adolescents, self-esteem, and community health and safety may be complementary to interventions addressing teen sexual health in rural areas; such approaches warrant further study. PMID:25344773

A cross-sectional survey on the attitudes and interests of rural population towards expanded pharmacist prescribing in India.

PubMed

Khan, Muhammad Umair; Arief, Mohammad; Ahmad, Akram; Malik, Sadiqa; Gogoi, Lakhya Jyoti; Kalita, Manabendra; Saleem, Fahad; Hassali, Mohamed Azmi Ahmad

2017-04-01

Background Shortage of qualified medical doctors and little or no access to basic medicines and medical facilities are the major rural health concerns in India. Expanding the role of pharmacists to provide prescribing services could improve rural health outcomes. Objective To assess the attitudes of rural population towards pharmacist prescribing and their interest in using expanded pharmacist prescribing services. Setting Rural population of Assam, India. Methods A descriptive, cross-sectional survey was conducted for a period of 2 months from March to April 2016 in the State of Assam, India. A multi-stage sampling was used to recruit (n = 410) eligible participants. Main outcome measure Rural population attitudes towards, and interests in using, pharmacist prescribing services. Results The attitudes of participants were generally positive towards pharmacist prescribing. A large proportion of participants (81.5%) agreed that pharmacists should have a prescribing role in rural India. Participants indicated their interest in using expanded pharmacist prescribing services, with greater interests in receiving medications in emergency situations (79.7%) and getting a treatment plan for their medical problem (75.6%). Participants with low income and tertiary education had better attitudes and showed more interest towards expanded pharmacist prescribing services (p < 0.05). Conclusions Most participants had positive attitudes towards pharmacist prescribing and were interested in using expanded pharmacist prescribing services.

Extensive diversity in the allelic frequency of Plasmodium falciparum merozoite surface proteins and glutamate-rich protein in rural and urban settings of southwestern Nigeria.

PubMed

Funwei, Roland I; Thomas, Bolaji N; Falade, Catherine O; Ojurongbe, Olusola

2018-01-02

Nigeria carries a high burden of malaria which makes continuous surveillance for current information on genetic diversity imperative. In this study, the merozoite surface proteins (msp-1, msp-2) and glutamate-rich protein (glurp) of Plasmodium falciparum collected from two communities representing rural and urban settings in Ibadan, southwestern Nigeria were analysed. A total of 511 febrile children, aged 3-59 months, whose parents/guardians provided informed consent, were recruited into the study. Capillary blood was obtained for malaria rapid diagnostic test, thick blood smears for parasite count and blood spots on filter paper for molecular analysis. Three-hundred and nine samples were successfully genotyped for msp-1, msp-2 and glurp genes. The allelic distribution of the three genes was not significantly different in the rural and urban communities. R033 and 3D7 were the most prevalent alleles in both rural and urban communities for msp-1 and msp-2, respectively. Eleven of glurp RII region genotypes, coded I-XII, with sizes ranging from 500 to 1100 base pairs were detected in the rural setting. Genotype XI (1000-1050 bp) had the highest prevalence of 41.5 and 38.5% in rural and urban settings, respectively. Overall, 82.1 and 70.0% of samples had multiclonal infection with msp-1 gene resulting in a mean multiplicity of infection (MOI) of 2.8 and 2.6 for rural and urban samples, respectively. Msp-1 and msp-2 genes displayed higher levels of diversity and higher MOI rates than the glurp gene. Significant genetic diversity was observed between rural and urban parasite populations in Ibadan, southwestern Nigeria. The results of this study show that malaria transmission intensity in these regions is still high. No significant difference was observed between rural and urban settings, except for a completely different msp-1 allele, compared to previous reports, thereby confirming the changing face of malaria transmission in these communities. This study provides important baseline information required for monitoring the impact of malaria elimination efforts in this region and data points useful in revising current protocols.

Childhood obesity prevention in rural settings: background, rationale, and study design of ‘4-Health,’ a parent-only intervention

PubMed Central

2012-01-01

Background Childhood obesity in rural communities is a serious but understudied problem. The current experiment aims to assess a wide range of obesity risk factors among rural youth and to offer an 8-month intervention program for parents to reduce obesity risk in their preteen child. Methods/Design A two-group, repeated measures design is used to assess the effectiveness of the 4-Health intervention program. Assessments include anthropometric measures, child self-evaluations, parent self-evaluations, and parent evaluations of child. County Extension agents from 21 rural Montana counties recruit approximately 150 parent–child dyads and counties are semi-randomly assigned to the active intervention group (4-Health Educational Program) or a “best-practices” (Healthy Living Information) control group. Discussion This study will shed light on the effectiveness of this parent-only intervention strategy in reducing obesity risk factors among rural preteens. The 4-Health program is designed to provide information and skills development for busy rural parents that will increase healthy lifestyles of their preteen children and improve the parents’ ability to intervene effectively in the lives of their families during this critical developmental period. Trial registration ClinicalTrials.gov ID: NCT01510587 PMID:22471650

Application of Deep Learning and Supervised Learning Methods to Recognize Nonlinear Hidden Pattern in Water Stress Levels from Spatiotemporal Datasets across Rural and Urban US Counties

NASA Astrophysics Data System (ADS)

Eisenhart, T.; Josset, L.; Rising, J. A.; Devineni, N.; Lall, U.

2017-12-01

In the wake of recent water crises, the need to understand and predict the risk of water stress in urban and rural areas has grown. This understanding has the potential to improve decision making in public resource management, policy making, risk management and investment decisions. Assuming an underlying relationship between urban and rural water stress and observable features, we apply Deep Learning and Supervised Learning models to uncover hidden nonlinear patterns from spatiotemporal datasets. Results of interest includes prediction accuracy on extreme categories (i.e. urban areas highly prone to water stress) and not solely the average risk for urban or rural area, which adds complexity to the tuning of model parameters. We first label urban water stressed counties using annual water quality violations and compile a comprehensive spatiotemporal dataset that captures the yearly evolution of climatic, demographic and economic factors of more than 3,000 US counties over the 1980-2010 period. As county-level data reporting is not done on a yearly basis, we test multiple imputation methods to get around the issue of missing data. Using Python libraries, TensorFlow and scikit-learn, we apply and compare the ability of, amongst other methods, Recurrent Neural Networks (testing both LSTM and GRU cells), Convolutional Neural Networks and Support Vector Machines to predict urban water stress. We evaluate the performance of those models over multiple time spans and combine methods to diminish the risk of overfitting and increase prediction power on test sets. This methodology seeks to identify hidden nonlinear patterns to assess the predominant data features that influence urban and rural water stress. Results from this application at the national scale will assess the performance of deep learning models to predict water stress risk areas across all US counties and will highlight a predominant Machine Learning method for modeling water stress risk using spatiotemporal data.

A Qualitative Study of Environmental Factors Important for Physical Activity in Rural Adults

PubMed Central

Cleland, Verity; Hughes, Clarissa; Thornton, Lukar; Venn, Alison; Squibb, Kathryn; Ball, Kylie

2015-01-01

Purpose Despite increasing evidence that the physical environment impacts on physical activity among urban-dwellers, little attention has been devoted to understanding this relationship in rural populations. Work in this area is further hindered by a lack of environmental measures specifically designed for rural settings. This qualitative study aimed to explore the salience of urban physical activity environment constructs among rural adults. Methods In 2011, 49 rural men and women from three distinct areas (coastal, animal-based farming, forestry/plant-based farming) of rural Tasmania, Australia, were purposively recruited to participate in semi-structured interviews. Interviews explored features of the built and social environment commonly examined in studies of urban adults, including functional characteristics (eg, lighting, footpaths, roads/verges), road and personal safety, availability and accessibility of places to be active, destinations, and aesthetics. Interviews were recorded, transcribed verbatim and analysed using a content-thematic approach using QSR NVivo software. Findings While some urban environmental constructs were salient to these rural adults, such as availability of and accessibility to places to be active, some constructs were operationalised differently, such as road safety (where large trucks and winding roads rather than traffic density was of concern), or were not considered relevant (eg, personal safety related to crime, availability of walkable destinations, aesthetics). Conclusions The measurement of the physical environment in rural populations may require reconsideration and/or modification to ensure salience and appropriate quantification of associations with physical activity in future studies. PMID:26554376

Estimating tuberculosis incidence from primary survey data: a mathematical modeling approach.

PubMed

Pandey, S; Chadha, V K; Laxminarayan, R; Arinaminpathy, N

2017-04-01

There is an urgent need for improved estimations of the burden of tuberculosis (TB). To develop a new quantitative method based on mathematical modelling, and to demonstrate its application to TB in India. We developed a simple model of TB transmission dynamics to estimate the annual incidence of TB disease from the annual risk of tuberculous infection and prevalence of smear-positive TB. We first compared model estimates for annual infections per smear-positive TB case using previous empirical estimates from China, Korea and the Philippines. We then applied the model to estimate TB incidence in India, stratified by urban and rural settings. Study model estimates show agreement with previous empirical estimates. Applied to India, the model suggests an annual incidence of smear-positive TB of 89.8 per 100 000 population (95%CI 56.8-156.3). Results show differences in urban and rural TB: while an urban TB case infects more individuals per year, a rural TB case remains infectious for appreciably longer, suggesting the need for interventions tailored to these different settings. Simple models of TB transmission, in conjunction with necessary data, can offer approaches to burden estimation that complement those currently being used.

Pedagogy of the Rural as a Lens for Understanding Beginning Teachers' Identity and Positionings in Rural Schools

ERIC Educational Resources Information Center

Walker-Gibbs, Bernadette; Ludecke, Michelle; Kline, Jodie

2018-01-01

Pedagogy of the Rural is an approach to capture the complexities of rural space and place by challenging simple understandings of what it means to be a teacher in rural settings. Using Harré's positioning theory, Baudrillard's concepts of simulation and simulacra, and Lefebvre's space and economic geographies to form a composite theory through…

Learning Partnerships in Rural Early Childhood Settings.

ERIC Educational Resources Information Center

Coombe, Kennece; Lubawy, Joy

A study examined six aspects of learning communities in early childhood settings in rural New South Wales (Australia). These aspects are reflection, individual development, diversity, conversation, caring, and shared responsibility. Surveys of 15 directors of early childhood programs indicated that the reflective component of the learning…

Potential Use of School Absenteeism Record for Disease Surveillance in Developing Countries, Case Study in Rural Cambodia

PubMed Central

Cheng, Calvin K. Y.; Channarith, Hing; Cowling, Benjamin J.

2013-01-01

Background Disease surveillance allows prospective monitoring of patterns in disease incidence in the general community, specific institutions (e.g. hospitals, elderly care homes), and other important population subgroups. Surveillance activities are now routinely conducted in many developed countries and in certain easy-to-reach areas of the developing ones. However due to limited health resources, population in rural area that consisted of the most the vulnerable groups are not under surveillance. Cheaper alternative ways for disease surveillance were needed in resource-limited settings. Methods and Findings In this study, a syndromic surveillance system using disease specific absenteeism rates was established in 47 pre-schools with 1,417 students 3–6 y of age in a rural area of Kampot province, Cambodia. School absenteeism data were collected via short message service. Data collected between 1st January and 31st December 2012 was used for system evaluation for future potential use in larger scale. The system appeared to be feasible and acceptable in the rural study setting. Moderate correlation was found between rates of school absenteeism due to illness and the reference data on rates of attendance at health centers in persons <16 y (maximum cross-correlation coefficient = 0.231 at lag = −1 week). Conclusions School absenteeism data is pre-existing, easily accessible and requires minimum time and resources after initial development, and our results suggest that this system may be able to provide complementary data for disease surveillance, especially in resource limited settings where there is very little information on illnesses in the community and traditional surveillance systems are difficult to implement. An important next step is to validate the syndromic data with other forms of surveillance including laboratory data. PMID:24155907

Impact of new information technologies on training and continuing education for rural health professionals.

PubMed

Crandall, L A; Coggan, J M

1994-01-01

Recently developed and emerging information and communications technologies offer the potential to move the clinical training of physicians and other health professionals away from the resource intensive urban academic health center, with its emphasis on tertiary care, and into rural settings that may be better able to place emphasis on the production of badly needed primary care providers. These same technologies also offer myriad opportunities to enhance the continuing education of health professionals in rural settings. This article explores the effect of new technologies for rural tele-education by briefly reviewing the effect of technology on health professionals' education, describing ongoing applications of tele-education, and discussing the likely effect of new technological developments on the future of tele-education. Tele-education has tremendous potential for improving the health care of rural Americans, and policy-makers must direct resources to its priority development in rural communities.

The School Experiences of Rural Youths: A Study in Appalachian Ohio

ERIC Educational Resources Information Center

Hoffman, Jill A.; Anderson-Butcher, Dawn; Fuller, Michael; Bates, Samantha

2017-01-01

Rural schools face unique challenges that affect student academic success or failure. Youths served in rural settings experience barriers to learning that negatively influence their achievement and developmental outcomes. To improve outcomes for rural youths, it is important for schools to understand overall school experiences so that school-wide…

Creative practicum leadership experiences in rural settings.

PubMed

Schoenfelder, Deborah Perry; Valde, Jill Gaffney

2009-01-01

Rural healthcare systems provide rich learning environments for nursing students, where strong nursing leaders manage care for people with diverse health problems across the lifespan. The authors describe the development, implementation, and evaluation of rural clinical leadership practicum, a prelicensure course that specifically focuses on the application of leadership concepts in small rural healthcare systems.

A Curriculum Infusion Approach to Preservice Rural Teacher Preparation: Strategies and Resources.

ERIC Educational Resources Information Center

Sarachan-Deily, Ann Beth; And Others

Collaborative strategies were used by The College of Saint Rose (CSR) and 15 rural school districts in upstate New York to implement preservice teacher training and programming to better meet the needs of handicapped learners in rural settings. Through meetings and questionnaires, rural administrative teams identified relevant skills and issues…

"Place" Value: The Rural Perspective. Occasional Paper.

ERIC Educational Resources Information Center

Long, Vena; Bush, William S.; Theobald, Paul

Place-based, or "contextualized," mathematics instruction gives learners the opportunity to see how mathematics is relevant to their lives. Such opportunities are crucial to the success of students in rural settings and may be crucial to the survival of rural communities. For the last half century, schools have educated rural children to believe…

Choices and Chances in Programs and Plans for the Gaining of Credentials: Perspectives from a Small Rural High School

ERIC Educational Resources Information Center

Franklin, Janice

2010-01-01

Research about rural education, and education policy directions for rural schools, are set against formal measures of "disadvantage". These measures about rural "disadvantage" have been defined, evaluated and compared to more "advantaged" provincial and urban schools. Rarely has educational research or policy been…

Urban-rural differences in disability-free life expectancy in Bangladesh using the 2010 HIES data.

PubMed

Islam, Md Shariful; Tareque, Md Ismail; Mondal, Md Nazrul Islam; Fazle Rabbi, Ahbab Mohammad; Khan, Hafiz T A; Begum, Sharifa

2017-01-01

Research on health expectancy has been carried out in Bangladesh but none of it has examined the differences in Disability-Free Life Expectancy (DFLE) between urban and rural setting in context of rapid urbanization of Bangladesh in past decades. The present study aims to estimate DFLE for people of all ages living in urban and rural areas in Bangladesh, and to examine the differences in DFLE between these two areas. Data from the Sample Vital Registration System 2010 and the Bangladesh Household Income and Expenditure Survey (HIES) 2010 were used in this study. The Sullivan method was applied to estimate DFLE in Bangladesh. Higher rates of mortality and disability were observed in rural areas compared to urban areas with few exceptions. Statistically significant differences in DFLE were revealed from birth to age 15 years for both sexes between urban and rural areas. Urban males had a longer life expectancy (LE), longer DFLE and shorter LE with disability both in number and proportion when compared to rural males. Rural females at age 20+ years had a longer LE than urban females but urban females had a longer DFLE and a shorter LE with disability in both number and proportion at all ages than did rural females. This study demonstrates that there were clear inequalities in LE, DFLE and LE with disability between rural and urban areas of Bangladesh along with age-specific differences as well. These findings may serve as useful and benchmark for intervention and policy implications for reducing the gap in health outcomes.

Recruitment and retention strategies for hospital laboratory personnel in urban and rural settings.

PubMed

Slagle, Derek R

2013-01-01

Laboratory directors and administrators play vital roles in the recruitment and retention processes of their employees. A total of 71 laboratory directors from hospitals across 51 counties in Tennessee responded to questionnaires regarding recruitment and retention strategies. Respondents reported strategies for recruitment and retention, which were agreed to be effective by management. Overall, these major strategies were consistent regardless of geographic location and limited differences were noted with regard to urban-rural locations. The findings that varied significantly between urban and rural locations included: 1) rural employees needed additional supervision; 2) rural hospitals relied on local residents more so than urban hospitals; 3) rural laboratory administrators noted more limited access to resources; and the 4) lower effectiveness of recruitment agencies and family relocation programs for rural hospitals. This is significant given the disparities often associated with rural areas, and the potential to develop more successful recruitment and retention strategies for those areas. Active managers in clinical laboratory science programs in the hospital setting should note effective strategies for both, recruitment and retention of personnel, and note the potential impact of geography on such processes.

Rural physician assistants: a survey of graduates of MEDEX Northwest.

PubMed Central

Larson, E H; Hart, L G; Hummel, J

1994-01-01

Graduates of MEDEX Northwest, the physician assistant training program at the University of Washington, were surveyed to describe differences between physician assistants practicing in rural settings and those practicing in urban settings. Differences in demography, satisfaction with practice and community, practice history, and practice content were explored. Of the 341 traceable graduates, 295 (86.5 percent) responded to the mail survey. Although rural- and urban-practicing physician assistants are remarkably similar in most respects--income, hours worked, levels of practice satisfaction, for example--those in rural primary care reported performing a much wider range of medical and administrative tasks than those in urban practice. Half of the physician assistants who grew up in small towns were practicing in rural places compared with 18 percent of those from large towns. The broader scope of practice available to primary care physician assistants in rural areas may be of particular interest to those considering rural careers, to people who train physician assistants, and to rural communities trying to recruit and retain physician assistants. Results also suggest that recruitment of students for rural practice should focus on rural residents. Some problems that rural practitioners are more likely to face than urban ones, such as unreasonable night call schedules and lack of acknowledgement and respect for them as professionals, need to be addressed if rural communities are to be able to attract and retain physician assistants. PMID:7908746

Task-Sharing Approaches to Improve Mental Health Care in Rural and Other Low-Resource Settings: A Systematic Review.

PubMed

Hoeft, Theresa J; Fortney, John C; Patel, Vikram; Unützer, Jürgen

2018-12-01

Rural areas persistently face a shortage of mental health specialists. Task shifting, or task sharing, is an approach in global mental health that may help address unmet mental health needs in rural and other low-resource areas. This review focuses on task-shifting approaches and highlights future directions for research in this area. Systematic review on task sharing of mental health care in rural areas of high-income countries included: (1) PubMed, (2) gray literature for innovations not yet published in peer-reviewed journals, and (3) outreach to experts for additional articles. We included English language articles published before August 31, 2013, on interventions sharing mental health care tasks across a team in rural settings. We excluded literature: (1) from low- and middle-income countries, (2) involving direct transfer of care to another provider, and (3) describing clinical guidelines and shared decision-making tools. The review identified approaches to task sharing focused mainly on community health workers and primary care providers. Technology was identified as a way to leverage mental health specialists to support care across settings both within primary care and out in the community. The review also highlighted how provider education, supervision, and partnerships with local communities can support task sharing. Challenges, such as confidentiality, are often not addressed in the literature. Approaches to task sharing may improve reach and effectiveness of mental health care in rural and other low-resource settings, though important questions remain. We recommend promising research directions to address these questions. © 2017 National Rural Health Association.

Differences between preschoolers with asthma and allergies in urban and rural environments.

PubMed

Marfortt, Daniel A; Josviack, Dario; Lozano, Alejandro; Cuestas, Eduardo; Agüero, Luis; Castro-Rodriguez, Jose A

2018-05-01

Previous studies have provided conflicting results about how living in a rural or urban environment influences schoolchildren with asthma and allergic diseases in different ways. The aim of the present study was to evaluate if recurrent wheezing preschoolers from rural or urban areas differ in asthma, allergic diseases, and atopy. A cross-sectional-study in Rafaela, Argentina, on 143 preschoolers with recurrent wheezing from rural and urban settings was performed (2010-2012). Diagnosis of asthma (by positive asthma predictive index [API]), allergic diseases (rhinitis, dermatitis), and atopy (by skin prick test [SPT], peripheral blood eosinophils, and serum total IgE) were assessed. Preschoolers from rural settings had significantly higher prevalence of vaginal delivery, longer breastfeeding, earlier onset of wheezing, more parental smoking, siblings, shared a bedroom, and more exposure to chemicals used in plant fumigation or farm animals, and unpasteurized milk consumption, in comparison to preschoolers living in urban setting. In contrast, preschoolers from urban areas had significantly higher prevalence of parental history of allergy, positive skin prick test, and positive API. After multivariate analysis adjusting for covariates, maternal smoking [odds ratio (OR) = 3.44] and positive SPT (OR = 5.57) significantly increase the risk of asthma diagnosis (positive API); in contrast, living in rural setting (OR = 0.04), and having more siblings (OR = 0.51) decrease their risk. Recurrent wheezing preschoolers from rural areas had a significant inverse odds of being diagnosed with asthma (type-2 inflammation) when compared to those from urban areas. Exposure to farm animals and consumption of unpasteurized milk might have a role.

Mapping knowledge management resources of maternal, newborn and child health (MNCH) among people living in rural and urban settings of Ilorin, Nigeria.

PubMed

Bolarinwa, Oladimeji Akeem; Ameen, Hafsat Abolore; Durowade, Kabir Adekunle; Akande, Tanimola Makanjuola

2014-01-01

Lack of access to information and knowledge about mother and child health was identified as a major contributor to poor maternal and child health in Nigeria. The Partnership for Maternal, Newborn and Child Health (PMNCH) has recognized mapping the knowledge management of Maternal Newborn and Child Health (MNCH) as one of the major strategies to be deployed in improving the health of these vulnerable groups. The main aim of this study is to map the knowledge management resources of Maternal, Newborn and Child Health (MNCH) in rural and urban settings of Ilorin West LGA of Kwara state Nigeria. It is a descriptive cross-sectional study with a comparative analysis of findings from urban and rural settings. Epi-mapping was used to carve out the LGA and map responses. The p-value of less than 0.05 was considered significant at 95% confidence level. The study showed that traditional leader was responsible for more than half of the traditional way of obtaining information by rural (66.7%) and urban (56.2%) respondents while documentation accounts for the main MNCH knowledge preservation for the rural (40.6%) and the urban (50%) dwellers. Traditional leaders (32.2%) and elders (46.7%) were the main people responsible for dissemination of knowledge in rural areas whereas elders (35.9%) and Parents (19.9%) were the main people responsible in urban areas. It was concluded that traditional and family institutions are important in the knowledge management of MNCH in both rural and urban settings of Nigeria.

The adoption of provider-based rural health clinics by rural hospitals: a study of market and institutional forces.

PubMed Central

Krein, S L

1999-01-01

OBJECTIVE: To examine the response of rural hospitals to various market and organizational signals by determining the factors that influence whether or not they establish a provider-based rural health clinic (RHC) (a joint Medicare/Medicaid program). DATA SOURCES/STUDY SETTING: Several secondary sources for 1989-1995: the AHA Annual Survey, the PPS Minimum Data Set and a list of RHCs from HCFA, the Area Resource File, and professional associations. The analysis includes all general medical/surgical rural hospitals operating in the United States during the study period. STUDY DESIGN: A longitudinal design and pooled cross-sectional data were used, with the rural hospital as the unit of analysis. Key variables were examined as sets and include measures of competitive pressures (e.g., hospital market share), physician resources, nurse practitioner/physician assistant (NP/PA) practice regulation, hospital performance pressures (e.g., operating margin), innovativeness, and institutional pressure (i.e., the cumulative force of adoption). PRINCIPAL FINDINGS: Adoption of provider-based RHCs by rural hospitals appears to be motivated less as an adaptive response to observable economic or internal organizational signals than as a reaction to bandwagon pressures. CONCLUSIONS: Rural hospitals with limited resources may resort to imitating others because of uncertainty or a limited ability to fully evaluate strategic activities. This can result in actions or behaviors that are not consistent with policy objectives and the perceived need for policy changes. Such activity in turn could have a negative effect on some providers and some rural residents. Images Figure 1 PMID:10201851

ENVIRONMENTAL INFLUENCES ON CHILDREN’S PHYSICAL ACTIVITY AND DIETS IN RURAL OREGON: RESULTS OF A YOUTH PHOTOVOICE PROJECT

PubMed Central

Findholt, Nancy E.; Michael, Yvonne L.; Davis, Melinda M.; Brogoitti, Victoria W.

2015-01-01

Little is known about the effect of the rural environment on children’s physical activity and food choices. In this study, six rural adolescents participated in a photovoice assessment to document conditions that influenced children’s activity and diets. Physical activity was hindered by inadequate recreational resources, unsafe streets, and distance, but was promoted by the natural environment and support for youth sports. Healthy eating was hindered by busy lifestyles, limited access to healthy foods, access to and promotion of unhealthy foods, and social values, but was promoted by the agricultural setting and gardening. While many of these factors occur in non-rural settings, the findings suggest that rural communities have unique strengths and barriers that must be considered when developing interventions. PMID:26346290

Helicopter Evacuation Following a Rural Trauma: An Emergency Medicine Simulation Scenario Using Innovative Simulation Technology

PubMed Central

Whalen, Desmond; Harty, Chris; Ravalia, Mohamed; Renouf, Tia; Alani, Sabrina; Brown, Robert

2016-01-01

The relevance of simulation as a teaching tool for medical professionals working in rural and remote contexts is apparent when low-frequency, high-risk situations are considered. Simulation training has been shown to enhance learning and improve patient outcomes in urban settings. However, there are few simulation scenarios designed to teach rural trauma management during complex medical transportation. In this technical report, we present a scenario using a medevac helicopter (Replica of Sikorsky S-92 designed by Virtual Marine Technology, St. John's, NL) at a rural community. This case can be used for training primary care physicians who are working in a rural or remote setting, or as an innovative addition to emergency medicine and pre-hospital care training programs. PMID:27081585

Access to chlamydia testing in remote and rural Scotland.

PubMed

Hawkins, Katherine E; Thompson, Lucy; Wilson, Philip

2016-01-01

The aim of this study was to assess access to sexual health care in remote and rural settings using Chlamydia testing as a focus by measuring the extent of Chlamydia testing and positivity across the Scottish Highlands in relation to the Scottish Index of Multiple Deprivation Quintile (SIMD) and Urban Rural 8-fold index (UR8). Tests processed through Raigmore Hospital in Inverness, the main testing laboratory for microbiology tests in North and West and South and Mid Highlands, were studied. Where people are tested in relation to where they live was assessed, as well as the type of test they opt for. Also assessed was the rate of positivity in male and female patients in rural compared with urban settings using the Scottish Government UR8 and in relation to the SIMD. 9644 results were analysed. 77.2% of the results were for females and 22.4% for males. 8.1% of the results were positive and 84.4% were negative. There were proportionately more positive tests from the sexual health sources than from general practice. The proportion of men who had positive tests was almost double that for women (12.7% vs 6.6%) although men made up only 27.9% of the total number of tests. There was no significant difference in positivity when compared with UR8 index or SIMD. 37.7% of people living in the most rural areas (UR8 7-8) had their test performed in a more urban setting (UR8 1-6), and 20.4% people had their test performed in a very urban setting (UR8 1-2). Of these tests, there was a tendency for UR8 7-8 patients to be more likely to have a positive test if tested in an urban setting. These results are similar to previous results in other countries that suggest that Chlamydia positivity is similar in rural and urban settings. A large proportion of people living in more rurally classified areas, and perhaps those with a higher risk, have their test in a central setting, suggesting that they may be bypassing local resources to get a test. The reason for this is not clear. The results also show that men are more likely to have their test in a genitourinary setting as well as have proportionately more positive results. These results support the case for customising sexual health services to the most rural areas and suggest that providing an anonymous testing service in these areas might be beneficial, especially for men.

7 CFR 22.205 - Allocation of loan and grant funds.

Code of Federal Regulations, 2010 CFR

2010-01-01

... responsibility for the rural development planning and priority setting functions. ....205 Agriculture Office of the Secretary of Agriculture RURAL DEVELOPMENT COORDINATION Roles and... review State and multicounty jurisdictional rural development programs and projects so that unused...

Fasting capillary blood glucose: an appropriate measurement in screening for diabetes and pre-diabetes in low-resource rural settings.

PubMed

Zhao, X; Zhao, W; Zhang, H; Li, J; Shu, Y; Li, S; Cai, L; Zhou, J; Li, Y; Hu, R

2013-01-01

To evaluate the efficiency of fasting capillary blood glucose (FCG) measurement as compared with fasting venous plasma glucose (FPG) measurement in screening diabetes and pre-diabetes in low-resource rural settings. In 2010, 993 participants were randomly selected from 9 villages in Yunnan province using cluster sampling method. Samples for FCG and FPG test were obtained after demographics and physical examination. The oral glucose tolerance test was performed in parallel as gold standard for diagnosis. Diagnostic capacities of the FCG measurement in predicting undiagnosed diabetes and pre-diabetes were assessed. The performance of FCG and FPG tests was compared. Fifty-seven individuals with undiagnosed diabetes and 145 subjects with pre-diabetes were detected. The concordance between FCG and FPG levels was high (r = 0.75, p < 0.001). The area under the curve (AUC) for FCG test in predicting diabetes was 0.88 [95% confidence interval (CI) 0.82-0.93] with the optimal cutoff value of 5.65 mmol/l, sensitivity of 84.2%, and specificity of 79.3%. The corresponding values in FPG tests were 0.92 (95% CI 0.88-0.97) (AUC), 6.51 mmol/l (optimal cutoff point), 82.5% (sensitivity) and 98.3% (specificity), respectively. No significant difference was found in the AUC for the two screening strategies. FCG measurement is considered to be a convenient, practicable screening method in low-resource rural communities with acceptable test properties.

Job Preferences of Nurses and Midwives for Taking Up a Rural Job in Peru: A Discrete Choice Experiment

PubMed Central

Huicho, Luis; Miranda, J. Jaime; Diez-Canseco, Francisco; Lema, Claudia; Lescano, Andrés G.; Lagarde, Mylene; Blaauw, Duane

2012-01-01

Background Robust evidence on interventions to improve the shortage of health workers in rural areas is needed. We assessed stated factors that would attract short-term contract nurses and midwives to work in a rural area of Peru. Methods and Findings A discrete choice experiment (DCE) was conducted to evaluate the job preferences of nurses and midwives currently working on a short-term contract in the public sector in Ayacucho, Peru. Job attributes, and their levels, were based on literature review, qualitative interviews and focus groups of local health personnel and policy makers. A labelled design with two choices, rural community or Ayacucho city, was used. Job attributes were tailored to these settings. Multiple conditional logistic regressions were used to assess the determinants of job preferences. Then we used the best-fitting estimated model to predict the impact of potential policy incentives on the probability of choosing a rural job or a job in Ayacucho city. We studied 205 nurses and midwives. The odds of choosing an urban post was 14.74 times than that of choosing a rural one. Salary increase, health center-type of facility and scholarship for specialization were preferred attributes for choosing a rural job. Increased number of years before securing a permanent contract acted as a disincentive for both rural and urban jobs. Policy simulations showed that the most effective attraction package to uptake a rural job included a 75% increase in salary plus scholarship for a specialization, which would increase the proportion of health workers taking a rural job from 36.4% up to 60%. Conclusions Urban jobs were more strongly preferred than rural ones. However, combined financial and non-financial incentives could almost double rural job uptake by nurses and midwifes. These packages may provide meaningful attraction strategies to rural areas and should be considered by policy makers for implementation. PMID:23284636

What keeps health professionals working in rural district hospitals in South Africa?

PubMed

Jenkins, Louis S; Gunst, Colette; Blitz, Julia; Coetzee, Johan F

2015-06-26

The theme of the 2014 Southern African Rural Health Conference was 'Building resilience in facing rural realities'. Retaining health professionals in South Africa is critical for sustainable health services. Only 12% of doctors and 19% of nurses have been retained in the rural areas. The aim of the workshop was to understand from health practitioners why they continued working in their rural settings. CONFERENCE WORKSHOP: The workshop consisted of 29 doctors, managers, academic family physicians, nurses and clinical associates from Southern Africa, with work experience from three weeks to 13 years, often in deep rural districts. Using the nominal group technique, the following question was explored, 'What is it that keeps you going to work every day?' Participants reflected on their work situation and listed and rated the important reasons for continuing to work. Five main themes emerged. A shared purpose, emanating from a deep sense of meaning, was the strongest reason for staying and working in a rural setting. Working in a team was second most important, with teamwork being related to attitudes and relationships, support from visiting specialists and opportunities to implement individual clinical skills. A culture of support was third, followed by opportunities for growth and continuing professional development, including teaching by outreaching specialists. The fifth theme was a healthy work-life balance. Health practitioners continue to work in rural settings for often deeper reasons relating to a sense of meaning, being part of a team that closely relate to each other and feeling supported.

Implementing an anti-smoking program in rural-remote communities: challenges and strategies.

PubMed

Tall, Julie A; Brew, Bronwyn K; Saurman, Emily; Jones, Therese C

2015-01-01

Rural-remote communities report higher smoking rates and poorer health outcomes than that of metropolitan areas. While anti-smoking programs are an important measure for addressing smoking and improving health, little is known of the challenges faced by primary healthcare staff implementing those programs in the rural-remote setting. The aim of this study was to explore the challenges and strategies of implementing an anti-smoking program by primary healthcare staff in rural-remote Australia. Guided by a phenomenological approach, semi-structured interviews and focus groups were conducted with health service managers, case managers and general practitioners involved in program implementation in Australian rural-remote communities between 2008 and 2010. Program implementation was reported to be challenged by limited primary and mental healthcare resources and client access to services; limited collaboration between health services; the difficulty of accessing staff training; high levels of community distress and disadvantage; the normalisation of smoking and its deleterious impact on smoking abstinence among program clients; and low morale among health staff. Strategies identified to overcome challenges included appointing tobacco-dedicated staff; improving health service collaboration, access and flexibility; providing subsidised pharmacotherapies and boosting staff morale. Findings may assist health services to better tailor anti-smoking programs for the rural-remote setting, where smoking rates are particularly high. Catering for the unique challenges of the rural-remote setting is necessary if anti-smoking programs are to be efficacious, cost-effective and capable of improving rural-remote health outcomes.

Environmental barriers and enablers to physical activity participation among rural adults: a qualitative study.

PubMed

Cleland, Verity; Hughes, Clarissa; Thornton, Lukar; Squibb, Kathryn; Venn, Alison; Ball, Kylie

2015-08-01

Social-ecological models of health behaviour acknowledge environmental influences, but research examining how the environment shapes physical activity in rural settings is limited. This study aimed to explore the environmental factors that act as barriers or facilitators to physical activity participation among rural adults. Forty-nine adults from three regions of rural Tasmania, Australia, participated in semi-structured interviews that explored features of the environment that supported or hindered physical activity. Interviews were digitally recorded, transcribed verbatim and analysed thematically. Four key themes emerged: functionality, diversity, spaces and places for all and realistic expectations. 'Functionality' included connectivity with other destinations, distance, safety, continuity, supporting infrastructure and surfacing. While there was limited 'diversity' of structured activities and recreational facilities, the importance of easy and convenient access to a natural environment that accommodated physical activity was highlighted. 'Spaces and places for all' highlighted the importance of shared-use areas, particularly those that were family- and dog-friendly. Despite desires for more physical activity opportunities, many participants had 'realistic expectations' of what was feasible in rural settings. Functionality, diversity, spaces and places for all and realistic expectations were identified as considerations important for physical activity among rural adults. Further research using quantitative approaches in larger samples is needed to confirm these findings. SO WHAT? Urban-centric views of environmental influences on physical activity are unlikely to be entirely appropriate for rural areas. Evidence-based recommendations are provided for creating new or modifying existing infrastructure to support active living in rural settings.

Measuring participant rurality in Web-based interventions.

PubMed

Danaher, Brian G; Hart, L Gary; McKay, H Garth; Severson, Herbert H

2007-08-31

Web-based health behavior change programs can reach large groups of disparate participants and thus they provide promise of becoming important public health tools. Data on participant rurality can complement other demographic measures to deepen our understanding of the success of these programs. Specifically, analysis of participant rurality can inform recruitment and social marketing efforts, and facilitate the targeting and tailoring of program content. Rurality analysis can also help evaluate the effectiveness of interventions across population groupings. We describe how the RUCAs (Rural-Urban Commuting Area Codes) methodology can be used to examine results from two Randomized Controlled Trials of Web-based tobacco cessation programs: the ChewFree.com project for smokeless tobacco cessation and the Smokers' Health Improvement Program (SHIP) project for smoking cessation. Using RUCAs methodology helped to highlight the extent to which both Web-based interventions reached a substantial percentage of rural participants. The ChewFree program was found to have more rural participation which is consistent with the greater prevalence of smokeless tobacco use in rural settings as well as ChewFree's multifaceted recruitment program that specifically targeted rural settings. Researchers of Web-based health behavior change programs targeted to the US should routinely include RUCAs as a part of analyzing participant demographics. Researchers in other countries should examine rurality indices germane to their country.

Evaluating a De-Centralized Regional Delivery System for Breast Cancer Screening and Patient Navigation for the Rural Underserved

PubMed Central

Inrig, Stephen J.; Tiro, Jasmin A.; Melhado, Trisha V.; Argenbright, Keith E.; Craddock Lee, Simon J.

2017-01-01

Providing breast cancer screening services in rural areas is challenging due to the fractured nature of healthcare delivery systems and complex reimbursement mechanisms that create barriers to access for the under- and uninsured. Interventions that reduce structural barriers to mammography, like patient navigation programs, are effective and recommended, especially for minority and underserved women. Although the literature on rural healthcare is significant, the field lacks studies of adaptive service delivery models and rigorous evaluation of evidence-based programs that facilitate routine screening and appropriate follow-up across large geographic areas. Objectives To better understand how to implement a decentralized regional delivery “hub & spoke” model for rural breast cancer screening and patient navigation, we have designed a rigorous, structured, multi-level and mixed-methods evaluation based on Glasgow’s RE-AIM model (Reach, Effectiveness, Adoption, Implementation, and Maintenance). Methods and Design The program is comprised of three core components: 1) Outreach to underserved women by partnering with county organizations; 2) Navigation to guide patients through screening and appropriate follow-up; and 3) Centralized Reimbursement to coordinate funding for screening services through a central contract with Medicaid Breast and Cervical Cancer Services (BCCS). Using Glasgow’s RE-AIM model, we will: 1) assess which counties have the resources and capacity to implement outreach and/or navigation components, 2) train partners in each county on how to implement components, and 3) monitor process and outcome measures in each county at regular intervals, providing booster training when needed. Discussion This evaluation strategy will elucidate how the heterogeneity of rural county infrastructure impacts decentralized service delivery as a navigation program expands. In addition to increasing breast cancer screening access, our model improves and maintains time to diagnostic resolution and facilitates timely referral to local cancer treatment services. We offer this evaluation approach as an exemplar for scientific methods to evaluate the translation of evidence-based federal policy into sustainable health services delivery in a rural setting. PMID:28713882

The role of public schools in HIV prevention: perspectives from African Americans in the rural South.

PubMed

Lloyd, Stacey W; Ferguson, Yvonne Owens; Corbie-Smith, Giselle; Ellison, Arlinda; Blumenthal, Connie; Council, Barbara J; Youmans, Selena; Muhammad, Melvin R; Wynn, Mysha; Adimora, Adaora; Akers, Aletha

2012-02-01

Though African-American youth in the South are at high risk for HIV infection, abstinence until marriage education continues to be the only option in some public schools. Using community-based participatory research methods, we conducted 11 focus groups with African-American adults and youth in a rural community in North Carolina with high rates of HIV infection with marked racial disparities. Focus group discussions explored participant views on contributors to the elevated rates of HIV and resources available to reduce transmission. Participants consistently identified the public schools' sex education policies and practices as major barriers toward preventing HIV infection among youth in their community. Ideas for decreasing youth's risk of HIV included public schools providing access to health services and sex education. Policymakers, school administrators, and other stakeholders should consider the public school setting as a place to provide HIV prevention education for youth in rural areas.

Breast cancer navigation and patient satisfaction: exploring a community-based patient navigation model in a rural setting.

PubMed

Hook, Ann; Ware, Laurie; Siler, Bobbie; Packard, Abbot

2012-07-01

To explore patient satisfaction among newly diagnosed patients with breast cancer in a rural community setting using a nurse navigation model. Nonexperimental, descriptive study. Large, multispecialty physician outpatient clinic serving about 150 newly diagnosed patients with breast cancer annually at the time of the study. 103 patients using nurse navigation services during a two-year period. A researcher-developed 14-item survey tool using a Likert-type scale was mailed to about 300 navigated patients. Nurse navigation and patient satisfaction. The majority of participants (n = 73, 72%) selected "strongly agree" in each survey statement when questioned about the benefits of nurse navigation. Patients receiving nurse navigation for breast cancer are highly satisfied with the services offered in this setting. Findings from this study offer insight regarding the effectiveness of an individualized supportive care approach to nurses and providers of oncology care. That information can be used to guide the implementation of future nurse navigation programs, determine effective methods of guiding patients through the cancer experience, and aid in promoting the highest standard of oncology care.

Influence of natural amenities on residential property values in a rural setting.

Treesearch

E.M. White; L.A. Leefers

2007-01-01

Most hedonic pricing studies have been completed in suburban and urban communities rather than rural areas. The hedonic pricing study presented here includes developed residential parcel transactions occurring in a rural county in Michigan. We develop two hedonic pricing models using transactions data for two rural residential parcel types: developed parcels located in...

Advice from Rural Elders: What It Takes to Age in Place

ERIC Educational Resources Information Center

Dye, Cheryl J.; Willoughby, Deborah F.; Battisto, Dina G.

2011-01-01

Older adults prefer to age in place (AIP), and there are psychological, physiological, and economic benefits in doing so. However, it is especially challenging to AIP in rural communities. AIP models have been tested in urban settings and age-segregated communities, but they are not appropriate for rural communities. This paper presents rural AIP…

Rural Residence and Prescription Medication Use by Community-Dwelling Older Adults: A Review of the Literature

ERIC Educational Resources Information Center

Grymonpre, Ruby E.; Hawranik, Pamela G.

2008-01-01

Context: Due to various barriers to health care access in the rural setting, there is concern that rural older adults might have lower access to prescribed medications than their urban counterparts. Purpose: To review published research reports to determine prevalence and mean medication use in rural, noninstitutionalized older adults and assess…

The Effectiveness and Cost-Effectiveness of a Rural Employer-Based Wellness Program

ERIC Educational Resources Information Center

Saleh, Shadi S.; Alameddine, Mohamad S.; Hill, Dan; Darney-Beuhler, Jessica; Morgan, Ann

2010-01-01

Context: The cost-effectiveness of employer-based wellness programs has been previously investigated with favorable financial and nonfinancial outcomes being detected. However, these investigations have mainly focused on large employers in urban settings. Very few studies examined wellness programs offered in rural settings. Purpose: This paper…

The rural nurse work environment and structural empowerment.

PubMed

Krebs, Julianne P; Madigan, Elizabeth A; Tullai-McGuinness, Susan

2008-02-01

Rural health care organizations struggle to attract and retain nurses, yet much of the research has focused on characteristics of the nurse work environment or empowerment in urban hospitals. The purpose of this study was to examine the nurse work environment in rural areas across settings by describing the relationship between structural empowerment and characteristics of the nurse work environment. Nurses ( N = 97) working in home care agencies and hospitals were surveyed. Significant differences were found between the groups, with home care nurses having significantly higher empowerment scores than medical/surgical nurses. A strong correlation was found between characteristics of the nurse work environment and empowerment. Policy makers are using evidence to guide development of policies, but much of the research has been conducted in urban hospital settings. This study begins to provide evidence that differences exist between urban and rural areas and between practice settings.

Cost-Effectiveness of Rural Incentive Packages for Graduating Medical Students in Lao PDR

PubMed Central

Keuffel, Eric; Jaskiewicz, Wanda; Theppanya, Khampasong; Tulenko, Kate

2017-01-01

Background: The dearth of health workers in rural settings in Lao People’s Democratic Republic (PDR) and other developing countries limits healthcare access and outcomes. In evaluating non-wage financial incentive packages as a potential policy option to attract health workers to rural settings, understanding the expected costs and effects of the various programs ex ante can assist policy-makers in selecting the optimal incentive package. Methods: We use discrete choice experiments (DCEs), costing analyses and recent empirical results linking health worker density and health outcomes to estimate the future location decisions of physicians and determine the cost-effectiveness of 15 voluntary incentives packages for new physicians in Lao PDR. Our data sources include a DCE survey completed by medical students (n = 329) in May 2011 and secondary cost, economic and health data. Mixed logit regressions provide the basis for estimating how each incentive package influences rural versus urban location choice over time. We estimate the expected rural density of physicians and the cost-effectiveness of 15 separate incentive packages from a societal perspective. In order to generate the cost-effectiveness ratios we relied on the rural uptake probabilities inferred from the DCEs, the costing data and prior World Health Organization (WHO) estimates that relate health outcomes to health worker density. Results: Relative to no program, the optimal voluntary incentive package would increase rural physician density by 15% by 2016 and 65% by 2041. After incorporating anticipated health effects, seven (three) of the 15 incentive packages have anticipated average cost-effectiveness ratio less than the WHO threshold (three times gross domestic product [GDP] per capita) over a 5-year (30 year) period. The optimal package’s incremental cost-effectiveness ratio is $1454/QALY (quality-adjusted life year) over 5 years and $2380/QALY over 30 years. Capital intensive components, such as housing or facility improvement, are not efficient. Conclusion: Conditional on using voluntary incentives, Lao PDR should emphasize non-capital intensive options such as advanced career promotion, transport subsidies and housing allowances to improve physician distribution and rural health outcomes in a cost-effective manner. Other countries considering voluntary incentive programs can implement health worker/trainee DCEs and costing surveys to determine which incentive bundles improve rural uptake most efficiently but should be aware of methodological caveats. PMID:28812834

Severe edentulism is a major risk factor influencing stroke incidence in rural Ecuador (The Atahualpa Project).

PubMed

Del Brutto, Oscar H; Mera, Robertino M; Zambrano, Mauricio; Del Brutto, Victor J

2017-02-01

Background There is no information on stroke incidence in rural areas of Latin America, where living conditions and cardiovascular risk factors are different from urban centers. Aim Using a population-based prospective cohort study design, we aimed to assess risk factors influencing stroke incidence in community-dwelling adults living in rural Ecuador. Methods First-ever strokes occurring from 1 June 2012 to 31 May 2016, in Atahualpa residents aged ≥40 years, were identified from yearly door-to-door surveys and other overlapping sources. Poisson regression models adjusted for demographics, cardiovascular risk factors, edentulism and the length of observation time per subject were used to estimate stroke incidence rate ratio as well as factors influencing such incidence. Results Of 807 stroke-free individuals prospectively enrolled in the Atahualpa Project, follow-up was achieved in 718 (89%), contributing 2,499 years of follow-up (average 3.48 ± 0.95 years). Overall stroke incidence rate was 2.97 per 100 person-years of follow-up (95% CI: 1.73-4.2), which increased to 4.77 (95% CI: 1.61-14.1) when only persons aged ≥57 years were considered. Poisson regression models, adjusted for relevant confounders, showed that high blood pressure (IRR: 5.24; 95% CI: 2.55-7.93) and severe edentulism (IRR: 5.06; 95% CI: 2.28-7.85) were the factors independently increasing stroke incidence. Conclusions Stroke incidence in this rural setting is comparable to that reported from the developed world. Besides age and high blood pressure, severe edentulism is a major factor independently predicting incident strokes. Public awareness of the consequences of poor dental care might reduce stroke incidence in rural settings.

a Geographic Weighted Regression for Rural Highways Crashes Modelling Using the Gaussian and Tricube Kernels: a Case Study of USA Rural Highways

NASA Astrophysics Data System (ADS)

Aghayari, M.; Pahlavani, P.; Bigdeli, B.

2017-09-01

Based on world health organization (WHO) report, driving incidents are counted as one of the eight initial reasons for death in the world. The purpose of this paper is to develop a method for regression on effective parameters of highway crashes. In the traditional methods, it was assumed that the data are completely independent and environment is homogenous while the crashes are spatial events which are occurring in geographic space and crashes have spatial data. Spatial data have spatial features such as spatial autocorrelation and spatial non-stationarity in a way working with them is going to be a bit difficult. The proposed method has implemented on a set of records of fatal crashes that have been occurred in highways connecting eight east states of US. This data have been recorded between the years 2007 and 2009. In this study, we have used GWR method with two Gaussian and Tricube kernels. The Number of casualties has been considered as dependent variable and number of persons in crash, road alignment, number of lanes, pavement type, surface condition, road fence, light condition, vehicle type, weather, drunk driver, speed limitation, harmful event, road profile, and junction type have been considered as explanatory variables according to previous studies in using GWR method. We have compered the results of implementation with OLS method. Results showed that R2 for OLS method is 0.0654 and for the proposed method is 0.9196 that implies the proposed GWR is better method for regression in rural highway crashes.

The business cycle and mortality: Urban versus rural counties.

PubMed

Sameem, Sediq; Sylwester, Kevin

2017-02-01

Many studies have found that mortality declines during recessions, but do such results remain consistent in both urban and rural settings? To help uncover explanations for such a pro-cyclical nature of mortality, the present study revisits this topic but allows for associations between unemployment and mortality to differ between urban and rural areas. Using a total of 66 863 observations across 3066 counties of the U.S. from 1990 to 2013, we allow the coefficient on unemployment to differ between urban and rural counties. With an exception of deaths due to external accidents being pro-cyclical in rural settings, we find that the negative association between unemployment and mortality more generally holds for urban areas, particularly for females and the elderly. Moreover, we find death due to circulatory disease or influenza/pneumonia to be especially more prevalent in urban areas. Given that the negative associations between unemployment and mortality are generally stronger in cities, views attempting to explain pro-cyclical mortality should focus on characteristics in urban settings. Copyright © 2016 Elsevier Ltd. All rights reserved.

Gender, Traumatic Events, and Mental Health Disorders in a Rural Asian Setting*

PubMed Central

Axinn, William G.; Ghimire, Dirgha J.; Williams, Nathalie E.; Scott, Kate M.

2014-01-01

Research shows a strong association between traumatic life experience and mental health and important gender differences in that relationship in the Western European Diaspora, but much less is known about these relationships in other settings. We investigate these relationships in a poor rural Asian setting that recently experienced a decade-long armed conflict. We use data from 400 adult interviews in rural Nepal. The measures come from World Mental Health survey instruments clinically validated for this study population to measure Depression, Post Traumatic Stress Disorder (PTSD), and Intermittent Explosive Disorder (IED). Our results demonstrate that traumatic life experience significantly increases the likelihood of mental health disorders in this setting and that these traumatic experiences have a larger effect on the mental health of women than men. These findings offer important clues regarding the potential mechanisms producing gender differences in mental health in many settings. PMID:24311755

Application of a Telecolposcopy Program in Rural Settings.

PubMed

Hitt, Wilbur C; Low, Gordon M; Lynch, Christian E; Gauss, C Heath; Magann, Everett F; Lowery, Curtis L; Eswaran, Hari

2016-10-01

Individuals in rural areas are often restricted by the amount of physicians' availability, thus limiting access to healthcare in those settings. While Pap smear screening has increased across the United States, the rural South still reports high rates of cervical cancer and mortality. One solution to improve patient outcomes related to cervical cancer in rural settings is telecolposcopy. Women with abnormal Pap results or an abnormal visual examination needing an evaluation by colposcopy were referred to a hospital-based telecolposcopy program. Descriptive data are provided that include patients' access to care based on travel time and transportation costs. Over a 15-month time period, 940 unique patients were seen using telecolposcopy. Telecolposcopy was done at eight spoke sites across Arkansas representing patients from 72 of the 75 counties. Data for risk factors that include smoking, first sexual experience, and number of sexual partners in past 12 months and in a lifetime are discussed. Pap results and impression are provided. In addition, avoided transportation costs and travel time have been calculated and included. Cervical cancer is important public health concern especially for women residing in rural areas. We were able to demonstrate that our telecolposcopy program has provided sustainability statewide since its inception and that patients are willing to participate. In addition to providing increased access to care, the program also reduced travel time and costs associated with a face-to-face visit. Telecolposcopy should be further explored and utilized in rural settings as a way to reduce patient costs and improve cervical cancer outcomes.

A casemix study of patients seen by a dermatology trainee in rural and urban outpatient settings.

PubMed

Tilakaratne, Dev; Warren, Lachlan; Menz, Jennifer

2016-02-01

For 8 years South Australian dermatologists have provided an outreach service to the Northern Territory (NT), including rural and remote areas. In 2012 and 2013, a trainee accompanied a dermatologist on these outreach visits. This is the first prospective study that documents the spectrum of dermatological diseases requiring outpatient specialist input in various settings in the NT, and also the first study to compare the clinical experience of one Australian dermatology trainee in urban and rural settings. Characteristics of patients managed primarily by the outreach dermatology registrar were recorded prospectively from February 2013 to July 2013. The data from the trainee's urban encounters were compared to that of the rural centres. The spectrum of conditions seen in these two settings was placed in the disease categories specified in the Australasian College of Dermatologists (ACD) curriculum. The Royal Adelaide Hospital outpatient experience provided greater exposure to skin neoplasms, lymphoproliferative and myeloproliferative disorders and non-infectious neutrophilic/eosinophilic disorders. The outreach sites provided greater exposure to infections, adnexal diseases and genodermatoses. Both urban and rural experiences provided a broad exposure to the disease categories outlined in the ACD curriculum. The spectrum of disease requiring specialist dermatology input varies between urban South Australia and rural NT. The inclusion of dermatology trainees in outreach visits broadens their clinical exposure. It is recommended that other dermatology service providers in Australia consider documenting clinical casemix comparisons to assess dermatology demand, outcomes and trainee exposure. © 2014 The Australasian College of Dermatologists.

The Implementation of Crisis Resolution Home Treatment Teams in Wales: Results of the National Survey 2007-2008

PubMed Central

Jones, Richard; Jordan, Sue

2010-01-01

Background: In mental health nursing, Crisis Resolution and Home Treatment (CRHT) services are key components of the shift from in-patient to community care. CRHT has been developed mainly in urban settings, and deployment in more rural areas has not been examined. Aim: We aimed to evaluate CRHT services’ progress towards policy targets. Participants and Setting: All 18 CRHT teams in Wales were surveyed. Methods: A service profile questionnaire was distributed to team leaders. Findings: Fourteen of 18 teams responded in full. All but one were led by nurses, who formed the main professional group. All teams reported providing an alternative to hospital admission and assisting early discharge. With one exception, teams were ‘gatekeeping’ hospital beds. There was some divergence in clients seen, perceived impact of the service, operational hours, distances travelled, team structure, input of consultant psychiatrists and caseloads. We found some differences between the 8 urban teams and the 6 teams serving rural or mixed areas: rural teams travelled more, had fewer inpatient beds, and less medical input (0.067 compared to 0.688 whole time equivalents).. Most respondents felt that resource constraints were limiting further developments. Implications: Teams met standards for CHRT services in Wales; however, these are less onerous than those in England, particularly in relation to operational hours and staffing complement. As services develop, it will be important to ensure that rural and mixed areas receive the same level of input as urban areas. PMID:20502646

Guidelines for Speed Reduction in Towns Along Rural Highways

DOT National Transportation Integrated Search

2013-10-01

This report presents the results of the study undertaken to develop a guideline for setting up speed limit in towns along rural highways of Nevada. Generally, speed zones are provided in towns along rural highways to reduce speed-related crashes. How...

Improving the management and care of refugees in Australian hospitals: a descriptive study.

PubMed

Ross, Lindsey; Harding, Catherine; Seal, Alexa; Duncan, Geraldine

2016-01-01

Objectives The aim of the present study was to investigate healthcare provider perceptions of the impact of refugee patients at two public hospitals, one rural and one urban, in designated refugee resettlement areas. Healthcare professionals' views regarding improvements that could be made in this area were also sought. Methods Two-page anonymous questionnaires containing demographic, quantitative and open-ended questions were distributed to 150 healthcare providers at each research site. Results Response rates at the rural and urban sites were 50% and 49%, respectively. Refugees were seen at least monthly by 40% of respondents. Additional support was requested by 70% of respondents. Confidence was associated with being born overseas (P=0.029) and increased time working with refugees (r s =0.418, P<0.001). Only 47% of respondents felt confident managing social and psychological needs of refugees. Midwives saw refugees more than nursing and allied healthcare staff combined, and this was significant at the rural hospital (P<0.001). Rural respondents reported that working with refugees enhanced their practice (P=0.025), although felt significantly less confident (P<0.001) than urban respondents. Themes that arose regarding barriers to care included language and cultural barriers, paucity of knowledge and issues accessing available services, including appropriate interpreters, Medicare eligibility and patient factors, including lack of patient trust in government systems. Desire for support was more pronounced in the rural setting (P=0.001). Conclusions Refugees were seen frequently in both settings and most respondents requested additional support, highlighting that caring for refugees in Australian hospitals is a significant challenge. Additional support and education should be targeted to those caring for refugees most frequently, particularly midwifery services, to reduce barriers to care. What is known about the topic? Refugees are a vulnerable group, often with complex health needs. These needs are often unmet because of issues including language and cultural barriers. What does this paper add? Refugees were seen frequently in the two public hospital settings involved in the present study and most often by midwifery services. Healthcare professionals require more support, more information about available services and better access to interpreter services. These issues were more pronounced in the rural setting where very limited research exists. What are the implications for practitioners? Implementing additional support and education regarding refugee health needs could increase knowledge and confidence when managing refugees, reducing barriers to care and improving quality of care.

Participatory mapping in low-resource settings: Three novel methods used to engage Kenyan youth and other community members in community-based HIV prevention research

PubMed Central

Green, Eric P.; Warren, Virginia Rieck; Broverman, Sherryl; Ogwang, Benson; Puffer, Eve S.

2017-01-01

Understanding the link between health and place can strengthen the design of health interventions, particularly in the context of HIV prevention. Individuals who might one day participate in such interventions—including youth—may further improve the design if engaged in a meaningful way in the formative research process. Increasingly, participatory mapping methods are being used to achieve both aims. We describe the development of three innovative mapping methods for engaging youth in formative community-based research: ‘dot map’ focus groups, geocaching games, and satellite imagery assisted daily activity logs. We demonstrate that these methods are feasible and acceptable in a low-resource, rural African setting. The discussion outlines the merits of each method and considers possible limitations. PMID:27064073

"Everybody Knows Everybody Else's Business"-Privacy in Rural Communities.

PubMed

Leung, Janni; Smith, Annetta; Atherton, Iain; McLaughlin, Deirdre

2016-12-01

Patients have a right to privacy in a health care setting. This involves conversational discretion, security of medical records and physical privacy of remaining unnoticed or unidentified when using health care services other than by those who need to know or whom the patient wishes to know. However, the privacy of cancer patients who live in rural areas is more difficult to protect due to the characteristics of rural communities. The purpose of this article is to reflect on concerns relating to the lack of privacy experienced by cancer patients and health care professionals in the rural health care setting. In addition, this article suggests future research directions to provide much needed evidence for educating health care providers and guiding health care policies that can lead to better protection of privacy among cancer patients living in rural communities.

Neuroimaging Field Methods Using Functional Near Infrared Spectroscopy (NIRS) Neuroimaging to Study Global Child Development: Rural Sub-Saharan Africa.

PubMed

Jasińska, Kaja K; Guei, Sosthène

2018-02-02

Portable neuroimaging approaches provide new advances to the study of brain function and brain development with previously inaccessible populations and in remote locations. This paper shows the development of field functional Near Infrared Spectroscopy (fNIRS) imaging to the study of child language, reading, and cognitive development in a rural village setting of Côte d'Ivoire. Innovation in methods and the development of culturally appropriate neuroimaging protocols allow a first-time look into the brain's development and children's learning outcomes in understudied environments. This paper demonstrates protocols for transporting and setting up a mobile laboratory, discusses considerations for field versus laboratory neuroimaging, and presents a guide for developing neuroimaging consent procedures and building meaningful long-term collaborations with local government and science partners. Portable neuroimaging methods can be used to study complex child development contexts, including the impact of significant poverty and adversity on brain development. The protocol presented here has been developed for use in Côte d'Ivoire, the world's primary source of cocoa, and where reports of child labor in the cocoa sector are common. Yet, little is known about the impact of child labor on brain development and learning. Field neuroimaging methods have the potential to yield new insights into such urgent issues, and the development of children globally.

Overseas trained nurses working in regional and rural practice settings: do we understand the issues?

PubMed

Wellard, S J; Stockhausen, L J

2010-01-01

Issues associated with the employment of overseas trained nurses (OTNs) in regional and rural practice settings have received little professional attention in Australia. The global nursing workforce crisis has dominated discussion about the migration of nurses. This review explored the contemporary understandings of the employment of OTNs in Australian regional and rural practice settings. An integrative literature review was undertaken to incorporate a range of literature types related to OTN employment. A search of electronic databases and relevant web pages was undertaken for the publication period 1995-2008. Integrative literature reviews incorporate assessment of empirical research as well as theoretical and opinion-based literature to present a broad synthesis of the topic of interest. Following identification of relevant literature, thematic analysis was undertaken to reveal patterns and relationships among concepts facilitating synthesis of findings across the range of literature. There is an abundance of literature exploring the international migration of nurses that demonstrates an imbalance of migration from poorer countries to more affluent countries. This review identified a number of economic and ethical issues, together with risks for potential exploitation of migrant nurses. There was minimal literature specific to the experiences of OTNs working in regional and rural areas. However, there has been some exploration of issues associated with medical recruitment to rural areas. The employment of OTNs is accompanied by complex and varied issues which require resourceful and proactive responses by healthcare employers. Further research is needed to understand the challenges OTNs have in working in rural settings, particularly in Australia. Increased understanding in clinical settings of factors that influence nurses to migrate, as well as the range of barriers they face in working and living in host countries, may assist in the retention of these nurses.

Risk assessment and decision making about in-labour transfer from rural maternity care: a social judgment and signal detection analysis

PubMed Central

2012-01-01

Background The importance of respecting women’s wishes to give birth close to their local community is supported by policy in many developed countries. However, persistent concerns about the quality and safety of maternity care in rural communities have been expressed. Safe childbirth in rural communities depends on good risk assessment and decision making as to whether and when the transfer of a woman in labour to an obstetric led unit is required. This is a difficult decision. Wide variation in transfer rates between rural maternity units have been reported suggesting different decision making criteria may be involved; furthermore, rural midwives and family doctors report feeling isolated in making these decisions and that staff in urban centres do not understand the difficulties they face. In order to develop more evidence based decision making strategies greater understanding of the way in which maternity care providers currently make decisions is required. This study aimed to examine how midwives working in urban and rural settings and obstetricians make intrapartum transfer decisions, and describe sources of variation in decision making. Methods The study was conducted in three stages. 1. 20 midwives and four obstetricians described factors influencing transfer decisions. 2. Vignettes depicting an intrapartum scenario were developed based on stage one data. 3. Vignettes were presented to 122 midwives and 12 obstetricians who were asked to assess the level of risk in each case and decide whether to transfer or not. Social judgment analysis was used to identify the factors and factor weights used in assessment. Signal detection analysis was used to identify participants’ ability to distinguish high and low risk cases and personal decision thresholds. Results When reviewing the same case information in vignettes midwives in different settings and obstetricians made very similar risk assessments. Despite this, a wide range of transfer decisions were still made, suggesting that the main source of variation in decision making and transfer rates is not in the assessment but the personal decision thresholds of clinicians. Conclusions Currently health care practice focuses on supporting or improving decision making through skills training and clinical guidelines. However, these methods alone are unlikely to be effective in improving consistency of decision making. PMID:23114289

Body Mass Index and Self-Perception of Overweight and Obesity in Rural, Urban and Rural-to-Urban Migrants: PERU MIGRANT Study

PubMed Central

Loret de Mola, Christian; Pillay, Timesh D.; Diez-Canseco, Francisco; Gilman, Robert H.; Smeeth, Liam; Miranda, J. Jaime

2012-01-01

Objective This study aimed to compare self-reported weight and body mass index (BMI) in order to determine discrepancies between subjective and objective obesity-related markers, and possible explanatory factors of overweight and obesity underestimation, in urban, rural and migrant populations. Materials and Methods Data from the PERU MIGRANT study, a cross-sectional study, in low-income settings, of urban, migrant (rural-to-urban), and rural groups, including BMI, self-reported weight and socio-demographic indicators were analyzed. Percentage of concurrences between BMI and self-reported weight and Kappa coefficients for inter-rater agreement were calculated. Univariate and standardized descriptive analyses were performed to identify potential explanatory variables for weight underestimation in only overweight and obese individuals, using established BMI and waist circumference cut offs. Results 983 Participants–199 urban, 583 migrants and 201 rural–were analyzed. Based on BMI, overall prevalence of obesity was 20.1% (95% CI 17.6%–22.6%), and overweight was 38.3% (95% CI 35.2%–41.2%), with differences between study groups (p<0.001). Only 43% of the whole sample had matching self-reported weight and BMI status, whereas 54% underestimated and 3% overestimated their BMI category. Kappa coefficient, between BMI and self-reported weight, for the entire sample was 0.16, rural residents had the lowest coefficient (0.01) and the most underestimation, especially in the overweight category. In overweight and obese individuals, deprivation index (p = 0.016), age (p = 0.014) and waist circumference (p<0.001) were associated with weight underestimation. Discussion Overall, high levels of overweight, obesity, and underestimation of BMI status were found, with poor agreement between BMI and self-reported weight, showing the unawareness of weight status severity in this low-income setting. PMID:23209688

Effectiveness and implementation of an obesity prevention intervention: the HeLP-her Rural cluster randomised controlled trial.

PubMed

Lombard, Catherine B; Harrison, Cheryce L; Kozica, Samantha L; Zoungas, Sophia; Keating, Catherine; Teede, Helena J

2014-06-16

To impact on the obesity epidemic, interventions that prevent weight gain across populations are urgently needed. However, even the most efficacious interventions will have little impact on obesity prevention unless they are successfully implemented in diverse populations and settings. Implementation research takes isolated efficacy studies into practice and policy and is particularly important in obesity prevention where there is an urgent need to accelerate the evidence to practice cycle. Despite the recognised need, few obesity prevention interventions have been implemented in real life settings and to our knowledge rarely target rural communities. Here we describe the rationale, design and implementation of a Healthy Lifestyle Program for women living in small rural communities (HeLP-her Rural). The primary goal of HeLP-her Rural is to prevent weight gain using a low intensity, self-management intervention. Six hundred women from 42 small rural communities in Australia will be randomised as clusters (n-21 control towns and n = 21 intervention towns). A pragmatic randomised controlled trial methodology will test efficacy and a comprehensive mixed methods community evaluation and cost analysis will inform effectiveness and implementation of this novel prevention program. Implementing population interventions to prevent obesity is complex, costly and challenging. To address these barriers, evidence based interventions need to move beyond isolated efficacy trials and report outcomes related to effectiveness and implementation. Large pragmatic trials provide an opportunity to inform both effectiveness and implementation leading to potential for greater impact at the population level. Pragmatic trials should incorporate both effectiveness and implementation outcomes and a multidimensional methodology to inform scale-up to population level. The learnings from this trial will impact on the design and implementation of population obesity prevention strategies nationally and internationally. ANZ clinical trial registry ACTRN12612000115831. Date of registration 24/01/2012.

Malaria prevalence in Bata district, Equatorial Guinea: a cross-sectional study.

PubMed

Ncogo, Policarpo; Herrador, Zaida; Romay-Barja, Maria; García-Carrasco, Emely; Nseng, Gloria; Berzosa, Pedro; Santana-Morales, Maria A; Riloha, Matilde; Aparicio, Pilar; Valladares, Basilio; Benito, Agustín

2015-11-16

Malaria has traditionally been a leading public health problem in Equatorial Guinea. After completion, in September 2011, of the integrated set of interventions against malaria launched by the Global Fund Malaria Programme in the mainland area, the epidemiological situation of malaria remains unknown. The aim of this study was to investigate the prevalence rate of malaria and associated factors based on the rapid diagnosis test (RDT) in Bata district, in order to provide evidence that will reinforce the National Malaria Control Programme. From June to August 2013, a representative cross sectional survey using a multistage, stratified, cluster-selected sample was carried out in urban zones and rural villages from Bata district. Data on socio-demographic, health status and malaria-related behaviours was collected. Malaria diagnosis was performed by RDT. Bivariate and multivariable statistical methods were employed to assess malaria prevalence and its association with different factors. Prevalence of malaria was higher in rural settings (58.9 %; CI 95 % 55.2-62.5 %) than in the sampled urban communities (33.9 %; CI 95 % 31.1-36.9 %). Presence of anaemia was also high, especially in rural sites (89.6 vs. 82.8 %, p < 0.001). The analyses show that a positive RDT result was significantly associated with age group, the most affected age range being 13 months-14 years old. Other significant covariates were ethnic group (only in urban sites), number of adults living in the house (only in rural villages) previous history of fever, anaemia (only in urban sites) and sleeping under a bed net. Moreover, those who never slept under a bed net were two times more likely to have malaria. The prevalence of malaria was high in Bata district, especially in rural villages. The National Programme to fight malaria in Equatorial Guinea should take into account the differences found between rural and urban communities and age groups to target appropriately those worst affected. The findings of this study will assist in planning and undertaking regional policy and other preventive initiatives.

Training Psychologists for Rural Practice: Exploring Opportunities and Constraints.

PubMed

Domino, Marisa Elena; Lin, Ching-Ching Claire; Morrissey, Joseph P; Ellis, Alan R; Fraher, Erin; Richman, Erica L; Thomas, Kathleen C; Prinstein, Mitchell J

2018-04-17

To examine trends in the psychologist workforce and training opportunities, including factors that may influence the decision of clinical psychologists to practice in rural settings. We use a mixed-methods approach to examine the psychologist workforce nationally and in North Carolina (NC), including (1) an analysis of the location of programs awarding doctoral degrees; (2) an analysis of the practice, demographic, and educational characteristics of the psychologist workforce; and (3) interviews with directors of doctoral programs in clinical psychology to understand where current graduates are getting jobs and why they may or may not be choosing to practice in rural communities. Fewer than 1% of programs and institutions awarding doctoral degrees in psychology in the United States are located in rural areas. In NC, approximately 80% of practicing psychologists have out-of-state degrees and about 80% of recent NC graduates are not currently licensed in the state. This juxtaposition undermines the utility of adding more in-state degree programs. While expansion of training programs within rural areas could help alleviate the shortages of mental health providers, adding new degree-granting programs alone will not necessarily increase supply. We discuss complementary recruitment and retention strategies, including greater incentives for rural training and practice as well as training in emerging technologies that don't require providers to be physically located in underserved areas, such as telemedicine. Increasing the supply of psychologists practicing in rural areas will require a thoughtful, multipronged approach to training this critical part of the behavioral health workforce. © 2018 National Rural Health Association.

How 3 rural safety net clinics integrate care for patients: a qualitative case study.

PubMed

Derrett, Sarah; Gunter, Kathryn E; Nocon, Robert S; Quinn, Michael T; Coleman, Katie; Daniel, Donna M; Wagner, Edward H; Chin, Marshall H

2014-11-01

Integrated care focuses on care coordination and patient centeredness. Integrated care supports continuity of care over time, with care that is coordinated within and between settings and is responsive to patients' needs. Currently, little is known about care integration for rural patients. To examine challenges to care integration in rural safety net clinics and strategies to address these challenges. Qualitative case study. Thirty-six providers and staff from 3 rural clinics in the Safety Net Medical Home Initiative. Interviews were analyzed using the framework method with themes organized within 3 constructs: Team Coordination and Empanelment, External Coordination and Partnerships, and Patient-centered and Community-centered Care. Participants described challenges common to safety net clinics, including limited access to specialists for Medicaid and uninsured patients, difficulty communicating with external providers, and payment models with limited support for care integration activities. Rurality compounded these challenges. Respondents reported benefits of empanelment and team-based care, and leveraged local resources to support care for patients. Rural clinics diversified roles within teams, shared responsibility for patient care, and colocated providers, as strategies to support care integration. Care integration was supported by 2 fundamental changes to organize and deliver care to patients-(1) empanelment with a designated group of patients being cared for by a provider; and (2) a multidisciplinary team able to address rural issues. New funding and organizational initiatives of the Affordable Care Act may help to further improve care integration, although additional solutions may be necessary to address particular needs of rural communities.

The Current State of Rural Neurosurgical Practice: An International Perspective

PubMed Central

Upadhyayula, Pavan S.; Yue, John K.; Yang, Jason; Birk, Harjus S.; Ciacci, Joseph D.

2018-01-01

Introduction: Rural and low-resource areas have diminished capacity to care for neurosurgical patients due to lack of infrastructure, healthcare investment, and training programs. This review summarizes the range of rural neurosurgical procedures, novel mechanisms for delivering care, rapid training programs, and outcome differences across international rural neurosurgical practice. Methods: A comprehensive literature search was performed for English language manuscripts with keywords “rural” and “neurosurgery” using the National Library of Medicine PubMed database (01/1971–06/2017). Twenty-four articles focusing on rural non-neurosurgical practice were included. Results: Time to care and/or surgery and shortage of trained personnel remain the strongest risk factors for mortality and poor outcome. Telemedicine consults to regional centers with neurosurgery housestaff have potential for increased timeliness of diagnosis/triage, improved time to surgery, and reductions in unnecessary transfers in remote areas. Mobile neurosurgery teams have been deployed with success in nations with large transport distances precluding initial transfers. Common neurosurgical procedures involve trauma mechanisms; accordingly, training programs for nonneurosurgery medical personnel on basic assessment and operative techniques have been successful in resource-deficient settings where neurosurgeons are unavailable. Conclusions: Protracted transport times, lack of resources/training, and difficulty retaining specialists are barriers to successful outcomes. Advances in telemedicine, mobile neurosurgery, and training programs for urgent operative techniques have been implemented efficaciously. Development of guidelines for paired partnerships between rural centers and academic hospitals, supplying surplus technology to rural areas, and rapid training of qualified local surgical personnel can create sustainable feed-forward programs for trainees and infrastructural solutions to address challenges in rural neurosurgery. PMID:29456356

Applied Strategies for Improving Patient Safety: A Comprehensive Process To Improve Care in Rural and Frontier Communities

ERIC Educational Resources Information Center

Westfall, John M.; Fernald, Douglas H.; Staton, Elizabeth W.; VanVorst, Rebecca; West, David; Pace, Wilson D.

2004-01-01

Medical errors and patient safety have gained increasing attention throughout all areas of medical care. Understanding patient safety in rural settings is crucial for improving care in rural communities. To describe a system to decrease medical errors and improve care in rural and frontier primary care offices. Applied Strategies for Improving…

Rural/Urban Disparities in Science Achievement in Post-Socialist Countries: The Evolving Influence of Socioeconomic Status

ERIC Educational Resources Information Center

Kryst, Erica L.; Kotok, Stephen; Bodovski, Katerina

2015-01-01

Disparities in educational outcomes exist between students in rural areas as compared to students in urban settings. While there is some evidence that these rural disparities are present in eastern Europe, little is known about young peoples' lives in the rural areas of this region. This paper presents an analysis of science achievement by…

High Technology in Rural Settings. State-of-the-Art Paper.

ERIC Educational Resources Information Center

Tweeten, Luther

The purpose of this paper is to identify the role of high technology in rural-to-urban and urban-to-rural movement and the implications of this technology for agriculture and rural areas. The first section of the paper considers the impact of technology on agriculture in the United States over the past 50 years. Because U.S. agriculture has…

Proposing an Affective Literacy Framework for Young Learners of English in Malaysian Rural Areas: Its Key Dimensions and Challenges

ERIC Educational Resources Information Center

Abdul Rahim, Fauziah; Chun, Lee Seung

2017-01-01

Purpose: This study investigated rural English teachers' perceptions of factors which influence the literacy development of young learners in rural school settings. This investigation led to a further enquiry on the dimensions of an affective literacy framework to support the English learning of rural young learners. Methodology: The study…

Capitated Medicaid Managed Care in a Rural Area: The Impact of Minnesota's PMAP Program

ERIC Educational Resources Information Center

Long, Sharon K.; Coughlin, Teresa A.; King, Jennifer

2005-01-01

Although states have had difficulty extending Medicaid managed care (MMC) to rural areas, rural models of capitated MMC are expected to grow in response to new federal regulations and the serious budget problems facing nearly all states. As such, understanding the effects of capitated MMC in rural settings is important for policy considerations.…

Training and experience of nurses in responding to alcohol misuse in rural communities.

PubMed

Kennedy, Alison J; Mellor, David; McCabe, Marita P; Ricciardelli, Lina A; Brumby, Susan A; Head, Alexandra; Mercer-Grant, Catherine

2013-07-01

Alcohol misuse by farmers continues to challenge rural nurses. This article reports on the experiences of Australian nurses participating in the Alcohol Intervention Training Program (AITP). Qualitative interviews of 15 rural and remote nurses. Semi-structured phone interviews were utilized to assess the response to and implementation of the AITP-an intervention designed to build nurses' knowledge, confidence and skills when responding to alcohol misuse. It comprises practical and theoretical components and was designed for rural and remote settings where nurses encounter alcohol misuse. Nurses found the training provided new-or built on existing-knowledge of alcohol misuse and offered practical hands-on "real life" skills. A range of workplace and personal situations where the content of the training was now being utilized were identified, and future use anticipated. Barriers to using the new knowledge and skills included both rural and generic issues. Constructive feedback to increasingly target the training to rural settings was recommended. The AITP is an effective training program. It can be further tailored to meet common needs of rural and remote nurses working with farmers who misuse alcohol, while recognizing diversity in rural practice. © 2013 Wiley Periodicals, Inc.

Conducting Program Evaluation with Hispanics in Rural Settings: Ethical Issues and Evaluation Challenges

ERIC Educational Resources Information Center

Loi, Claudia X. Aguado; McDermott, Robert J.

2010-01-01

Conducting evaluations that are both valid and ethical is imperative for the support and sustainability of programs that address underserved and vulnerable populations. A key component is to have evaluators who are knowledgeable about relevant cultural issues and sensitive to population needs. Hispanics in rural settings are vulnerable for many…

The Family Home Environment, Food Insecurity, and Body Mass Index in Rural Children

ERIC Educational Resources Information Center

Jackson, Jennifer A.; Smit, Ellen; Branscum, Adam; Gunter, Katherine; Harvey, Marie; Manore, Melinda M.; John, Deborah

2017-01-01

Background. Family homes are a key setting for developing lifelong eating and physical activity habits, yet little is known about how family home nutrition and physical activity (FNPA) environments influence food insecurity (FI) and childhood obesity, particularly in rural settings. Aims. This study examined associations among FNPA, FI, and body…

Exploring Rural High School Learners' Experience of Mathematics Anxiety in Academic Settings

ERIC Educational Resources Information Center

Hlalele, Dipane

2012-01-01

The purpose of the study was to explore rural high school learners' experience of mathematics anxiety in academic settings. Mathematics anxiety has been found to have an adverse effect on confidence, motivation and achievement. This quantitative study is exploratory and descriptive in nature. The participants were 403 learners doing mathematics in…

China's rural public health system performance: a cross-sectional study.

PubMed

Tian, Miaomiao; Feng, Da; Chen, Xi; Chen, Yingchun; Sun, Xi; Xiang, Yuanxi; Yuan, Fang; Feng, Zhanchun

2013-01-01

In the past three years, the Government of China initiated health reform with rural public health system construction to achieve equal access to public health services for rural residents. The study assessed trends of public health services accessibility in rural China from 2008 to 2010, as well as the current situation about the China's rural public health system performance. The data were collected from a cross-sectional survey conducted in 2011, which used a multistage stratified random sampling method to select 12 counties and 118 villages from China. Three sets of indicators were chosen to measure the trends in access to coverage, equality and effectiveness of rural public health services. Data were disaggregated by provinces and by participants: hypertension patients, children, elderly and women. We examined the changes in equality across and within region. China's rural public health system did well in safe drinking water, children vaccinations and women hospital delivery. But more hypertension patients with low income could not receive regular healthcare from primary health institutions than those with middle and high income. In 2010, hypertension treatment rate of Qinghai in Western China was just 53.22% which was much lower than that of Zhejiang in Eastern China (97.27%). Meanwhile, low performance was showed in effectiveness of rural public health services. The rate of effective treatment for controlling their blood pressure within normal range was just 39.7%. The implementation of health reform since 2009 has led the public health development towards the right direction. Physical access to public health services had increased from 2008 to 2010. But, inter- and intra-regional inequalities in public health system coverage still exist. Strategies to improve the quality and equality of public health services in rural China need to be considered.

Evaluating Adaptation of a Cancer Clinical Trial Decision Aid for Rural Cancer Patients: A Mixed-Methods Approach.

PubMed

Pathak, Swati; George, Nerissa; Monti, Denise; Robinson, Kathy; Politi, Mary C

2018-06-03

Rural-residing cancer patients often do not participate in clinical trials. Many patients misunderstand cancer clinical trials and their rights as participant. The purpose of this study is to modify a previously developed cancer clinical trials decision aid (DA), incorporating the unique needs of rural populations, and test its impact on knowledge and decision outcomes. The study was conducted in two phases. Phase I recruited 15 rural-residing cancer survivors in a qualitative usability study. Participants navigated the original DA and provided feedback regarding usability and implementation in rural settings. Phase II recruited 31 newly diagnosed rural-residing cancer patients. Patients completed a survey before and after using the revised DA, R-CHOICES. Primary outcomes included decisional conflict, decision self-efficacy, knowledge, communication self-efficacy, and attitudes towards and willingness to consider joining a trial. In phase I, the DA was viewed positively by rural-residing cancer survivors. Participants provided important feedback about factors rural-residing patients consider when thinking about trial participation. In phase II, after using R-CHOICES, participants had higher certainty about their choice (mean post-test = 3.10 vs. pre-test = 2.67; P = 0.025) and higher trial knowledge (mean percentage correct at post-test = 73.58 vs. pre-test = 57.77; P < 0.001). There was no significant change in decision self-efficacy, communication self-efficacy, and attitudes towards or willingness to join trials. The R-CHOICES improved rural-residing patients' knowledge of cancer clinical trials and reduced conflict about making a trial decision. More research is needed on ways to further support decisions about trial participation among this population.

Measuring Rural Hospital Quality

ERIC Educational Resources Information Center

Moscovice, Ira; Wholey, Douglas R.; Klingner, Jill; Knott, Astrid

2004-01-01

Increased interest in the measurement of hospital quality has been stimulated by accrediting bodies, purchaser coalitions, government agencies, and other entities. This paper examines quality measurement for hospitals in rural settings. We seek to identify rural hospital quality measures that reflect quality in all hospitals and that are sensitive…

Integrating the Arts in Rural Schools.

ERIC Educational Resources Information Center

Galles, Karen

1986-01-01

Describes integrated approach to teaching the arts which can be utilized in single or multi-grade classrooms in rural settings by teachers who may not have a background in any art form. Addresses problems of time, preparation, and resources that hinder curriculum development by rural educators. (NEC)

Exploring the impact of wheelchair design on user function in a rural South African setting.

PubMed

Visagie, Surona; Duffield, Svenje; Unger, Mariaan

2015-01-01

Wheelchairs provide mobility that can enhance function and community integration. Function in a wheelchair is influenced by wheelchair design. To explore the impact of wheelchair design on user function and the variables that guided wheelchair prescription in the study setting. A mixed-method, descriptive design using convenience sampling was implemented. Quantitative data were collected from 30 wheelchair users using the functioning every day with a Wheelchair Scale and a Wheelchair Specification Checklist. Qualitative data were collected from ten therapists who prescribed wheelchairs to these users, through interviews. The Kruskal-Wallis test was used to identify relationships, and content analysis was undertaken to identify emerging themes in qualitative data. Wheelchairs with urban designs were issued to 25 (83%) participants. Wheelchair size, fit, support and functional features created challenges concerning transport, operating the wheelchair, performing personal tasks, and indoor and outdoor mobility. Users using wheelchairs designed for use in semi-rural environments achieved significantly better scores regarding the appropriateness of the prescribed wheelchair than those using wheelchairs designed for urban use ( p = <0.01). Therapists prescribed the basic, four-wheel folding frame design most often because of a lack of funding, lack of assessment, lack of skills and user choice. Issuing urban type wheelchairs to users living in rural settings might have a negative effect on users' functional outcomes. Comprehensive assessments, further training and research, on long term cost and quality of life implications, regarding provision of a suitable wheelchair versus a cheaper less suitable option is recommended.

Effect of wheelchair design on wheeled mobility and propulsion efficiency in less-resourced settings

PubMed Central

2017-01-01

Background Wheelchair research includes both qualitative and quantitative approaches, primarily focuses on functionality and skill performance and is often limited to short testing periods. This is the first study to use the combination of a performance test (i.e. wheelchair propulsion test) and a multiple-day mobility assessment to evaluate wheelchair designs in rural areas of a developing country. Objectives Test the feasibility of using wheel-mounted accelerometers to document bouts of wheeled mobility data in rural settings and use these data to compare how patients respond to different wheelchair designs. Methods A quasi-experimental, pre- and post-test design was used to test the differences between locally manufactured wheelchairs (push rim and tricycle) and an imported intervention product (dual-lever propulsion wheelchair). A one-way repeated measures analysis of variance was used to interpret propulsion and wheeled mobility data. Results There were no statistical differences in bouts of mobility between the locally manufactured and intervention product, which was explained by high amounts of variability within the data. With regard to the propulsion test, push rim users were significantly more efficient when using the intervention product compared with tricycle users. Conclusion Use of wheel-mounted accelerometers as a means to test user mobility proved to be a feasible methodology in rural settings. Variability in wheeled mobility data could be decreased with longer acclimatisation periods. The data suggest that push rim users experience an easier transition to a dual-lever propulsion system. PMID:28936416

Clinician Attitudes Toward Adoption of Pediatric Emergency Telemedicine in Rural Hospitals.

PubMed

Ray, Kristin N; Felmet, Kathryn A; Hamilton, Melinda F; Kuza, Courtney C; Saladino, Richard A; Schultz, Brian R; Watson, R Scott; Kahn, Jeremy M

2017-04-01

Although there is growing evidence regarding the utility of telemedicine in providing care for acutely ill children in underserved settings, adoption of pediatric emergency telemedicine remains limited, and little data exist to inform implementation efforts. Among clinician stakeholders, we examined attitudes regarding pediatric emergency telemedicine, including barriers to adoption in rural settings and potential strategies to overcome these barriers. Using a sequential mixed-methods approach, we first performed semistructured interviews with clinician stakeholders using thematic content analysis to generate a conceptual model for pediatric emergency telemedicine adoption. Based on this model, we then developed and fielded a survey to further examine attitudes regarding barriers to adoption and strategies to improve adoption. Factors influencing adoption of pediatric emergency telemedicine were identified and categorized into 3 domains: contextual factors (such as regional geography, hospital culture, and individual experience), perceived usefulness of pediatric emergency telemedicine, and perceived ease of use of pediatric emergency telemedicine. Within the domains of perceived usefulness and perceived ease of use, belief in the relative advantage of telemedicine was the most pronounced difference between telemedicine proponents and nonproponents. Strategies identified to improve adoption of telemedicine included patient-specific education, clinical protocols for use, decreasing response times, and simplifying the technology. More effective adoption of pediatric emergency telemedicine among clinicians will require addressing perceived usefulness and perceived ease of use in the context of local factors. Future studies should examine the impact of specific identified strategies on adoption of pediatric emergency telemedicine and patient outcomes in rural settings.

What keeps health professionals working in rural district hospitals in South Africa?

PubMed Central

Gunst, Colette; Blitz, Julia; Coetzee, Johan F.

2015-01-01

Background The theme of the 2014 Southern African Rural Health Conference was ‘Building resilience in facing rural realities’. Retaining health professionals in South Africa is critical for sustainable health services. Only 12% of doctors and 19% of nurses have been retained in the rural areas. The aim of the workshop was to understand from health practitioners why they continued working in their rural settings. Conference workshop The workshop consisted of 29 doctors, managers, academic family physicians, nurses and clinical associates from Southern Africa, with work experience from three weeks to 13 years, often in deep rural districts. Using the nominal group technique, the following question was explored, ‘What is it that keeps you going to work every day?’ Participants reflected on their work situation and listed and rated the important reasons for continuing to work. Results Five main themes emerged. A shared purpose, emanating from a deep sense of meaning, was the strongest reason for staying and working in a rural setting. Working in a team was second most important, with teamwork being related to attitudes and relationships, support from visiting specialists and opportunities to implement individual clinical skills. A culture of support was third, followed by opportunities for growth and continuing professional development, including teaching by outreaching specialists. The fifth theme was a healthy work-life balance. Conclusion Health practitioners continue to work in rural settings for often deeper reasons relating to a sense of meaning, being part of a team that closely relate to each other and feeling supported. PMID:26245623

Does the universal health insurance program affect urban-rural differences in health service utilization among the elderly? Evidence from a longitudinal study in taiwan.

PubMed

Liao, Pei-An; Chang, Hung-Hao; Yang, Fang-An

2012-01-01

To assess the impact of the introduction of Taiwan's National Health Insurance (NHI) on urban-rural inequality in health service utilization among the elderly. A longitudinal data set of 1,504 individuals aged 65 and older was constructed from the Survey of Health and Living Status of the Elderly. A difference-in-differences model was employed and estimated by the random-effect probit method. The introduction of universal NHI in Taiwan heterogeneously affected outpatient and inpatient health service utilization among the elderly in urban and rural areas. The introduction of NHI reduced the disparity of outpatient (inpatient) utilization between the previously uninsured and insured older urban residents by 12.9 (22.0) percentage points. However, there was no significant reduction in the utilization disparity between the previously uninsured and insured elderly among rural residents. Our study on Taiwan's experience should provide a valuable lesson to countries that are in an initial stage of proposing a universal health insurance system. Although NHI is designed to ensure the equitable right to access health care, it may result in differential impacts on health service utilization among the elderly across areas. The rural elderly tend to confront more challenges in accessing health care associated with spatial distance, transportation, social isolation, poverty, and a lack of health care providers, especially medical specialists. © 2011 National Rural Health Association.

The effect of Insecticide Treated Nets (ITNs) on Plasmodium falciparum infection in rural and semi-urban communities in the south west region of Cameroon.

PubMed

Apinjoh, Tobias O; Anchang-Kimbi, Judith K; Mugri, Regina N; Tangoh, Delphine A; Nyingchu, Robert V; Chi, Hanesh F; Tata, Rolland B; Njumkeng, Charles; Njua-Yafi, Clarisse; Achidi, Eric A

2015-01-01

Insecticide Treated Nets (ITNs) have been shown to reduce morbidity and mortality, but coverage and proper utilization continues to be moderate in many parts of sub-Saharan Africa. The gains made through a nationwide free distribution were explored as well as the effect on malaria prevalence in semi-urban and rural communities in south western Cameroon. A cross sectional survey was conducted between August and December 2013. Information on net possession, status and use were collected using a structured questionnaire while malaria parasitaemia was determined on Giemsa-stained blood smears by light microscopy. ITN ownership increased from 41.9% to 68.1% following the free distribution campaign, with 58.3% (466/799) reportedly sleeping under the net. ITN ownership was lower in rural settings (adjusted OR = 1.93, 95%CI = 1.36-2.74, p<0.001) and at lower altitude (adjusted OR = 1.79, 95%CI = 1.22-2.62, p = 0.003) compared to semi-urban settings and intermediate altitude respectively. Conversely, ITN usage was higher in semi-urban settings (p = 0.002) and at intermediate altitude (p = 0.002) compared with rural localities and low altitude. Malaria parasitaemia prevalence was higher in rural (adjusted OR = 1.63, 95%CI = 1.07-2.49) compared to semi-urban settings and in those below 15 years compared to those 15 years and above. Overall, participants who did not sleep under ITN were more susceptible to malaria parasitaemia (adjusted OR = 1.70, 95%CI = 1.14-2.54, p = 0.009). Despite the free distribution campaign, ITN ownership and usage, though improved, is still low. As children who reside in rural settings have greater disease burden (parasitemia) than children in semi-urban settings, the potential gains on both reducing inequities in ITN possession as well as disease burden might be substantial if equitable distribution strategies are adopted.

A mixed-methods impact evaluation of the feasibility of an initiative in small rural stores to improve access to fruit and vegetables.

PubMed

Palermo, Claire; Gardiner, Breeana; Gee, Carena; Charaktis, Stella; Blake, Miranda

2016-02-01

Retail stores are a promising setting for improving access to nutritious food. This study opportunistically evaluated an initiative that supported stores in small rural Victorian towns to sell fresh fruit and vegetables. It aimed to measure whether the initiative showed a trend towards improved access to fruit and vegetables in these rural communities. A mixed-methods, pre-post evaluation was employed to measure the range and price of 39 fruits and 45 vegetables, together with 15 interviews with stakeholders 2.5 years after the commencement of the initiative. Twenty-one of 35 eligible stores took up the initiative. Analysis of qualitative and quantitative data showed that the initiative improved the availability of and access to fruit and vegetables, and that stores have a role in improving access to fruit and vegetables. The overall range of fruit and vegetables increased over 18 months from a median of 10 varieties (n=10) to 17 varieties (n=15) (P=0.028) and the prices decreased over 12 months in five out of seven stores where data was available. The capacity to influence availability of fruit and vegetables was affected by time, human resources and community support. Sustaining change to fruit and vegetables access is challenging. Using stores for health promotion may be an effective strategy for improving rural populations' fruit and vegetable intake.

Age-Associated Perceptions of Physical Activity Facilitators and Barriers Among Women in Rural Southernmost Illinois

PubMed Central

Carnahan, Leslie R.; Peacock, Nadine R.

2016-01-01

Introduction Women living in rural areas in the United States experience disproportionately high rates of diseases such as obesity and heart disease and are less likely than women living in urban areas to meet daily physical activity (PA) recommendations. The purpose of our research was to understand age-specific perceptions of barriers and facilitators to rural women engaging in PA and to identify strategies to promote PA among these women. Methods As part of a community health assessment to learn about women’s health issues, 110 adult women participated in 14 focus groups. The women were divided into 4 age groups, and focus groups were held in various community settings. We used qualitative analysis methods to explore themes in the women’s narratives, including themes related to PA knowledge, PA behavior, and access to PA facilities. Results Participants described multiple and often conflicting individual, social, and environmental barriers and facilitators to PA. Several barriers and facilitators were shared across age groups (eg, competing priorities and inadequate knowledge about PA’s role in disease prevention and disease management). Other barriers (eg, illness and injury) and facilitators (eg, PA as a social opportunity) differed by age group. Conclusion Rural women in southernmost Illinois have often contradictory barriers and facilitators to PA, and those barriers and facilitators are different at different points in a woman’s life. Our findings suggest the need for multilevel, multisector approaches to promote PA. Additionally, this research supports the need for tailored PA promotion programs for rural women to address the barriers these women face across their lifespan. PMID:27685431

Streptococcus pneumoniae Carriage Prevalence in Nepal: Evaluation of a Method for Delayed Transport of Samples from Remote Regions and Implications for Vaccine Implementation

PubMed Central

Hanieh, Sarah; Hamaluba, Mainga; Kelly, Dominic F.; Metz, Jane A.; Wyres, Kelly L.; Fisher, Roberta; Pradhan, Rahul; Shakya, Disuja; Shrestha, Lochan; Shrestha, Amrita; Joshi, Anip; Habens, Jocelyn; Maharjan, Bishnu D.; Thorson, Stephen; Bohler, Erik; Yu, Ly-Mee; Kelly, Sarah; Plested, Emma; John, Tessa; Werno, Anja M.; Adhikari, Neelam; Murdoch, David R.; Brueggemann, Angela B.; Pollard, Andrew J.

2014-01-01

Background Pneumococcal disease is a significant cause of morbidity and mortality in young children in Nepal, and currently available pneumococcal conjugate vaccines offer moderate coverage of invasive disease isolates. Methods A prevalence study of children aged 1.5 to 24 months in urban and rural Nepal was conducted. In the urban group, nasopharyngeal swabs (NPS) were transported using silica desiccant packages (SDP) with delayed processing (2 weeks), or skim-milk-tryptone-glucose-glycerin (STGG) with immediate processing (within 8 hours). Pneumococcal nasopharyngeal carriage prevalence, serogroup/type distribution and isolate genotypes (as defined by multilocus sequence typing) were determined. Results 1101 children were enrolled into the study: 574 in the urban group and 527 in the rural group. Overall carriage prevalence based on culture from specimens transported and stored in STGG was 58.7% (337/574), compared to 40.9% (235/574) in SDP. There was concordance of detection of pneumococcus in 67% of samples. Using the SDP method, pneumococcal carriage prevalence was higher in the rural population (69.2%; 364/526) compared to the urban population (40.9%; 235/574). Serogroup/type distribution varied with geographical location. Over half of the genotypes identified in both the urban and rural pneumococcal populations were novel. Conclusion The combination of delayed culture and transport using SDP underestimates the prevalence of pneumococcal carriage; however, in remote areas, this method could still provide a useful estimate of carriage prevalence and serogroup/type distribution. Vaccine impact is unpredictable in a setting with novel genotypes and limited serotype coverage as described here. Consequently, continued surveillance of pneumococcal isolates from carriage and disease in Nepali children following the planned introduction of pneumococcal conjugate vaccines introduction will be essential. PMID:24905574

Survey of Rural Information Infrastructure Technologies.

ERIC Educational Resources Information Center

Allen, Kenneth C.; And Others

Communication and information technologies can reduce the barriers of distance and space that disadvantage rural areas. This report defines a set of distinct voice, computer, and video telecommunication services; describes several rural information applications that make use of these services; and surveys various wireline and wireless systems and…

Challenges and Changes Faced by Rural Superintendents

ERIC Educational Resources Information Center

Lamkin, Marcia L.

2006-01-01

This research study was designed to build grounded theory about the challenges faced by rural superintendents. Participating rural superintendents identified five areas that presented a challenge but that also applied to superintendents in other settings: school law, finance, personnel, government mandates, and district or board policies. Further,…

What factors influence the choice of urban or rural location for future practice of Nepalese medical students? A cross-sectional descriptive study.

PubMed

Sapkota, Bhim Prasad; Amatya, Archana

2015-11-10

Nepal is experiencing a public health issue similar to the rest of the world, i.e., the geographical maldistribution of physicians. Although there is some documentation about the reasons physicians elect to leave Nepal to work abroad, very little is known about the salient factors that influence the choice of an urban versus rural practice setting for those physicians who do not migrate. In recent years, around 1000 medical students became doctors within Nepal, but their distribution in rural locations is not adequate. The purpose of this study was to explore what factors influence the choice of urban or rural location for the future clinical practice of Nepalese medical students in the final year of their program A cross-sectional descriptive study design was used for this study involving Nepalese medical students in their final year of study and currently doing an internship in a medical college. The sample consisted of 393 medical students from four medical colleges in Nepal that were selected randomly. An anonymous self-administered questionnaire was used for data collection. To determine the association with rural location choice for their future practice setting, a comparison was done that involved demographic, socio-economic, and educational factors. Data were entered in EpiData and analyzed by using SPSS version 16. Among the 393 respondents, two thirds were male (66.9%) and more than half were below 25 years of age. Almost all (93%) respondents were single and about two thirds (63.4%) were of Brahmin and Chhetri ethnic origin. About two thirds (64.1%) of the respondents were born in a rural setting, and 58.8% and 53.3% had a place of rearing and permanent address in a rural location, respectively. The predictors of future rural location choice for their clinical practice (based on the bivariate analysis) included: (a) Rural (versus urban) place of birth, place of rearing, and permanent address (b) Source of family income (service, business, and agriculture) (c) Occupation of father (service, business and agriculture) (d) Wealth ranking (higher, middle, and lower wealth rank) (e) Educational factors: location, type of secondary education, and type of higher secondary education. For medical students who were soon to complete their studies, demographic and educational factors were found to be significant predictors for a rural location choice, as opposed to socio-economic factors. Our findings indicate that to ensure the rural retention of physicians, the government of Nepal should attract potential medical students from those who were reared and educated in a rural setting.

How on Earth Did You Hear About Us? A Study of Exemplary Rural School Practices in the Upper Midwest.

ERIC Educational Resources Information Center

D'Amico, Joseph J.

As part of ongoing research into rural school improvement, the North Central Regional Educational Laboratory (NCREL) at the request of its Rural Advisory Council set out to find, examine, and profile exemplary, successful school improvement programs in rural schools and districts in the upper Midwest. This paper is a summary of the first year…

Beyond 50. challenges at work for older nurses and allied health workers in rural Australia: a thematic analysis of focus group discussions

PubMed Central

2011-01-01

Background The health workforce in Australia is ageing, particularly in rural areas, where this change will have the most immediate implications for health care delivery and workforce needs. In rural areas, the sustainability of health services will be dependent upon nurses and allied health workers being willing to work beyond middle age, yet the particular challenges for older health workers in rural Australia are not well known. The purpose of this research was to identify aspects of work that have become more difficult for rural health workers as they have become older; and the age-related changes and exacerbating factors that contribute to these difficulties. Findings will support efforts to make workplaces more 'user-friendly' for older health workers. Methods Nurses and allied health workers aged 50 years and over were invited to attend one of six local workshops held in the Hunter New England region of NSW, Australia. This qualitative action research project used a focus group methodology and thematic content analysis to identify and interpret issues arising from workshop discussions. Results Eighty older health workers from a range of disciplines attended the workshops. Tasks and aspects of work that have become more difficult for older health workers in hospital settings, include reading labels and administering medications; hearing patients and colleagues; manual handling; particular movements and postures; shift work; delivery of babies; patient exercises and suturing. In community settings, difficulties relate to vehicle use and home visiting. Significant issues across settings include ongoing education, work with computers and general fatigue. Wider personal challenges include coping with change, balancing work-life commitments, dealing with attachments and meeting goals and expectations. Work and age-related factors that exacerbate difficulties include vision and hearing deficits, increasing tiredness, more complex professional roles and a sense of not being valued in the context of greater perceived workload. Conclusions Older health workers are managing a range of issues, on top of the general challenges of rural practice. Personal health, wellbeing and other realms of life appear to take on increasing importance for older health workers when faced with increasing difficulties at work. Solutions need to address difficulties at personal, workplace and system wide levels. PMID:21338525

Quality and rural-urban comparison of tuberculosis care in Rivers State, Nigeria.

PubMed

Tobin-West, Charles Ibiene; Isodje, Anastasia

2016-01-01

Nigeria ranks among countries with the highest burden of tuberculosis. Yet evidence continues to indicate poor treatment outcomes which have been attributed to poor quality of care. This study aims to identify some of the systemic problems in order to inform policy decisions for improved quality of services and treatment outcomes in Nigeria. A comparative assessment of the quality of TB care in rural and urban health facilities was carried out between May and June 2013, employing the Donabedian model of quality assessment. Data was analysed using the SPSS software package version 20.0. The level of significance was set at p < 0.05. Health facility infrastructures were more constrained in the urban than rural settings. Both the urban and rural facilities lacked adequate facilities for infection control such as, running water, air filter respirators, hand gloves and extractor fans. Health education and HIV counselling and testing (HCT) were limited in rural facilities compared to urban facilities. Although anti-TB drugs were generally available in both settings, the DOTS strategy in patient care was completely ignored. Finally, laboratory support for diagnosis and patient monitoring was limited in the rural facilities. The study highlights suboptimal quality of TB care in Rivers State with limitations in health education and HCT of patients for HIV as well as laboratory support for TB care in rural health facilities. We, therefore, recommend that adequate infection control measures, strict observance of the DOTS strategy and sufficient laboratory support be provided to TB clinics in the State.

Estimating tuberculosis incidence from primary survey data: a mathematical modeling approach

PubMed Central

Chadha, V. K.; Laxminarayan, R.; Arinaminpathy, N.

2017-01-01

SUMMARY BACKGROUND: There is an urgent need for improved estimations of the burden of tuberculosis (TB). OBJECTIVE: To develop a new quantitative method based on mathematical modelling, and to demonstrate its application to TB in India. DESIGN: We developed a simple model of TB transmission dynamics to estimate the annual incidence of TB disease from the annual risk of tuberculous infection and prevalence of smear-positive TB. We first compared model estimates for annual infections per smear-positive TB case using previous empirical estimates from China, Korea and the Philippines. We then applied the model to estimate TB incidence in India, stratified by urban and rural settings. RESULTS: Study model estimates show agreement with previous empirical estimates. Applied to India, the model suggests an annual incidence of smear-positive TB of 89.8 per 100 000 population (95%CI 56.8–156.3). Results show differences in urban and rural TB: while an urban TB case infects more individuals per year, a rural TB case remains infectious for appreciably longer, suggesting the need for interventions tailored to these different settings. CONCLUSIONS: Simple models of TB transmission, in conjunction with necessary data, can offer approaches to burden estimation that complement those currently being used. PMID:28284250

Using statistical process control methods to trace small changes in perinatal mortality after a training program in a low-resource setting.

PubMed

Mduma, Estomih R; Ersdal, Hege; Kvaloy, Jan Terje; Svensen, Erling; Mdoe, Paschal; Perlman, Jeffrey; Kidanto, Hussein Lessio; Soreide, Eldar

2018-05-01

To trace and document smaller changes in perinatal survival over time. Prospective observational study, with retrospective analysis. Labor ward and operating theater at Haydom Lutheran Hospital in rural north-central Tanzania. All women giving birth and birth attendants. Helping Babies Breathe (HBB) simulation training on newborn care and resuscitation and some other efforts to improve perinatal outcome. Perinatal survival, including fresh stillbirths and early (24-h) newborn survival. The variable life-adjusted plot and cumulative sum chart revealed a steady improvement in survival over time, after the baseline period. There were some variations throughout the study period, and some of these could be linked to different interventions and events. To our knowledge, this is the first time statistical process control methods have been used to document changes in perinatal mortality over time in a rural Sub-Saharan hospital, showing a steady increase in survival. These methods can be utilized to continuously monitor and describe changes in patient outcomes.

Rural Trends in Diagnosis and Services for Autism Spectrum Disorder

PubMed Central

Antezana, Ligia; Scarpa, Angela; Valdespino, Andrew; Albright, Jordan; Richey, John A.

2017-01-01

Rural communities face significant challenges regarding the adequate availability of diagnostic-, treatment-, and support-services for individuals with autism spectrum disorder (ASD). Specifically, a variety of factors, including geographic distance between families and service providers, low reliance on health care professionals, and cultural characteristics, contribute to the diminished availability and utilization of services. Together, these factors lead to risks for delayed ASD screening and diagnosis, yielding lower educational and functional outcomes. The purpose of this review is to outline the specific diagnosis and treatment barriers that affect individuals with ASD and their families in rural settings. Telehealth feasibility and efficacy research is also reviewed, suggesting that telecommunication services may offer an inroad for addressing the specific service barriers faced by rural communities. Together, the current review identifies specific needs for both research and support services that address the specific access barriers characteristic of rural settings. PMID:28473784

Association between prenatal exposure to traffic-related air pollution and preterm birth in the PELAGIE mother-child cohort, Brittany, France. Does the urban-rural context matter?

PubMed

Bertin, Mélanie; Chevrier, Cécile; Serrano, Tania; Monfort, Christine; Rouget, Florence; Cordier, Sylvaine; Viel, Jean-François

2015-10-01

Evidence has accumulated that exposure to ambient air pollution during pregnancy may influence preterm birth (PTB) in urban settings. Conversely, this relation has barely been investigated in rural areas where individual characteristics (demographic, socioeconomic, and psychosocial factors) and environmental co-exposures may differ. We examined the association between prenatal exposure to traffic-related air pollution and PTB among pregnant women from the PELAGIE mother-child cohort (Brittany, France, 2002-2006) living in urban (n=1550) and rural (n=959) settings. Women's residences were classified as either urban or rural according to the French census bureau rural-urban definitions. Nitrogen dioxide (NO2) concentrations at home addresses were estimated from adjusted land-use regression models as a marker of traffic-related pollution. Associations between NO2 concentrations and PTB were assessed with logistic regression models. Prevalence of PTB was similar among women living in urban (3.2%) and in rural (3.5%) settings. More positive socioeconomic characteristics and health behaviors but more single-parent families were observed among urban women. NO2 exposure averaged 20.8±6.6 µg m(-3) for women residing in urban areas and 18.8±5.6 µg m(-3) for their rural counterparts. A statistically significant increased risk of PTB was observed among women exposed to NO2 concentrations ≥16.4 µg m(-3) and residing in urban areas but not among their rural counterparts. The results of this study, conducted in a region with interspersed urban-rural areas, are in line with previous findings suggesting an increased risk of PTB associated with higher NO2 concentrations for women living in urban areas. The absence of association among their rural counterparts for whom exposure levels were similar suggests that environmental mixtures and psychosocial inequalities might play a role in this heterogeneity. Copyright © 2015 Elsevier Inc. All rights reserved.

Conceptualization and Measurement of the Neighborhood in Rural Settings: A Systematic Review of the Literature

ERIC Educational Resources Information Center

De Marco, Allison; De Marco, Molly

2010-01-01

Interest in the effects of neighborhood context on individual wellbeing has increased in recent years. We now know that neighborhood conditions, such as poverty and deprivation, negatively impact residents. However, most of the extant work has taken an urban focus. Less is known about these processes in rural settings. Neighborhood…

Fast Track, Bush Track: Late Career Female Rural School Leaders Taking the Slow Road

ERIC Educational Resources Information Center

Miller, Judith; Graham, Lorraine; Al-Awiwe, Azhar

2014-01-01

Previous research related to this study explored early career female leaders' experiences in rural school settings, and probed the personal and professional challenges they faced and their motivations to accept formal and informal leadership roles ahead of the usual timeframes (e.g., Graham, Miller & Paterson, 2009). This study set out to…

The Potential of Computer-Based Expert Systems for Special Educators in Rural Settings.

ERIC Educational Resources Information Center

Parry, James D.; Ferrara, Joseph M.

Knowledge-based expert computer systems are addressing issues relevant to all special educators, but are particularly relevant in rural settings where human experts are less available because of distance and cost. An expert system is an application of artificial intelligence (AI) that typically engages the user in a dialogue resembling the…

County-Level Poverty Is Equally Associated with Unmet Health Care Needs in Rural and Urban Settings

ERIC Educational Resources Information Center

Peterson, Lars E.; Litaker, David G.

2010-01-01

Context: Regional poverty is associated with reduced access to health care. Whether this relationship is equally strong in both rural and urban settings or is affected by the contextual and individual-level characteristics that distinguish these areas, is unclear. Purpose: Compare the association between regional poverty with self-reported unmet…

Moving on? Predictors of Intent to Leave among Rural and Remote RNs in Canada

ERIC Educational Resources Information Center

Stewart, Norma J.; D'Arcy, Carl; Kosteniuk, Julie; Andrews, Mary Ellen; Morgan, Debra; Forbes, Dorothy; MacLeod, Martha L. P.; Kulig, Judith C.; Pitblado, J. Roger

2011-01-01

Context: Examination of factors related to the retention or voluntary turnover of Registered Nurses (RNs) has mainly focused on urban, acute care settings. Purpose: This paper explored predictors of intent to leave (ITL) a nursing position in all rural and remote practice settings in Canada. Based on the conceptual framework developed for this…

The Efficacy of Conjoint Behavioral Consultation in the Home Setting: Outcomes and Mechanisms in Rural Communities

ERIC Educational Resources Information Center

Sheridan, Susan M.; Witte, Amanda L.; Holmes, Shannon; Wu, ChaoRong; Bhatia, Sonya A.; Angell, Samantha

2017-01-01

This study reports the results of a randomized controlled trial examining the effect of Conjoint Behavioral Consultation (CBC), a family-school partnership intervention, on children's behaviors, parents' skills, and parent-teacher relationships in rural community and town settings. Participants were 267 children, 267 parents, and 152 teachers in…

Aged-care nurses in rural Tasmanian clinical settings more likely to think hypothetical medication error would be reported and disclosed compared to hospital and community nurses.

PubMed

Carnes, Debra; Kilpatrick, Sue; Iedema, Rick

2015-12-01

This study aims to determine the likelihood that rural nurses perceive a hypothetical medication error would be reported in their workplace. This employs cross-sectional survey using hypothetical error scenario with varying levels of harm. Clinical settings in rural Tasmania. Participants were 116 eligible surveys received from registered and enrolled nurses. Frequency of responses indicating the likelihood that severe, moderate and near miss (no harm) scenario would 'always' be reported or disclosed. Eighty per cent of nurses viewed a severe error would 'always' be reported, 64.8% a moderate error and 45.7% a near-miss error. In regards to disclosure, 54.7% felt this was 'always' likely to occur for a severe error, 44.8% for a moderate error and 26.4% for a near miss. Across all levels of severity, aged-care nurses were more likely than nurses in other settings to view error to 'always' be reported (ranging from 72-96%, P = 0.010 to 0.042,) and disclosed (68-88%, P = 0.000). Those in a management role were more likely to view error to 'always' be disclosed compared to those in a clinical role (50-77.3%, P = 0.008-0.024). Further research in rural clinical settings is needed to improve the understanding of error management and disclosure. © 2015 The Authors. Australian Journal of Rural Health published by Wiley Publishing Asia Pty Ltd on behalf of National Rural Health Alliance.

Incorporating Geographic Information Systems (GIS) into program evaluation: lessons from a rural medicine initiative.

PubMed

Booza, Jason C; Bridge, Patrick D; Neale, Anne Victoria; Schenk, Maryjean

2010-01-01

To address the shortage of physicians practicing in rural areas of Michigan, the Wayne State University School of Medicine developed an integrated rural core curriculum to interest students in rural practice careers. Here we focus on the evaluation strategy used to determine the extent to which students in the new rural medicine interest group who self-identified as selecting a rural clerkship or externship did secure a clinical training experience in a rural setting. Three measures of rurality were compared to determine whether students were placed in rural training settings: (1) the percentage of the county living in rural areas; (2) a county-level dichotomous measure of rural/nonrural; and (3) a dichotomous measure based on urban area boundaries within the county. Practice address and geographic data were integrated into geographic information systems software, which we used to map out rural characteristics of Michigan counties through a process called thematic mapping; this shows characteristic variation by color-shading geographic features. In addition, reference maps were created showing the boundaries of urban areas and metropolitan/micropolitan areas. Once these processes were completed, we overlaid the practice location on the contextual-level geographic features to produce a visual representation of the relationship between student placement and rural areas throughout the state. The outcome of student placement in rural practices varied by the definition of rural. We concluded that, although students were not placed in the most rural areas of Michigan, they received clerkship or externship training near rural areas or in semirural areas. This process evaluation had a direct impact on program management by highlighting gaps in preceptor recruitment. A greater effort is being made to recruit physicians for more rural areas of the state rather than urban and semirural areas. Geographic information systems mapping also defined levels of ruralism for students to help them make informed selections of training sties. This is especially important for students who are not sure about a rural experience and might be discouraged by placement in a remote rural area.

Enhanced curriculum intervention did not result in increased postnatal physical activity in rural, Southern, primarily African American women

USDA-ARS?s Scientific Manuscript database

Purpose. To test the impact of two home visiting curricula on postnatal physical activity in rural, Southern, African American mothers. Design. Randomized controlled trial. Setting. Three rural counties in Mississippi. Subjects. Between September 2013 and May 2016, 54 postpartum women randomized...

A Qualitative Assessment of Weight Control among Rural Kansas Women

ERIC Educational Resources Information Center

Ely, Andrea C.; Befort, Christie; Banitt, Angela; Gibson, Cheryl; Sullivan, Debra

2009-01-01

Objective: To explore weight control beliefs, attitudes, knowledge, and practices among rural Kansas women, and to characterize the relationship of these women with their primary-care providers around weight control. Design: Qualitative research using focus groups. Setting: Three separate communities of rural Kansas. Participants: Six focus groups…

Sustaining the Rural Workforce: Nursing Perspectives on Worklife Challenges

ERIC Educational Resources Information Center

Hunsberger, Mabel; Baumann, Andrea; Blythe, Jennifer; Crea, Mary

2009-01-01

Context: Concerns have been raised about the sustainability of health care workforces in rural settings. According to the literature, rural nurses' work satisfaction varies with the resources and supports available to respond to specific challenges. Given the probable effects of stressors on retention, it is essential to understand the unique…

Poverty and Rural Schools. Research Brief

ERIC Educational Resources Information Center

Johnston, Howard

2009-01-01

Impoverished populations and schools in rural areas face special challenges that are different from other settings. Among these are the distances from social services, the sparse availability of assistance programs, and the shortage of resources to support educational programs and student learning. Rural schools, do, however, have assets that can…

Pathways of Youth Development in a Rural Trailer Park

ERIC Educational Resources Information Center

MacTavish, Katherine A.; Salamon, Sonya

2006-01-01

Limited empirical documentation exists for the developmental pathways available to "rural" youth growing up in low-resource community settings. Drawing on ethnographic data, this article examines the developmental pathways experienced by youth in a rural trailer park. Findings reveal how various factors, some inherent to working poor class status…

Teaching Rural Sociology to Students with Non-Rural Backgrounds.

ERIC Educational Resources Information Center

Spaulding, Irving A.

A course designed to teach rural sociology to urban and suburban university students is described in this paper. Introductory material sets forth the objectives and the conceptual approach of the course, which systematically examines social changes associated with food and fiber production throughout the world. Five concepts--group, imperative…

Issues in Rural Palliative Care: Views from the Countryside

ERIC Educational Resources Information Center

Robinson, Carole A.; Pesut, Barbara; Bottorff, Joan L.

2010-01-01

Context: Growing concern exists among health professionals over the dilemma of providing necessary health care for Canada's aging population. Hospice palliative services are an essential need in both urban and rural settings. Rural communities, in particular, are vulnerable to receiving inadequate services due to their geographic isolation.…

Graduate Teacher Preparation for Rural Schools in Victoria and Queensland

ERIC Educational Resources Information Center

Kline, Jodie; Walker-Gibbs, Bernadette

2015-01-01

Graduate teachers' preparedness for working in rural settings are mediated by the development of pedagogical expertise, professional engagement with parents and the community, and broader notions of preparation to teach in rural contexts. The Studying the Effectiveness of Teacher Education (SETE) project is a four-year longitudinal study tracking…

Development of a Support Tool for Complex Decision-Making in the Provision of Rural Maternity Care

PubMed Central

Hearns, Glen; Klein, Michael C.; Trousdale, William; Ulrich, Catherine; Butcher, David; Miewald, Christiana; Lindstrom, Ronald; Eftekhary, Sahba; Rosinski, Jessica; Gómez-Ramírez, Oralia; Procyk, Andrea

2010-01-01

Context: Decisions in the organization of safe and effective rural maternity care are complex, difficult, value laden and fraught with uncertainty, and must often be based on imperfect information. Decision analysis offers tools for addressing these complexities in order to help decision-makers determine the best use of resources and to appreciate the downstream effects of their decisions. Objective: To develop a maternity care decision-making tool for the British Columbia Northern Health Authority (NH) for use in low birth volume settings. Design: Based on interviews with community members, providers, recipients and decision-makers, and employing a formal decision analysis approach, we sought to clarify the influences affecting rural maternity care and develop a process to generate a set of value-focused objectives for use in designing and evaluating rural maternity care alternatives. Setting: Four low-volume communities with variable resources (with and without on-site births, with or without caesarean section capability) were chosen. Participants: Physicians (20), nurses (18), midwives and maternity support service providers (4), local business leaders, economic development officials and elected officials (12), First Nations (women [pregnant and non-pregnant], chiefs and band members) (40), social workers (3), pregnant women (2) and NH decision-makers/administrators (17). Results: We developed a Decision Support Manual to assist with assessing community needs and values, context for decision-making, capacity of the health authority or healthcare providers, identification of key objectives for decision-making, developing alternatives for care, and a process for making trade-offs and balancing multiple objectives. The manual was deemed an effective tool for the purpose by the client, NH. Conclusions: Beyond assisting the decision-making process itself, the methodology provides a transparent communication tool to assist in making difficult decisions. While the manual was specifically intended to deal with rural maternity issues, the NH decision-makers feel the method can be easily adapted to assist decision-making in other contexts in medicine where there are conflicting objectives, values and opinions. Decisions on the location of new facilities or infrastructure, or enhancing or altering services such as surgical or palliative care, would be examples of complex decisions that might benefit from this methodology. PMID:21286270

Assessing the Consistency and Microbiological Effectiveness of Household Water Treatment Practices by Urban and Rural Populations Claiming to Treat Their Water at Home: A Case Study in Peru

PubMed Central

Rosa, Ghislaine; Huaylinos, Maria L.; Gil, Ana; Lanata, Claudio; Clasen, Thomas

2014-01-01

Background Household water treatment (HWT) can improve drinking water quality and prevent disease if used correctly and consistently by vulnerable populations. Over 1.1 billion people report treating their water prior to drinking it. These estimates, however, are based on responses to household surveys that may exaggerate the consistency and microbiological performance of the practice—key factors for reducing pathogen exposure and achieving health benefits. The objective of this study was to examine how HWT practices are actually performed by households identified as HWT users, according to international monitoring standards. Methods and Findings We conducted a 6-month case study in urban (n = 117 households) and rural (n = 115 households) Peru, a country in which 82.8% of households report treating their water at home. We used direct observation, in-depth interviews, surveys, spot-checks, and water sampling to assess water treatment practices among households that claimed to treat their drinking water at home. While consistency of reported practices was high in both urban (94.8%) and rural (85.3%) settings, availability of treated water (based on self-report) at time of collection was low, with 67.1% and 23.0% of urban and rural households having treated water at all three sampling visits. Self-reported consumption of untreated water in the home among adults and children <5 was common and this was corroborated during home observations. Drinking water of self-reported users was significantly better than source water in the urban setting and negligible but significantly better in the rural setting. However, only 46.3% and 31.6% of households had drinking water <1 CFU/100 mL at all follow-up visits. Conclusions Our results raise questions about the usefulness of current international monitoring of HWT practices and their usefulness as a proxy indicator for drinking water quality. The lack of consistency and sub-optimal microbiological effectiveness also raises questions about the potential of HWT to prevent waterborne diseases. PMID:25522371

Malnutrition and non-communicable diseases among Bangladeshi women: an urban–rural comparison

PubMed Central

Zahangir, M S; Hasan, M M; Richardson, A; Tabassum, S

2017-01-01

Background/Objectives: This study aims at examining the urban–rural differentials in the effects of socioeconomic predictors on underweight and obesity of ever-married women in Bangladesh. The effect of malnutrition and other risk factors on non-communicable diseases is also examined. Subjects/Methods: The information regarding nutritional status, socioeconomic and demographic background, and non-communicable diseases of ever-married women was extracted from the nationally representative, cross-sectional Bangladesh Demographic and Health Survey (BDHS 2011) data set. Both bivariate (χ2 test) and multivariate (multinomial logistic regression model) analyses were performed in determining the risk factors of malnutrition. The effect of malnutrition and associated risk factors on non-communicable diseases was determined using binary logistic regression models. Results: The overall prevalence as well as the effects of individual risk factors of malnutrition differ in urban and rural settings. Regional differentials in the prevalence of underweight were statistically significant only for rural areas. In rural and urban settings, women from households with poor economic status were 67% (odds ratio (OR) 0.33, 95% CI 0.26–0.43) and 81% (OR=0.19, 95% CI 0.13–0.29) less likely to be overweight, respectively, with respect to those from affluent households. Women from the Rangpur division were significantly more likely to suffer from anemia (OR=1.41, 95% CI 1.13–1.77) and hypertension (OR=1.67, 95% CI 1.19–2.34) than those from the Sylhet division (reference division). With respect to those considered as underweight, women who were categorized as overweight were 0.47 (OR=0.53, 95% CI 0.43–0.65) times less likely to suffer from anemia, and 1.83 (OR=2.83, 95% CI 1.99–4.02) and 1.70 (OR=2.70, 95% CI 2.09–3.50) times more likely to suffer from diabetes and hypertension, respectively. Conclusions: Rural–urban differentials in the effects of individual risk factors of malnutrition were observed. Wealth status of households and nutritional status of women showed significant effect on the prevalence of anemia, diabetes and hypertension. PMID:28319102

Facilitating HIV status disclosure for pregnant women and partners in rural Kenya: a qualitative study

PubMed Central

2013-01-01

Background Women’s ability to safely disclose their HIV-positive status to male partners is essential for uptake and continued use of prevention of mother-to-child transmission (PMTCT) services. However, little is known about the acceptability of potential approaches for facilitating partner disclosure. To lay the groundwork for developing an intervention, we conducted formative qualitative research to elicit feedback on three approaches for safe HIV disclosure for pregnant women and male partners in rural Kenya. Methods This qualitative acceptability research included in-depth interviews with HIV-infected pregnant women (n = 20) and male partners of HIV-infected women (n = 20) as well as two focus groups with service providers (n = 16). The participants were recruited at health care facilities in two communities in rural Nyanza Province, Kenya, during the period June to November 2011. Data were managed in NVivo 9 and analyzed using a framework approach, drawing on grounded theory. Results We found that facilitating HIV disclosure is acceptable in this context, but that individual participants have varying expectations depending on their personal situation. Many participants displayed a strong preference for couples HIV counseling and testing (CHCT) with mutual disclosure facilitated by a trained health worker. Home-based approaches and programs in which pregnant women are asked to bring their partners to the healthcare facility were equally favored. Participants felt that home-based CHCT would be acceptable for this rural setting, but special attention must be paid to how this service is introduced in the community, training of the health workers who will conduct the home visits, and confidentiality. Conclusion Pregnant couples should be given different options for assistance with HIV disclosure. Home-based CHCT could serve as an acceptable method to assist women and men with safe disclosure of HIV status. These findings can inform the design and implementation of programs geared at promoting HIV disclosure among pregnant women and partners, especially in the home-setting. PMID:24294994

Hidden love: sexual ideologies and relationship ideals among rural South African adolescents in the context of HIV/AIDS.

PubMed

Harrison, Abigail

2008-02-01

In KwaZulu/Natal, South Africa, the social construction of young people's sexuality reflects both a complex historical process of cultural and religious integration, as well as the contemporary resurgence of 'traditionalism'. How do young people interpret these factors to construct and give meaning to their own sexualities? This multi-method qualitative study examined sexuality and relationship formation among sexually experienced young people aged 14-19 in a rural sub-district. In this setting, sexual activity is highly stigmatised, particularly for young teenage women. Dominant sexual ideologies centre on 'good behaviour', the idea that 'sex is wrong', and abstinence as a preferred prevention strategy. Young women's relationships are often hidden but sexual relationships are also an important part of the transition to adulthood. These dichotomies of love and romance versus stigma and secrecy frame young people's discourse about sexuality. A discourse about healthy sexuality is largely absent, impeding the prevention of HIV in this setting.

Appropriate training and retention of community doctors in rural areas: a case study from Mali.

PubMed

Van Dormael, Monique; Dugas, Sylvie; Kone, Yacouba; Coulibaly, Seydou; Sy, Mansour; Marchal, Bruno; Desplats, Dominique

2008-11-18

While attraction of doctors to rural settings is increasing in Mali, there is concern for their retention. An orientation course for young practicing rural doctors was set up in 2003 by a professional association and a NGO. The underlying assumption was that rurally relevant training would strengthen doctors' competences and self-confidence, improve job satisfaction, and consequently contribute to retention. Programme evaluation distinguished trainees' opinions, competences and behaviour. Data were collected through participant observation, group discussions, satisfaction questionnaires, a monitoring tool of learning progress, and follow up visits. Retention was assessed for all 65 trainees between 2003 and 2007. The programme consisted of four classroom modules--clinical skills, community health, practice management and communication skills--and a practicum supervised by an experienced rural doctor. Out of the 65 trained doctors between 2003 and 2007, 55 were still engaged in rural practice end of 2007, suggesting high retention for the Malian context. Participants viewed the training as crucial to face technical and social problems related to rural practice. Discussing professional experience with senior rural doctors contributed to socialisation to novel professional roles. Mechanisms underlying training effects on retention include increased self confidence, self esteem as rural doctor, and sense of belonging to a professional group sharing a common professional identity. Retention can however not be attributed solely to the training intervention, as rural doctors benefit from other incentives and support mechanisms (follow up visits, continuing training, mentoring...) affecting job satisfaction. Training increasing self confidence and self esteem of rural practitioners may contribute to retention of skilled professionals in rural areas. While reorientations of curricula in training institutions are necessary, other types of professional support are needed. This experience suggests that professional associations dedicated to strengthening quality of care can contribute significantly to rural practitioners' morale.

Developing Intervention Strategies to Optimise Body Composition in Early Childhood in South Africa

PubMed Central

Tomaz, Simone A.; Stone, Matthew; Hinkley, Trina; Jones, Rachel A.; Louw, Johann; Twine, Rhian; Kahn, Kathleen; Norris, Shane A.

2017-01-01

Purpose. The purpose of this research was to collect data to inform intervention strategies to optimise body composition in South African preschool children. Methods. Data were collected in urban and rural settings. Weight status, physical activity, and gross motor skill assessments were conducted with 341 3–6-year-old children, and 55 teachers and parents/caregivers participated in focus groups. Results. Overweight and obesity were a concern in low-income urban settings (14%), but levels of physical activity and gross motor skills were adequate across all settings. Focus group findings from urban and rural settings indicated that teachers would welcome input on leading activities to promote physical activity and gross motor skill development. Teachers and parents/caregivers were also positive about young children being physically active. Recommendations for potential intervention strategies include a teacher-training component, parent/child activity mornings, and a home-based component for parents/caregivers. Conclusion. The findings suggest that an intervention focussed on increasing physical activity and improving gross motor skills per se is largely not required but that contextually relevant physical activity and gross motor skills may still be useful for promoting healthy weight and a vehicle for engaging with teachers and parents/caregivers for promoting other child outcomes, such as cognitive development. PMID:28194417

Impact and management of dual relationships in metropolitan, regional and rural mental health practice.

PubMed

Endacott, Ruth; Wood, Anita; Judd, Fiona; Hulbert, Carol; Thomas, Ben; Grigg, Margaret

2006-01-01

To explore the extent and impact of professional boundary crossings in metropolitan, regional and rural mental health practice in Victoria and identify strategies mental health clinicians use to manage dual relationships. Nine geographically located focus groups consisting of mental health clinicians: four focus groups in rural settings; three in a regional city and two in a metropolitan mental health service. A total of 52 participants were interviewed. Data revealed that professional boundaries were frequently breached in regional and rural settings and on occasions these breaches had a significantly negative impact. Factors influencing the impact were: longevity of the clinician's relationship with the community, expectations of the community, exposure to community 'gossip' and size of the community. Participants reported greater stress when the boundary crossing affected their partner and/or children. Clinicians used a range of proactive and reactive strategies, such as private telephone number, avoidance of social community activities, when faced with a potential boundary crossing. The feasibility of reactive strategies depended on the service configuration: availability of an alternative case manager, requirement for either patient or clinician to travel. The greater challenges faced by rural and regional clinicians were validated by metropolitan participants with rural experience and rural participants with metropolitan experience. No single strategy is used or appropriate for managing dual relationships in rural settings. Employers and professional bodies should provide clearer guidance for clinicians both in the management of dual relationships and the distinction between boundary crossings and boundary violation. Clinicians are clearly seeking to represent and protect the patients' interests; consideration should be given by consumer groups to steps that can be taken by patients to reciprocate.

Prescription Opioid Misuse Among Rural Community Pharmacy Patients: Pilot Study for Screening and Implications for Future Practice and Research.

PubMed

Cochran, Gerald T; Engel, Rafael J; Hruschak, Valerie J; Tarter, Ralph E

2017-10-01

Opioid misuse imposes a disproportionately heavy burden on individuals living in rural areas. Community pharmacy has the potential to expand and coordinate with health professionals to identify and intervene with those who misuse opioids. Rural and urban community pharmacy patients were recruited in this pilot project to describe and compare patterns of opioid misuse. We administered a health screening survey in 4 community pharmacies among patients filling opioid medications. Univariate statistics were used to assess differences in health characteristics and opioid medication misuse behaviors between rural and urban respondents. Multivariable statistics were used to identify risk factors associated with rural and urban opioid misuse. A total of 333 participants completed the survey. Participants in rural settings had poorer overall health, higher pain levels, lower education, and a higher rate of unemployment compared to patients in urban pharmacies. Rural respondents with illicit drug use (adjustable odds ratio [aOR]: 14.34, 95% confidence interval [CI] = 2.16-95.38), posttraumatic stress disorder (aOR: 5.44, 95% CI = 1.52-19.50), and ≤high school education (aOR: 6.68, 95% CI = 1.06-42.21) had increased risk for opioid misuse. Community pharmacy represents a promising resource for potential identification of opioid misuse, particularly in rural communities. Continued research must extend these findings and work to establish collaborative services in rural settings.

Research on the evaluation method of rural hollowing based on RS and GIS technology: a case study of the Ningxia Hui autonomous region in China

NASA Astrophysics Data System (ADS)

Yin, Kai; Wen, MeiPing; Zhang, FeiFei; Yuan, Chao; Chen, Qiang; Zhang, Xiupeng

2016-10-01

With the acceleration of urbanization in China, most rural areas formed a widespread phenomenon, i.e., destitute village, labor population loss, land abandonment and rural hollowing. And it formed a unique hollow village problem in China finally. The governance of hollow village was the objective need of the development of economic and social development in rural area for Chinese government, and the research on the evaluation method of rural hollowing was the premise and basis of the hollow village governance. In this paper, several evaluation methods were used to evaluate the rural hollowing based on the survey data, land use data, social and economic development data. And these evaluation indexes were the transition of homesteads, the development intensity of rural residential areas, the per capita housing construction area, the residential population proportion in rural area, and the average annual electricity consumption, which can reflect the rural hollowing degree from the land, population, and economy point of view, respectively. After that, spatial analysis method of GIS was used to analyze the evaluation result for each index. Based on spatial raster data generated by Kriging interpolation, we carried out re-classification of all the results. Using the fuzzy clustering method, the rural hollowing degree in Ningxia area was reclassified based on the two spatial scales of county and village. The results showed that the rural hollowing pattern in the Ningxia Hui Autonomous Region had a spatial distribution characteristics that the rural hollowing degree was obvious high in the middle of the study area but was low around the study area. On a county scale, the specific performances of the serious rural hollowing were the higher degree of extensive land use, and the lower level of rural economic development and population transfer concentration. On a village scale, the main performances of the rural hollowing were the rural population loss and idle land. The evaluation method of rural hollowing constructed in this paper can effectively carry out a comprehensive degree zoning of rural hollowing, which can make orderly decision support plans of hollow village governance for the government.

Effect of tele-emergency services on recruitment and retention of US rural physicians.

PubMed

Potter, Andrew J; Mueller, Keith J; Mackinney, A Clinton; Ward, Marcia M

2014-01-01

As competition for physicians intensifies in the USA, rural areas are at a disadvantage due to challenges unique to rural medical practice. Telemedicine improves access to care not otherwise available in rural settings. Previous studies have found that telemedicine also has positive effects on the work environment, suggesting that telemedicine may improve rural physician recruitment and retention, although few have specifically examined this. Using a mixed-method approach, clients of a single telemedicine service in the Upper Midwestern USA were surveyed and interviewed about their views of the impact of tele-emergency on physician recruitment and retention and the work environment. Surveys were completed by 292 clinical and administrative staff at 71 hospitals and semi-structured interviews were conducted with clinicians and administrators at 16 hospitals. Survey respondents agreed that tele-emergency had a positive effect on physician recruitment and retention and related workplace factors. Interviewees elucidated how the presence of tele-emergency played an important role in enhancing physician confidence, providing educational opportunities, easing burden, and supplementing care, workplace factors that interviewees believed would impact recruitment and retention. However, gains were limited by hospitals' interpretation of the Emergency Medical Treatment and Labor Act as requiring on-site physician coverage even if tele-emergency was used. Results indicate that, all other factors being equal, tele-emergency increases the likelihood of physicians entering and remaining in rural practice. New regulatory guidance by the Centers for Medicare and Medicaid Services related to on-site physician coverage will likely accelerate implementation of tele-emergency services in rural hospitals. Telemedicine may prove to be an increasingly valuable recruitment and retention tool for rural hospitals as competition for physicians intensifies.

Using audit to enhance quality of maternity care in resource limited countries: lessons learnt from rural Tanzania.

PubMed

Nyamtema, Angelo S; de Jong, Alise Bartsch; Urassa, David P; van Roosmalen, Jos

2011-11-16

Although clinical audit is an important instrument for quality care improvement, the concept has not yet been adequately taken on board in rural settings in most resource limited countries where the problem of maternal mortality is immense. Maternal mortality and morbidity audit was established at Saint Francis Designated District Hospital (SFDDH) in rural Tanzania in order to generate information upon which to base interventions. Methods are informed by the principles of operations research. An audit system was established, all patients fulfilling the inclusion criteria for maternal mortality and severe morbidity were reviewed and selected cases were audited from October 2008 to July 2010. The causes and underlying factors were identified and strategic action plans for improvement were developed and implemented. There were 6572 deliveries and 363 severe maternal morbidities of which 36 women died making institutional case fatality rate of 10%. Of all morbidities 341 (94%) had at least one area of substandard care. Patients, health workers and administration related substandard care factors were identified in 50% - 61% of women with severe morbidities. Improving responsiveness to obstetric emergencies, capacity building of the workforce for health care, referral system improvement and upgrading of health centres located in hard to reach areas to provide comprehensive emergency obstetric care (CEmOC) were proposed and implemented as a result of audit. Our findings indicate that audit can be implemented in rural resource limited settings and suggest that the vast majority of maternal mortalities and severe morbidities can be averted even where resources are limited if strategic interventions are implemented.

Reporting diarrhoea through a vernacular term in Quechua-speaking settings of rural Bolivia.

PubMed

Pacheco, Gonzalo Durán; Christen, Andri; Arnold, Ben; Hattendorf, Jan; Colford, John M; Smith, Thomas A; Mäusezahl, Daniel

2011-12-01

Field studies often use caregiver-reported diarrhoea and related symptoms to measure child morbidity. There are various vernacular terms to define diarrhoea that vary across the local cultural contexts. The relationship between vernacular definitions of diarrhoea and symptoms-based definitions is not well-documented. This paper describes the association of the vernacular Quechua term k'echalera with the symptoms-based standard definition of diarrhoea in rural Bolivian settings. During a cluster randomized trial in rural Bolivia, both signs and symptoms of diarrhoea and reports of k'echalera were collected for children aged less than five years. Reported k'echalera were found to be associated with important changes in stool frequency, consistency, and presence of blood and mucus. Reported k'echalera were highly related to three of four recorded categories of watery stool. The intermediate (milk-rice) stool consistency, which fits into the definition of watery stool, was not strongly related to k'echalera. Mucus in the stool was also associated with k'echalera; however, its presence in k'echalera-free days accounted for at least 50% of the possible false negatives. The sensitivity and specificity of the term k'echalera were estimated by Bayesian methods, allowing for both symptoms of diarrhoea and reports of k'echalera to be subject to diagnosis error. An average specificity of at least 97% and the sensitivity of at least 50% were obtained. The findings suggest that the use of k'echalera would identify fewer cases of diarrhoea than a symptom-based definition in rural Bolivia.

Reporting Diarrhoea through a Vernacular Term in Quechua-speaking Settings of Rural Bolivia

PubMed Central

Christen, Andri; Arnold, Ben; Hattendorf, Jan; Colford, John M.; Smith, Thomas A.; Mäusezahl, Daniel

2011-01-01

Field studies often use caregiver-reported diarrhoea and related symptoms to measure child morbidity. There are various vernacular terms to define diarrhoea that vary across the local cultural contexts. The relationship between vernacular definitions of diarrhoea and symptoms-based definitions is not well-documented. This paper describes the association of the vernacular Quechua term k'echalera with the symptoms-based standard definition of diarrhoea in rural Bolivian settings. During a cluster randomized trial in rural Bolivia, both signs and symptoms of diarrhoea and reports of k'echalera were collected for children aged less than five years. Reported k'echalera were found to be associated with important changes in stool frequency, consistency, and presence of blood and mucus. Reported k'echalera were highly related to three of four recorded categories of watery stool. The intermediate (milk-rice) stool consistency, which fits into the definition of watery stool, was not strongly related to k'echalera. Mucus in the stool was also associated with k'echalera; however, its presence in k'echalera-free days accounted for at least 50% of the possible false negatives. The sensitivity and specificity of the term k'echalera were estimated by Bayesian methods, allowing for both symptoms of diarrhoea and reports of k'echalera to be subject to diagnosis error. An average specificity of at least 97% and the sensitivity of at least 50% were obtained. The findings suggest that the use of k'echalera would identify fewer cases of diarrhoea than a symptom-based definition in rural Bolivia. PMID:22283028

Higher Prices, Fewer Choices: Shopping for Food in Rural America.

ERIC Educational Resources Information Center

Morris, Patricia McGrath

The Food Stamp Program is the U.S. government's primary program to prevent the rural poor from going hungry. Food stamp allotments are set each year based on the cost of the "Thrifty Food Plan" (TFP), a minimally adequate diet defined by the U.S. Department of Agriculture (USDA), which sets costs by examining average food prices in urban…

Historia Verdadera del Chicano del Norte. [True History of the Chicano of the North].

ERIC Educational Resources Information Center

Herrera, David; Bryan, Clifford E.

Very little is known about the Chicanos in the northern U.S., especially those in the Northwest. Research and writing on Chicanos have concentrated on the Southwest or large urban settings, thus excluding those Chicanos residing in rural settings except for those in the migrant stream. These rural residents have become a forgotten people,…

Examining the Effects of School-Based Drug Prevention Programs on Drug Use in Rural Settings: Methodology and Initial Findings

ERIC Educational Resources Information Center

Brown, C. Hendricks; Guo, Jing; Singer, L. Terri; Downes, Katheryne; Brinales, Joseph M.

2007-01-01

Context: Although there have been substantial advances in knowledge about drug prevention over the last decade, the majority of school-based drug prevention studies have been conducted in urban settings. There is little knowledge about the effectiveness of such programs when they are implemented in rural populations. Purpose: To examine the…

Action Learning Sets and Social Capital: Ameliorating the Burden of Clergy Isolation in One Rural Diocese

ERIC Educational Resources Information Center

Muskett, Judith A.; Village, Andrew

2016-01-01

Rural clergy often lack colleagues and may struggle with isolation, especially if over-extended in multi-parish benefices. Theory suggests that this sense of isolation could be addressed by launching clergy action learning sets, which have the potential to establish a peer support network through the formation of social capital as a by-product of…

The Impact of Afterschool Tutoring on Reading Achievement of Elementary Students in a Mississippi Rural School Setting

ERIC Educational Resources Information Center

Lacy, Sharone Sanders

2011-01-01

The purpose of this study was to determine what impact a No Child Left Behind (NCLB)-related afterschool tutoring program had on reading achievement of elementary students in a Mississippi rural school setting. The research questions that guided this study were (1) Is there a significant difference between the 2008 and 2009 Mississippi Curriculum…

An exploratory study of mental health and HIV risk behavior among drug-using rural women in jail

PubMed Central

Staton-Tindall, Michele; Harp, Kathi LH; Minieri, Alexandra; Oser, Carrie; Webster, J. Matthew; Havens, Jennifer; Leukefeld, Carl

2014-01-01

Objective Rural women, particularly those involved in the criminal justice system, are at risk for HIV due to the increasing prevalence of injection drug use, as well as limited services. Research on HIV risk correlates, including drug use and mental health, has primarily focused on urban women incarcerated in prisons. The purpose of this exploratory study is to examine dual HIV risk behavior by three different mental health problems (depression, anxiety, and PTSD) among drug-using women in rural jails. Methods This study involved random selection, screening, and face-to-face interviews with 136 women from rural jails in one Appalachian state. Analyses focused on the relationship between mental health and HIV risk among this sample of drug-using women. Findings Nearly 80% of women self-reported symptoms of depression, and more than 60% endorsed symptoms consistent with anxiety and PTSD symptoms. Mental health was significantly correlated with severity of certain types of drug use, as well as risky sexual activity. In addition, for women experiencing anxiety and PTSD, injection drug use moderated the relationship between mental health and risky sexual activity. Implications Based on these rates of drug use, mental health problems, and the emergence of injection drug use in rural Appalachia, the need to explore the relationships between these issues among vulnerable and understudied populations, such as rural women, is critical. Due to service limitations in rural communities, criminal justice venues such as jails provide opportune settings for screening, assessment, and intervention for drug use, mental health, and HIV education and prevention. PMID:25799305

Nutrition-Related Policy and Environmental Strategies to Prevent Obesity in Rural Communities: A Systematic Review of the Literature, 2002–2013

PubMed Central

Leeman, Jennifer; Jilcott Pitts, Stephanie B.; Khan, Laura Kettel; Fleischhacker, Sheila; Evenson, Kelly R.; Schreiner, Michelle; Byker, Carmen; Owens, Clint; McGuirt, Jared; Barnidge, Ellen; Dean, Wesley; Johnson, Donna; Kolodinsky, Jane; Piltch, Emily; Pinard, Courtney; Quinn, Emilee; Whetstone, Lauren; Ammerman, Alice

2015-01-01

Introduction Residents of rural communities in the United States are at higher risk for obesity than their urban and suburban counterparts. Policy and environmental-change strategies supporting healthier dietary intake can prevent obesity and promote health equity. Evidence in support of these strategies is based largely on urban and suburban studies; little is known about use of these strategies in rural communities. The purpose of this review was to synthesize available evidence on the adaptation, implementation, and effectiveness of policy and environmental obesity-prevention strategies in rural settings. Methods The review was guided by a list of Centers for Disease Control and Prevention Recommended Community Strategies and Measurements to Prevent Obesity in the United States, commonly known as the “COCOMO” strategies. We searched PubMed, Cumulative Index of Nursing and Allied Health Literature, Public Affairs Information Service, and Cochrane databases for articles published from 2002 through 2013 that reported findings from research on nutrition-related policy and environmental strategies in rural communities in the United States and Canada. Two researchers independently abstracted data from each article, and resolved discrepancies by consensus. Results Of the 663 articles retrieved, 33 met inclusion criteria. The interventions most commonly focused on increasing access to more nutritious foods and beverages or decreasing access to less nutritious options. Rural adaptations included accommodating distance to food sources, tailoring to local food cultures, and building community partnerships. Conclusions Findings from this literature review provide guidance on adapting and implementing policy and environmental strategies in rural communities. PMID:25927605

Hearing loss and social support in urban and rural communities.

PubMed

Hay-McCutcheon, Marcia J; Hyams, Adriana; Yang, Xin; Parton, Jason

2018-04-19

Perceived social support and hearing handicap were assessed in adults with and without hearing loss who lived in different geographical regions of Alabama. The Hearing Handicap Inventory for Adults (HHIA) assessed emotional and social consequences of hearing loss. The Medical Outcomes Study (MOS) Social Support Survey and the Social Functioning, Role Emotional and Mental Health scales of the SF-36 were administered. Data were collected from 71 study participants with hearing loss and from 45 adults without hearing loss. Degree of hearing loss and outcomes from the HHIA did not differ between adults who lived in rural or urban settings. Tangible support was poorer for adults with hearing loss who lived in rural settings compared to those who lived in urban settings. For adults without hearing loss, residency was not associated with tangible support. For these adults, income was associated with other types of social support (i.e. informational support, affection, positive social interaction). Adults with hearing loss living in rural areas had poor perceived tangible support. The provision of support to address a hearing loss could be worse for these adults compared to adults who lived in urban settings.

Rural Parentage and Labor Market Disadvantage in a Sub-Saharan Setting: Sources and Trends

ERIC Educational Resources Information Center

Giroux, Sarah C.

2008-01-01

High unemployment in many developing countries is intensifying job competition and raising concern for the employment prospects of vulnerable groups, including children of rural parents. This paper examines the trends and sources in employment disadvantage associated with rural parentage in Cameroon. In documenting the sources of inequality, the…

Novice Rural Principals' Successful Leadership Practices in Financial Management: Multiple Accountabilities

ERIC Educational Resources Information Center

Myende, Phumlani Erasmus; Samuel, Michael Anthony; Pillay, Ansurie

2018-01-01

Research studies on financial management in South African public schools expands recurrent literature, most of which have largely pathologised school leadership and management, and rural schools in particular. This article instead draws from a qualitative case study of success, which examined how five novice principals in a rural setting went…

7 CFR 634.1 - Purpose and scope.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AGRICULTURE LONG TERM CONTRACTING RURAL CLEAN WATER PROGRAM General § 634.1 Purpose and scope. (a) The purpose.... Environmental Protection Agency (EPA), to set forth regulations to carry out a Rural Clean Water Program (RCWP) under section 35, Pub. L. 95-217; 91 Stat. 1579; 33 U.S.C. 1288. (b) The Rural Clean Water Program...

7 CFR 634.1 - Purpose and scope.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AGRICULTURE LONG TERM CONTRACTING RURAL CLEAN WATER PROGRAM General § 634.1 Purpose and scope. (a) The purpose.... Environmental Protection Agency (EPA), to set forth regulations to carry out a Rural Clean Water Program (RCWP) under section 35, Pub. L. 95-217; 91 Stat. 1579; 33 U.S.C. 1288. (b) The Rural Clean Water Program...

7 CFR 634.1 - Purpose and scope.

Code of Federal Regulations, 2012 CFR

2012-01-01

... AGRICULTURE LONG TERM CONTRACTING RURAL CLEAN WATER PROGRAM General § 634.1 Purpose and scope. (a) The purpose.... Environmental Protection Agency (EPA), to set forth regulations to carry out a Rural Clean Water Program (RCWP) under section 35, Pub. L. 95-217; 91 Stat. 1579; 33 U.S.C. 1288. (b) The Rural Clean Water Program...

Access to Transportation and Health Care Utilization in a Rural Region

ERIC Educational Resources Information Center

Arcury, Thomas A.; Preisser, John S.; Gesler, Wilbert M.; Powers, James M.

2005-01-01

Access to transportation to transverse the large distances between residences and health services in rural settings is a necessity. However, little research has examined directly access to transportation in analyses of rural health care utilization. This analysis addresses the association of transportation and health care utilization in a rural…

Study on Role of Radio for Rural Education in Pakistan

ERIC Educational Resources Information Center

Jumani, Nabi Bux

2009-01-01

It was found that the majority of the listeners possessed radio sets and was getting benefit from the educational programmes of radio. The programmes were informative and motivating. The strategies of radio for rural education were appreciable because these infused mobility, widened horizon of rural people and focused attention on the goals and…

Improving Work Environment Perceptions for Nurses Employed in a Rural Setting

ERIC Educational Resources Information Center

Teasley, Susan L.; Sexton, Kathleen A.; Carroll, Cathryn A.; Cox, Karen S.; Riley, Michele; Ferriell, Kathleen

2007-01-01

Context: Effective recruitment and retention of professional nurses is a survival strategy for health care facilities, especially in rural areas. Purpose: This study examines the use of the Individual Workload Perception Scale to measure nurse satisfaction by a small rural hospital in order to make positive changes in the work environment for…

Preparing Teachers for Rural Appointments: Lessons from Australia

ERIC Educational Resources Information Center

Lock, Graeme

2008-01-01

Education authorities continue to experience difficulty in recruiting and retaining teachers in rural and remote schools. In Western Australia (WA), a state noted for its vastness and number of schools located in rural and remote settings, a scheme developed by the Western Australian Department of Education and Training (DET) and the WA Chamber of…

Clinical Decision Making of Rural Novice Nurses

ERIC Educational Resources Information Center

Seright, Teresa J.

2010-01-01

The purpose of this study was to develop substantive theory regarding decision making by the novice nurse in a rural hospital setting. Interviews were guided by the following research questions: What cues were used by novice rural registered nurses in order to make clinical decisions? What were the sources of feedback which influenced subsequent…

Pedagogical Mentorship, Indigenous Settings, and Rural Education: Perspectives from Guatemalan Teachers

ERIC Educational Resources Information Center

de la Garza, Katy

2014-01-01

Rural and Indigenous populations have the lowest educational achievement indicators and teachers with the least years of training. Global education movements have led to an increase in access to schooling by rural and Indigenous populations but high drop-out rates persist and education policies, curricular contents, and teacher trainings have…

Guidelines for Becoming a Teacher Leader in Rural Special Education

ERIC Educational Resources Information Center

Collins, Belva C.; Leahy, Maria Marsella; Ault, Melinda Jones

2017-01-01

Special education teachers have a unique set of skills and opportunities to become leaders in the field of education. Some rural special education teachers, however, may not see themselves as potential leaders or believe they have opportunities to be leaders. This article provides guidelines for rural special education teachers to consider in…

Common Challenges Faced by Rural Principals: A Review of the Literature

ERIC Educational Resources Information Center

Preston, Jane P.; Jakubiec, Brittany A. E.; Kooymans, Robin

2013-01-01

Within this article, we thematically present common challenges associated with the role of the rural principal. In this literature review, we delimit our search to work published from 2003-2013. A limitation of this study is that it represents data predominantly from American, Canadian, and Australian rural settings, restricting a global…

Impoverished Students with Academic Promise in Rural Settings: 10 Lessons from Project Aspire

ERIC Educational Resources Information Center

Burney, Virginia H.; Cross, Tracy L.

2006-01-01

Project Aspire was created to identify poor rural students with academic potential and to provide them with academic and counseling support in advanced placement courses and prerequisites. This article describes Project Aspire and its foundations; the relevant lessons learned from the literature on poverty, small schools, rural schools, and gifted…

Engineers for Rural Development: Europe and Latin America Getting in Tune.

ERIC Educational Resources Information Center

Marechal, Gilles

The European program Amerique Latine-Formation Academique (ALFA) has provided 12 Latin-American and 10 European universities and colleges with a framework for creating an International Master in Rural Development. Globalization, regional integration, and sustainability have created a new set of questions for rural areas, both in Europe and in…

Prevalence and correlates of home delivery amongst HIV-infected women attending care at a rural public health facility in Coastal Kenya

PubMed Central

Mwangi, Tabitha W.; Ndirangu, Kennedy K.; Abdullahi, Osman A.; Munywoki, Patrick K.

2018-01-01

Background Home delivery, referring to pregnant women giving birth in the absence of a skilled birth attendant, is a significant contributor to maternal mortality, and is encouragingly reported to be on a decline in the general population in resource limited settings. However, much less is known about home delivery amongst HIV-infected women in sub-Saharan Africa (sSA). We described the prevalence and correlates of home delivery among HIV-infected women attending care at a rural public health facility in Kilifi, Coastal Kenya. Methods A cross-sectional design using mixed methods was used. Quantitative data were collected using interviewer-administered questionnaires from HIV-infected women with a recent pregnancy (within 5 years, n = 425), whilst qualitative data were collected using focused group discussions (FGD, n = 5). Data were analysed using logistic regression and a thematic framework approach respectively. Results Overall, 108 (25.4%, [95% CI: 21.3–29.8]) participants delivered at home. Correlates of home delivery included lack of formal education (aOR 12.4 [95% CI: 3.4–46.0], p<0.001), history of a previous home delivery (2.7 [95% CI:1.2–6.0], p = 0.019) and being on highly active antiretroviral therapy (HAART, 0.4 [95% CI:0.2–0.8], p = 0.006).Despite a strong endorsement against home delivery, major thematic challenges included consumer-associated barriers, health care provider associated barriers and structural barriers. Conclusion A quarter of HIV-infected women delivered at home, which is comparable to estimates reported from the general population in this rural setting, and much lower than estimates from other sSA settings. A tailored package of care targeting women with no formal education and with a history of a previous home delivery, coupled with interventions towards scaling up HAART and improving the quality of maternal care in HIV-infected women may positively contribute to a decline in home delivery and subsequent maternal mortality in this setting. PMID:29558474

A new tent trap for sampling exophagic and endophagic members of the Anopheles gambiae complex.

PubMed

Govella, Nicodemus J; Chaki, Prosper P; Geissbuhler, Yvonne; Kannady, Khadija; Okumu, Fredros; Charlwood, J Derek; Anderson, Robert A; Killeen, Gerry F

2009-07-14

Mosquito sampling methods are essential for monitoring and evaluating malaria vector control interventions. In urban Dar es Salaam, human landing catch (HLC) is the only method sufficiently sensitive for monitoring malaria-transmitting Anopheles. HLC is labour intensive, cumbersome, hazardous, and requires such intense supervision that is difficulty to sustain on large scales. Novel tent traps were developed as alternatives to HLC. The Furvela tent, designed in Mozambique, incorporates a CDC Light trap (LT) components, while two others from Ifakara, Tanzania (designs A and B) require no electricity or moving parts. Their sensitivity for sampling malaria vectors was compared with LT and HLC over a wide range of vector abundances in rural and urban settings in Tanzania, with endophagic and exophagic populations, respectively, using randomised Latin-square and cross- over experimental designs. The sensitivity of LTs was greater than HLC while the opposite was true of Ifakara tent traps (crude mean catch of An. gambiae sensu lato relative to HLC = 0.28, 0.65 and 1.30 for designs A, B and LT in a rural setting and 0.32 for design B in an urban setting). However, Ifakara B catches correlated far better to HLC (r2 = 0.73, P < 0.001) than any other method tested (r2 = 0.04, P = 0.426 and r2 = 0.19, P = 0.006 for Ifakara A and LTs respectively). Only Ifakara B in a rural setting with high vector density exhibited constant sampling efficiency relative to HLC. The relative sensitivity of Ifakara B increased as vector densities decreased in the urban setting and exceeded that of HLC at the lowest densities. None of the tent traps differed from HLC in terms of the proportions of parous mosquitoes (P >or= 0.849) or An. gambiae s.l. sibling species (P >or= 0.280) they sampled but both Ifakara A and B designs failed to reduce the proportion of blood-fed mosquitoes caught (Odds ratio [95% Confidence Interval] = 1.6 [1.2, 2.1] and 1.0 [0.8, 1.2], P = 0.002 and 0.998, respectively), probably because of operator exposure while emptying the trap each morning. The Ifakara B trap may have potential for monitoring and evaluating a variety of endophagic and exophagic Afrotropical malaria vectors, particularly at low but epidemiologically relevant population densities. However, operator exposure to mosquito bites remains a concern so additional modifications or protective measures will be required before this design can be considered for widespread, routine use.

Openness to Experience as a Moderator of the Relationship between Intelligence and Creative Thinking: A Study of Chinese Children in Urban and Rural Areas.

PubMed

Shi, Baoguo; Dai, David Y; Lu, Yongli

2016-01-01

Using testing and questionnaire methods, this study investigated the relationships among openness to experience, intelligence and creative thinking. This study focused on the moderating effects of openness to experience on the relationship between intelligence and creative thinking in a sample of 831 primary school students in China. The findings showed significant positive relationships among openness to experience, intelligence and creative thinking. In relation to the focus of this study, openness to experience moderated the relationship between intelligence and creative thinking. However, the correlation between openness to experience and creative thinking was stronger for urban children than for rural children, and the moderating effect existed only in urban settings.

Openness to Experience as a Moderator of the Relationship between Intelligence and Creative Thinking: A Study of Chinese Children in Urban and Rural Areas

PubMed Central

Shi, Baoguo; Dai, David Y.; Lu, Yongli

2016-01-01

Using testing and questionnaire methods, this study investigated the relationships among openness to experience, intelligence and creative thinking. This study focused on the moderating effects of openness to experience on the relationship between intelligence and creative thinking in a sample of 831 primary school students in China. The findings showed significant positive relationships among openness to experience, intelligence and creative thinking. In relation to the focus of this study, openness to experience moderated the relationship between intelligence and creative thinking. However, the correlation between openness to experience and creative thinking was stronger for urban children than for rural children, and the moderating effect existed only in urban settings. PMID:27199866

Catatonia in Resource Limited Settings: A Case Series and Treatment Protocol

PubMed Central

Smith, Stephanie L.; Grelotti, David J.; Fils-Aime, Reginald; Uwimana, Eugenie; Ndikubwimana, Jean-Sauveur; Therosme, Tatiana; Severe, Jennifer; Dushimiyimana, Dominique; Uwamariya, Clemence; Bienvenu, Robert; Alcindor, Yoldie; Eustache, Eddy; Raviola, Giuseppe J.; Fricchione, Gregory L.

2014-01-01

Objective The Catatonic Syndrome (“catatonia”) is characterized by motor and motivation dysregulation and is associated with a number of neuropsychiatric and medical disorders. It is recognizable in a variety of clinical settings. We present observations from the treatment of four individuals with catatonia in Haiti and Rwanda, and introduce a treatment protocol for use in resource limited settings Methods Four patients from rural Haiti and Rwanda with clinical signs of catatonia and a positive screen using the Bush-Francis-Catatonia Rating Scale were treated collaboratively by general physicians and mental health clinicians with either lorazepam or diazepam. Success in treatment was clinically assessed by complete remittance of catatonia symptoms. Results The four patients in this report exhibited a range of characteristic and recognizable signs of catatonia, including immobility/stupor, stereotypic movements, echophenomena, posturing, odd mannerisms, mutism, and refusal to eat or drink. All four cases presented initially to rural outpatient general health services in low resource settings. In some cases, diagnostic uncertainty initially led to treatment with typical antipsychotics. In each case, proper identification and treatment of catatonia with benzodiazepines led to significant clinical improvement. Conclusion Catatonia can be effectively and inexpensively treated in resource limited settings. Identification and management of catatonia is critical for the health and safety of patients with this syndrome. Familiarity with the clinical features of catatonia is essential for health professionals working in low resource settings. To facilitate early recognition of this treatable disorder, catatonia should feature more prominently in global mental health discourse. PMID:25467078

The impact of self-interviews on response patterns for sensitive topics: a randomized trial of electronic delivery methods for a sexual behaviour questionnaire in rural South Africa.

PubMed

Harling, Guy; Gumede, Dumile; Mutevedzi, Tinofa; McGrath, Nuala; Seeley, Janet; Pillay, Deenan; Bärnighausen, Till W; Herbst, Abraham J

2017-08-17

Self-interviews, where the respondent rather than the interviewer enters answers to questions, have been proposed as a way to reduce social desirability bias associated with interviewer-led interviews. Computer-assisted self-interviews (CASI) are commonly proposed since the computer programme can guide respondents; however they require both language and computer literacy. We evaluated the feasibility and acceptability of using electronic methods to administer quantitative sexual behaviour questionnaires in the Somkhele demographic surveillance area (DSA) in rural KwaZulu-Natal, South Africa. We conducted a four-arm randomized trial of paper-and-pen-interview, computer-assisted personal-interview (CAPI), CASI and audio-CASI with an age-sex-urbanicity stratified sample of 504 adults resident in the DSA in 2015. We compared respondents' answers to their responses to the same questions in previous surveillance rounds. We also conducted 48 cognitive interviews, dual-coding responses using the Framework approach. Three hundred forty (67%) individuals were interviewed and covariates and participation rates were balanced across arms. CASI and audio-CASI were significantly slower than interviewer-led interviews. Item non-response rates were higher in self-interview arms. In single-paper meta-analysis, self-interviewed individuals reported more socially undesirable sexual behaviours. Cognitive interviews found high acceptance of both self-interviews and the use of electronic methods, with some concerns that self-interview methods required more participant effort and literacy. Electronic data collection methods, including self-interview methods, proved feasible and acceptable for completing quantitative sexual behaviour questionnaires in a poor, rural South African setting. However, each method had both benefits and costs, and the choice of method should be based on context-specific criteria.

The Rural Context of Illicit Substance Offers: A Study of Appalachian Rural Adolescents

PubMed Central

Pettigrew, Jonathan; Miller-Day, Michelle; Krieger, Janice; Hecht, Michael L.

2015-01-01

Rural adolescents are at risk for early initiation and problematic substance use, but to date few studies have examined the rural context of substance use. To better understand substance offers in the rural context, semi-structured interviews were conducted with 118, 12-19 year old adolescents (M = 13.68, SD = 1.37) from Appalachian, rural school districts in Pennsylvania and Ohio. Interviews elicited stories about substance offer-response episodes including where offers occurred, who offered substances, and how youth gained access to illicit substances. Findings describe the settings in which substance offers and use occur for these rural adolescents and advance prevention efforts for tailoring health messages to this target population. PMID:25620838

Studying the burden of community-acquired pneumonia in adults aged ⩾50 years in primary health care: an observational study in rural Crete, Greece

PubMed Central

Bertsias, Antonios; Tsiligianni, Ioanna G; Duijker, George; Siafakas, Nikolaos; Lionis, Christos

2014-01-01

Background: Community-acquired pneumonia (CAP) is a potentially life-threatening condition that often requires hospitalisation particularly in the elderly population or in patients with comorbidities. Aims: The aims of this study were to estimate the CAP frequency and severity in a well-defined primary healthcare setting in rural Crete, to record patient characteristics, their immunisation status and to estimate hospitalisation frequency and determinants. Methods: An observational study was designed and implemented in a rural setting within the prefecture of Heraklion in the island of Crete, Greece. Eligible patients were those aged 50 years or above, presenting with CAP based on signs and symptoms and positive X-ray findings. Results: A total of 124 CAP cases were recorded, 40 of which (32.3%) were hospitalised. Τhe age-standardised CAP incidence was estimated to be 236.7 cases per 100,000 persons aged ⩾50 years. Forty-three patients (35.2%) were vaccinated against pneumococcus. The most frequent chronic illnesses were heart disease (64.5%), chronic obstructive pulmonary disease (32.5%), and type 2 diabetes (21%). Hospitalisation determinants included advanced age (⩾74 years, Odds ratio (OR) 7.13; P value=0.001; 95% confidence interval (CI), 2.23–22.79), obesity (OR 3.36, P=0.037; 95% CI, 1.08–10.52), ⩾40 pack-years of smoking (OR 3.82, P value=0.040; 95% CI, 1.07–18.42), presence of multimorbidity (OR 5.77, P value=0.003; 95% CI, 1.81–18.42) and pneumococcal vaccination (OR 0.29, P value=0.041; 95% CI, 0.09–0.95). Conclusions: This study highlighted patient characteristics and aspects of CAP epidemiology in the context of a rural primary care setting in southern Europe where limited data have been published until now. PMID:24965889

The use of video conferencing to develop a community of practice for preceptors located in rural and non traditional placement settings: an evaluation study.

PubMed

Zournazis, Helen E; Marlow, Annette H

2015-03-01

Support for nursing students in rural and non-traditional health environments within Tasmania is predominately undertaken by preceptors. It is recognised that preceptors who work within these environments, require support in their role and opportunities to communicate with academic staff within universities. Multiple methods of information distribution support and networking opportunities provide preceptors with flexible options to keep them abreast of the student learning process. This paper presents survey findings from preceptors in rural and non-traditional professional experience placement environments taken from a pilot project regarding the implementation of video conferencing forums for education and peer networking in Tasmania. The purpose of the evaluation was to establish whether video conferencing met the requirements of preceptors' understanding of learning and teaching requirements during students' professional experience placement. The findings reveal preceptors' workload pressures and the need for organisational support were key barriers that prevented preceptor participation. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Barriers to primary care hospital follow-up among older adults in rural or semi-rural communities.

PubMed

Hardman, Bobbi; Newcomb, Patricia

2016-02-01

Failure to follow-up with a primary care provider (PCP) following discharge from an acute care setting is strongly associated with readmission within 90 days among elderly patients. The purpose of this study was to identify barriers to primary care follow-up among older adults in rural communities. This was an explanatory mixed methods study which included scaled survey and interview techniques. Descriptive and inferential statistics were calculated for scaled concepts. Standard content analysis was performed on the qualitative items. Correlation between intention to follow-up with a PCP and actual follow-up was poor (r=0.20). Patients encountered substantial obstacles to the PCP follow-up visit. Obstacles clustered into two groups: 1) healthcare or social system barriers and 2) personal characteristics of patients. Individualized discharge planning that reflects the complexities of post-hospitalization adaptation for elders is most likely to be useful for ensuring PCP follow-up. Copyright © 2015 Elsevier Inc. All rights reserved.

Older Parents Benefit More in Health Outcome From Daughters’ Than Sons’ Emotional Care in China

PubMed Central

Zeng, Yi; Brasher, Melanie Sereny; Gu, Danan; Vaupel, James W.

2018-01-01

Objective To examine whether older parents in China would benefit more from daughters’ care than from sons’ emotional care. Method Analysis of the unique data sets of the Chinese Longitudinal Healthy Longevity Survey conducted in 2002, 2005, and 2008–2009 in 22 provinces. Results As compared with having son(s), having daughter(s) is significantly more beneficial at older ages in China, with regard to maintaining higher cognitive capacity and reducing mortality risk. Such daughter advantages in providing emotional care to older parents are more profound among the oldest-old aged 80+ as compared with the young-old aged 65 to 79 and surprisingly more profound in rural areas as compared with urban areas, even though son preference is much more common among rural residents. Discussion We describe how educational campaigns aimed at informing the public about the benefits of daughter(s) for older parents’ health outcome could help promote gender equality and reduce traditional son preference, especially in rural China. PMID:26746225

Comparative study on perceived abuse and social neglect among rural and urban geriatric population.

PubMed

Kaur, Jaspreet; Kaur, Jasbir; Sujata, N

2015-01-01

Elder abuse and social neglect are unrecognized problem. Many forms of elder abuse exist including physical, psychological, financial, sexual and social neglect. Social neglect is experienced by elderly through loss of friends and family members. Comparison of perceived abuse and social neglect among elderly residing in selected rural and urban areas. Study setting was a rural area Pohir and urban area Jamalpur of district Ludhiana. A sample of 200 subjects (100 subjects each from rural and urban area respectively) of age 60 years and above was drawn by cluster sampling technique and interview method was used to collect data by using Likert scale. Descriptive and inferential statistics were carried out with SPSS package. Results of the present study revealed that perceived physical abuse (25%) was higher among elderly residing in rural and it was found significantly higher among female elderly who were illiterate, widow/widower and partially dependent on caregiver whereas perceived psychological abuse (71%), financial abuse (37%) and social neglect (74%) were higher among elderly residing in urban. A significant association was found between psychological abuse and educational status, which inferred that as the level of education increases perception of psychological abuse also increases. The perceived financial abuse was significantly higher among male elderly who were financially independent. It was concluded that social neglect was most common, followed by psychological abuse and financial abuse among elderly residing in urban whereas physical abuse was more prevalent among elderly residing in rural.

Is the health of people living in rural areas different from those in cities? Evidence from routine data linked with the Scottish Health Survey

PubMed Central

2012-01-01

Background To examine the association between rurality and health in Scotland, after adjusting for differences in individual and practice characteristics. Methods Design: Mortality and hospital record data linked to two cross sectional health surveys. Setting: Respondents in the community-based 1995 and 1998 Scottish Health Survey who consented to record-linkage follow-up. Main outcome measures: Hypertension, all-cause premature mortality, total hospital stays and admissions due to coronary heart disease (CHD). Results Older age and lower social class were strongly associated with an increased risk of each of the four health outcomes measured. After adjustment for individual and practice characteristics, no consistent pattern of better or poorer health in people living in rural areas was found, compared to primary cities. However, individuals living in remote small towns had a lower risk of a hospital admission for CHD and those in very remote rural had lower mortality, both compared with those living in primary cities. Conclusion This study has shown how linked data can be used to explore the possible influence of area of residence on health. We were unable to find a consistent pattern that people living in rural areas have materially different health to that of those living in primary cities. Instead, we found stronger relationships between compositional determinants (age, gender and socio-economic status) and health than contextual factors (including rurality). PMID:22340710

The modular socket system in a rural setting in Indonesia.

PubMed

Giesberts, Bob; Ennion, Liezel; Hjelmstrom, Olle; Karma, Agusni; Lechler, Knut; Hekman, Edsko; Bergsma, Arjen

2018-06-01

Prosthetic services are inaccessible to people living in rural areas. Systems like the modular socket system have the potential to be fabricated outside of the prosthetic workshop. This study aimed to evaluate the patient's performance and satisfaction with the use of the modular socket system, and the technical feasibility of its implementation in a rural setting. A quantitative longitudinal descriptive study design was followed. A total of 15 persons with a lower limb amputation were fitted with the modular socket system and followed over 4-6 months. Performance was measured using a 2-min walk test, 10-m walk test and mobility and function questionnaire. Satisfaction was measured by the Socket Fit Comfort Score, Prosthesis Evaluation Questionnaire and EuroQoL 5 Dimensions 5 Levels. Notes on technical feasibility were taken at the moment of fitting ( t 0 ), at 1-3 months post fitting ( t 1 ) and at the end evaluation at 4-6 months post fitting ( t 2 ). Performance did not change between t 0 and t 2 . The comfort of the socket fit reduced between t 0 and t 2 . Satisfaction with prosthesis and general health status stayed constant over time. The average fitting-time for the modular socket system was 6.4 h. The modular socket system can be considered a useful alternative for use in rural settings. Clinical relevance The use of the modular socket system is feasible and can improve accessibility to prosthetic technology in rural areas. Experienced prosthetic users were satisfied with the performance and the device. The shorter manufacturing time and use of only hand-held tools makes it an ideal alternative for use in remote and rural settings.

Rural Indonesian health care workers' constructs of infection prevention and control knowledge.

PubMed

Marjadi, Brahmaputra; McLaws, Mary-Louise

2010-06-01

Understanding the constructs of knowledge behind clinical practices in low-resource rural health care settings with limited laboratory facilities and surveillance programs may help in designing resource-appropriate infection prevention and control education. Multiple qualitative methods of direct observations, individual and group focus discussions, and document analysis were used to examine health care workers' knowledge of infection prevention and control practices in intravenous therapy, antibiotic therapy, instrument reprocessing, and hand hygiene in 10 rural Indonesian health care facilities. Awareness of health care-associated infections was low. Protocols were in the main based on verbal instructions handed down through the ranks of health care workers. The evidence-based knowledge gained across professional training was overridden by empiricism, nonscientific modifications, and organizational and societal cultures when resources were restricted or patients demanded inappropriate therapies. This phenomenon remained undetected by accreditation systems and clinical educators. Rural Indonesian health care workers would benefit from a formal introduction to evidence-based practice that would deconstruct individual protocols that include nonscientific knowledge. To achieve levels of acceptable patient safety, protocols would have to be both evidence-based and resource-appropriate. Copyright 2010 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

Rural women are more likely to use long acting contraceptive in Tigray region, Northern Ethiopia: a comparative community-based cross sectional study.

PubMed

Alemayehu, Mussie; Kalayu, Aster; Desta, Alem; Gebremichael, Hailay; Hagos, Tesfalem; Yebyo, Henock

2015-09-04

In the latest report of Ethiopian Demographic and Health Survey (EDHS) 2011, the maternal mortality ratio (MMR) was estimated at 676/100,000 live births, with total fertility rate at 4.8 and contraceptive prevalence rate at 29 %. Knowledge and utilization of long acting contraceptive in the Tigray region are low. This study aims at comparing and identifying factors related to the utilization of long acting contraceptive in urban versus rural settings of Ethiopia. A comparative community-based cross-sectional study, comprised of quantitative and qualitative methods, was conducted among 1035 married women in Wukro (urban area) and Kilteawlaelo district (rural area) in March, 2013. Stratified sampling technique was employed to approach the study participants. Data were analyzed using SPSS version 20. Multiple logistic regression analysis was used to identify the respective effect of independent predictors on utilization of long acting contraceptive. The proportion of long acting contraceptive use among the respondents was 19.9 % in the town of Wukro and 37.8 % in the district of Kilteawlaelo. Implanon was the most common type of contraceptive used in both districts, urban (75 %) and rural (94 %). The odds of using the long acting contraceptive method were three times higher among married women in the rural areas as compared with the urban women [AOR = 3. 30; 95 %, CI:2.17, 5.04]. No or limited support from male partners was an obstacle to using long acting contraceptive method [AOR = 0. 24, 95 of CI: 0.13, 0.44]. Moreover, married women whose partner did not permit them to use long acting contraceptive [AOR = 0. 47, 95 % of CI: 0.24, 0.92] and women who attended primary education [AOR = 0.24, 95 %, CI: 0.13, 0.44] were significantly associated with long acting contraceptive use. Overall, the proportion of long acting contraceptive use has found to be low. Rural women were more likely to use long acting contraceptives as compared to urban women. Moreover, educational status and the partner's permission to use contraception could influence the utilization of long acting contraceptives.

Telehealth to Expand Community Health Nurse Education in Rural Guatemala: A Pilot Feasibility and Acceptability Evaluation.

PubMed

McConnell, Kelly A; Krisher, Lyndsay K; Lenssen, Maureen; Bunik, Maya; Bunge Montes, Saskia; Domek, Gretchen J

2017-01-01

Telehealth education has the potential to serve as an important, low-cost method of expanding healthcare worker education and support, especially in rural settings of low- and middle-income countries. We describe an innovative educational strategy to strengthen a long-term health professional capacity building partnership between Guatemalan and US-based partners. In this pilot evaluation, community health nurses in rural Guatemala received customized, interactive education via telehealth from faculty at the supporting US-based institution. Program evaluation of this 10 lecture series demonstrated high levels of satisfaction among learners and instructors as well as knowledge gain by learners. An average of 5.5 learners and 2 instructors attended the 10 lectures and completed surveys using a Likert scale to rate statements regarding lecture content, technology, and personal connection. Positive statements about lecture content and the applicability to daily work had 98% or greater agreement as did statements regarding ease of technology and convenience. The learners agreed with feeling connected to the instructors 100% of the time, while instructors had 86.4% agreement with connection related statements. Instructors, joining at their respective work locations, rated convenience statements at 100% agreement. This evaluation also demonstrated effectiveness with an average 10.7% increase in pre- to posttest knowledge scores by learners. As the global health community considers efficiency in time, money, and our environment, telehealth education is a critical method to consider and develop for health worker education. Our pilot program evaluation shows that telehealth may be an effective method of delivering education to frontline health workers in rural Guatemala. While larger studies are needed to quantify the duration and benefits of specific knowledge gains and to perform a cost-effectiveness analysis of the program, our initial pilot results are encouraging and show that a telehealth program between a US-based university and a rural community health program in a low- and middle-income country is both feasible and acceptable.

OBSTACLES TO FAMILY PLANNING USE AMONG RURAL WOMEN IN ATIAK HEALTH CENTER IV, AMURU DISTRICT, NORTHERN UGANDA

PubMed Central

Ouma, S.; Turyasima, M.; Acca, H.; Nabbale, F.; Obita, K. O.; Rama, M.; Adong, C. C.; Openy, A.; Beatrice, M. O.; Odongo-Aginya, E. I.; Awor, S.

2016-01-01

Background Uganda’s rapid population growth (3.2%) since 1948 has placed more demands on health sector and lowered living standard of Ugandans resulting into 49% of people living in acute poverty especially in post conflict Northern Uganda. The population rise was due to low use of contraceptive methods (21% in rural areas and 43% in urban areas) and coupled with high unmet need for family planning (41%). This indicated poor access to reproductive health services. Effective use of family planning could reduce the rapid population growth. Objective To determine obstacles to family planning use among rural women in Northern Uganda. Design A descriptive cross-sectional analytical study. Setting Atiak Health Centre IV, Amuru District, rural Northern Uganda. Subjects Four hundred and twenty four females of reproductive ages were selected from both Inpatient and Outpatient Departments of Atiak Health Centre IV. Results There was high level of awareness 418 (98.6%), positive attitude 333 (78.6%) and fair level of utilisation 230 (54.2%) of family planning. However, significant obstacles to family planning usage included; long distance to Health facility, unavailability of preferred contraceptive methods, absenteeism of family planning providers, high cost of managing side effects, desire for big family size, children dying less than five years old, husbands forbidding women from using family planning and lack of community leaders’ involvement in family planning programme. Conclusions In spites of the high level of awareness, positive attitude, and free family planning services, there were obstacles that hindered family planning usage among these rural women. However, taking services close to people, reducing number of children dying before their fifth birthday, educating men about family planning, making sure family planning providers and methods are available, reducing cost of managing side effects and involving community leaders will improve utilisation of family planning and thus reduce the rapid population growth and poverty. PMID:27099401

Telehealth to Expand Community Health Nurse Education in Rural Guatemala: A Pilot Feasibility and Acceptability Evaluation

PubMed Central

McConnell, Kelly A.; Krisher, Lyndsay K.; Lenssen, Maureen; Bunik, Maya; Bunge Montes, Saskia; Domek, Gretchen J.

2017-01-01

Telehealth education has the potential to serve as an important, low-cost method of expanding healthcare worker education and support, especially in rural settings of low- and middle-income countries. We describe an innovative educational strategy to strengthen a long-term health professional capacity building partnership between Guatemalan and US-based partners. In this pilot evaluation, community health nurses in rural Guatemala received customized, interactive education via telehealth from faculty at the supporting US-based institution. Program evaluation of this 10 lecture series demonstrated high levels of satisfaction among learners and instructors as well as knowledge gain by learners. An average of 5.5 learners and 2 instructors attended the 10 lectures and completed surveys using a Likert scale to rate statements regarding lecture content, technology, and personal connection. Positive statements about lecture content and the applicability to daily work had 98% or greater agreement as did statements regarding ease of technology and convenience. The learners agreed with feeling connected to the instructors 100% of the time, while instructors had 86.4% agreement with connection related statements. Instructors, joining at their respective work locations, rated convenience statements at 100% agreement. This evaluation also demonstrated effectiveness with an average 10.7% increase in pre- to posttest knowledge scores by learners. As the global health community considers efficiency in time, money, and our environment, telehealth education is a critical method to consider and develop for health worker education. Our pilot program evaluation shows that telehealth may be an effective method of delivering education to frontline health workers in rural Guatemala. While larger studies are needed to quantify the duration and benefits of specific knowledge gains and to perform a cost-effectiveness analysis of the program, our initial pilot results are encouraging and show that a telehealth program between a US-based university and a rural community health program in a low- and middle-income country is both feasible and acceptable. PMID:28405582

Remote Monitoring Technologies for the Prevention of Metabolic Syndrome: The Diabetes and Technology for Increased Activity (DaTA) Study

PubMed Central

Stuckey, Melanie; Fulkerson, Robyn; Read, Emily; Russell-Minda, Elizabeth; Munoz, Claudio; Kleinstiver, Peter; Petrella, Robert

2011-01-01

Objectives Remote monitoring technologies are ideally suited for rural communities with limited access to health care. In an 8-week pilot study, we examined the feasibility of implementing and conducting a technology-intensive intervention in an underserviced rural setting. Our goal was to test the utility of self-monitoring technologies, physical activity, and education as tools to manage health indicators for the development of the cardiovascular complications (CVCs) of type 2 diabetes. Research Design and Methods The Diabetes and Technology for Increased Activity study was an open single-center study conducted in a community-based research setting. All 24 participants were provided with a Blackberry™ Smartphone, blood pressure monitor, glucometer, and pedometer. Smartphones transmitted measurements and survey results to the database, interfaced participants with the clinical team, and allowed for self-monitoring. Results Outcomes were improved body composition, improved markers of CVC risk factors, increased daily exercise, and interest in or awareness of lifestyle changes that impact health outcomes. Participants had excellent compliance for measurements, as self-monitoring provided a sense of security that improved from week 4 to week 8. Conclusions Our team gained substantial insight into the operational requirements of technology-facilitated health care, including redefined hours of service; data reporting, management, and access protocols; and the utility of real-time clinical measures by remote monitoring. We developed an understanding of knowledge translation strategies as well as successful motivational and educational tools. Importantly, remote monitoring technology was found to be feasible and accepted in a rural setting. PMID:21880237

The zoonotic potential of Giardia intestinalis assemblage E in rural settings.

PubMed

Abdel-Moein, Khaled A; Saeed, Hossam

2016-08-01

Giardiasis is a globally re-emerging protozoan disease with veterinary and public health implications. The current study was carried out to investigate the zoonotic potential of livestock-specific assemblage E in rural settings. For this purpose, a total of 40 microscopically positive Giardia stool samples from children with gastrointestinal complaints with or without diarrhea were enrolled in the study as well as fecal samples from 46 diarrheic cattle (18 dairy cows and 28 calves). Animal samples were examined by sedimentation method to identify Giardia spp., and then, all Giardia positive samples from human and animals were processed for molecular detection of livestock-specific assemblage E through amplification of assemblage-specific triosephosphate isomerase (tpi) gene using nested polymerase chain reaction (PCR). The results of the study revealed high unexpected occurrence of assemblage E among human samples (62.5 %), whereas the distribution among patients with diarrhea and those without was 42.1 and 81 %, respectively. On the other hand, the prevalence of Giardia spp. among diarrheic dairy cattle was (8.7 %), while only calves yielded positive results (14.3 %) and all bovine Giardia spp. were genetically classified as Giardia intestinalis assemblage E. Moreover, DNA sequencing of randomly selected one positive human sample and another bovine one revealed 100 and 99 % identity with assemblage E tpi gene sequences available at GenBank after BLAST analysis. In conclusion, the current study highlights the wide dissemination of livestock-specific assemblage E among humans in rural areas, and thus, zoonotic transmission cycle should not be discounted during the control of giardiasis in such settings.

Periodic gastroenterology and hepatology meetings with primary care. Reasons for consultation.

PubMed

Mata-Román, Laura; del Olmo-Martínez, Lourdes; Briso-Montiano, Raquel; García-Pascual, Agustina; Catón-Valdés, Manuela; Jiménez-Rodríguez-Vila, Manuel; Castellanos-Alonso, Maria Jose; Laso, Lucinio; Gómez-Gómez, Pilar; Otero, Antonio; Pinilla-Gimeno, Jose Ignacio; del-Río-Hortega, Juan; Pradera-Leonardo, Juan; Vallelado, Rosario; Villuela-González, Fernando; Ibañes-Jalón, Elisa; Sañudo, Soledad; Mayo, Agustin; Caro-Patón, Agustin; Almaraz-Gómez, Ana

2013-10-01

care overload, aging of population, and increased chronic diseases lead to increased referrals from primary care, which may sometimes overload the health system. Thus, different interventions have been carried out attempting to improve these aspects. to assess the most frequent causes of consultation of general physicians, both in joint consultations and clinical sessions held jointly with specialist consultant in primary care, in the urban and rural setting, and the influence on referrals to first consultations of gastroenterology. a mainly training type of intervention was carried out, consisting of regular meetings in both urban and rural primary care center, to perform joint consultations and clinical sessions on patients and topics related to the specialty of gastroenterology. The intervention period (divided in two subperiods) was compared with a control period. most reasons for consultation were those corresponding to lower gastrointestinal tract, followed by liver disease and upper gastrointestinal tract. Significant differences were only found in distribution of diagnoses between the two centers in joint consultations. There was a relative (percent) decrease in referrals at the global level in both subperiods, only significant in the first (51.45 %), as well as in rural setting (45.24 %). common consultations motifs were similar in urban and rural settings, with some relevance of lower gastrointestinal tract disease. Most of them can be solved at primary care, with the help of consultant specialist. There is impact on referrals to the outpatient first consultations of gastroenterology, mainly in rural setting.

Telecommunications technology and rural education in the United States

NASA Technical Reports Server (NTRS)

Perrine, J. R.

1975-01-01

The rural sector of the US is examined from the point of view of whether telecommunications technology can augment the development of rural education. Migratory farm workers and American Indians were the target groups which were examined as examples of groups with special needs in rural areas. The general rural population and the target groups were examined to identify problems and to ascertain specific educational needs. Educational projects utilizing telecommunications technology in target group settings were discussed. Large scale regional ATS-6 satellite-based experimental educational telecommunications projects were described. Costs and organizational factors were also examined for large scale rural telecommunications projects.

Improving Tanzanian childbirth service quality.

PubMed

Jaribu, Jennie; Penfold, Suzanne; Green, Cathy; Manzi, Fatuma; Schellenberg, Joanna

2018-04-16

Purpose The purpose of this paper is to describe a quality improvement (QI) intervention in primary health facilities providing childbirth care in rural Southern Tanzania. Design/methodology/approach A QI collaborative model involving district managers and health facility staff was piloted for 6 months in 4 health facilities in Mtwara Rural district and implemented for 18 months in 23 primary health facilities in Ruangwa district. The model brings together healthcare providers from different health facilities in interactive workshops by: applying QI methods to generate and test change ideas in their own facilities; using local data to monitor improvement and decision making; and health facility supervision visits by project and district mentors. The topics for improving childbirth were deliveries and partographs. Findings Median monthly deliveries increased in 4 months from 38 (IQR 37-40) to 65 (IQR 53-71) in Mtwara Rural district, and in 17 months in Ruangwa district from 110 (IQR 103-125) to 161 (IQR 148-174). In Ruangwa health facilities, the women for whom partographs were used to monitor labour progress increased from 10 to 57 per cent in 17 months. Research limitations/implications The time for QI innovation, testing and implementation phases was limited, and the study only looked at trends. The outcomes were limited to process rather than health outcome measures. Originality/value Healthcare providers became confident in the QI method through engagement, generating and testing their own change ideas, and observing improvements. The findings suggest that implementing a QI initiative is feasible in rural, low-income settings.

An eHealth Intervention for Patients in Rural Areas: Preliminary Findings From a Pilot Feasibility Study

PubMed Central

Schrader, Geoffrey; Harris, Melanie; Newman, Lareen; Lynn, Sarah; Peterson, Leigh; Battersby, Malcolm

2014-01-01

Background eHealth facilitation of chronic disease management has potential to increase engagement and effectiveness and extend access to care in rural areas. Objective The objective of this study was to demonstrate the feasibility and acceptability of an eHealth system for the management of chronic conditions in a rural setting. Methods We developed an online management program which incorporated content from the Flinders Chronic Condition Management Program (Flinders Program) and used an existing software platform (goACT), which is accessible by patients and health care workers using either Web-enabled mobile phone or Internet, enabling communication between patients and clinicians. We analyzed the impact of this eHealth system using qualitative and simple quantitative methods. Results The eHealth system was piloted with 8 recently hospitalized patients from rural areas, average age 63 (SD 9) years, each with an average of 5 chronic conditions and high level of psychological distress with an average K10 score of 32.20 (SD 5.81). Study participants interacted with the eHealth system. The average number of logins to the eHealth system by the study participants was 26.4 (SD 23.5) over 29 weeks. The login activity was higher early in the week. Conclusions The pilot demonstrated the feasibility of implementing and delivering a chronic disease management program using a Web-based patient-clinician application. A qualitative analysis revealed burden of illness and low levels of information technology literacy as barriers to patient engagement. PMID:24927511

Spatial distribution and source apportionment of water pollution in different administrative zones of Wen-Rui-Tang (WRT) river watershed, China.

PubMed

Yang, Liping; Mei, Kun; Liu, Xingmei; Wu, Laosheng; Zhang, Minghua; Xu, Jianming; Wang, Fan

2013-08-01

Water quality degradation in river systems has caused great concerns all over the world. Identifying the spatial distribution and sources of water pollutants is the very first step for efficient water quality management. A set of water samples collected bimonthly at 12 monitoring sites in 2009 and 2010 were analyzed to determine the spatial distribution of critical parameters and to apportion the sources of pollutants in Wen-Rui-Tang (WRT) river watershed, near the East China Sea. The 12 monitoring sites were divided into three administrative zones of urban, suburban, and rural zones considering differences in land use and population density. Multivariate statistical methods [one-way analysis of variance, principal component analysis (PCA), and absolute principal component score-multiple linear regression (APCS-MLR) methods] were used to investigate the spatial distribution of water quality and to apportion the pollution sources. Results showed that most water quality parameters had no significant difference between the urban and suburban zones, whereas these two zones showed worse water quality than the rural zone. Based on PCA and APCS-MLR analysis, urban domestic sewage and commercial/service pollution, suburban domestic sewage along with fluorine point source pollution, and agricultural nonpoint source pollution with rural domestic sewage pollution were identified to the main pollution sources in urban, suburban, and rural zones, respectively. Understanding the water pollution characteristics of different administrative zones could put insights into effective water management policy-making especially in the area across various administrative zones.

Does Missed Care in Isolated Rural Hospitals Matter?

PubMed

Smith, Jessica G

2018-06-01

Missed care is associated with adverse outcomes such as patient falls and decreased nurse job satisfaction. Although studied in populations of interest such as neonates, children, and heart failure patients, there are no studies about missed care in rural hospitals. Reducing care omissions in rural hospitals might help improve rural patient outcomes and ensure that rural hospitals can remain open in an era of hospital reimbursement dependent on care outcomes, such as through value-based purchasing. Understanding the extent of missed nursing care and its implications for rural populations might provide crucial information to alert rural hospital administrators and nurses about the incidence and influence of missed care on health outcomes. Focusing on missed care within rural hospitals and other rural health care settings is important to address the specific health needs of aging rural U.S. residents who are isolated from high-volume, urban health care facilities.

Roadmap to an effective quality improvement and patient safety program implementation in a rural hospital setting.

PubMed

Ingabire, Willy; Reine, Petera M; Hedt-Gauthier, Bethany L; Hirschhorn, Lisa R; Kirk, Catherine M; Nahimana, Evrard; Nepomscene Uwiringiyemungu, Jean; Ndayisaba, Aphrodis; Manzi, Anatole

2015-12-01

Implementation lessons: (1) implementation of an effective quality improvement and patient safety program in a rural hospital setting requires collaboration between hospital leadership, Ministry of Health and other stakeholders. (2) Building Quality Improvement (QI) capacity to develop engaged QI teams supported by mentoring can improve quality and patient safety. Copyright © 2015 Elsevier Inc. All rights reserved.

Food Insecurity in Urban and Rural Areas in Central Brazil: Transition from Locally Produced Foods to Processed Items.

PubMed

Rodrigues, Livia Penna Firme; Carvalho, Raissa Costa; Maciel, Agatha; Otanasio, Polyanna Nunes; Garavello, Maria Elisa de Paula Eduardo; Nardoto, Gabriela Bielefeld

2016-01-01

Aiming to investigate the effect of diet and food consumption with regard to health, environment, and economy in light of nutrition ecology, we studied the dimensions of nutrition and food security in urban and rural settings in the region of Chapada dos Veadeiros, Central Brazil. We tracked diet and food consumption through carbon and nitrogen stable isotope ratios in fingernails of these inhabitants together with food intake data as a proxy for their diet patterns. We estimated household food insecurity by using the Brazilian Food Insecurity Scale. Nutrition and food insecurity was observed in both urban and rural areas, but was accentuated in rural settings. The diet pattern had high δ(13)C values in fingernails and low δ(15)N. Both urban and rural areas have diets with low diversity and relying on low-quality processed food staples at the same time that nutrition and food insecurity is quite high in the region.

Neighbourhood food environment and area deprivation: spatial accessibility to grocery stores selling fresh fruit and vegetables in urban and rural settings.

PubMed

Smith, Dianna M; Cummins, Steven; Taylor, Mathew; Dawson, John; Marshall, David; Sparks, Leigh; Anderson, Annie S

2010-02-01

The 'deprivation amplification' hypothesis suggests that residents of deprived neighbourhoods have universally poorer access to high-quality food environments, which in turn contributes to the development of spatial inequalities in diet and diet-related chronic disease. This paper presents results from a study that quantified access to grocery stores selling fresh fruit and vegetables in four environmental settings in Scotland, UK. Spatial accessibility, as measured by network travel times, to 457 grocery stores located in 205 neighbourhoods in four environmental settings (island, rural, small town and urban) in Scotland was calculated using Geographical Information Systems. The distribution of accessibility by neighbourhood deprivation in each of these four settings was investigated. Overall, the most deprived neighbourhoods had the best access to grocery stores and grocery stores selling fresh produce. Stratified analysis by environmental setting suggests that the least deprived compared with the most deprived urban neighbourhoods have greater accessibility to grocery stores than their counterparts in island, rural and small town locations. Access to fresh produce is better in more deprived compared with less deprived urban and small town neighbourhoods, but poorest in the most affluent island communities with mixed results for rural settings. The results presented here suggest that the assumption of a universal 'deprivation amplification' hypothesis in studies of the neighbourhood food environment may be misguided. Associations between neighbourhood deprivation and grocery store accessibility vary by environmental setting. Theories and policies aimed at understanding and rectifying spatial inequalities in the distribution of neighbourhood exposures for poor diet need to be context specific.

Revisiting Rurality and Schooling: A Teacher's Story

ERIC Educational Resources Information Center

Pillay, Daisy; Saloojee, Sheeren

2012-01-01

This paper presents an understanding of what it means to be a teacher in a school defined as "rural". From a sociological perspective, we consider the mechanisms and ways of knowing that are adopted by a teacher for understanding not only the external world but for being a certain kind of teacher for a school in a rural setting.…

The Small Rural School Principalship: Key Challenges and Cross-School Responses

ERIC Educational Resources Information Center

Starr, Karen; White, Simone

2008-01-01

This article explores the responses of school principals of small rural schools in Victoria, Australia to leadership challenges they identify as characteristic of these contexts. The research is an exercise in grounded theory building, with the focus on the principalship as it is enacted in small rural settings. The article also seeks to trace the…

Faces of Change. Five Rural Societies in Transition: Bolivia, Kenya, Afghanistan, Taiwan, China Coast.

ERIC Educational Resources Information Center

Miller, Norman N., Ed.; Spitzer, Manon L., Ed.

The multidisciplinary film project focuses attention on what is happening to rural populations of the world, particularly among developing countries. The roles of women, education, social and economic systems, and the effects of modernization on values are themes explored in each of five rural settings--Bolivian highlands, northern Kenya, northern…

The Role of Language in Interactions with Others on Campus for Rural Appalachian College Students

ERIC Educational Resources Information Center

Dunstan, Stephany Brett; Jaeger, Audrey J.

2016-01-01

Dialects of English spoken in rural, Southern Appalachia are heavily stigmatized in mainstream American culture, and speakers of Appalachian dialects are often subject to prejudice and stereotypes which can be detrimental in educational settings. We explored the experiences of rural, Southern Appalachian college students and the role speaking a…

Mathematics Education in Rural Communities in Light of Current Trends in Mathematics Education. Working Paper.

ERIC Educational Resources Information Center

Schultz, James E.

Despite the considerable efforts now under way to improve our nation's mathematics education for all students, students in rural settings do not receive their share of attention. This paper considers school mathematics in rural communities in the larger context of current reform from a number of perspectives, including curricular materials,…

Barriers and Enablers to Clinical Fieldwork Education in Rural Public and Private Allied Health Practice

ERIC Educational Resources Information Center

Maloney, Phoebe; Stagnitti, Karen; Schoo, Adrian

2013-01-01

There is a need to maximise rural clinical fieldwork placement to build health workforce capacity. This study investigated allied health professionals' (AHPs) experience of supervising students as part of work-integrated learning in public and private rural health settings. An anonymous postal questionnaire with 30 questions was used to collect…

Cultural Politics in Revolution: Teachers, Peasants, and Schools in Mexico, 1930-1940.

ERIC Educational Resources Information Center

Vaughan, Mary Kay

In the 1930s, Mexican rural schools became arenas for cultural politics--the process of articulating and disputing definitions of culture, from national identity to the broader sense of social behavior and meaning. Created in 1921, the Secretaria de Educacion Publica (SEP) set up federal rural schools to nationalize and modernize rural peasants.…

Accessing the Food Systems in Urban and Rural Minnesotan Communities

ERIC Educational Resources Information Center

Smith, Chery; Miller, Hannah

2011-01-01

Objective: Explore how urban and rural Minnesotans access the food system and to investigate whether community infrastructure supports a healthful food system. Design: Eight (4 urban and 4 rural) focus groups were conducted. Setting and Participants: Eight counties with urban influence codes of 1, 2, 4, 5, 8, and 10. Fifty-nine (urban, n = 27;…

Reasons for Student Dropout in an Online Course in a Rural K-12 Setting

ERIC Educational Resources Information Center

de la Varre, Claire; Irvin, Matthew J.; Jordan, Adam W.; Hannum, Wallace H.; Farmer, Thomas W.

2014-01-01

Rural schools in the USA use online courses to overcome problems such as attracting and retaining teachers, geographic isolation, low student enrollment, and financial constraints. This paper reports on the reasons that 39% of rural high school students who enrolled in an online Advanced Placement course subsequently dropped the course. Students…

Providing Services to Survivors of Domestic Violence: A Comparison of Rural and Urban Service Provider Perceptions

ERIC Educational Resources Information Center

Eastman, Brenda J.; Bunch, Shelia Grant

2007-01-01

Although there is a considerable body of knowledge about domestic violence, a limited proportion focuses on domestic violence in rural settings. Using a nonprobability purposive sampling technique, 93 providers of domestic violence services from rural and urban localities in North Carolina and Virginia were located and asked to complete a…

NREL Evaluates National Charging Infrastructure Needs for Growing Fleet of

Science.gov Websites

PEV charging requirements within urban and rural communities and along interstate corridors. For each spacing set to enhance station utility and economics. Compared to interstate corridors, urban and rural stations would be needed to provide a minimum level of urban and rural coverage nationwide. In a PEV market

Using Technology to Address Barriers in Rural Special Education for Students with Autism: A Do-It-Yourself Guide

ERIC Educational Resources Information Center

McKissick, Bethany R.; Diegelmann, Karen M.; Parker, Sarah

2017-01-01

Providing high-quality special education services in rural settings has a variety of challenges such as geographic isolation and a lack of resources. One particularly challenging aspect of rural special education is providing general curriculum access. Computer-assisted instruction is one way to provide high-quality specialized instruction that…

Teacher Professional Development outside the Lecture Room: Voices of Professionally Unqualified Practicing Teachers in Rural Zimbabwe Secondary Schools

ERIC Educational Resources Information Center

Mukeredzi, Tabitha Grace

2016-01-01

Attempts to address global pressure to achieve Education for All have been hampered by two fundamental challenges in developing countries, namely an acute shortage of teachers and large rural populations in these countries. In addition, qualified, competent teachers shun working in rural settings. While recruitment of professionally unqualified…

The adoption of provider-based rural health clinics by rural hospitals: a study of market and institutional forces.

PubMed

Krein, S L

1999-04-01

To examine the response of rural hospitals to various market and organizational signals by determining the factors that influence whether or not they establish a provider-based rural health clinic (RHC) (a joint Medicare/Medicaid program). Several secondary sources for 1989-1995: the AHA Annual Survey, the PPS Minimum Data Set and a list of RHCs from HCFA, the Area Resource File, and professional associations. The analysis includes all general medical/surgical rural hospitals operating in the United States during the study period. A longitudinal design and pooled cross-sectional data were used, with the rural hospital as the unit of analysis. Key variables were examined as sets and include measures of competitive pressures (e.g., hospital market share), physician resources, nurse practitioner/physician assistant (NP/PA) practice regulation, hospital performance pressures (e.g., operating margin), innovativeness, and institutional pressure (i.e., the cumulative force of adoption). Adoption of provider-based RHCs by rural hospitals appears to be motivated less as an adaptive response to observable economic or internal organizational signals than as a reaction to bandwagon pressures. Rural hospitals with limited resources may resort to imitating others because of uncertainty or a limited ability to fully evaluate strategic activities. This can result in actions or behaviors that are not consistent with policy objectives and the perceived need for policy changes. Such activity in turn could have a negative effect on some providers and some rural residents.

Adapting and Evaluating a Rapid, Low-Cost Method to Enumerate Flies in the Household Setting

PubMed Central

Wolfe, Marlene K.; Dentz, Holly N.; Achando, Beryl; Mureithi, MaryAnne; Wolfe, Tim; Null, Clair; Pickering, Amy J.

2017-01-01

Diarrhea is a leading cause of death among children under 5 years of age worldwide. Flies are important vectors of diarrheal pathogens in settings lacking networked sanitation services. There is no standardized method for measuring fly density in households; many methods are cumbersome and unvalidated. We adapted a rapid, low-cost fly enumeration technique previously developed for industrial settings, the Scudder fly grill, for field use in household settings. We evaluated its performance in comparison to a sticky tape fly trapping method at latrine and food preparation areas among households in rural Kenya. The grill method was more sensitive; it detected the presence of any flies at 80% (433/543) of sampling locations versus 64% (348/543) of locations by the sticky tape. We found poor concordance between the two methods, suggesting that standardizing protocols is important for comparison of fly densities between studies. Fly species identification was feasible with both methods; however, the sticky tape trap allowed for more nuanced identification. Both methods detected a greater presence of bottle flies near latrines compared with food preparation areas (P < 0.01). The grill method detected more flies at the food preparation area compared with near the latrine (P = 0.014) while the sticky tape method detected no difference. We recommend the Scudder grill as a sensitive fly enumeration tool that is rapid and low cost to implement. PMID:27956654

Increased vulnerability of rural children on antiretroviral therapy attending public health facilities in South Africa: a retrospective cohort study

PubMed Central

2010-01-01

Background A large proportion of the 340,000 HIV-positive children in South Africa live in rural areas, yet there is little sub-Saharan data comparing rural paediatric antiretroviral therapy (ART) programme outcomes with urban facilities. We compared clinical, immunological and virological outcomes between children at seven rural and 37 urban facilities across four provinces in South Africa. Methods We conducted a retrospective cohort study of routine data of children enrolled on ART between November 2003 and March 2008 in three settings, namely: urban residence and facility attendance (urban group); rural residence and facility attendance (rural group); and rural residents attending urban facilities (rural/urban group). Outcome measures were: death, loss to follow up (LTFU), virological suppression, and changes in CD4 percentage and weight-for-age-z (WAZ) scores. Kaplan-Meier estimates, logrank tests, multivariable Cox regression and generalized estimating equation models were used to compare outcomes between groups. Results In total, 2332 ART-naïve children were included, (1727, 228 and 377 children in the urban, rural and rural/urban groups, respectively). At presentation, rural group children were older (6.7 vs. 5.6 and 5.8 years), had lower CD4 cell percentages (10.0% vs. 12.8% and 12.7%), lower WAZ scores (-2.06 vs. -1.46 and -1.41) and higher proportions with severe underweight (26% vs.15% and 15%) compared with the urban and rural/urban groups, respectively. Mortality was significantly higher in the rural group and LTFU significantly increased in the rural/urban group. After 24 months of ART, mortality probabilities were 3.4% (CI: 2.4-4.8%), 7.7% (CI: 4.5-13.0%) and 3.1% (CI: 1.7-5.6%) p = 0.0137; LTFU probabilities were 11.5% (CI: 9.3-14.0%), 8.8% (CI: 4.5-16.9%) and 16.6% (CI: 12.4-22.6%), p = 0.0028 in the urban, rural and rural/urban groups, respectively. The rural group had an increased adjusted mortality probability, adjusted hazards ratio 2.41 (CI: 1.25-4.67) and the rural/urban group had an increased adjusted LTFU probability, aHR 2.85 (CI: 1.41-5.79). The rural/urban group had a decreased adjusted probability of virological suppression compared with the urban group at any timepoint on treatment, adjusted odds ratio 0.67 (CI: 0.48-0.93). Conclusions Rural HIV-positive children are a vulnerable group, exhibiting delayed access to ART and an increased risk of poor outcomes while on ART. Expansion of rural paediatric ART programmes, with future research exploring improvements to rural health system effectiveness, is required. PMID:21108804

Capture-recapture estimates of drug misuse in urban and non-urban settings in the north east of Scotland.

PubMed

Hay, G

2000-12-01

To estimate the prevalence of opiate or benzodiazepine misuse in the Grampian Health Board area, Scotland and illustrate the use of the capture-recapture method in both rural and urban settings. Capture-recapture analyses on six distinct sources of data with unequal coverage of the geographical area. Grampian Health Board area, including the City of Aberdeen. Data were collated from the Police, Social Work Departments, GPs contributing to the Scottish Drug Misuse Database, statutory drug agencies, a voluntary sector drug agency and a needle/syringe exchange. In total 1770 individuals were identified as misusing opiates or benzodiazepines and residing in the Grampian Health Board area; 1129 individuals were resident in the City of Aberdeen. The total number of opiate or benzodiazepine misusers in the City of Aberdeen was estimated to be 2519 (95% CI 2048-3200). This figure corresponds to 2.0% (1.6-2.5%) of the population aged 15-54 years. In a town to the north of Aberdeenshire where high levels of heroin use had previously been reported in the media, 2.5% of the population aged 15-54 (1.8-3.8%) were estimated to be misusing opiates or benzodiazepines. Although there may be difficulties in applying capture-recapture methods in all settings, the methodology can give valuable information on the extent of drug misuse in both urban and non-urban areas. This information is particularly important to assess the spread of drug misuse from cities to rural areas.

Primary health care service delivery networks for the prevention and management of type 2 diabetes: using social network methods to describe interorganisational collaboration in a rural setting.

PubMed

McDonald, Julie; Jayasuriya, Rohan; Harris, Mark Fort

2011-01-01

Adults with type 2 diabetes or with behavioural risk factors require comprehensive and well coordinated responses from a range of health care providers who often work in different organisational settings. This study examines three types of collaborative links between organisations involved in a rural setting. Social network methods were employed using survey data on three types of links, and data was collected from a purposive sample of 17 organisations representing the major provider types. The analysis included a mix of unconfirmed and confirmed links, and network measures. General practices were the most influential provider group in initiating referrals, and they referred to the broadest range of organisations in the network. Team care arrangements formed a small part of the general practice referral network. They were used more for access to private sector allied health care providers and less for sharing care with public sector health services. Involvement in joint programs/activities was limited to public and non-government sector services, with no participation from the private sector. The patterns of interactions suggest that informal referral networks provide access to services and coordination of care for individual patients with diabetes. Two population subgroups would benefit from more proactive approaches to ensure equitable access to services and coordination of care across organisational boundaries: people with more complex health care needs and people at risk of developing diabetes.

Community Perspectives on Access to and Availability of Healthy Food in Rural, Low-Resource, Latino Communities

PubMed Central

Ramírez, A. Susana; Estrada, Erendira; Grassi, Kathleen; Nathan, Stephanie

2016-01-01

Introduction Attention has focused on the food environment as a result of the growing concern with obesity rates among Latinos in rural areas. Researchers have observed associations between a lack of physical access to affordable produce in areas where supermarkets and grocery stores are limited and poor dietary intake and obesity; these associations are high in rural, low-resource neighborhoods with a high population of Latino residents. We aimed to engage residents of low-resource, Latino-majority neighborhoods in discussions of food access in a rural yet agricultural community setting, which is typically described as a “food desert.” Methods We used a mixed-methods approach and conducted 3 focus groups (n = 20) and in-depth interviews (n = 59) and surveys (n = 79) with residents of a rural yet agricultural community. We used thematic analysis to explore residents’ perceptions of access to healthy foods. Results Residents (n = 79; mean age, 41.6 y; 72% female; 79% Latino; 53% Spanish-speaking) reported that dollar and discount stores in this agricultural area provided access to produce; however, produce at retail stores was less affordable than produce at nonretail outlets such as fruit and vegetable stands. Gifts and trades of fruits and vegetables from neighbors and community organizations supplied no-cost or low-cost healthy foods. Residents’ suggestions to improve food access centered on lowering the cost of produce in existing retail outlets and seeking out nonretail outlets. Conclusion Our findings contribute to understanding of the food environment in low-resource, rural yet agricultural areas. Although such areas are characterized as “food deserts,” residents identified nonretail outlets as a viable source of affordable produce, while indicating that the cost of retail produce was a concern. Innovative policy solutions to increase healthy food consumption must focus on affordability as well as accessibility, and consider alternate, nonretail food outlets in agricultural areas. PMID:27978407

Evaluating a De-Centralized Regional Delivery System for Breast Cancer Screening and Patient Navigation for the Rural Underserved.

PubMed

Inrig, Stephen J; Tiro, Jasmin A; Melhado, Trisha V; Argenbright, Keith E; Craddock Lee, Simon J

2014-01-01

Providing breast cancer screening services in rural areas is challenging due to the fractured nature of healthcare delivery systems and complex reimbursement mechanisms that create barriers to access for the under- and uninsured. Interventions that reduce structural barriers to mammography, like patient navigation programs, are effective and recommended, especially for minority and underserved women. Although the literature on rural healthcare is significant, the field lacks studies of adaptive service delivery models and rigorous evaluation of evidence-based programs that facilitate routine screening and appropriate follow-up across large geographic areas. To better understand how to implement a decentralized regional delivery "hub & spoke" model for rural breast cancer screening and patient navigation, we have designed a rigorous, structured, multi-level and mixed-methods evaluation based on Glasgow's RE-AIM model (Reach, Effectiveness, Adoption, Implementation, and Maintenance). The program is comprised of three core components: 1) Outreach to underserved women by partnering with county organizations; 2) Navigation to guide patients through screening and appropriate follow-up; and 3) Centralized Reimbursement to coordinate funding for screening services through a central contract with Medicaid Breast and Cervical Cancer Services (BCCS). Using Glasgow's RE-AIM model, we will: 1) assess which counties have the resources and capacity to implement outreach and/or navigation components, 2) train partners in each county on how to implement components, and 3) monitor process and outcome measures in each county at regular intervals, providing booster training when needed. This evaluation strategy will elucidate how the heterogeneity of rural county infrastructure impacts decentralized service delivery as a navigation program expands. In addition to increasing breast cancer screening access, our model improves and maintains time to diagnostic resolution and facilitates timely referral to local cancer treatment services. We offer this evaluation approach as an exemplar for scientific methods to evaluate the translation of evidence-based federal policy into sustainable health services delivery in a rural setting.

Reproductive Tract Infections in Rural Vietnam, Women's Knowledge, and Health-Seeking Behavior: A Cross-Sectional Study.

PubMed

Nielsen, Anna; Lan, Pham Thi; Marrone, Gaetano; Phuc, Ho Dang; Chuc, Nguyen Thi Kim; Stålsby Lundborg, Cecilia

2016-01-01

We interviewed 1,805 women in a rural setting in Vietnam with the aim of investigating women's knowledge regarding reproductive tract infections (RTIs) and their health-seeking behavior. We found that women's overall knowledge was poor. Furthermore, only one-third of the symptomatic women sought health care. RTIs affect millions of women globally each year. Most vulnerable are women in low- and middle-income countries where poverty and gender inequities affect their access to health care services. Findings from our study can be used in similar rural settings worldwide to understand and manage the widespread problem of RTIs.

Appalachian versus non-Appalachian US traffic fatalities, 2008-2010

PubMed Central

Zhu, Motao; Zhao, Songzhu; Gurka, Kelly K.; Kandati, Sahiti; Coben, Jeffrey H.

2013-01-01

Purpose Though myriad health disparities exist in Appalachia, limited research has examined traffic fatalities in the region. This study compared traffic-fatality rates in Appalachia and the non-Appalachian US. Methods Fatality Analysis Reporting System and Census data from 2008-2010 were used to calculate traffic-fatality rates. Poisson models were used to estimate unadjusted (RR) and adjusted rate ratios (aRR), controlling for age, sex, and county-specific population density levels. Results: The Appalachian traffic-fatality rate was 45% (95% CI: 1.42, 1.47) higher than the non-Appalachian rate. Though only 29% of fatalities occur in rural counties in non-Appalachia versus 48% in Appalachia, rates in rural counties were similar (RR=0.97; 95% CI: 0.95, 1.00). However, the rate for urban, Appalachian counties was 42% (95% CI: 1.38, 1.45) higher than among urban, non-Appalachian counties. Appalachian rates were higher for passenger-vehicle drivers, motorcyclists, and all-terrain-vehicle riders, regardless of rurality, as well as for passenger-vehicle passengers overall and for urban counties. Conversely, Appalachia experienced lower rates among pedestrians and bicyclists, regardless of rurality. Conclusions Disparities in traffic fatality rates exist in Appalachia. Though elevated rates are partially explained by the proportion of residents living in rural settings, overall rates in urban Appalachia were consistently higher than in urban non-Appalachia. PMID:23619016

Systematic Review of Palliative Care in the Rural Setting.

PubMed

Bakitas, Marie A; Elk, Ronit; Astin, Meka; Ceronsky, Lyn; Clifford, Kathleen N; Dionne-Odom, J Nicholas; Emanuel, Linda L; Fink, Regina M; Kvale, Elizabeth; Levkoff, Sue; Ritchie, Christine; Smith, Thomas

2015-10-01

Many of the world's population live in rural areas. However, access and dissemination of the advances taking place in the field of palliative care to patients living in rural areas have been limited. We searched 2 large databases of the medical literature and found 248 relevant articles; we also identified another 59 articles through networking and a hand search of reference lists. Of those 307 articles, 39 met the inclusion criteria and were grouped into the following subcategories: intervention (n = 4), needs assessment (n = 2), program planning (n = 3), program evaluation (n = 4), education (n = 7), financial (n = 8), and comprehensive/systematic literature reviews (n = 11). We synthesized the current state of rural palliative care research and practice to identify important gaps for future research. Studies were conducted in the United States, Australia, Canada, Africa, Sweden, and India. Two randomized control trials were identified, both of which used telehealth approaches and had positive survival outcomes. One study demonstrated positive patient quality of life and depression outcomes. Research to guide rural palliative care practice is sparse. Approaches to telehealth, community- academic partnerships, and training rural health care professionals show promise, but more research is needed to determine best practices for providing palliative care to patients living in rural settings.

Women’s decision-making autonomy and children’s schooling in rural Mozambique

PubMed Central

Luz, Luciana; Agadjanian, Victor

2015-01-01

BACKGROUND Women’s decision-making autonomy in developing settings has been shown to improve child survival and health outcomes. However, little research has addressed possible connections between women’s autonomy and children’s schooling. OBJECTIVE To examine the relationship between rural women’s decision-making autonomy and enrollment status of primary school-age children living in their households and how this relationship differs by child’s gender. METHODS The analysis uses data from a 2009 survey of rural households in four districts of Gaza province in southern Mozambique. Multilevel logistic models predict the probability of being in school for children between 6 and 14 years old. RESULTS The results show a positive association of women’s decision-making autonomy with the probability of being enrolled in primary school for daughters, but not for sons. The effect of women’s autonomy is net of other women’s characteristics typically associated with enrollment and does not mediate the effects of those characteristics. CONCLUSIONS Based on the results, we argue that women with higher levels of decision-making autonomy may have a stronger preference for daughters’ schooling and may have a greater say in making and implementing decisions regarding daughters’ education, compared to women with lower autonomy levels. Results also illustrate a need for considering a broader set of autonomy-related characteristics when examining the effects of women’s status on children’s educational outcomes. PMID:26491400

Associations between the Social Organization of Communities and Psychiatric Disorders in Rural Asia

PubMed Central

Axinn, William G.; Ghimire, Dirgha J.; Williams, Nathalie E.; Scott, Kate M.

2015-01-01

Purpose We provide rare evidence of factors producing psychiatric variation in a general population sample from rural South Asia. The setting is particularly useful for demonstrating that variations in the social organization of communities, often difficult to observe in rich countries, are associated with important variations in mental health. Methods Clinically validated survey measures are used to document variation in psychiatric disorders among 401 adults. This sample is chosen from a systematic sample of the general population of rural Nepal, in a community-level controlled comparison design. Multilevel logistic regression is used to estimate multivariate models of the association between community-level nonfamily social organization and individual-level psychiatric disorders. Results Schools, markets, health services and social support groups each substantially reduce the odds of depression, post-traumatic stress disorder (PTSD), intermittent explosive disorder (IED) and anxiety disorders. Associations between schools, health services and social support groups and depression are statistically significant and independent of each other. The association between access to markets and PTSD is statistically significant and independent of other social organization and support groups. Conclusions Community integration of some nonfamily social organizations promotes mental health in ways that may go unobserved in settings with many such organizations. More research on the mechanisms producing these associations is likely to reveal potential avenues for public policy and programs to improve mental health in the general population. PMID:25796491

Geography, private costs and uptake of screening for abdominal aortic aneurysm in a remote rural area

PubMed Central

Lindsay, Sandra M; Duncan, John L; Cairns, John; Godden, David J

2006-01-01

Background The relationship between geographical location, private costs, health provider costs and uptake of health screening is unclear. This paper examines these relationships in a screening programme for abdominal aortic aneurysm in the Highlands and Western Isles of Scotland, a rural and remote area of over 10,000 square miles. Methods Men aged 65–74 (n = 9323) were invited to attend screening at 51 locations in 50 settlements. Effects of geography, deprivation and age on uptake were examined. Among 8,355 attendees, 8,292 completed a questionnaire detailing mode of travel and costs incurred, time travelled, whether accompanied, whether dependants were cared for, and what they would have been doing if not attending screening, thus allowing private costs to be calculated. Health provider (NHS) costs were also determined. Data were analysed by deprivation categories, using the Scottish Indices of Deprivation (2003), and by settlement type ranging from urban to very remote rural. Results Uptake of screening was high in all settlement types (mean 89.6%, range 87.4 – 92.6%). Non-attendees were more deprived in terms of income, employment, education and health but there was no significant difference between non-attendees and attendees in terms of geographical access to services. Age was similar in both groups. The highest private costs (median £7.29 per man) and NHS screening costs (£18.27 per man invited) were observed in very remote rural areas. Corresponding values for all subjects were: private cost £4.34 and NHS cost £15.72 per man invited. Conclusion Uptake of screening for abdominal aortic aneurysm in this remote and rural setting was high in comparison with previous studies, and this applied across all settlement types. Geographical location did not affect uptake, most likely due to the outreach approach adopted. Private and NHS costs were highest in very remote settings but still compared favourably with other published studies. PMID:16571121

Magnitude and Frequency of Floods for Urban and Small Rural Streams in Georgia, 2008

USGS Publications Warehouse

Gotvald, Anthony J.; Knaak, Andrew E.

2011-01-01

A study was conducted that updated methods for estimating the magnitude and frequency of floods in ungaged urban basins in Georgia that are not substantially affected by regulation or tidal fluctuations. Annual peak-flow data for urban streams from September 2008 were analyzed for 50 streamgaging stations (streamgages) in Georgia and 6 streamgages on adjacent urban streams in Florida and South Carolina having 10 or more years of data. Flood-frequency estimates were computed for the 56 urban streamgages by fitting logarithms of annual peak flows for each streamgage to a Pearson Type III distribution. Additionally, basin characteristics for the streamgages were computed by using a geographical information system and computer algorithms. Regional regression analysis, using generalized least-squares regression, was used to develop a set of equations for estimating flows with 50-, 20-, 10-, 4-, 2-, 1-, 0.5-, and 0.2-percent annual exceedance probabilities for ungaged urban basins in Georgia. In addition to the 56 urban streamgages, 171 rural streamgages were included in the regression analysis to maintain continuity between flood estimates for urban and rural basins as the basin characteristics pertaining to urbanization approach zero. Because 21 of the rural streamgages have drainage areas less than 1 square mile, the set of equations developed for this study can also be used for estimating small ungaged rural streams in Georgia. Flood-frequency estimates and basin characteristics for 227 streamgages were combined to form the final database used in the regional regression analysis. Four hydrologic regions were developed for Georgia. The final equations are functions of drainage area and percentage of impervious area for three of the regions and drainage area, percentage of developed land, and mean basin slope for the fourth region. Average standard errors of prediction for these regression equations range from 20.0 to 74.5 percent.

The Relationship of Age to Personal Network Size, Relational Multiplexity, and Proximity to Alters in the Western United States

PubMed Central

Smith, Emily J.; Marcum, Christopher S.; Boessen, Adam; Almquist, Zack W.; Hipp, John R.; Nagle, Nicholas N.

2015-01-01

Objectives. This study examines the association of age and other sociodemographic variables with properties of personal networks; using samples of individuals residing in the rural western United States and the City of Los Angeles, we evaluate the degree to which these associations vary with geographical context. For both samples, we test the hypothesis that age is negatively associated with network size (i.e., degree) and positively associated with network multiplexity (the extent of overlap) on 6 different relations: core discussion members, social activity participants, emergency contacts, neighborhood safety contacts, job informants, and kin. We also examine the relationship between age and spatial proximity to alters. Method. Our data consist of a large-scale, spatially stratified egocentric network survey containing information about respondents and those to whom they are tied. We use Poisson regression to test our hypothesis regarding degree while adjusting for covariates, including education, gender, race, and self-reported sense of neighborhood belonging. We use multiple linear regression to test our hypotheses on multiplexity and distance to alters. Results. For both rural and urban populations, we find a nonmonotone association between age and numbers of core discussants and emergency contacts, with rural populations also showing nonmonotone associations for social activity partners and kin. These nonmonotone relationships show a peak in expected degree at midlife, followed by an eventual decline. We find a decline in degree among the elderly for all relations in both populations. Age is positively associated with distance to nonhousehold alters for the rural population, although residential tenure is associated with shorter ego-alter distances in both rural and urban settings. Additionally, age is negatively associated with network multiplexity for both populations. Discussion. Although personal network size ultimately declines with age, we find that increases for some relations extend well into late-midlife and most elders still maintain numerous contacts across diverse relations. The evidence we present suggests that older people tap into an wider variety of different network members for different types of relations than do younger people. This is true even for populations in rural settings, for whom immediate access to potential alters is more limited. PMID:25324292

Prevalence of and Differences in Salad Bar Implementation in Rural Versus Urban Arizona Schools.

PubMed

Blumenschine, Michelle; Adams, Marc; Bruening, Meg

2018-03-01

Rural children consume more calories per day on average than urban children, and they are less likely to consume fruit. Self-service salad bars have been proposed as an effective approach to better meet the National School Lunch Program's fruit and vegetable recommendations. No studies have examined how rural and urban schools differ in the implementation of school salad bars. To compare the prevalence of school-lunch salad bars and differences in implementation between urban and rural Arizona schools. Secondary analysis of a cross-sectional web-based survey. School nutrition managers (N=596) in the state of Arizona. National Center for Education Statistics locale codes defined rural and urban classifications. Barriers to salad bar implementation were examined among schools that have never had, once had, and currently have a school salad bar. Promotional practices were examined among schools that once had and currently have a school salad bar. Generalized estimating equation models were used to compare urban and rural differences in presence and implementation of salad bars, adjusting for school-level demographics and the clustering of schools within districts. After adjustment, the prevalence of salad bars did not differ between urban and rural schools (46.9%±4.3% vs 46.8%±8.5%, respectively). Rural schools without salad bars more often reported perceived food waste and cost of produce as barriers to implementing salad bars, and funding was a necessary resource for offering a salad bar in the future, as compared with urban schools (P<0.05). No other geographic differences were observed in reported salad bar promotion, challenges, or resources among schools that currently have or once had a salad bar. After adjustment, salad bar prevalence, implementation practices, and concerns are similar across geographic settings. Future research is needed to investigate methods to address cost and food waste concerns in rural areas. Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Area-level risk factors for adverse birth outcomes: trends in urban and rural settings

PubMed Central

2013-01-01

Background Significant and persistent racial and income disparities in birth outcomes exist in the US. The analyses in this manuscript examine whether adverse birth outcome time trends and associations between area-level variables and adverse birth outcomes differ by urban–rural status. Methods Alabama births records were merged with ZIP code-level census measures of race, poverty, and rurality. B-splines were used to determine long-term preterm birth (PTB) and low birth weight (LBW) trends by rurality. Logistic regression models were used to examine differences in the relationships between ZIP code-level percent poverty or percent African-American with either PTB or LBW. Interactions with rurality were examined. Results Population dense areas had higher adverse birth outcome rates compared to other regions. For LBW, the disparity between population dense and other regions increased during the 1991–2005 time period, and the magnitude of the disparity was maintained through 2010. Overall PTB and LBW rates have decreased since 2006, except within isolated rural regions. The addition of individual-level socioeconomic or race risk factors greatly attenuated these geographical disparities, but isolated rural regions maintained increased odds of adverse birth outcomes. ZIP code-level percent poverty and percent African American both had significant relationships with adverse birth outcomes. Poverty associations remained significant in the most population-dense regions when models were adjusted for individual-level risk factors. Conclusions Population dense urban areas have heightened rates of adverse birth outcomes. High-poverty African American areas have higher odds of adverse birth outcomes in urban versus rural regions. These results suggest there are urban-specific social or environmental factors increasing risk for adverse birth outcomes in underserved communities. On the other hand, trends in PTBs and LBWs suggest interventions that have decreased adverse birth outcomes elsewhere may not be reaching isolated rural areas. PMID:23759062

Mapping and modeling the urban landscape in Bangkok, Thailand: Physical-spectral-spatial relations of population-environmental interactions

NASA Astrophysics Data System (ADS)

Shao, Yang

This research focuses on the application of remote sensing, geographic information systems, statistical modeling, and spatial analysis to examine the dynamics of urban land cover, urban structure, and population-environment interactions in Bangkok, Thailand, with an emphasis on rural-to-urban migration from rural Nang Rong District, Northeast Thailand to the primate city of Bangkok. The dissertation consists of four main sections: (1) development of remote sensing image classification and change-detection methods for characterizing imperviousness for Bangkok, Thailand from 1993-2002; (2) development of 3-D urban mapping methods, using high spatial resolution IKONOS satellite images, to assess high-rises and other urban structures; (3) assessment of urban spatial structure from 2-D and 3-D perspectives; and (4) an analysis of the spatial clustering of migrants from Nang Rong District in Bangkok and the neighborhood environments of migrants' locations. Techniques are developed to improve the accuracy of the neural network classification approach for the analysis of remote sensing data, with an emphasis on the spectral unmixing problem. The 3-D building heights are derived using the shadow information on the high-resolution IKONOS image. The results from the 2-D and 3-D mapping are further examined to assess urban structure and urban feature identification. This research contributes to image processing of remotely-sensed images and urban studies. The rural-urban migration process and migrants' settlement patterns are examined using spatial statistics, GIS, and remote sensing perspectives. The results show that migrants' spatial clustering in urban space is associated with the source village and a number of socio-demographic variables. In addition, the migrants' neighborhood environments in urban setting are modeled using a set of geographic and socio-demographic variables, and the results are scale-dependent.

How health professionals conceive and construct interprofessional practice in rural settings: a qualitative study.

PubMed

Parker, Vicki; McNeil, Karen; Higgins, Isabel; Mitchell, Rebecca; Paliadelis, Penelope; Giles, Michelle; Parmenter, Glenda

2013-12-01

Although interprofessional practice (IPP) offers the potential to enhance rural health services and provide support to rural clinicians, IPP may itself be problematic due to workforce limitations and service fragmentation. Differing socioeconomic and geographic characteristics of rural communities means that the way that IPP occurs in rural contexts will necessarily differ from that occurring in metropolitan contexts. The aim of this study was to investigate the factors contributing to effective IPP in rural contexts, to examine how IPP happens and to identify barriers and enablers. Using Realistic Evaluation as a framework, semi-structured interviews were conducted with health professionals in a range of rural healthcare contexts in NSW, Australia. Independent thematic analysis was undertaken by individual research team members, which was then integrated through consensus to achieve a qualitative description of rural IPP practice. There was clear evidence of diversity and complexity associated with IPP in the rural settings that was supported by descriptions of collaborative integrated practice. There were instances where IPP doesn't and could happen. There were a number of characteristics identified that significantly impacted on IPP including the presence of a shared philosophical position and valuing of IPP and recognition of the benefits, funding to support IPP, pivotal roles, proximity and workforce resources. The nature of IPP in rural contexts is diverse and determined by a number of critical factors. This study goes some of the way towards unravelling the complexity of IPP in rural contexts, highlighting the strong motivating factors that drive IPP. However, it has also identified significant structural and relational barriers related to workload, workforce, entrenched hierarchies and ways of working and service fragmentation. Further research is required to explicate the mechanisms that drive successful IPP across a range of diverse rural contexts in order to inform the implementation of robust flexible strategies that will support sustainable models of rural IPP.

Comparing progress toward the millennium development goal for under-five mortality in León and Cuatro Santos, Nicaragua, 1990–2008

PubMed Central

2014-01-01

Background Social inequality in child survival hampers the achievement of Millennium Development Goal 4 (MDG4). Monitoring under-five mortality in different social strata may contribute to public health policies that strive to reduce social inequalities. This population-based study examines the trends, causes, and social inequality of mortality before the age of five years in rural and urban areas in Nicaragua. Methods The study was conducted in one rural (Cuatro Santos) and one urban/rural area (León) based on data from Health and Demographic Surveillance Systems. We analyzed live births from 1990 to 2005 in the urban/rural area and from 1990 to 2008 in the rural area. The annual average rate reduction (AARR) and social under-five mortality inequality were calculated using the education level of the mother as a proxy for socio-economic position. Causes of child death were based on systematic interviews (verbal autopsy). Results Under-five mortality in all areas is declining at a rate sufficient to achieve MDG4 by 2015. Urban León showed greater reduction (AARR = 8.5%) in mortality and inequality than rural León (AARR = 4.5%) or Cuatro Santos (AARR = 5.4%). Social inequality in mortality had increased in rural León and no improvement in survival was observed among mothers who had not completed primary school. However, the poor and remote rural area Cuatro Santos was on track to reach MDG4 with equitable child survival. Most of the deaths in both areas were due to neonatal conditions and infectious diseases. Conclusions All rural and urban areas in Nicaragua included in this study were on track to reach MDG4, but social stratification in child survival showed different patterns; unfavorable patterns with increasing inequity in the peri-urban rural zone and a more equitable development in the urban as well as the poor and remote rural area. An equitable progress in child survival may also be accelerated in very poor settings. PMID:24428933

Urban–rural differentials in the factors associated with exposure to second-hand smoke in India

PubMed Central

Singh, Akansha; Sahoo, Namita

2013-01-01

Objectives This study aims to investigate the role of different factors associated with exposure to second-hand smoke (SHS) in the workplace and home in the urban and rural areas of India. Design Secondary analysis of the data from the Global Adult Tobacco Survey conducted in 2009–2010. Setting and participants Data were analysed from 32 738 rural and 23 202 urban non-smokers at home and 4809 rural and 6227 urban non-smokers in the workplace in India. Outcomes and methods We used two measures of SHS: exposure to SHS at home and exposure to SHS in the workplace. SHS exposure at home is estimated for non-smokers who reported anyone smoking inside his/her home. Exposure to SHS in the workplace is estimated for non-smokers who reported anyone smoking in the workplace in the past 30 days before the survey. Statistical techniques such as χ2 test, logistic regression and discriminant function analysis were used. Results The results showed that SHS exposure in the workplace and home is higher in the rural areas than in the urban areas. As compared with men, women are significantly more likely to be exposed to SHS at home (OR=1.20, 95% CI 1.10 to 1.30) in the rural areas, and less likely at the workplace in the urban areas (OR=0.49, 95% CI 0.40 to 0.59). Education and region are significant predictors of exposure levels to SHS at home and the workplace in the rural and urban areas. The knowledge of number of smoking-related hazards significantly discriminates the SHS exposure in the rural workplace. SHS exposure at home is most affected by region in the rural areas and education in the urban areas. Conclusions The factors which affect SHS exposure differ in the rural and urban areas of India. The study concludes that the risk of getting exposed to SHS at home and the workplace among non-smokers is higher in the rural areas of the country. PMID:24282245

Two-lane rural highways safety performance functions.

DOT National Transportation Integrated Search

2016-05-01

This report documents findings from a comprehensive set of safety performance functions developed for the entire : state two-lane rural highway system in Washington. The findings indicate that random parameter models and : heterogeneous negative bino...

Does the design and implementation of proven innovations for delivering basic primary health care services in rural communities fit the urban setting: the case of Ghana’s Community-based Health Planning and Services (CHPS)

PubMed Central

2014-01-01

Background Rapid urban population growth is of global concern as it is accompanied with several new health challenges. The urban poor who reside in informal settlements are more vulnerable to these health challenges. Lack of formal government public health facilities for the provision of health care is also a common phenomenon among communities inhabited by the urban poor. To help ameliorate this situation, an innovative urban primary health system was introduced in urban Ghana, based on the milestones model developed with the rural Community-Based Health Planning and Services (CHPS) system. This paper provides an overview of innovative experiences adapted while addressing these urban health issues, including the process of deriving constructive lessons needed to inform discourse on the design and implementation of the sustainable Community-Based Health Planning and Services (CHPS) model as a response to urban health challenges in Southern Ghana. Methods This research was conducted during the six-month pilot of the urban CHPS programme in two selected areas acting as the intervention and control arms of the design. Daily routine data were collected based on milestones initially delineated for the rural CHPS model in the control communities whilst in the intervention communities, some modifications were made to the rural milestones. Results The findings from the implementation activities revealed that many of the best practices derived from the rural CHPS experiment could not be transplanted to poor urban settlements due to the unique organizational structures and epidemiological characteristics found in the urban context. For example, constructing Community Health Compounds and residential facilities within zones, a central component to the rural CHPS strategy, proved inappropriate for the urban sector. Night and weekend home visit schedules were initiated to better accommodate urban residents and increase coverage. The breadth of the disease burden of the urban residents also requires a broader expertise and training of the CHOs. Conclusions Access to improved urban health services remains a challenge. However, current policy guidelines for the implementation of a primary health model based on rural experiences and experimental design requires careful review and modifications to meet the needs of the urban settings. PMID:24690310

Prevention of Diabetes in Rural India with a Telemedicine Intervention

PubMed Central

Mohan, Viswanathan; Deepa, Mohan; Pradeepa, Rajendra; Prathiba, Venkat; Datta, Manjula; Sethuraman, Ravikumar; Rakesh, Hari; Sucharita, Yarlagadda; Webster, Premila; Allender, Steven; Kapur, Anil; Anjana, Ranjit Mohan

2012-01-01

Background Diabetes care is not presently available, accessible, or affordable to people living in rural areas in developing countries, such as India. The Chunampet Rural Diabetes Prevention Project (CRDPP) was conceived with the aim of implementing comprehensive diabetes screening, prevention, and treatment using a combination of telemedicine and personalized care in rural India. Methods This project was undertaken in a cluster of 42 villages in and around the Chunampet village in the state of Tamil Nadu in southern India. A telemedicine van was used to screen for diabetes and its complications using retinal photography, Doppler imaging, biothesiometry, and electrocardiography using standardized techniques. A rural diabetes center was set up to provide basic diabetes care. Results Of the total 27,014 adult population living in 42 villages, 23,380 (86.5%) were screened for diabetes, of which 1138 (4.9%) had diabetes and 3410 (14.6%) had prediabetes. A total of 1001 diabetes subjects were screened for complications (response rate of 88.0%). Diabetic retinopathy was detected in 18.2%, neuropathy in 30.9%, microalbuminuria in 24.3%, peripheral vascular disease in 7.3%, and coronary artery disease in 10.8%. The mean hemoglobin A1c levels among the diabetes subjects in the whole community decreased from 9.3 ± 2.6% to 8.5 ± 2.4% within 1 year. Less than 5% of patients needed referral for further management to the tertiary diabetes hospital in Chennai. Conclusions The Chunampet Rural Diabetes Prevention Project is a successful model for screening and for delivery of diabetes health care and prevention to underserved rural areas in developing countries such as India. PMID:23294780

Year One: An Evaluation of School-Based Development Corporations in Five Rural Arkansas Towns.

ERIC Educational Resources Information Center

Arkansas Community Education Development Association, Little Rock.

Rural school districts in five Arkansas towns set up school-based development corporations (SBDCs) to provide vocational and career training relevant to the needs of rural high school students and the community and to improve the economic and social welfare of the community as a whole. Each SBDC owned and operated businesses using student labor…

Preventing Adolescent Risk Behavior in the Rural Context: An Integrative Analysis of Adolescent, Parent, and Provider Perspectives

ERIC Educational Resources Information Center

Rishel, Carrie W.; Cottrell, Lesley; Kingery, Tricia

2012-01-01

Adolescent risk behavior remains prevalent and contributes to numerous social problems and growing health care costs. Contrary to popular perception, adolescents in rural areas engage in risky behaviors at least as much as youth from urban or suburban settings. Little research, however, focuses on risk behavior prevention in the rural context.…

Teens, Crime, and Rural Communities. How Youth in Rural America Can Help Reduce Violent and Property Crimes.

ERIC Educational Resources Information Center

Donovan, Erin; O'Neil, Jean F., Ed.

Featuring the Teens, Crime, and Community (TCC) program, this monograph focuses on youth crime and crime prevention in rural settings. TCC actively involves teens and adults in a partnership designed to reduce teen victimization and to encourage teens to be catalysts of change for community safety. The guide provides teachers, administrators, and…

SRDC Plan of Work: Southern States' Title V Programs, 1978. SRDC Series Publication No. 24.

ERIC Educational Resources Information Center

Southern Rural Development Center, State College, MS.

Moving rural development program and research information to users summarizes the Southern Rural Development Center (SRDC) Plan of Work for 1978. One of 4 regional centers set up by the 1972 Rural Development Act, SRDC coordinates cooperation between research and extension at 28 land-grant institutions in 13 states and Puerto Rico which have rural…

APPROACHES TO JUVENILE DELINQUENCY PREVENTION AND TREATMENT IN RURAL SETTINGS. RURAL AND SMALL-TOWN DELINQUENCY--NEW UNDERSTANDING AND APPROACHES.

ERIC Educational Resources Information Center

SCHAFER, WALTER E.

ALTHOUGH THERE IS A LOWER DELINQUENCY RATE IN RURAL AREAS, THE PROBLEM OF DELINQUENCY IS OF MAJOR CONCERN. THE NATURE OF DELINQUENT ACTS IS USUALLY IN THE FORM OF MINOR BURGLARY, TRESPASSING, AND GENERAL MISCONDUCT, WHILE CHARACTERISTICS OF THE DELINQUENTS INCLUDE LACK OF ACADEMIC ACHIEVEMENT, NEGATIVE ATTITUDES TOWARD SELF AND COMMUNITY, CHOICE…

Rural Students in Washington State: STEM as a Strategy for Building Rigor, Postsecondary Aspirations, and Relevant Career Opportunities

ERIC Educational Resources Information Center

Peterson, Barbara; Bornemann, Greta; Lydon, Cheryl; West, Kimberly

2015-01-01

In rural settings, leaving for college can mean a young person's first step in leaving home forever (Sherman & Sage, 2011). That presents a serious challenge for college recruiters as they ask parents from Indian reservations or close-knit Hispanic or rural farming communities to allow their children to consider postsecondary opportunities. In…

Health Promotion Intervention for Hygienic Disposal of Children's Faeces in a Rural Area of Nigeria

ERIC Educational Resources Information Center

Jinadu, M. K.; Adegbenro, C. A.; Esmai, A. O.; Ojo, A. A.; Oyeleye, B. A.

2007-01-01

Objective: Community-based health promotion intervention for improving unhygienic disposal of children's faeces was conducted in a rural area of Nigeria. Setting: The study was conducted in Ife South Local Government area of Osun State, Nigeria. Design: The study was conducted in 10 randomly selected rural villages: five control and five active.…

How Green is My Valley? Tracking Rural and Urban Environmentalism in the Southern Appalachian Ecoregion

Treesearch

Robert Emmet Jones; J. Mark Fly; H. Ken Cordell

1999-01-01

Research on the social bases of environmentalism in the United States has generally found that urban residents are more concerned about the environment than rural residents. Recent research suggests this may no longer be the case, particularly in specific settings or under certain conditions. This paper examines the issue by reviewing recent survey research on rural...

School and Community, Community and School: A Case Study of a Rural Missouri Setting

ERIC Educational Resources Information Center

Franklin, Melia K.

2011-01-01

How do a school and a community interact? This question guided this dissertation examining one rural school and community. The purpose of this case study was to investigate the relationship between the rural Marceline R-V School District (a K-12 school system) and its community, Marceline, Missouri. The framework for this study included the…

''I Eat to Be Happy, to Be Strong, and to Live.'' Perceptions of Rural and Urban Adolescents in Cameroon, Africa

ERIC Educational Resources Information Center

Dapi, Leonie N.; Omoloko, Cecile; Janlert, Urban; Dahlgren, Lars; Haglin, Lena

2007-01-01

Objective: To investigate factors influencing rural and urban adolescents' food perceptions during a time of nutritional transition in Cameroon, Africa. Design: Qualitative in-depth interviews. Settings: Yaounde urban and Bandja rural areas. Participants: Fifteen adolescents 12 to 15 years old purposely selected from schools in urban and rural…

RECREATION PROBLEMS OF RURAL YOUTH IN A CHANGING ENVIRONMENT.

ERIC Educational Resources Information Center

PRENDERGAST, JOSEPH

RURAL YOUTH WHO ARE MOVING TO URBAN AREAS ARE NOT PREPARED TO PARTICIPATE IN URBAN TYPES OF RECREATION PROGRAMS. THE RECREATION SKILLS OF THOSE WHO HAVE LEFT THE FARM BUT ARE STILL IN RURAL SETTINGS DO NOT MATCH THE URBAN OPPORTUNITIES REACHING OUT TO THEM. THOSE STILL ON THE FARMS ARE GETTING RECREATION IDEAS THROUGH MASS MEDIA WITHOUT FINDING…

Are Rural Schools Inferior to Urban Schools? A Multilevel Analysis of School Accountability Trends in Kentucky

ERIC Educational Resources Information Center

Reeves, Edward B.; Bylund, Robert A.

2005-01-01

Recent research does not provide clear evidence that rural schools are inferior to urban schools. For example, one prominent study finds that students in rural schools perform less well than their urban counterparts, but other studies using the same national data set have reached divergent conclusions. The present study reassesses the issue using…

Rural Health Professions Education at East Tennessee State University: Survey of Graduates from the First Decade of the Community Partnership Program

ERIC Educational Resources Information Center

Florence, Joseph A.; Goodrow, Bruce; Wachs, Joy; Grover, Susan; Olive, Kenneth E.

2007-01-01

Context: To help meet rural Appalachian needs, and with initial support from the W.K. Kellogg Foundation, East Tennessee State University partnered with 2 counties to implement a health curriculum for nursing, public health, and medical students in a rural setting. The Community Partnerships Program 3-year longitudinal curriculum included…

SRDC Plan of Work - Southern States' Title V Programs. SRDC Series Publication No. 22, June 1977.

ERIC Educational Resources Information Center

Southern Rural Development Center, State College, MS.

The Southern Rural Development Center's 1977 plan focuses on ways to move rural development program and research information to the users. One of four regional centers set by the 1972 Rural Development Act, the southern center works with research and extension staffs in 27 land-grant institutions in 13 states and Puerto Rico. Its publication…

The Demand for Special Education Teachers in Rural Schools Revisited: An Update on Progress

ERIC Educational Resources Information Center

Sindelar, Paul T.; Pua, Daisy J.; Fisher, Tiffany; Peyton, David J.; Brownell, Mary T.; Mason-Williams, Loretta

2018-01-01

In this commentary, we revisit "NCLB and the Demand for Highly Qualified Teachers: Challenges and Solutions for Rural Schools," an article we published in this journal in 2005. We consider the predictions we made then about the impact of the Highly Qualified Teacher mandate on special education teacher (SET) shortages in rural states and…

Quality of Care for Acute Myocardial Infarction in Rural and Urban US Hospitals

ERIC Educational Resources Information Center

Baldwin, Laura-Mae; MacLehose, Richard F.; Hart, L. Gary; Beaver, Shelli K.; Every,Nathan; Chan,Leighton

2004-01-01

Context: Acute myocardial infarction (AMI) is a common and important cause of admission to US rural hospitals, as transport of patients with AMI to urban settings can result in unacceptable delays in care. Purpose: To examine the quality of care for patients with AMI in rural hospitals with differing degrees of remoteness from urban centers.…

Distinct clinical characteristics and helminth co-infections in adult tuberculosis patients from urban compared to rural Tanzania.

PubMed

Sikalengo, George; Hella, Jerry; Mhimbira, Francis; Rutaihwa, Liliana K; Bani, Farida; Ndege, Robert; Sasamalo, Mohamed; Kamwela, Lujeko; Said, Khadija; Mhalu, Grace; Mlacha, Yeromin; Hatz, Christoph; Knopp, Stefanie; Gagneux, Sébastien; Reither, Klaus; Utzinger, Jürg; Tanner, Marcel; Letang, Emilio; Weisser, Maja; Fenner, Lukas

2018-03-24

Differences in rural and urban settings could account for distinct characteristics in the epidemiology of tuberculosis (TB). We comparatively studied epidemiological features of TB and helminth co-infections in adult patients from rural and urban settings of Tanzania. Adult patients (≥ 18 years) with microbiologically confirmed pulmonary TB were consecutively enrolled into two cohorts in Dar es Salaam, with ~ 4.4 million inhabitants (urban), and Ifakara in the sparsely populated Kilombero District with ~ 400 000 inhabitants (rural). Clinical data were obtained at recruitment. Stool and urine samples were subjected to diagnose helminthiases using Kato-Katz, Baermann, urine filtration, and circulating cathodic antigen tests. Differences between groups were assessed by χ 2 , Fisher's exact, and Wilcoxon rank sum tests. Logistic regression models were used to determine associations. Between August 2015 and February 2017, 668 patients were enrolled, 460 (68.9%) at the urban and 208 (31.1%) at the rural site. Median patient age was 35 years (interquartile range [IQR]: 27-41.5 years), and 454 (68%) were males. Patients from the rural setting were older (median age 37 years vs. 34 years, P = 0.003), had a lower median body mass index (17.5 kg/m 2 vs. 18.5 kg/m 2 , P <  0.001), a higher proportion of recurrent TB cases (9% vs. 1%, P <  0.001), and in HIV/TB co-infected patients a lower median CD4 cell counts (147 cells/μl vs. 249 cells/μl, P = 0.02) compared to those from urban Tanzania. There was no significant difference in frequencies of HIV infection, diabetes mellitus, and haemoglobin concentration levels between the two settings. The overall prevalence of helminth co-infections was 22.9% (95% confidence interval [CI]: 20.4-27.0%). The significantly higher prevalence of helminth infections at the urban site (25.7% vs. 17.3%, P = 0.018) was predominantly driven by Strongyloides stercoralis (17.0% vs. 4.8%, P <  0.001) and Schistosoma mansoni infection (4.1% vs. 16.4%, P <  0.001). Recurrent TB was associated with living in a rural setting (adjusted odds ratio [aOR]: 3.97, 95% CI: 1.16-13.67) and increasing age (aOR: 1.06, 95% CI: 1.02-1.10). Clinical characteristics and helminth co-infections pattern differ in TB patients in urban and rural Tanzania. The differences underline the need for setting-specific, tailored public health interventions to improve clinical management of TB and comorbidities.

Assessing Rural Sustainable Development potentialities using a Dominance-based Rough Set Approach.

PubMed

Boggia, Antonio; Rocchi, Lucia; Paolotti, Luisa; Musotti, Francesco; Greco, Salvatore

2014-11-01

Rural Development is a priority in Europe and it is supported by specific, financial programmes. At the same time, sustainability is the key word for the European Union to construct programmes and policies for all human activities. However, measuring sustainability of rural areas is not easy, due to their particular features. The improvement of knowledge on sustainability in rural areas is important to build long term policies and strategies for those territories. The objective of this study is the development of a decision support system based on the Dominance-based Rough Set Approach (DRSA), to assess the level of Rural Sustainable Development in specific areas. We used DRSA to analyze the level of sustainability of the 92 municipalities of the Region of Umbria, Italy. The results were synthesized in a final ranking, taking into account the equilibrium and the integration between development and sustainability of each municipality. DRSA showed a high potential in the context of management or planning, and for supporting Decision Makers. DRSA is able to give a ranking as well as an explanation of the main factors driving sustainable development in rural areas. Copyright © 2014 Elsevier Ltd. All rights reserved.

Use of Lot Quality Assurance Sampling to Ascertain Levels of Drug Resistant Tuberculosis in Western Kenya

PubMed Central

Cohen, Ted; Zignol, Matteo; Nyakan, Edwin; Hedt-Gauthier, Bethany L.; Gardner, Adrian; Kamle, Lydia; Injera, Wilfred; Carter, E. Jane

2016-01-01

Objective To classify the prevalence of multi-drug resistant tuberculosis (MDR-TB) in two different geographic settings in western Kenya using the Lot Quality Assurance Sampling (LQAS) methodology. Design The prevalence of drug resistance was classified among treatment-naïve smear positive TB patients in two settings, one rural and one urban. These regions were classified as having high or low prevalence of MDR-TB according to a static, two-way LQAS sampling plan selected to classify high resistance regions at greater than 5% resistance and low resistance regions at less than 1% resistance. Results This study classified both the urban and rural settings as having low levels of TB drug resistance. Out of the 105 patients screened in each setting, two patients were diagnosed with MDR-TB in the urban setting and one patient was diagnosed with MDR-TB in the rural setting. An additional 27 patients were diagnosed with a variety of mono- and poly- resistant strains. Conclusion Further drug resistance surveillance using LQAS may help identify the levels and geographical distribution of drug resistance in Kenya and may have applications in other countries in the African Region facing similar resource constraints. PMID:27167381

Use of Lot Quality Assurance Sampling to Ascertain Levels of Drug Resistant Tuberculosis in Western Kenya.

PubMed

Jezmir, Julia; Cohen, Ted; Zignol, Matteo; Nyakan, Edwin; Hedt-Gauthier, Bethany L; Gardner, Adrian; Kamle, Lydia; Injera, Wilfred; Carter, E Jane

2016-01-01

To classify the prevalence of multi-drug resistant tuberculosis (MDR-TB) in two different geographic settings in western Kenya using the Lot Quality Assurance Sampling (LQAS) methodology. The prevalence of drug resistance was classified among treatment-naïve smear positive TB patients in two settings, one rural and one urban. These regions were classified as having high or low prevalence of MDR-TB according to a static, two-way LQAS sampling plan selected to classify high resistance regions at greater than 5% resistance and low resistance regions at less than 1% resistance. This study classified both the urban and rural settings as having low levels of TB drug resistance. Out of the 105 patients screened in each setting, two patients were diagnosed with MDR-TB in the urban setting and one patient was diagnosed with MDR-TB in the rural setting. An additional 27 patients were diagnosed with a variety of mono- and poly- resistant strains. Further drug resistance surveillance using LQAS may help identify the levels and geographical distribution of drug resistance in Kenya and may have applications in other countries in the African Region facing similar resource constraints.

Medical residencies and increased admissions in rural hospitals with fewer than 200 beds.

PubMed

Connor, R A

2000-01-01

Medical education programs in general, and rural residency programs in particular, can be beneficial for rural hospitals. This study of 1,792 non-metropolitan statistical area, acute general hospitals with fewer than 200 beds from 1993 to 1996 was designed to help rural hospitals and communities to quantify the likely effects of rural residency programs on hospital admissions. Data came from the hospital Prospective Payment System minimum data set. The results show that additional residents at rural hospitals with fewer than 200 beds generally result in an increase of approximately 100 to 200 admissions per resident--more for smaller hospitals and fewer for larger hospitals. Because increased admissions generally improve the financial health and continued operation of rural hospitals, this study confirms the importance of education-based strategies in ensuring access to care in rural communities.

ISS-An Electronic Syndromic Surveillance System for Infectious Disease in Rural China

PubMed Central

Yan, Weirong; Palm, Lars; Lu, Xin; Nie, Shaofa; Xu, Biao; Zhao, Qi; Tao, Tao; Cheng, Liwei; Tan, Li; Dong, Hengjin; Diwan, Vinod K.

2013-01-01

Background syndromic surveillance system has great advantages in promoting the early detection of epidemics and reducing the necessities of disease confirmation, and it is especially effective for surveillance in resource poor settings. However, most current syndromic surveillance systems are established in developed countries, and there are very few reports on the development of an electronic syndromic surveillance system in resource-constrained settings. Objective this study describes the design and pilot implementation of an electronic surveillance system (ISS) for the early detection of infectious disease epidemics in rural China, complementing the conventional case report surveillance system. Methods ISS was developed based on an existing platform ‘Crisis Information Sharing Platform’ (CRISP), combining with modern communication and GIS technology. ISS has four interconnected functions: 1) work group and communication group; 2) data source and collection; 3) data visualization; and 4) outbreak detection and alerting. Results As of Jan. 31st 2012, ISS has been installed and pilot tested for six months in four counties in rural China. 95 health facilities, 14 pharmacies and 24 primary schools participated in the pilot study, entering respectively 74256, 79701, and 2330 daily records into the central database. More than 90% of surveillance units at the study sites are able to send daily information into the system. In the paper, we also presented the pilot data from health facilities in the two counties, which showed the ISS system had the potential to identify the change of disease patterns at the community level. Conclusions The ISS platform may facilitate the early detection of infectious disease epidemic as it provides near real-time syndromic data collection, interactive visualization, and automated aberration detection. However, several constraints and challenges were encountered during the pilot implementation of ISS in rural China. PMID:23626853

Validity and Utility of the Patient Health Questionnaire (PHQ)‐2 and PHQ‐9 for Screening and Diagnosis of Depression in Rural Chiapas, Mexico: A Cross‐Sectional Study

PubMed Central

Aguerrebere, Mercedes; Raviola, Giuseppe; Flores, Hugo; Elliott, Patrick; Espinosa, Azucena; Reyes, Andrea; Ortiz‐Panozo, Eduardo; Rodriguez‐Gutierrez, Elena G.; Mukherjee, Joia; Palazuelos, Daniel; Franke, Molly F.

2017-01-01

Background Depressive disorders are frequently under diagnosed in resource‐limited settings because of lack of access to mental health care or the inability of healthcare providers to recognize them. The Patient Health Questionnaire (PHQ)‐2 and the PHQ‐9 have been widely used for screening and diagnosis of depression in primary care settings; however, the validity of their use in rural, Spanish‐speaking populations is unknown. Method We used a cross‐sectional design to assess the psychometric properties of the PHQ‐9 for depression diagnosis and estimated the sensitivity and specificity of the PHQ‐2 for depression screening. Data were collected from 223 adults in a rural community of Chiapas, Mexico, using the PHQ‐2, the PHQ‐9, and the World Health Organization Quality of Life BREF Scale (WHOQOL‐ BREF). Results Confirmatory factor analysis suggested that the 1‐factor structure fit reasonably well. The internal consistency of the PHQ‐9 was good (Cronbach's alpha > = 0.8) overall and for subgroups defined by gender, literacy, and age. The PHQ‐9 demonstrated good predictive validity: Participants with a PHQ‐9 diagnosis of depression had lower quality of life scores on the overall WHOQOL‐BREF Scale and each of its domains. Using the PHQ‐9 results as a gold standard, the optimal PHQ‐2 cutoff score for screening of depression was 3 (sensitivity 80.00%, specificity 86.88%, area under receiver operating characteristic curve = 0.89; 95% confidence interval [0.84, 0.94]). Conclusion The PHQ‐2 and PHQ‐9 demonstrated good psychometric properties, suggesting their potential benefit as tools for depression screening and diagnosis in rural, Spanish‐speaking populations. PMID:28195649

Distance from household to clinic and its association with the uptake of prevention of mother-to-child HIV transmission regimens in rural Zambia

PubMed Central

Escamilla, Veronica; Chibwesha, Carla J.; Gartland, Matthew; Chintu, Namwinga; Mubiana-Mbewe, Mwangelwa; Musokotwane, Kebby; Musonda, Patrick; Miller, William C.; Stringer, Jeffrey S. A.; Chi, Benjamin H.

2016-01-01

Background In rural settings, HIV-infected pregnant women often live significant distances from facilities that provide prevention of mother-to-child transmission (PMTCT) services. Methods We implemented a pilot project to offer universal maternal combination antiretroviral regimens in 4 clinics in rural Zambia. To evaluate the impact of services, we conducted a household survey in communities surrounding each facility. We collected information about HIV status and antenatal service utilization from women who delivered in the past two years. Using household global positing systems coordinates collected in the survey, we measured Euclidean (i.e., straight line) distance between individual households and clinics. Multivariable logistic regression and predicted probabilities were used to determine associations between distance and uptake of any PMTCT regimen and combination antiretroviral regimens specifically. Results From March to December 2011, 390 HIV-infected mothers were surveyed across four communities. Of these, 254 (65%) had household geographical coordinates documented. 168 women reported use of a PMTCT regimen during pregnancy, including 102 who initiated a combination antiretroviral regimen. The probability of PMTCT regimen initiation was highest within 1.9 km of the facility and gradually declined. Overall, 103 of 145 (71%) who lived within 1.9 km of the facility initiated PMTCT, versus 65 of 109 (60%) who lived farther away. For every kilometer increase, the association with PMTCT regimen uptake (adjusted odds ratio [AOR]: 0.90, 95%CI: 0.82—0.99) and combination antiretroviral regimen uptake (AOR: 0.88, 95%CI: 0.80—0.97) decreased. Conclusions In this rural African setting, uptake of PMTCT regimens was influenced by distance to health facility. Program models that further decentralize care into remote communities are urgently needed. PMID:26470035

Spatial and Temporal Spread of Acute Viral Respiratory Infections in Young Children Living in High-Altitude Rural Communities: A Prospective Household-Based Study

PubMed Central

Cherry, Charlotte Buehler; Griffin, Marie R.; Edwards, Kathryn M.; Williams, John V.; Gil, Ana I.; Verastegui, Hector; Lanata, Claudio F.; Grijalva, Carlos G

2016-01-01

Background Few studies have described patterns of transmission of viral acute respiratory infections (ARI) in children in developing countries. We examined the spatial and temporal spread of viral ARI among young children in rural Peruvian highland communities. Previous work has described intense social interactions in those communities, which could influence the transmission of viral infections. Methods We enrolled and followed children <3 years of age for detection of ARI during the 2009–2011 respiratory seasons in a rural setting with relatively wide geographic dispersion of households and communities. Viruses detected included influenza, respiratory syncytial virus (RSV), human metapneumovirus (MPV), and parainfluenza 2 and 3 viruses (PIV2; PIV3). We used geospatial analyses to identify specific viral infection hot spots with high ARI incidence. We also explored the local spread of ARI from index cases using standard deviational ellipses. Results Geospatial analyses revealed hot spots of high ARI incidence around the index cases of influenza outbreaks and RSV outbreak in 2010. Although PIV3 in 2009 and PIV2 in 2010 showed distinct spatial hot spots, clustering was not in proximity to their respective index cases. No significant aggregation around index cases was noted for other viruses. Standard deviational ellipse analyses suggested that influenza B and RSV in 2010, and MPV in 2011 spread temporally in alignment with the major road network. Conclusions Despite the geographic dispersion of communities in this rural setting, we observed a rapid spread of viral ARI among young children. Influenza strains and RSV in 2010 had distinctive outbreaks arising from their index cases. PMID:27404599

Cultural Respect Encompassing Simulation Training: Being Heard About Health Through Broadband

PubMed Central

Min-Yu Lau, Phyllis; Woodward-Kron, Robyn; Livesay, Karen; Elliott, Kristine; Nicholson, Patricia

2016-01-01

Background Cultural Respect Encompassing Simulation Training (CREST) is a learning program that uses simulation to provide health professional students and practitioners with strategies to communicate sensitively with culturally and linguistically diverse (CALD) patients. It consists of training modules with a cultural competency evaluation framework and CALD simulated patients to interact with trainees in immersive simulation scenarios. The aim of this study was to test the feasibility of expanding the delivery of CREST to rural Australia using live video streaming; and to investigate the fidelity of cultural sensitivity – defined within the process of cultural competency which includes awareness, knowledge, skills, encounters and desire – of the streamed simulations. Design and Methods In this mixed-methods evaluative study, health professional trainees were recruited at three rural academic campuses and one rural hospital to pilot CREST sessions via live video streaming and simulation from the city campus in 2014. Cultural competency, teaching and learning evaluations were conducted. Results Forty-five participants rated 26 reliable items before and after each session and reported statistically significant improvement in 4 of 5 cultural competency domains, particularly in cultural skills (P<0.05). Qualitative data indicated an overall acknowledgement amongst participants of the importance of communication training and the quality of the simulation training provided remotely by CREST. Conclusions Cultural sensitivity education using live video-streaming and simulation can contribute to health professionals’ learning and is effective in improving cultural competency. CREST has the potential to be embedded within health professional curricula across Australian universities to address issues of health inequalities arising from a lack of cultural sensitivity training. Significance for public health There are significant health inequalities for migrant populations. They commonly have poorer access to health services and poorer health outcomes than the Australian-born population. The factors are multiple, complex and include language and cultural barriers. To address these disparities, culturally competent patient-centred care is increasingly recognised to be critical to improving care quality, patient satisfaction, patient compliance and patient outcomes. Yet there is a lack of quality in the teaching and learning of cultural competence in healthcare education curricula, particularly in rural settings where qualified trainers and resources can be limited. The Cultural Respect Encompassing Simulation Training (CREST) program offers opportunities to health professional students and practitioners to learn and develop communication skills with professionally trained culturally and linguistically diverse simulated patients who contribute their experiences and health perspectives. It has already been shown to contribute to health professionals' learning and is effective in improving cultural competency in urban settings. This study demonstrates that CREST when delivered via live video-streaming and simulation can achieve similar results in rural settings. PMID:27190975

Principal component analysis of socioeconomic factors and their association with malaria and arbovirus risk in Tanzania: a sensitivity analysis.

PubMed

Homenauth, Esha; Kajeguka, Debora; Kulkarni, Manisha A

2017-11-01

Principal component analysis (PCA) is frequently adopted for creating socioeconomic proxies in order to investigate the independent effects of wealth on disease status. The guidelines and methods for the creation of these proxies are well described and validated. The Demographic and Health Survey, World Health Survey and the Living Standards Measurement Survey are examples of large data sets that use PCA to create wealth indices particularly in low and middle-income countries (LMIC), where quantifying wealth-disease associations is problematic due to the unavailability of reliable income and expenditure data. However, the application of this method to smaller survey data sets, especially in rural LMIC settings, is less rigorously studied.In this paper, we aimed to highlight some of these issues by investigating the association of derived wealth indices using PCA on risk of vector-borne disease infection in Tanzania focusing on malaria and key arboviruses (ie, dengue and chikungunya). We demonstrated that indices consisting of subsets of socioeconomic indicators provided the least methodologically flawed representations of household wealth compared with an index that combined all socioeconomic variables. These results suggest that the choice of the socioeconomic indicators included in a wealth proxy can influence the relative position of households in the overall wealth hierarchy, and subsequently the strength of disease associations. This can, therefore, influence future resource planning activities and should be considered among investigators who use a PCA-derived wealth index based on community-level survey data to influence programme or policy decisions in rural LMIC settings. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Instrumental and socioemotional communications in doctor-patient interactions in urban and rural clinics.

PubMed

Desjarlais-deKlerk, Kristen; Wallace, Jean E

2013-07-08

Location of practice, such as working in a rural or urban clinic, may influence how physicians communicate with their patients. This exploratory pilot study examines the communication styles used during doctor-patient interactions in urban and rural family practice settings in Western Canada. We analyzed observation and interview data from four physicians practicing in these different locations. Using a grounded theory approach, communications were categorized as either instrumental or socioemotional. Instrumental communication refers to "cure-oriented interactions" and tends to be more task-oriented focusing on the patient's health concerns and reason for the appointment. In contrast, socioemotional communication refers to more "care-oriented interactions" that may make the patient feel comfortable, relieve patient anxiety and build a trusting relationship. The physicians in small, rural towns appear to know their patients and their families on a more personal level and outside of their office, and engage in more socioemotional communications compared to those practicing in suburban clinics in a large urban centre. Knowing patients outside the clinic seems to change the nature of the doctor-patient interaction, and, in turn, the doctor-patient relationship itself. Interactions between urban doctors and their patients had a mixture of instrumental and socioemotional communications, while interactions between rural doctors and their patients tended to be highly interpersonal, often involving considerable socioemotional communication and relationship-building. Despite the different ways that doctors and patients communicate with each other in the two settings, rural and urban doctors spend approximately the same amount of time with their patients. Thus, greater use of socioemotional communication by rural doctors, which may ease patient anxiety and increase patient trust, did not appear to add extra time to the patient visit. Research suggests that socioemotional communication may ultimately lead to better patient outcomes, which implies that health differences between rural and urban settings could be linked to differences in doctor-patient communication styles.

A Multi-Method Inquiry of the Practice and Context of Rural School Psychology

ERIC Educational Resources Information Center

Goforth, Anisa N.; Yosai, Erin R.; Brown, Jacqueline A.; Shindorf, Zachary R.

2017-01-01

This multi-method inquiry used (1) quantitative examination of context, characteristics, roles, and responsibilities of rural school psychologists compared to their suburban and urban counterparts and (2) qualitative examination of two focus groups of rural school psychologists. Results showed that rural school psychologists served more schools,…

Attitudes of undergraduate medical students of Addis Ababa University towards medical practice and migration, Ethiopia

PubMed Central

2012-01-01

Background The health care system of Ethiopia is facing a serious shortage of health workforce. While a number of strategies have been developed to improve the training and retention of medical doctors in the country, understanding the perceptions and attitudes of medical students towards their training, future practice and intent to migrate can contribute in addressing the problem. This study was carried out to assess the attitudes of Ethiopian medical students towards their training and future practice of medicine, and to identify factors associated with the intent to practice in rural or urban settings, or to migrate abroad. Methods A cross-sectional study was conducted in June 2009 among 600 medical students (Year I to Internship program) of the Faculty of Medicine at Addis Ababa University in Ethiopia. A pre-tested self-administered structured questionnaire was used for data collection. Descriptive statistics were used for data summarization and presentation. Degree of association was measured by Chi Square test, with significance level set at p < 0.05. Bivariate and multivariate logistic regression analyses were used to assess associations. Results Only 20% of the students felt ‘excellent’ about studying medicine; followed by ‘very good’ (19%), ‘good’ (30%), ‘fair’ (21%) and ‘bad’ (11%). About 35% of respondents responded they felt the standard of medical education was below their expectation. Only 30% of the students said they would like to initially practice medicine in rural settings in Ethiopia. However, students with rural backgrounds were more likely than those with urban backgrounds to say they intended to practice medicine in rural areas (adjusted OR = 2.50, 95% CI = 1.18-5.26). Similarly, students in clinical training program preferred to practice medicine in rural areas compared to pre-clinical students (adjusted OR = 1.83, 95% CI = 1.12-2.99). About 53% of the students (57% males vs. 46% females, p = 0.017) indicated aspiration to emigrate following graduation, particularly to the United States of America (42%) or European countries (15%). The attitude towards emigration was higher among Year IV (63%) and Internship (71%) students compared to Year I to Year III students (45-54%). Male students were more likely to say they would emigrate than females (adjusted OR = 1.57, 95% CI = 1.10-2.29). Likewise, students with clinical training were more likely to want to emigrate than pre-clinical students, although the difference was marginally significant (adjusted OR = 1.58, 95% CI = 1.00-2.49). Conclusions The attitudes of the majority of Ethiopian medical students in the capital city towards practicing medicine in rural areas were found to be poor, and the intent to migrate after completing medical training was found to be very high among the study participants, creating a huge potential for brain drain. This necessitates the importance of improving the quality of education and career choice satisfaction, creating conducive training and working conditions including retention efforts for medical graduates to serve their nation. It follows that recruiting altruistic and rural background students into medical schools is likely to produce graduates who are more likely to practice medicine in rural settings. PMID:22867022

Recruitment and Retention in Rural Nursing: It's Still an Issue!

PubMed

Kulig, Judith C; Kilpatrick, Kelley; Moffitt, Pertice; Zimmer, Lela

2015-06-01

A perennial issue for rural and remote communities in Canada and in other parts of the world is access to a healthcare delivery system including healthcare personnel to provide care to their residents. In total, 18% of Canadians live in rural locations but by proportion have fewer healthcare providers compared with urban settings. Relying on a recently completed documentary analysis of published reports and grey literature on rural and remote nursing practice from Canada and around the world, we recognize that recruitment and retention will be a recurring issue. However, a variety of programs and initiatives have been developed to address this age-old problem. A discussion is provided about educational opportunities, financial incentives and enhanced infrastructure that have been developed to address recruitment and retention challenges. Ongoing evaluations of each of these areas are necessary but require cooperation across provincial and national settings. Copyright © 2015 Longwoods Publishing.

A community-based health education analysis of an infectous disease control program in Nigeria.

PubMed

Adeyanju, O M

1987-01-01

This descriptive study utilized the strategy of primary health care in program development-especially a community-based health education intervention approach-in the control of guinea-worm in rural communities of Nigeria. Two closely related rural communities in two states served as target groups. Committee system approach, nominal group process, interview methods, audio-visual aids, and health care volunteer trainingship were the educational strategies employed in a control and experimental set up. The PRECEDE model was applied in the analysis. Results show a significant control action on guinea-worm infestation in the experimental community and a tremendous achievement in preventive health education interventions through organized community participation/involvement and ultimate self-reliance and individual responsibility. A positive increase in health knowledge and attitude examined through interview method, and observable changes in health behavior were noticed. Wells were provided, drinking water treated, while personal and community health promotion strategies were encouraged by all. The study has shown the effectiveness/efficacy of a community-based effort facilitated by a health educator.

Rural:urban inequalities in post 2015 targets and indicators for drinking-water.

PubMed

Bain, R E S; Wright, J A; Christenson, E; Bartram, J K

2014-08-15

Disparities in access to drinking water between rural and urban areas are pronounced. Although use of improved sources has increased more rapidly in rural areas, rising from 62% in 1990 to 81% in 2011, the proportion of the rural population using an improved water source remains substantially lower than in urban areas. Inequalities in coverage are compounded by disparities in other aspects of water service. Not all improved sources are safe and evidence from a systematic review demonstrates that water is more likely to contain detectable fecal indicator bacteria in rural areas. Piped water on premises is a service enjoyed primarily by those living in urban areas so differentiating amongst improved sources would exacerbate rural:urban disparities yet further. We argue that an urban bias may have resulted due to apparent stagnation in urban coverage and the inequity observed between urban and peri-urban areas. The apparent stagnation at around 95% coverage in urban areas stems in part from relative population growth - over the last two decades more people gained access to improved water in urban areas. There are calls for setting higher standards in urban areas which would exacerbate the already extreme rural disadvantage. Instead of setting different targets, health, economic, and human rights perspectives, We suggest that the focus should be kept on achieving universal access to safe water (primarily in rural areas) while monitoring progress towards higher service levels, including greater water safety (both in rural and urban areas and among different economic strata). Copyright © 2014 Elsevier B.V. All rights reserved.

Development of a tool to measure person-centered maternity care in developing settings: validation in a rural and urban Kenyan population.

PubMed

Afulani, Patience A; Diamond-Smith, Nadia; Golub, Ginger; Sudhinaraset, May

2017-09-22

Person-centered reproductive health care is recognized as critical to improving reproductive health outcomes. Yet, little research exists on how to operationalize it. We extend the literature in this area by developing and validating a tool to measure person-centered maternity care. We describe the process of developing the tool and present the results of psychometric analyses to assess its validity and reliability in a rural and urban setting in Kenya. We followed standard procedures for scale development. First, we reviewed the literature to define our construct and identify domains, and developed items to measure each domain. Next, we conducted expert reviews to assess content validity; and cognitive interviews with potential respondents to assess clarity, appropriateness, and relevance of the questions. The questions were then refined and administered in surveys; and survey results used to assess construct and criterion validity and reliability. The exploratory factor analysis yielded one dominant factor in both the rural and urban settings. Three factors with eigenvalues greater than one were identified for the rural sample and four factors identified for the urban sample. Thirty of the 38 items administered in the survey were retained based on the factors loadings and correlation between the items. Twenty-five items load very well onto a single factor in both the rural and urban sample, with five items loading well in either the rural or urban sample, but not in both samples. These 30 items also load on three sub-scales that we created to measure dignified and respectful care, communication and autonomy, and supportive care. The Chronbach alpha for the main scale is greater than 0.8 in both samples, and that for the sub-scales are between 0.6 and 0.8. The main scale and sub-scales are correlated with global measures of satisfaction with maternity services, suggesting criterion validity. We present a 30-item scale with three sub-scales to measure person-centered maternity care. This scale has high validity and reliability in a rural and urban setting in Kenya. Validation in additional settings is however needed. This scale will facilitate measurement to improve person-centered maternity care, and subsequently improve reproductive outcomes.

'We're it', 'we're a team', 'we're family' means a sense of belonging.

PubMed

Sedgwick, Monique G; Yonge, Olive

2008-01-01

'Belonging' is a universal characteristic of human beings and is a basic human need. Rural nurses describe the nature of their practice as being embedded in working as a team where belonging is central to the success of the team and the individual nurse. As a result they form close professional and personal ties. The challenge for nursing students is to develop a sense of belonging to the rural hospital team so that preceptorship is successful. To describe the cultural theme of a sense of belonging that nursing students develop during a rural hospital preceptorship. Using a focused ethnographic method, a purposive sample of fourth year nursing students and nurse preceptors was drawn from 11 rural communities across central and northern Alberta and Yukon, Canada. Individual interviews and a focus group interview, as well as student journals were analyzed. Ethnographic analysis was used to uncover the system of cultural meaning, 'a sense of belonging' which was the foundation for a successful rural hospital-based preceptorship for the fourth year nursing students. Nurse preceptors assist students to become members of the team and foster the development of feeling as if they belong by building bridges among the staff and students. For students, the work of being preceptored is developing a sense of belonging. Students feel they belong and are part of the team when they are known personally and professionally. Identifying and describing factors that influence students' sense of belonging enhances the effectiveness of the preceptorship model, and increases the potential of recruiting and retaining competent health professionals in the rural hospital setting.

The association of sleep duration and depressive symptoms in rural communities of southeastern Missouri, Tennessee, and Arkansas

PubMed Central

JJ, Chang; J, Salas; K, Habicht; GW, Pien; KA, Stamatakis; RC, Brownson

2012-01-01

Purpose To determine the association between sleep duration and depressive symptoms in a rural setting. Methods We conducted a cross-sectional study using data from Wave 3 of the Walk the Ozarks to Wellness Project including 12 rural communities in Missouri, Arkansas, and Tennessee (N = 1,204). Sleep duration was defined based on average weeknight and weekend hours per day: short (< 7), optimal (7-8), and long (> 8). The primary outcome was self-reported elevated depressive symptoms. Multivariable logistic regression was used to estimate adjusted prevalence odds ratios (aPOR) and 95% confidence intervals (95% CI). Findings Elevated depressive symptoms were common in this rural population (17%). Depressive symptoms were more prevalent among subjects with short (26.1%) and long (24%) sleep duration compared to those with optimal (11.8%) sleep duration. After adjusting for age, gender, race, education, employment status, income, and BMI, short sleep duration was associated with increased odds of elevated depressive symptoms (aPOR=2.12, 95% CI: 1.49, 3.01), compared to optimal sleep duration. Conversely, the association between long sleep duration and depressive symptoms was not statistically significant after covariate adjustment. Similar findings were observed when we excluded individuals with insomnia symptoms for analysis. Conclusions This study suggests that short sleep duration (<7 hours per night) and depressive symptoms are common among rural populations. Short sleep duration is positively associated with elevated depressive symptoms. The economic and healthcare burden of depression may be more overwhelming among rural populations, necessitating the need to target modifiable behaviors such as sleep habits to improve mental health. PMID:22757951

Rural patients' experiences of the open disclosure of adverse events.

PubMed

Piper, Donella; Iedema, Rick; Bower, Kate

2014-08-01

To analyse rural patients' and their families' experiences of open disclosure and offer recommendations to improve disclosure in rural areas. Retrospective qualitative study based on a subset of 13 semistructured, in-depth interviews with rural patients from a larger dataset. The larger data set form a nationwide, multisite, retrospective-qualitative study that included 100 semistructured, in-depth interviews with 119 patients and family members who were involved in high-severity health care incidents and incident disclosure. The larger study is known as the '100 Patient Stories' study. Interviews were transcribed verbatim and analysed by one analyst (D.P.) for recurrent experiences and concerns. Acute care. A sub-set of 13 of the 100 participants from the '100 Patient Stories' study who identified as experiencing an adverse incident in a rural or regional area. Patients' and family members' perceptions and experiences of health care incident disclosure, as expressed in interviews. Rural patients and clinicians experience additional challenges to metropolitan patients and clinicians in their experiences of health care incidents. These additional barriers include: a lack of resources at small hospitals; delays in diagnosis and transfer; distance between services; and a lack of communication between providers. These challenges impact not only upon how patients and their families experience incidents, but also how open disclosure is implemented. This analysis of 13 of the 100 Patient Stories interviews provides guidance to rural health services on how to conduct open disclosure. © 2014 National Rural Health Alliance Inc.

Urban and rural dietary patterns are associated with anthropometric and biochemical indicators of nutritional status of adolescent Mozambican girls.

PubMed

Hauta-Alus, Helena H; Korkalo, Liisa; Freese, Riitta; Ismael, Carina; Mutanen, Marja

2018-04-01

The objective of the present study was to explore whether dietary patterns (DP) are associated with nutritional status indicators among adolescent Mozambican girls. Design/Setting/Subjects In this population-based cross-sectional study we used the FFQ data of 547 girls aged 14-19 years from Central Mozambique to derive dietary patterns by means of principal component analysis. We used two-level linear regression models to examine the associations between the DP and anthropometric and biochemical indicators of nutritional status. We identified three DP: 'Urban bread and fats', 'Rural meat and vegetables' and 'Rural cassava and coconut'. The 'Urban bread and fats' DP was positively associated with BMI-for-age Z-score (BMIZ), mid-upper arm circumference (MUAC), triceps skinfold (P for all<0·001) and blood Hb (P=0·025). A negative association was observed between the 'Urban bread and fats' DP and serum folate (P<0·001). The 'Rural meat and vegetables' DP and the 'Rural cassava and coconut' DP were associated negatively with BMIZ, MUAC and triceps skinfold (P for all<0·05), but the 'Rural meat and vegetables' DP was associated positively with serum ferritin (P=0·007). Urban and rural DP were associated with nutritional status indicators. In a low-resource setting, urban diets may promote body fat storage and blood Hb concentrations but compromise serum folate concentration. It is important to continue valuing the traditional, rural foods that are high in folate.

Burden of invasive non-typhoidal Salmonella disease in a rural and urban site in Kenya, 2009–2014

PubMed Central

Verani, Jennifer R.; Toroitich, Samuel; Auko, Joshua; Kiplang’at, Samuel; Cosmas, Leonard; Audi, Allan; Mogeni, Ondari D.; Aol, George; Oketch, Dismas; Odiembo, Herine; Katieno, Jim; Wamola, Newton; Onyango, Clayton O.; Juma, Bonventure W.; Fields, Barry S.; Bigogo, Godfrey; Montgomery, Joel M.

2016-01-01

Background Invasive infections with non-typhoidal Salmonella (NTS) lead to bacteremia in children and adults and are an important cause of illness in Africa; however, few data on the burden of NTS bacteremia are available. We sought to determine the burden of invasive NTS disease in a rural and urban setting in Kenya. Methods We conducted the study in a population-based surveillance platform in a rural setting in western Kenya (Lwak), and an informal urban settlement in Nairobi (Kibera) from 2009 to 2014. We obtained blood culture specimens from participants presenting with acute lower respiratory tract illness, or acute febrile illness to a designated outpatient facility in each site, or any hospital admission for a potentially infectious cause (rural site only). Incidence was calculated using a defined catchment population and adjusting for specimen collection and healthcare seeking practices. Results A total of 12,683 and 9,524 blood cultures were analyzed from Lwak and Kibera, respectively. Of these, 428 (3.4%) and 533 (5.6%) grew a pathogen; among those 208 (48.6%) and 70 (13.1%) were positive for NTS in Lwak and Kibera, respectively. Overall, the adjusted incidence of invasive NTS disease was higher in Lwak (839.4 per 100,000 person-years observation [pyo]) compared with Kibera (202.5 per 100,000 pyo). The highest adjusted incidences were observed in children <5 years of age (Lwak 3,914.3 per 100,000 pyo and Kibera 997.9 per 100,000 pyo). In Lwak the highest adjusted annual incidence was 1,927.3 per 100,000 pyo (in 2010) and in Kibera 220.5 per 100,000 pyo (in 2011); the lowest incidences were 303.3 and 62.5 per 100,000 pyo respectively (in 2012). In both sites, invasive NTS disease incidence generally declined over the study period. Conclusion We observed an extremely high burden of invasive NTS disease in a rural area of Kenya and a lesser, but still substantial, burden in an urban slum. Although the incidences in both sites declined during the study period, invasive NTS infections remain an important cause of morbidity in these settings, particularly among children < 5 years old. PMID:26449945

Motivation and incentives of rural maternal and neonatal health care providers: a comparison of qualitative findings from Burkina Faso, Ghana and Tanzania

PubMed Central

2013-01-01

Background In Burkina Faso, Ghana and Tanzania strong efforts are being made to improve the quality of maternal and neonatal health (MNH) care. However, progress is impeded by challenges, especially in the area of human resources. All three countries are striving not only to scale up the number of available health staff, but also to improve performance by raising skill levels and enhancing provider motivation. Methods In-depth interviews were used to explore MNH provider views about motivation and incentives at primary care level in rural Burkina Faso, Ghana and Tanzania. Interviews were held with 25 MNH providers, 8 facility and district managers, and 2 policy-makers in each country. Results Across the three countries some differences were found in the reasons why people became health workers. Commitment to remaining a health worker was generally high. The readiness to remain at a rural facility was far less, although in all settings there were some providers that were willing to stay. In Burkina Faso it appeared to be particularly difficult to recruit female MNH providers to rural areas. There were indications that MNH providers in all the settings sometimes failed to treat their patients well. This was shown to be interlinked with differences in how the term ‘motivation’ was understood, and in the views held about remuneration and the status of rural health work. Job satisfaction was shown to be quite high, and was particularly linked to community appreciation. With some important exceptions, there was a strong level of agreement regarding the financial and non-financial incentives that were suggested by these providers, but there were clear country preferences as to whether incentives should be for individuals or teams. Conclusions Understandings of the terms and concepts pertaining to motivation differed between the three countries. The findings from Burkina Faso underline the importance of gender-sensitive health workforce planning. The training that all levels of MNH providers receive in professional ethics, and the way this is reinforced in practice require closer attention. The differences in the findings across the three settings underscore the importance of in-depth country-level research to tailor the development of incentives schemes. PMID:23617375

“Quality of prenatal and maternal care: bridging the know-do gap” (QUALMAT study): an electronic clinical decision support system for rural Sub-Saharan Africa

PubMed Central

2013-01-01

Background Despite strong efforts to improve maternal care, its quality remains deficient in many countries of Sub-Saharan Africa as persistently high maternal mortality rates testify. The QUALMAT study seeks to improve the performance and motivation of rural health workers and ultimately quality of primary maternal health care services in three African countries Burkina Faso, Ghana, and Tanzania. One major intervention is the introduction of a computerized Clinical Decision Support System (CDSS) for rural primary health care centers to be used by health care workers of different educational levels. Methods A stand-alone, java-based software, able to run on any standard hardware, was developed based on assessment of the health care situation in the involved countries. The software scope was defined and the final software was programmed under consideration of test experiences. Knowledge for the decision support derived from the World Health Organization (WHO) guideline “Pregnancy, Childbirth, Postpartum and Newborn Care; A Guide for Essential Practice”. Results The QUALMAT CDSS provides computerized guidance and clinical decision support for antenatal care, and care during delivery and up to 24 hours post delivery. The decision support is based on WHO guidelines and designed using three principles: (1) Guidance through routine actions in maternal and perinatal care, (2) integration of clinical data to detect situations of concern by algorithms, and (3) electronic tracking of peri- and postnatal activities. In addition, the tool facilitates patient management and is a source of training material. The implementation of the software, which is embedded in a set of interventions comprising the QUALMAT study, is subject to various research projects assessing and quantifying the impact of the CDSS on quality of care, the motivation of health care staff (users) and its health economic aspects. The software will also be assessed for its usability and acceptance, as well as for its influence on workflows in the rural setting of primary health care in the three countries involved. Conclusion The development and implementation of a CDSS in rural primary health care centres presents challenges, which may be overcome with careful planning and involvement of future users at an early stage. A tailored software with stable functionality should offer perspectives to improve maternal care in resource-poor settings. Trial registration http://www.clinicaltrials.gov/NCT01409824. PMID:23574764

Retainment incentives in three rural practice settings: variations in job satisfaction among staff registered nurses.

PubMed

Stratton, T D; Dunkin, J W; Juhl, N; Geller, J M

1995-05-01

Researchers have demonstrated repeatedly the importance of the relationship linking job satisfaction to employee retention. In rural areas of the country, where a persistent maldistribution of nurses continues to hamper health care delivery, the potential benefits of bolstering retention via enhancements in job satisfaction are of utmost utility to administrators and providers alike. Data were gathered from a multistate survey of registered nurses (RNs) practicing in rural hospitals, skilled nursing facilities, and community/public health settings (N = 1,647; response rate = 40.3%). The investigators found that the use of tuition reimbursement corresponded significantly with increased levels of job satisfaction among nurses in all three practice environments, as did day care services for nurses in acute care settings. Also, among hospital-based RNs, level of nursing education was found to be a significant factor in the relationship between tuition reimbursement and job satisfaction, with the highest level occurring among diploma-prepared nurses.

Utilising a collective case study system theory mixed methods approach: a rural health example

PubMed Central

2014-01-01

Background Insight into local health service provision in rural communities is limited in the literature. The dominant workforce focus in the rural health literature, while revealing issues of shortage of maldistribution, does not describe service provision in rural towns. Similarly aggregation of data tends to render local health service provision virtually invisible. This paper describes a methodology to explore specific aspects of rural health service provision with an initial focus on understanding rurality as it pertains to rural physiotherapy service provision. Method A system theory-case study heuristic combined with a sequential mixed methods approach to provide a framework for both quantitative and qualitative exploration across sites. Stakeholder perspectives were obtained through surveys and in depth interviews. The investigation site was a large area of one Australian state with a mix of rural, regional and remote communities. Results 39 surveys were received from 11 locations within the investigation site and 19 in depth interviews were conducted. Stakeholder perspectives of rurality and workforce numbers informed the development of six case types relevant to the exploration of rural physiotherapy service provision. Participant perspective of rurality often differed with the geographical classification of their location. The numbers of onsite colleagues and local access to health services contributed to participant perceptions of rurality. Conclusions The complexity of understanding the concept of rurality was revealed by interview participants when providing their perspectives about rural physiotherapy service provision. Dual measures, such as rurality and workforce numbers, provide more relevant differentiation of sites to explore specific services, such rural physiotherapy service provision, than single measure of rurality as defined by geographic classification. The system theory-case study heuristic supports both qualitative and quantitative exploration in rural health services research. PMID:25066241

"A Child Is Also a Teacher": Exploring the Potential for Children as Change Agents in the Context of a School-Based WASH Intervention in Rural Eastern Zambia

ERIC Educational Resources Information Center

Bresee, S.; Caruso, B. A.; Sales, J.; Lupele, J.; Freeman, M. C.

2016-01-01

As part of water, sanitation and hygiene interventions in low-income settings, it is frequently assumed that pupils can disseminate information and catalyze change at home, yet this assumption has not been rigorously assessed. We employed qualitative research methods in two phases to assess the potential for children to be change agents in five…

Prevalence of common mental disorders in mothers in the semiarid region of Alagoas and its relationship with nutritional status.

PubMed

Paffer, Adriana Toledo de; Ferreira, Haroldo da Silva; Cabral Júnior, Cyro Rego; Miranda, Claudio Torres de

2012-01-01

Compromised maternal mental health (MMH) is considered to be a risk factor for child malnutrition in low income areas. Psychosocial variables associated with MMH are potentially different between urban and rural environments. The aim here was to investigate whether associations existed between MMH and selected sociodemographic risk factors and whether specific to urban or rural settings. Cross-sectional study on a representative population sample of mothers from the semiarid region of Alagoas. Multistage sampling was used. The subjects were mothers of children aged up to 60 months. MMH was evaluated through the Self-Reporting Questionnaire-20. Mothers' nutritional status was assessed using the body mass index and waist circumference. Univariate analysis used odds ratios (OR) and chi-square. Logistic regression was performed separately for urban and rural subsamples using MMH as the dependent variable. The sample comprised 288 mothers. The prevalences of common mental disorders (CMD) in rural and urban areas were 56.2% and 43.8%, respectively (OR = 1.03; 95% CI: 0.64-1.63). In univariate analysis and logistic regression, the variable of education remained associated with MMH (OR = 2.2; 95% CI: 1.03-4.6) in urban areas. In rural areas, the variable of lack of partner remained associated (OR = 2.6; 95% CI: 1.01-6.7). The prevalence of CMD is high among mothers of children aged up to two years in the semiarid region of Alagoas. This seems to be associated with lower educational level in urban settings and lack of partner in rural settings.

Differentiating Countryside: Social Representations and Governance Patterns in Rural Areas with High Social Density--The Case of Chianti, Italy

ERIC Educational Resources Information Center

Brunori, Gianluca; Rossi, Adanella

2007-01-01

One of the key factors for the success of development strategies in rural areas is the setting up of appropriate governance patterns, whose main outcome is a fluid communication between public and private organisations and an effective integration of objectives and policies. Through a "post-rural" approach, this paper aims to analyse an…

In-Migration, Entrepreneurship and Rural-Urban Interdependencies: The Case of East Cleveland, North East England

ERIC Educational Resources Information Center

Kalantaridis, Christos

2010-01-01

In-migration is a key influence in the process of rural economic development in England, Continental Europe and the US. New arrivals are often viewed in the literature as contributors in new venture creation, as well as catalysts in enhancing rural-urban interdependencies in the countryside. This paper sets out to explore the validity of this view…

Barriers to and Suggestions for a Healthful, Active Lifestyle as Perceived by Rural and Urban Costa Rican Adolescents

ERIC Educational Resources Information Center

Monge-Rojas, Rafael; Garita-Arce, Carlos; Sanchez-Lopez, Marta; Colon-Ramos, Uriyoan

2009-01-01

Objective: To assess the perceptions of rural and urban Costa Rican adolescents regarding which barriers and motivators affect their adoption of an active lifestyle. Design: Data were collected in focus group discussions. Participants: 108 male and female adolescents aged 12 to 18 from the 7th to 11th grades. Setting: Two urban and 1 rural high…

Students with Severe to Profound Mental Handicaps and Multiple Disabilities in Rural Schools: Can Their Needs Be Met?

ERIC Educational Resources Information Center

Cates, Dennis L.; Kinnison, Lloyd

The education of students with severe to profound mental handicaps (SPH) or multiple disabilities may be greatly limited in rural settings. A survey investigating this issue in a southwestern state was completed by 136 of 346 directors of special education, 67 of whom worked in rural special education cooperatives. These cooperatives served 393…

Physician recruitment and retention in Manitoba: results from a survey of physicians' preferences for rural jobs.

PubMed

Witt, Julia

2017-01-01

Rural recruitment and retention continues to present challenges to health workforce planners. This paper reports and analyzes the results of a survey sent to physicians in Manitoba, eliciting their opinions regarding rural jobs. A survey was sent to all physicians in Manitoba. Part 1 of the survey included questions about background and demographic information; part 2 was a set of job satisfaction questions regarding respondents' current job; and part 3 included 2 sets of stated-choice questions eliciting preferences for a set of attributes relevant to rural recruitment and retention. Of the 2487 physicians who received surveys, 561 (22.6%) responded. Respondents indicated that income, hours worked and on-call frequency are very important: overall job satisfaction increased with income and decreased with hours worked. Income, hours and on-call frequency were ranked "very important" by the largest proportions of physicians. The estimated compensation for on-call more frequent than 1-in-4 was very high (82% of average income), and additional hours worked were worth $183 per hour. Other attributes that were important included professional interaction, housing availability and community incentives during the first year, which were valued at 11%-31% of annual income. Work-life balance is a key consideration for rural jobs, and there are incentives that can compensate for less desirable attributes.

Health worker performance in rural health organizations in low- and middle-income countries: do organizational factors predict non-task performance?

PubMed

Jayasuriya, Rohan; Jayasinghe, Upali W; Wang, Qian

2014-07-01

Health worker (HW) performance is a critical issue facing many low- and middle-income countries (LMICs). The aim of this study was to test the effects of factors in the work environment, such as organizational culture and climate, on HW non-task performance in rural health work settings in a LMIC. The data for the study is from a sample of 963 HWs from rural health centres (HCs) in 16 of the 20 provinces in Papua New Guinea. The reliability and validity of measures for organizational citizenship behaviour (OCB), counterproductive work behaviour (CWB) and work climate (WC) were tested. Multilevel linear regression models were used to test the relationship of individual and HC level factors with non-task performance. The survey found that 62 per cent of HCs practised OCB "often to always" and 5 percent practised CWB "often to always". Multilevel analysis revealed that WC had a positive effect on organizational citizenship behaviour (OCB) and a negative effect on CWB. The mediation analyses provided evidence that the relationship between WC and OCB was mediated through CWB. Human resource policies that improve WC in rural health settings would increase positive non-task behaviour and improve the motivation and performance of HWs in rural settings in LMICs. Copyright © 2014 Elsevier Ltd. All rights reserved.

Understanding the Use of Rural Space: The Need for Multi-Methods

ERIC Educational Resources Information Center

Madsen, Lene M.; Adriansen, Hanne Kirstine

2004-01-01

Although the late 1990s saw increasing use of qualitative data in rural studies and a turn towards issues such as identities and the construction of rurality, many rural researchers still rely on a range of different methods and use both qualitative and quantitative data. However, the challenge of combining quantitative and qualitative data and…

Risk aversion and willingness to pay for water quality: The case of non-farm rural residents.

PubMed

Larue, Bruno; West, Gale E; Singbo, Alphonse; Tamini, Lota Dabio

2017-07-15

Stated choice experiments are used to investigate the economic valuation of rural residents living in the province of Quebec for water quality improvements. In Quebec, rural residents played an important role in the setting of stricter environmental regulations. Unlike most stated choice experiments about the valuation of improvements in water quality, this study explicitly accounts for risk in the design and analysis of choice experiments. Risk in phosphorus and coliform reductions is introduced through a three-point uniform distribution in the choice sets. The results show greater support for constant absolute risk aversion preferences than for constant relative risk aversion. Rural residents value coliform and phosphorus reductions and the more educated ones are particularly willing to see the government tax farmers and taxpayers to secure such reductions. As the science improves and risk in water quality outcomes decrease and as the political weight of non-farm rural residents increase, it should be easier for governments to replace voluntary cost-share programs by polluter-payer programs. Copyright © 2017 Elsevier Ltd. All rights reserved.

Recruitment of rural healthcare professionals for live continuing education.

PubMed

Holuby, Ronnie Scott; Pellegrin, Karen L; Barbato, Anna; Ciarleglio, Anita

2015-01-01

Introduction The availability of rural healthcare is a growing concern in the United States as fewer healthcare providers choose to work in rural areas. Accessing quality continuing education (CE) for rural healthcare practitioners (HCPs) remains a challenge and may pose a barrier to quality care. Methods To maximize attendance at a live, in-person, free CE program focusing on geriatric medication and issues specifically targeted to HCPs in rural areas, two methods were implemented sequentially. The first method used formal advertising implemented by a professional marketing service to promote CE events. The second method enlisted local healthcare organizations and physician groups to promote the CE event to their employees. Cost per attendee was calculated for comparison. Results Professional marketing services recruited 31 HCPs (March 2011) and resulted in a per-participant recruitment cost of US$428.62. Local healthcare organizations and physician groups' marketing recruited 48 HCPs (July-August 2011) and resulted in a per-participant recruitment cost of US$55.19. Discussion Providing free CE coordinated through local healthcare organizations and physician groups was the most cost-effective method of recruiting rural HCPs for CE. Formal advertising added cost without increasing the number of participants per event. Although this is the first study of the cost-effectiveness of recruitment methods targeting HCPs in rural areas, results are consistent with research on cost-effectiveness of outreach to rural lay community members.

Mobile crisis management teams as part of an effective crisis management system for rural communities.

PubMed

Trantham, Doug; Sherry, Anne

2012-01-01

Mobile crisis management teams provide crisis prevention and intervention services in community settings. The Appalachian Community Services crisis management program shows how such teams can be used to effectively serve rural communities.

Children's height and weight in rural and urban populations in low-income and middle-income countries: a systematic analysis of population-representative data

PubMed Central

Paciorek, Christopher J; Stevens, Gretchen A; Finucane, Mariel M; Ezzati, Majid

2013-01-01

Summary Background Urban living affects children's nutrition and growth, which are determinants of their survival, cognitive development, and lifelong health. Little is known about urban–rural differences in children's height and weight, and how these differences have changed over time. We aimed to investigate trends in children's height and weight in rural and urban settings in low-income and middle-income countries, and to assess changes in the urban–rural differentials in height and weight over time. Methods We used comprehensive population-based data and a Bayesian hierarchical mixture model to estimate trends in children's height-for-age and weight-for-age Z scores by rural and urban place of residence, and changes in urban–rural differentials in height and weight Z scores, for 141 low-income and middle-income countries between 1985 and 2011. We also estimated the contribution of changes in rural and urban height and weight, and that of urbanisation, to the regional trends in these outcomes. Findings Urban children are taller and heavier than their rural counterparts in almost all low-income and middle-income countries. The urban–rural differential is largest in Andean and central Latin America (eg, Peru, Honduras, Bolivia, and Guatemala); in some African countries such as Niger, Burundi, and Burkina Faso; and in Vietnam and China. It is smallest in southern and tropical Latin America (eg, Chile and Brazil). Urban children in China, Chile, and Jamaica are the tallest in low-income and middle-income countries, and children in rural areas of Burundi, Guatemala, and Niger the shortest, with the tallest and shortest more than 10 cm apart at age 5 years. The heaviest children live in cities in Georgia, Chile, and China, and the most underweight in rural areas of Timor-Leste, India, Niger, and Bangladesh. Between 1985 and 2011, the urban advantage in height fell in southern and tropical Latin America and south Asia, but changed little or not at all in most other regions. The urban–rural weight differential also decreased in southern and tropical Latin America, but increased in east and southeast Asia and worldwide, because weight gain of urban children outpaced that of rural children. Interpretation Further improvement of child nutrition will require improved access to a stable and affordable food supply and health care for both rural and urban children, and closing of the the urban–rural gap in nutritional status. Funding Bill & Melinda Gates Foundation, Grand Challenges Canada, UK Medical Research Council. PMID:25104494

Living with breast cancer: the influence of rurality on women's suffering and resilience. a postmodern feminist inquiry.

PubMed

Rogers-Clark, Cath

This paper focuses on rural living as a dimension of women's experiences of living through breast cancer. The findings presented emanate from a feminist narrative research project that examined the experiences of rural women from south-west Queensland who were long-term survivors of breast cancer. This project aimed to listen, report and interpret rural women's stories of resilience in surviving breast cancer and moving on with their lives. The participants reported that there were both positive and negative aspects of living in a rural setting, especially when ill. Eight of the nine participants, however, felt strongly that the positive aspects of rural living outweighed the difficulties. This suggests that rurality in the context of health and illness must be considered as a multifaceted dimension, with resources to support cancer survivors building on the existing strengths in rural communities.

Associations between gestational anthropometry, maternal HIV, and fetal and early infancy growth in a prospective rural/semi-rural Tanzanian cohort, 2012-13.

PubMed

Wilkinson, Amanda L; Pedersen, Sarah H; Urassa, Mark; Michael, Denna; Todd, Jim; Kinung'hi, Safari; Changalucha, John; McDermid, Joann M

2015-10-29

Healthcare access and resources differ considerably between urban and rural settings making cross-setting generalizations difficult. In resource-restricted rural/semi-rural environments, identification of feasible screening tools is a priority. The objective of this study was to evaluate gestational anthropometry in relation to birth and infant growth in a rural/semi-rural Tanzanian prospective cohort of mothers and their infants. Mothers (n = 114: 44 HIV-positive) attending antenatal clinic visits were recruited in their second or third trimester between March and November, 2012, and followed with their infants through 6-months post-partum. Demographic, clinical, and infant feeding data were obtained using questionnaires administered by a Swahili-speaking research nurse on demographic, socioeconomic, clinical, and infant feeding practices. Second or third trimester anthropometry (mid-upper arm circumference [MUAC], triceps skinfold thickness, weight, height), pregnancy outcomes, birth (weight, length, head circumference) and infant anthropometry (weight-for-age z-score [WAZ], length-for-age z-score [LAZ]) were obtained. Linear regression and mixed effect modeling were used to evaluate gestational factors in relation to pregnancy and infant outcomes. Gestational MUAC and maternal HIV status (HIV-positive mothers = 39%) were associated with infant WAZ and LAZ from birth to 6-months in multivariate models, even after adjustment for infant feeding practices. The lowest gestational MUAC tertile was associated with lower WAZ throughout early infancy, as well as lower LAZ at 3 and 6-months. In linear mixed effects models through 6-months, each 1 cm increase in gestational MUAC was associated with a 0.11 increase in both WAZ (P < 0.001) and LAZ (P = 0.001). Infant HIV-exposure was negatively associated with WAZ (β = -0.65, P < 0.001) and LAZ (β = -0.49, P < 0.012) from birth to 6-months. Lower gestational MUAC, evaluated using only a tape measure and minimal training that is feasible in non-urban clinic and community settings, was associated with lower infant anthropometric measurements. In this rural and semi-rural setting, HIV-exposure was associated with poorer anthropometry through 6-months despite maternal antiretroviral access. Routine assessment of MUAC has the potential to identify at-risk women in need of additional health interventions designed to optimize pregnancy outcomes and infant growth. Further research is needed to establish gestational MUAC reference ranges and to define interventions that successfully improve MUAC during pregnancy.

Expanding health insurance to increase health care utilization: will it have different effects in rural vs. urban areas?

PubMed

Erlyana, Erlyana; Damrongplasit, Kannika Kampanya; Melnick, Glenn

2011-05-01

This study investigates the importance of medical fee and distance to health care provider on individual's decision to seek care in developing countries. The estimation method used a mixed logit model applied to data from the third wave of the Indonesian family life survey (2000). The key variables of interest include medical fee and distance to different types of health care provider and individual characteristic variables. Urban dweller's decision to choose health care providers are sensitive to the monetary cost of medical care as measured by medical fee but they are not sensitive to distance. For those who reside in rural area, they are sensitive to the non-medical component cost of care as measured by travel distance but they are not sensitive to medical fee. As a result of those findings, policy makers should consider different sets of policy instruments when attempting to expand health service's usage in urban and rural areas of Indonesia. To increase access in urban areas, we recommend expansion of health insurance coverage in order to lower out-of-pocket medical expenditures. As for rural areas, expansion of medical infrastructures to reduce commuting distance and costs will be needed to increase utilization. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Seniors' Recreation Centers in Rural India: Need of the Hour

PubMed Central

Paul, Sherin Susan; Ramamurthy, Prashant Hanumanthappa; Kumar, Rakesh; Ashirvatham, Mathew; John, Kamala Russel; Isaac, Rita

2016-01-01

Aim: To empower and bring the underprivileged senior citizens in the rural areas to the mainstream of life through setting up of model “senior citizens' recreation centers” that can be replicated in the other parts of the country. Materials and Methods: Six senior citizens' recreation centers are run in six villages under a community health program of a leading Medical College in South India, which were started by looking into their perceived needs and in a location where organized self-help women groups (SHGs) showed willingness to take the role of caretakers. Together there are 140 members in 6 centers and the most deserving members were identified using a participatory rural appraisal (PRA) method. These centers are open for 5 days a week and the main attraction of the center has been provision of one good, wholesome, noon-meal a day, apart from several recreational activities. The members were also assessed for chronic energy deficiency (CED) and quality of life at the beginning of enrolment using body mass index (BMI) and WHO-BREF scale. Results: The attendance to these centers was nearly 90% of the enrolled beneficiaries. A statistically significant improvement was noticed in quality of life in the physical, psychological, social, and environmental domain (P < 0.05). There was also a significant increase in the average BMI after 1 year of the intervention (P < 0.05). Conclusion: Care of underprivileged senior citizens is a growing need in the rural areas and the “Recreation centers” proved to be a beneficial model that can be easily replicated. PMID:27385876

Rural Palliative Care in North India: Rapid Evaluation of a Program Using a Realist Mixed Method Approach.

PubMed

Munday, Daniel F; Haraldsdottir, Erna; Manak, Manju; Thyle, Ann; Ratcliff, Cathy M

2018-01-01

Palliative care has not developed widely in rural North India. Since 2010, the Emmanuel Hospitals Association (EHA) has been developing a model of palliative care appropriate for this setting, based on teams undertaking home visits with the backup of outpatient and inpatient services. A project to further develop the model operated from 2012 to 2015 supported by funding from the UK. This study aims to evaluate the EHA palliative care project. Rapid evaluation method using a mixed method realist approach at the five project hospital sites. An overview of the project was obtained by analyzing project documents and key informant interviews. Questionnaire data from each hospital were collected, followed by interviews with staff, patients, and relatives and observations of home visits and other activities at each site. Descriptive analysis of quantitative and thematic analysis of qualitative data was undertaken. Each site was measured against the Indian Minimum Standards Tool for Palliative Care (IMSTPC). Each team followed the EHA model, with local modifications. Services were nurse led with medical support. Eighty percent of patients had cancer. Staff demonstrated good palliative care skills and patients and families appreciated the care. Most essential IMSTPC markers were achieved but morphine licenses were available to only two teams. Remarkable synergy was emerging between palliative care and community health. Hospitals planned to fund palliative care through income from surgical services. Excellent palliative care appropriate for rural north India is delivered through the EHA model. It could be extended to other similar sites.

A pilot program of knowledge translation and implementation for newborn resuscitation using US Peace Corps Volunteers in rural Madagascar.

PubMed

Close, Kristin; Karel, Michele; White, Michelle

2016-11-16

Prevention of adverse perinatal outcome using the Helping Babies Breathe (HBB) neonatal resuscitation algorithm can reduce perinatal mortality in low income settings. Mercy Ships is a non-governmental organisation providing free healthcare education in sub-Saharan Africa and in an attempt to reach more rural areas of Madagascar with our neonatal resuscitation training we designed a novel approach in collaboration with US Peace Corps Volunteers (PCV). PCVs work in rural areas and contribute to locally determined public health initiatives. We used a model of knowledge translation and implementation to train non-medical PCVs in HBB who would then train rural healthcare workers. Bulb suction and a self-inflating bag were donated to each health centre. We evaluated knowledge translation and behaviour change at 4 months using the Kirkpatrick model of evaluation. Ten PCVs received training and then trained 42 healthcare workers in 10 rural health centres serving a combined population of over 1 million. Both PCVs and rural healthcare workers showed significant increases in knowledge and skills (p < 0.001). The commonest behaviour changes persisting at 4 months were adequate preparation before delivery; use of rubbing and drying as a means of stimulation instead of foot tapping or back slapping; and use of the self-inflating bag to give respirations. Anecdotal evidence of changes in neonatal outcome were reported in several health care centres. Our study demonstrates that non-medically trained PCVs can be used to successfully train rural healthcare workers in newborn resuscitation using the HBB algorithm and this results in improvements in personal and organizational practice at 4 months, including anecdotal evidence of improved patient outcome. Our novel method of training, including the provision of essential equipment, may be another tool in the armamentarium of those seeking to disseminate good practice to the most rural areas.

Obesity risk in rural, urban and rural-to-urban migrants: prospective results of the PERU MIGRANT study

PubMed Central

Carrillo-Larco, R M; Bernabé-Ortiz, A; Pillay, T D; Gilman, R H; Sanchez, J F; Poterico, J A; Quispe, R; Smeeth, L; Miranda, J J

2016-01-01

Background: Although migration and urbanization have been linked with higher obesity rates, especially in low-resource settings, prospective information about the magnitude of these effects is lacking. We estimated the risk of obesity and central obesity among rural subjects, rural-to-urban migrants and urban subjects. Methods: Prospective data from the PERU MIGRANT Study were analyzed. Baseline data were collected in 2007–2008 and participants re-contacted in 2012–2013. At follow-up, outcomes were obesity and central obesity measured by body mass index and waist circumference. At baseline, the primary exposure was demographic group: rural, rural-to-urban migrant and urban. Other exposures included an assets index and educational attainment. Cumulative incidence, incidence ratio (IR) and 95% confidence intervals (95% CI) for obesity and central obesity were estimated with Poisson regression models. Results: At baseline, mean age (±s.d.) was 47.9 (±12.0) years, and 53.0% were females. Rural subjects comprised 20.2% of the total sample, whereas 59.7% were rural-to-urban migrants and 20.1% were urban dwellers. A total of 3598 and 2174 person-years were analyzed for obesity and central obesity outcomes, respectively. At baseline, the prevalence of obesity and central obesity was 20.0 and 52.5%. In multivariable models, migrant and urban groups had an 8- to 9.5-fold higher IR of obesity compared with the rural group (IR migrants=8.19, 95% CI=2.72–24.67; IR urban=9.51, 95% CI=2.74–33.01). For central obesity, there was a higher IR only among the migrant group (IR=1.95; 95% CI=1.22–3.13). Assets index was associated with a higher IR of central obesity (IR top versus bottom tertile 1.45, 95% CI=1.03–2.06). Conclusions: Peruvian urban individuals and rural-to-urban migrants show a higher incidence of obesity compared with their rural counterparts. Given the ongoing urbanization occurring in middle-income countries, the rapid development of increased obesity risk by rural-to-urban migrants suggests that measures to reduce obesity should be a priority for this group. PMID:26228458

Community perspectives on roles and responsibilities for strengthening primary health care in rural Ethiopia.

PubMed

Curry, Leslie A; Alpern, Rachelle; Webster, Tashonna R; Byam, Patrick; Zerihun, Abraham; Tarakeshwar, Nalini; Cherlin, Emily J; Bradley, Elizabeth H

2012-01-01

Government-community partnerships are central to developing effective, sustainable models of primary health care in low-income countries; however, evidence about the nature of partnerships lacks the perspective of community members. Our objective was to characterise community perspectives regarding the respective roles and responsibilities of government and the community in efforts to strengthen primary health care in low-income settings. We conducted a qualitative study using focus groups (n=14 groups in each of seven primary health care units in Amhara and Oromia, Ethiopia, with a total of 140 participants) in the context of the Ethiopian Millennium Rural Initiative. Results indicated that community members defined important roles and responsibilities for both communities and governments. Community roles included promoting recommended health behaviours; influencing social norms regarding health; and contributing resources as feasible. Government roles included implementing oversight of health centres; providing human resources, infrastructure, equipment, medication and supplies; and demonstrating support for community health workers, who are seen as central to the rural health system. Renewed efforts in health system strengthening highlight the importance of community participation in initiatives to improve primary health care in rural settings. Community perspectives provide critical insights to defining, implementing and sustaining partnerships in these settings.

Fecal contamination of food, water, hands, and kitchen utensils at the household level in rural areas of Peru.

PubMed

Gil, Ana I; Lanata, Claudio F; Hartinger, Stella M; Mäusezahl, Daniel; Padilla, Beatriz; Ochoa, Theresa J; Lozada, Michelle; Pineda, Ines; Verastegui, Hector

2014-01-01

The study described in this article evaluated sources of contamination of children's food and drinking water in rural households in the highlands of Peru. Samples from children's meals, drinking water, kitchen utensils, and caregivers' and children's hands were analyzed for total coliforms and E. coli counts using Petrifilm EC. Thermotolerant coliforms in water were measured using DelAgua test kits while diarrheagenic E. coli was identified using polymerase chain reaction methods (PCR). Thermotolerant coliforms were found in 48% of all water samples. E. coli was found on 23% of hands, 16% of utensils, and 4% of meals. Kitchen cloths were the item most frequently contaminated with total coliforms (89%) and E. coli (42%). Diarrheagenic E. coli was found in 33% of drinking water, 27% of meals, and on 23% of kitchen utensils. These findings indicate a need to develop hygiene interventions that focus on specific kitchen utensils and hand washing practices, to reduce the contamination of food, water, and the kitchen environment in these rural settings.

EARLY CHILDHOOD MENTAL HEALTH CONSULTATION: AN EVALUATION OF EFFECTIVENESS IN A RURAL COMMUNITY.

PubMed

Vuyk, M Alexandra; Sprague-Jones, Jessica; Reed, Christie

2016-01-01

Little research has been done to evaluate the effectiveness of early childhood mental health consultation (ECMHC) in rural, applied settings. In this mixed-methods study, we evaluated an approach to ECMHC used in rural Southwest Kansas with individualized services for childcare providers. Twenty-nine home-based and center-based childcare providers completed measures on provider growth, perceptions of child outcomes, and satisfaction with sessions. In total, 162 data points were collected and analyzed using multilevel growth models. In addition, 16 providers participated in qualitative interviews. Both home-based and center-based providers reported very high satisfaction with consultation sessions which increased with time, although home-based providers showed significantly higher satisfaction than did center-based providers. Provider growth, encompassing personal well-being, scheduling and transitions, connections with parents, and positive discipline strategies increased significantly over time. Child outcomes, encompassing prosocial behavior, resilience, and overall well-being also improved significantly in providers' perception. ECMHC as conducted in Southwest Kansas appears to have a positive effect on childcare providers and the children in their care. © 2015 Michigan Association for Infant Mental Health.

7 CFR 1925.3 - Servicing taxes.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, RURAL BUSINESS-COOPERATIVE... the Government's security interests. Any unusual situations that may arise with respect to tax... through routine servicing of loans by emphasizing the advantages of setting aside sufficient income to...

Sex Education in Rural Churches.

ERIC Educational Resources Information Center

Isberner, Fred R.; And Others

1990-01-01

Describes Open Communication Teens or Parents Understanding Sexuality (OCTOPUS), rural teenage pregnancy prevention program. Program presented in religious setting to improve sexual attitudes and parent-child communication. Finds that participants generally gained in knowledge and self-assessment, but teenagers showed no improvement in attitude…

The Eco-Behavioral Approach to Surveys and Social Accounts for Rural Communities: Exploratory Analyses and Interpretations of Roger G. Barker's Microdata from the Behavior Setting Survey of Midwest, Kansas in 1963-64.

ERIC Educational Resources Information Center

Fox, Karl A.

The concept of behavior settings--the environments shaping individual behavior--was originated by Roger Barker in 1950 in connection with his community surveys in a small Kansas town, code-named Midwest. This book seeks to provide rural social scientists with an understanding of Barker's eco-behavioral approach and proposed adaptations of it to…

Treatment-seeking behaviour, cost burdens and coping strategies among rural and urban households in Coastal Kenya: an equity analysis.

PubMed

Chuma, Jane; Gilson, Lucy; Molyneux, Catherine

2007-05-01

Ill-health can inflict costs on households directly through spending on treatment and indirectly through impacting on labour productivity. The financial burden can be high and, for poor households, contributes significantly to declining welfare. We investigated socio-economic inequities in self-reported illnesses, treatment-seeking behaviour, cost burdens and coping strategies in a rural and urban setting along the Kenyan coast. We conducted a survey of 294 rural and 576 urban households, 9 FGDs and 9 in-depth interviews in each setting. Key findings were significantly higher levels of reported chronic and acute conditions in the rural setting, differences in treatment-seeking patterns by socio-economic status (SES) and by setting, and regressive cost burdens in both areas. These data suggest the need for greater governmental and non-governmental efforts towards protecting the poor from catastrophic illness cost burdens. Promising health sector options are elimination of user fees, at least in targeted hardship areas, developing more flexible charging systems, and improving quality of care in all facilities. The data also strongly support the need for a multi-sectoral approach to protecting households. Potential interventions beyond the health sector include supporting the social networks that are key to household livelihood strategies and promoting micro-finance schemes that enable small amounts of credit to be accessed with minimal interest rates.