WorldWideScience

Sample records for rural access program

  1. Pediatric Diabetes Telemedicine Program Improves Access to Care for Rural Families: Role of APRNs.

    Science.gov (United States)

    Smith, Nancy Marie; Satyshur, Rosemarie DiMauro

    2016-01-01

    Type 1 diabetes mellitus has increased in children by 23% from 2001 to 2009. Rural communities additionally have increased disparities related to access barriers and a large minority population with poorer overall health. Research evidence supports telemedicine as an effective alternative to bring preventive diabetes care to remote areas. This article presents an overview of the leadership role of advanced practice registered nurses (APRNs) with the implementation and evaluation of a pediatric diabetes telemedicine program at a rural pediatric outpatient specialty clinic in partnership with a tertiary center telemedicine network. The telemedicine program quality improvement (QI) project explored caregiver satisfaction with a convenience sample of caregivers (N = 14) using a nine-item Telemedicine Diabetes Caregiver Satisfaction Survey (TDCSS), with responses ranging from 1 = strongly disagree to 5 = strongly agree. Findings indicate caregivers were highly satisfied with communication/ privacy (M = 4.8), access to care (M = 4.1), and quality of services (M = 5.0). The multidisciplinary collaborative teamwork, continuous QI, and dependable technology were integral to the quality of the telemedicine clinical initiative. APRNs provided technology expertise, interdisciplinary collaboration leadership, care coordination, and advocacy for policy changes. Results demonstrate that telemedicine and APRN leadership can help implement innovative programs into rural communities to improve access to care, healthcare cost, and outcomes.

  2. State-level employment, accessibility and rurality

    Directory of Open Access Journals (Sweden)

    Casey Abington

    2014-09-01

    Full Text Available Employment and economic growth in rural areas as a policy issue has been recently highlighted by the federal government. In August 2011, the White House released a report entitled “Jobs and Economic Security for Rural America”. While the document listed various programs and policies that have reportedly benefited rural America, it also stated that rural communities are still facing many challenges. For example, many rural communities have lower incomes and higher poverty rates than more urban areas. One possible reason for rural communities being at a disadvantage compared to urban areas involves transportation, especially in terms of journey to work. Thus, one can ask how employment rates vary with accessibility, as measured by journey to work times, as well as location (rural versus urban. Using 2007 state level data, OLS analysis is used to examine the relationship between employment rates and journey to work times and rurality. The analysis confirms that employment rates decrease with increased journey to work times. However, measures of rurality were only marginally significant and the negative coefficient on each measure indicates that employment rates decrease with greater urbanization. Improving accessibility between (very rural and larger areas might improve employment opportunities. Although weighing the benefits of such (reduced unemployment against the costs of providing better highways or public transit might lead to a different conclusion.

  3. Modern energy access to all in rural India: An integrated implementation strategy

    International Nuclear Information System (INIS)

    Balachandra, P.

    2011-01-01

    Expanding energy access to the rural population of India presents a critical challenge for its government. The presence of 364 million people without access to electricity and 726 million who rely on biomass for cooking indicate both the failure of past policies and programs, and the need for a radical redesign of the current system. We propose an integrated implementation framework with recommendations for adopting business principles with innovative institutional, regulatory, financing and delivery mechanisms. The framework entails establishment of rural energy access authorities and energy access funds, both at the national and regional levels, to be empowered with enabling regulatory policies, capital resources and the support of multi-stakeholder partnership. These institutions are expected to design, lead, manage and monitor the rural energy interventions. At the other end, trained entrepreneurs would be expected to establish bioenergy-based micro-enterprises that will produce and distribute energy carriers to rural households at an affordable cost. The ESCOs will function as intermediaries between these enterprises and the international carbon market both in aggregating carbon credits and in trading them under CDM. If implemented, such a program could address the challenges of rural energy empowerment by creating access to modern energy carriers and climate change mitigation. - Highlights: ► Expanding rural energy access in India is critical with majority lacking access to modern energy. ► Innovative and integrated implementation strategy for achieving universal rural energy access. ► Design of an integrated rural energy policy and proposal for new institutional mechanism. ► Establishing rural energy access authorities and energy access funds as supporting mechanisms. ► Bioenergy-based micro-enterprises for delivering energy services at an affordable cost.

  4. The financial performance of rural hospitals and implications for elimination of the Critical Access Hospital program.

    Science.gov (United States)

    Holmes, George M; Pink, George H; Friedman, Sarah A

    2013-01-01

    To compare the financial performance of rural hospitals with Medicare payment provisions to those paid under prospective payment and to estimate the financial consequences of elimination of the Critical Access Hospital (CAH) program. Financial data for 2004-2010 were collected from the Healthcare Cost Reporting Information System (HCRIS) for rural hospitals. HCRIS data were used to calculate measures of the profitability, liquidity, capital structure, and financial strength of rural hospitals. Linear mixed models accounted for the method of Medicare reimbursement, time trends, hospital, and market characteristics. Simulations were used to estimate profitability of CAHs if they reverted to prospective payment. CAHs generally had lower unadjusted financial performance than other types of rural hospitals, but after adjustment for hospital characteristics, CAHs had generally higher financial performance. Special payment provisions by Medicare to rural hospitals are important determinants of financial performance. In particular, the financial condition of CAHs would be worse if they were paid under prospective payment. © 2012 National Rural Health Association.

  5. Assessing Program Efficiency: A Time and Motion Study of the Mental Health Emergency Care — Rural Access Program in NSW Australia

    Directory of Open Access Journals (Sweden)

    Emily Saurman

    2014-07-01

    Full Text Available The Mental Health Emergency Care-Rural Access Program (MHEC-RAP is a telehealth solution providing specialist emergency mental health care to rural and remote communities across western NSW, Australia. This is the first time and motion (T&M study to examine program efficiency and capacity for a telepsychiatry program. Clinical services are an integral aspect of the program accounting for 6% of all activities and 50% of the time spent conducting program activities, but half of this time is spent completing clinical paperwork. This finding emphasizes the importance of these services to program efficiency and the need to address variability of service provision to impact capacity. Currently, there is no efficiency benchmark for emergency telepsychiatry programs. Findings suggest that MHEC-RAP could increase its activity without affecting program responsiveness. T&M studies not only determine activity and time expenditure, but have a wider application assessing program efficiency by understanding, defining, and calculating capacity. T&M studies can inform future program development of MHEC-RAP and similar telehealth programs, both in Australia and overseas.

  6. Characterizing Rural Food Access in Remote Areas.

    Science.gov (United States)

    Bardenhagen, Chris J; Pinard, Courtney A; Pirog, Rich; Yaroch, Amy Lazarus

    2017-10-01

    Residents of rural areas may have limited access to healthy foods, leading to higher incidence of diet related health issues. Smaller grocers in rural areas experience challenges in maintaining fresh produce and other healthy foods available for customers. This study assessed the rural food environment in northeast Lower Michigan in order to inform healthy food financing projects such as the Michigan Good Food Fund. The area's retail food businesses were categorized using secondary licensing, business, and nutrition program databases. Twenty of these stores were visited in person to verify the validity of the categories created, and to assess the availability of healthy foods in their aisles. In-depth interviews with key informants were carried out with store owners, economic development personnel, and other food system stakeholders having knowledge about food access, in order to learn more about the specific challenges that the area faces. Out-shopping, seasonality, and economic challenges were found to affect healthy food availability. Mid-sized independent stores were generally found to have a larger selection of healthy foods, but smaller rural groceries also have potential to provide fresh produce and increase food access. Potential healthy food financing projects are described and areas in need of further research are identified.

  7. Urban-Rural Differences in School Nurses' Asthma Training Needs and Access to Asthma Resources.

    Science.gov (United States)

    Carpenter, Delesha M; Estrada, Robin Dawson; Roberts, Courtney A; Elio, Alice; Prendergast, Melissa; Durbin, Kathy; Jones, Graceann Clyburn; North, Steve

    Few studies have examined school nurses preferences' for asthma training. Our purpose was to: 1) assess school nurses' perceived asthma training needs, 2) describe nurses' access to asthma educational resources, and 3) identify urban-rural differences in training needs and access to resources in southern states. A convenience sample of school nurses (n=162) from seven counties (two urban and five rural) in North Carolina and South Carolina completed an online, anonymous survey. Chi-square tests were used to examine urban-rural differences. Although most nurses (64%) had received asthma training within the last five years, urban nurses were more likely to have had asthma training than rural nurses (χ 2 =10.84, p=0.001). A majority of nurses (87%) indicated they would like to receive additional asthma training. Approximately half (45%) of nurses reported access to age-appropriate asthma education materials, but only 16% reported that their schools implemented asthma education programs. Urban nurses were more likely than rural nurses to have access to asthma education programs (χ 2 =4.10, p=0.04) and age-appropriate asthma education materials (χ 2 =8.86, p=0.003). Few schools are implementing asthma education programs. Rural nurses may be disadvantaged in terms of receiving asthma training and having access to asthma education programs and materials. Schools are an ideal setting for delivering age-appropriate asthma education. By providing school nurses with access to age-appropriate asthma education resources and additional asthma training, we can help them overcome several of the barriers that impede their ability to deliver asthma care to their students. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    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.

  9. Exposing some important barriers to health care access in the rural USA.

    Science.gov (United States)

    Douthit, N; Kiv, S; Dwolatzky, T; Biswas, S

    2015-06-01

    To review research published before and after the passage of the Patient Protection and Affordable Care Act (2010) examining barriers in seeking or accessing health care in rural populations in the USA. This literature review was based on a comprehensive search for all literature researching rural health care provision and access in the USA. Pubmed, Proquest Allied Nursing and Health Literature, National Rural Health Association (NRHA) Resource Center and Google Scholar databases were searched using the Medical Subject Headings (MeSH) 'Rural Health Services' and 'Rural Health.' MeSH subtitle headings used were 'USA,' 'utilization,' 'trends' and 'supply and distribution.' Keywords added to the search parameters were 'access,' 'rural' and 'health care.' Searches in Google Scholar employed the phrases 'health care disparities in the USA,' inequalities in 'health care in the USA,' 'health care in rural USA' and 'access to health care in rural USA.' After eliminating non-relevant articles, 34 articles were included. Significant differences in health care access between rural and urban areas exist. Reluctance to seek health care in rural areas was based on cultural and financial constraints, often compounded by a scarcity of services, a lack of trained physicians, insufficient public transport, and poor availability of broadband internet services. Rural residents were found to have poorer health, with rural areas having difficulty in attracting and retaining physicians, and maintaining health services on a par with their urban counterparts. Rural and urban health care disparities require an ongoing program of reform with the aim to improve the provision of services, promote recruitment, training and career development of rural health care professionals, increase comprehensive health insurance coverage and engage rural residents and healthcare providers in health promotion. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights

  10. Perceived ease of access to alcohol, tobacco and other substances in rural and urban US students.

    Science.gov (United States)

    Warren, Jacob C; Smalley, K Bryant; Barefoot, K Nikki

    2015-01-01

    Ease of access to substances has been shown to have a direct and significant relationship with substance use for school-aged children. Previous research involving rural samples of middle and high school students reveals that perceived ease of access to substances is a significant predictor of recent use among rural adolescents; however, it is unclear if perceived access to substances varies between rural and urban areas. The purpose of the present study was to examine rural-urban differences in perceived ease of access to alcohol, smoking and chewing tobacco, marijuana, and seven other substances in the US state of Georgia in order to better inform and promote future substance use prevention and programming efforts in rural areas. Data were analyzed from the 2013 Georgia Student Health Survey II, administered in all public and interested private/charter schools in the state of Georgia. A total of 513 909 students (18.2% rural) indicated their perceived ease of access to 11 substances on a four-point Likert-type scale. Rural-urban differences were investigated using χ2 analysis. In general, it appeared the rural-urban differences fell along legal/illicit lines. For middle school students, a significant difference in perceived ease of access was found for each substance, with rural students reporting greater access to smoking tobacco, chewing tobacco, and steroids, and urban students reporting greater access to alcohol, marijuana, cocaine, inhalants, ecstasy, methamphetamine, hallucinogens, and prescription drugs. Rural high school students reported higher access to alcohol, smoking tobacco, chewing tobacco, and steroids, with urban students reporting higher access to marijuana, cocaine, inhalants, ecstasy, and hallucinogens. Perceptions of ease of access more than doubled for each substance in both geographies between middle and high school. The present study found multiple and fairly consistent differences between rural and urban students' perceived ease of access

  11. Rural-Urban Differences in Access to Preventive Health Care Among Publicly Insured Minnesotans.

    Science.gov (United States)

    Loftus, John; Allen, Elizabeth M; Call, Kathleen Thiede; Everson-Rose, Susan A

    2018-02-01

    Reduced access to care and barriers have been shown in rural populations and in publicly insured populations. Barriers limiting health care access in publicly insured populations living in rural areas are not understood. This study investigates rural-urban differences in system-, provider-, and individual-level barriers and access to preventive care among adults and children enrolled in a public insurance program in Minnesota. This was a secondary analysis of a 2008 statewide, cross-sectional survey of publicly insured adults and children (n = 4,388) investigating barriers associated with low utilization of preventive care. Sampling was stratified with oversampling of racial/ethnic minorities. Rural enrollees were more likely to report no past year preventive care compared to urban enrollees. However, this difference was no longer statistically significant after controlling for demographic and socioeconomic factors (OR: 1.37, 95% CI: 1.00-1.88). Provider- and system-level barriers associated with low use of preventive care among rural enrollees included discrimination based on public insurance status (OR: 2.26, 95% CI: 1.34-2.38), cost of care concerns (OR: 1.72, 95% CI: 1.03-2.89) and uncertainty about care being covered by insurance (OR: 1.70, 95% CI: 1.01-2.85). These and additional provider-level barriers were also identified among urban enrollees. Discrimination, cost of care, and uncertainty about insurance coverage inhibit access in both the rural and urban samples. These barriers are worthy targets of interventions for publicly insured populations regardless of residence. Future studies should investigate additional factors associated with access disparities based on rural-urban residence. © 2017 National Rural Health Association.

  12. Accessibility of public libraries by rural dwellers in rural areas of ...

    African Journals Online (AJOL)

    In conclusion, public libraries are essential to rural dwellers; therefore it is recommended that all types of information be made available to public libraries. Sensitization programmes should be encouraged. This will in turn bring about positive impact on the rural dwellers. Key words: Accessibility, Public, Library, rural, ...

  13. Competition and rural primary care programs.

    Science.gov (United States)

    Ricketts, T C

    1990-04-01

    Rural primary care programs were established in areas where there was thought to be no competition for patients. However, evidence from site visits and surveys of a national sample of subsidized programs revealed a pattern of competitive responses by the clinics. In this study of 193 rural primary care programs, mail and telephone surveys produced uniform data on the organization, operation, finances, and utilization of a representative sample of clinics. The programs were found to compete in terms of: (1) price, (2) service mix, (3) staff availability, (4) structural accessibility, (5) outreach, and (6) targeting a segment of the market. The competitive strategies employed by the clinics had consequences that affected their productivity and financial stability. The strategies were related to the perceived missions of the programs, and depended heavily upon the degree of isolation of the program and the targeting of the services. The competitive strategy chosen by a particular program could not be predicted based on service area population and apparent competitors in the service area. The goals and objectives of the programs had more to do with their competitive responses than with market characteristics. Moreover, the chosen strategies may not meet the demands of those markets.

  14. Equity in access to health care in a rural population in Malaysia: A cross-sectional study.

    Science.gov (United States)

    Lim, Ka Keat; Sivasampu, Sheamini; Mahmud, Fatihah

    2017-04-01

    To examine the extent of equity in access to health care, their determinants and reasons of unmet need of a rural population in Malaysia. Exploratory cross-sectional survey administered by trained interviewers among participants of a health screening program. A rural plantation estate in the West Coast of Peninsular Malaysia. One hundred and thirty out of 142 adults above 18 years old who attended the program. Percentages of respondents reporting realised access and unmet need to health care, determinants of both access indicators and reasons for unmet need. Realised access associated with need but not predisposing or enabling factors and unmet need not associated with any variables were considered equitable. A total of 88 (67.7%) respondents had visited a doctor (realised access) in the past 6 months and 24.8% (n = 31) experienced unmet need in the past 12 months. Using logistic regression, realised access was associated with presence of chronic disease (OR 6.97, P  RM 2000 per month) (OR 51.27, P population, the latter associated with education level, subjective health status and income. Despite not being generalisable, the findings highlight the need for a national level study on equity in access before the country reforms its health system. © 2016 National Rural Health Alliance Inc.

  15. Rural adolescents' access to adolescent friendly health services.

    Science.gov (United States)

    Secor-Turner, Molly A; Randall, Brandy A; Brennan, Alison L; Anderson, Melinda K; Gross, Dean A

    2014-01-01

    The purpose of this study was to assess rural North Dakota adolescents' experiences in accessing adolescent-friendly health services and to examine the relationship between rural adolescents' communication with health care providers and risk behaviors. Data are from the Rural Adolescent Health Survey (RAHS), an anonymous survey of 14- to 19-year-olds (n = 322) attending secondary schools in four frontier counties of North Dakota. Descriptive statistics were used to assess participants' access to adolescent-friendly health services characterized as accessible, acceptable, and appropriate. Logistic regressions were used to examine whether participant-reported risk behaviors predicted communication with health care providers about individual health risk behaviors. Rural adolescents reported high access to acceptable primary health care services but low levels of effective health care services. Participant report of engaging in high-risk behaviors was associated with having received information from health care providers about the leading causes of morbidity and mortality. These findings reveal missed opportunities for primary care providers in rural settings to provide fundamental health promotion to adolescents. Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  16. Developing an agenda for research about policies to improve access to healthy foods in rural communities: a concept mapping study

    Science.gov (United States)

    2014-01-01

    Background Policies that improve access to healthy, affordable foods may improve population health and reduce health disparities. In the United States most food access policy research focuses on urban communities even though residents of rural communities face disproportionately higher risk for nutrition-related chronic diseases compared to residents of urban communities. The purpose of this study was to (1) identify the factors associated with access to healthy, affordable food in rural communities in the United States; and (2) prioritize a meaningful and feasible rural food policy research agenda. Methods This study was conducted by the Rural Food Access Workgroup (RFAWG), a workgroup facilitated by the Nutrition and Obesity Policy Research and Evaluation Network. A national sample of academic and non-academic researchers, public health and cooperative extension practitioners, and other experts who focus on rural food access and economic development was invited to complete a concept mapping process that included brainstorming the factors that are associated with rural food access, sorting and organizing the factors into similar domains, and rating the importance of policies and research to address these factors. As a last step, RFAWG members convened to interpret the data and establish research recommendations. Results Seventy-five participants in the brainstorming exercise represented the following sectors: non-extension research (n = 27), non-extension program administration (n = 18), “other” (n = 14), policy advocacy (n = 10), and cooperative extension service (n = 6). The brainstorming exercise generated 90 distinct statements about factors associated with rural food access in the United States; these were sorted into 5 clusters. Go Zones were established for the factors that were rated highly as both a priority policy target and a priority for research. The highest ranked policy and research priorities include strategies designed to

  17. Health care access for rural youth on equal terms? A mixed methods study protocol in northern Sweden.

    Science.gov (United States)

    Goicolea, Isabel; Carson, Dean; San Sebastian, Miguel; Christianson, Monica; Wiklund, Maria; Hurtig, Anna-Karin

    2018-01-11

    The purpose of this paper is to propose a protocol for researching the impact of rural youth health service strategies on health care access. There has been no published comprehensive assessment of the effectiveness of youth health strategies in rural areas, and there is no clearly articulated model of how such assessments might be conducted. The protocol described here aims to gather information to; i) Assess rural youth access to health care according to their needs, ii) Identify and understand the strategies developed in rural areas to promote youth access to health care, and iii) Propose actions for further improvement. The protocol is described with particular reference to research being undertaken in the four northernmost counties of Sweden, which contain a widely dispersed and diverse youth population. The protocol proposes qualitative and quantitative methodologies sequentially in four phases. First, to map youth access to health care according to their health care needs, including assessing horizontal equity (equal use of health care for equivalent health needs,) and vertical equity (people with greater health needs should receive more health care than those with lesser needs). Second, a multiple case study design investigates strategies developed across the region (youth clinics, internet applications, public health programs) to improve youth access to health care. Third, qualitative comparative analysis of the 24 rural municipalities in the region identifies the best combination of conditions leading to high youth access to health care. Fourth, a concept mapping study involving rural stakeholders, care providers and youth provides recommended actions to improve rural youth access to health care. The implementation of this research protocol will contribute to 1) generating knowledge that could contribute to strengthening rural youth access to health care, as well as to 2) advancing the application of mixed methods to explore access to health care.

  18. The Relationship between of Rural Accessibility and Development

    Directory of Open Access Journals (Sweden)

    Thomas Soseco

    2016-09-01

    Full Text Available Rural accessibility has been an important situation to enhance people living. Lack of access limiting people’s opportunity to not only economic choices but also educational and health aspects. Various studies found that there was a positive relationship between better accessibility and poverty, health, and educational measurements. One indicator to measure accessibility is Rural Access Index (RAI, which developed by The Worldbank. Eventhough Indonesia has quite high RAI, but in realty Indonesia still experience large disparity of road condition in its regions. Accessibility became big problems because it may cause worse effect on wider aspects, for instance health. Health, which proxied by infant mortality rate, is worse in villages with poor acessibility. Thus, government must do adequate efforts to enhance accessibility and at the same time make sure that more villages can gain better access.

  19. Rural Gas Program manual

    Energy Technology Data Exchange (ETDEWEB)

    1987-11-01

    The intent and purpose of this manual is to describe the various guideliness and administrative procedures associated with the Alberta Rural Gas Program and to consolidate and expand upon the legislation under which the Program has been developed. It is intended primarily for the use and information of rural gas distributors, their agents, and other private or government parties having an interest in the Rural Gas Program. Information is presented on: rural gas franchises, technical applications, contracts and tenders, determination of system capital costs for grant support, grants, Gas Alberta brokerage arrangements, insurance coverage, utility rights-of-way, and lien notes.

  20. Access to and use of research by rural nurses.

    Science.gov (United States)

    Winters, C A; Lee, H J; Besel, J; Strand, A; Echeverri, R; Jorgensen, K P; Dea, J E

    2007-01-01

    The use of relevant research findings to inform clinical practice is important for nurses, regardless of setting. Although there have been studies addressing the use of research among various practitioners, little is known about how nurses in rural areas access health information (specifically research findings), nor how such findings are incorporated into daily practice. The purpose of this study was to explore rural nurses' access, use and perceived usefulness of research for rural practice. The study was conducted in a sparsely populated state located in the western part of the USA. An ethnographic method was chosen to answer the research questions for this descriptive study. Semi-structured interviews were conducted with 29 rural nurses from nine communities by graduate nursing students enrolled in a rural nursing course following in-class instruction and practice. Field notes taken by the students supplemented the interview data. The students' notes included a windshield survey or description of the context and location within which the participants lived and/or practiced as well as the interviewers' observations, thoughts and impressions about the research project. Interviews were audiotaped and transcribed verbatim. Once transcribed, the interview narratives, windshield data and field notes were analyzed by the students for common themes; the students then wrote and submitted papers to the faculty addressing the themes that emerged from their interviews. The analysis conducted by the faculty members included four sources of data: transcriptions of interviews; field notes; windshield data; and students' papers. The process of identifying themes was facilitated by using the software program NUD*IST (QSR International; Melbourne, VIC, Australia). Demographic information was entered into the Statistical Package for Social Scientists (SPSS Inc; Chicago, IL, USA) to compile descriptive information about the sample. Twenty-seven female and two male nurses

  1. Knowledge Access in Rural Inter-connected Areas Network ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Knowledge Access in Rural Inter-connected Areas Network (KariaNet) - Phase II ... the existing network to include two thematic networks on food security and rural ... Woman conquering male business in Yemen : Waleya's micro-enterprise.

  2. Expanding rural access to mental health care through online postgraduate nurse practitioner education.

    Science.gov (United States)

    Kverno, Karan; Kozeniewski, Kate

    2016-12-01

    Workforce shortages in mental health care are especially relevant to rural communities. People often turn to their primary care providers for mental healthcare services, yet primary care providers indicate that more education is needed to fill this role. Rural primary care nurse practitioners (NPs) are ideal candidates for educational enhancement. Online programs allow NPs to continue living and working in their communities while developing the competencies to provide comprehensive and integrated mental healthcare services. This article presents a review of current online postgraduate psychiatric mental health NP (PMHNP) options. Website descriptions of online PMHNP programs were located using keywords: PMHNP or psychiatric nurse practitioner, postgraduate or post-master's, and distance or online. Across the United States, 15 online postgraduate certificate programs were located that are designed for primary care NPs seeking additional PMHNP specialization. For rural primary care NPs who are ready, willing, and able, a postgraduate PMHNP specialty certificate can be obtained online in as few as three to four semesters. The expected outcome is a cadre of dually credentialed NPs capable of functioning in an integrated role and of increasing rural access to comprehensive mental healthcare services. ©2016 American Association of Nurse Practitioners.

  3. Integrated rural development programs: a skeptical perspective.

    Science.gov (United States)

    Ruttan, V W

    1975-11-01

    In examining integrated rural development programs the question that arises is why is it possible to identify several relatively successful small-scale or pilot rural development projects yet so difficult to find examples of successful rural development programs. 3 bodies of literature offer some insight into the morphology of rural development projects, programs, and processes: the urban-industrial impact hypothesis; the theory of induced technical change; and the new models of institutional change that deal with institution building and the economics of bureaucratic behavior. The urban-industrial impact hypothesis helps in the clarification of the relationships between the development of rural areas and the development of the total society of which rural areas are a part. It is useful in understanding the spatial dimensions of rural development where rural development efforts are likely to be most successful. Formulation of the hypothesis generated a series of empirical studies designed to test its validity. The effect of these studies has been the development of a rural development model in which the rural community is linked to the urban-industrial economy through a series of market relationships. Both the urban economy's rate of growth and the efficiency of the intersector product and factor markets place significant constraints on the possibilities of rural area development. It is not possible to isolate development processes in the contemporary rural community in a developing society from development processes in the larger society. The induced technical change theory provides a guide as to what must be done to gain access to efficient sources of economic growth, the new resources and incomes that are necessary to sustain rural development. Design of a successful rural development strategy involves a combination of technical and institutional change. The ability of rural areas to respond to the opportunities for economic growth generated by local urban

  4. Rural electrification program with renewable energy sources: An analysis of China’s Township Electrification Program

    International Nuclear Information System (INIS)

    Shyu, Chian-Woei

    2012-01-01

    Given the fact that 1.4 billion people, over 20% of the world’s population, lack access to electricity, rural electrification remains a common challenge for many developing countries. The ‘Township Electrification Program’ launched by the Chinese government in 2002 is known as the world’s largest renewable energy-based rural electrification program in terms of investment volume ever carried out by a country. This study gives an in-depth examination of the program implemented in two selected townships in remote of rural areas of western China. The results showed that the implementation of the program possessed a technical orientation (e.g., construction of stations, installation of systems), and underestimated the financial implications (e.g., electricity tariff, households’ ability to pay electricity fees, financial management) as well as human resources available (e.g., training for operators, household participation) and institutional capacity building (e.g., good governance, regulatory framework) at the local level. Even though electricity was provided by the solar PV power stations, households still relied on traditional energy sources, such as candles and dry cell batteries, due to the fact that electricity service was unreliable and electricity supply was not sufficient for households’ needs. - Highlights: ► China’s electrification rate has reached the level of OECD countries. ► Township Electrification Program is the world’s largest electrification program. ► The program possessed a technical orientation and underestimated other aspects. ► Households still relied on traditional energy, such as candles and batteries. ► Having electricity access did not mean that electricity was actually used.

  5. A long way from home: Access to cancer care for rural Australians

    International Nuclear Information System (INIS)

    Smith, Tony

    2012-01-01

    In 2002, the Commonwealth Radiation Oncology Inquiry reported that access to cancer care services in Australia was seriously limited. Several recommendations were made, including improving access to cancer care in rural areas by increasing the number of comprehensive oncology facilities outside the cities. Much has changed since 2002, with the establishment of a number of Regional Integrated Cancer Centres. This has been boosted again in 2011 by further Commonwealth Government funding. Cancer is primarily a disease of the elderly and, with the ageing population access to cancer care for rural and remote Australians remains a major challenge. Cancer is the second most common cause of death in Australia, exceeded only by cardiovascular disease. It has been reported that the relative risk of dying of cancer within 5 years of diagnosis is 35% higher for those living in remote locations compared with major cities. Overall cancer mortality is significantly higher in rural and remote locations (206 deaths per 100,000) compared with urbanised areas (172 per 100,000). Cancer mortality is higher again for the Aboriginal population (230 per 100,000). The reasons for the disparity in cancer outcomes for metropolitan versus non-metropolitan Australians are varied. In general, rural and remote residents have to travel long distances and stay away from home, family and work for long periods of time to access the care they need. Hence, distance is the overriding barrier to access, compounded by the financial costs and disruption to family life, not to mention the endemic lack of specialist medical and allied health workforce outside the major cities. Some rural and remote Australians choose to compromise, accessing whatever care they can locally, although this contributes to the need for cancer care services close to where people choose to live and die, to deal with the complex associated morbidities. Recent government investment in new regional cancer care infrastructure is

  6. Access to rural banking credit by agribusiness investors in Ahiazu ...

    African Journals Online (AJOL)

    This paper examines access to rural banking credit by agribusiness investors and issues for policies in Ahiazu Mbaise local government area of Imo state. The work is important because the existence of limited access of agribusiness investors to formal rural banking credit and extension services is provided by extension ...

  7. Access to Drinking Water and Sanitation in Rural Kazakhstan.

    Science.gov (United States)

    Tussupova, Kamshat; Hjorth, Peder; Berndtsson, Ronny

    2016-11-09

    The Sustainable Development Goals (SDGs) require nations to ensure adequate water supply for all. For Kazakhstan, this means that rural areas will need much stronger attention as they have been rather neglected in efforts to comply with the Millennium Development Goals (MDGs). This study aims to establish a baseline data concerning the current situation in villages that will need interventions according to the SDGs. The study was performed by means of questionnaires. The results should be seen as initial guidelines that can help to illuminate some of the uncounted challenges in future efforts to meet the SDG targets. As hardly any information exists about sanitation in rural Kazakhstan, the study essentially focuses on water services. The results show that 65% of rural dwellers want to connect and pay for the piped water supply. At the same time, about 80% have toilets outside their home. Consequently, the water program aiming at providing 80% of rural people with access to tap water from a centralized piped system will not be possible. However, by carefully managing the existing water supply and sanitation system in joint collaboration with the local users, significant progress can be made. The present results show the important first steps that need to be taken in this direction.

  8. Access to Drinking Water and Sanitation in Rural Kazakhstan

    Directory of Open Access Journals (Sweden)

    Kamshat Tussupova

    2016-11-01

    Full Text Available The Sustainable Development Goals (SDGs require nations to ensure adequate water supply for all. For Kazakhstan, this means that rural areas will need much stronger attention as they have been rather neglected in efforts to comply with the Millennium Development Goals (MDGs. This study aims to establish a baseline data concerning the current situation in villages that will need interventions according to the SDGs. The study was performed by means of questionnaires. The results should be seen as initial guidelines that can help to illuminate some of the uncounted challenges in future efforts to meet the SDG targets. As hardly any information exists about sanitation in rural Kazakhstan, the study essentially focuses on water services. The results show that 65% of rural dwellers want to connect and pay for the piped water supply. At the same time, about 80% have toilets outside their home. Consequently, the water program aiming at providing 80% of rural people with access to tap water from a centralized piped system will not be possible. However, by carefully managing the existing water supply and sanitation system in joint collaboration with the local users, significant progress can be made. The present results show the important first steps that need to be taken in this direction.

  9. Using the integrated rural mobility and access (IRMA) approach in prospering rural South Africa

    CSIR Research Space (South Africa)

    Chakwizira, J

    2008-11-01

    Full Text Available settlements implications of current rural development approaches are outlined. The potential and impact of the integrated rural mobility and access approach (IRMA) in unlocking socio-economic and spatial livelihood opportunities are discussed. In this regard...

  10. Measuring potential access to food stores and food-service places in rural areas in the U.S.

    Science.gov (United States)

    Sharkey, Joseph R

    2009-04-01

    Geographic access to healthy food resources remains a major focus of research that examines the contribution of the built environment to healthful eating. Methods used to define and measure spatial accessibility can significantly affect the results. Considering the implications for marketing, policy, and programs, adequate measurement of the food environment is important. Little of the published work on food access has focused on rural areas, where the burden of nutrition-related disease is greater. This article seeks to expand our understanding of the challenges to measurement of potential spatial access to food resources in rural areas in the U.S. Key challenges to the accurate measurement of the food environment in rural areas include: (1) defining the rural food environment while recognizing that market factors may be changing; (2) describing characteristics that may differentiate similar types of food stores and food-service places; and (3) determining location coordinates for food stores and food-service places. In order to enhance measurements in rural areas, "ground-truthed" methodology, which includes on-site observation and collection of GPS data, should become the standard for rural areas. Measurement must also recognize the emergence of new and changing store formats. Efforts should be made to determine accessibility, in terms of both proximity to a single location and variety of multiple locations within a specified buffer, from origins other than the home, and consider multipurpose trips and trip chaining. The measurement of food access will be critical for community-based approaches to meet dietary needs. Researchers must be willing to take the steps necessary for rigorous measurement of a dynamic food environment.

  11. Women's access needs in maternity care in rural Tasmania, Australia: a mixed methods study.

    Science.gov (United States)

    Hoang, Ha; Le, Quynh; Terry, Daniel

    2014-03-01

    This study investigates (i) maternity care access issues in rural Tasmania, (ii) rural women's challenges in accessing maternity services and (iii) rural women's access needs in maternity services. A mixed-method approach using a survey and semi-structured interviews was conducted. The survey explored women's views of rural maternity services from antenatal to postnatal care, while interviews reinforced the survey results and provided insights into the access issues and needs of women in maternity care. The survey was completed by n=210 women, with a response rate of 35%, with n=22 follow-up interviews being conducted. The survey indicated the majority of rural women believed antenatal education and check-ups and postnatal check-ups should be provided locally. The majority of women surveyed also believed in the importance of having a maternity unit in the local hospital, which was further iterated and clarified within the interviews. Three main themes emerged from the interview data, namely (i) lack of access to maternity services, (ii) difficulties in accessing maternity services, and (iii) rural women's access needs. The study suggested that women's access needs are not fully met in some rural areas of Tasmania. Rural women face many challenges when accessing maternity services, including financial burden and risk of labouring en route. The study supports the claim that the closure of rural maternity units shifts cost and risk from the health care system to rural women and their families. Copyright © 2013 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  12. Rural women and violence situation: access and accessibility limits to the healthcare network.

    Science.gov (United States)

    Costa, Marta Cocco da; Silva, Ethel Bastos da; Soares, Joannie Dos Santos Fachinelli; Borth, Luana Cristina; Honnef, Fernanda

    2017-07-13

    To analyze the access and accessibility to the healthcare network of women dwelling in rural contexts undergoing violence situation, as seen from the professionals' speeches. A qualitative, exploratory, descriptive study with professionals from the healthcare network services about coping with violence in four municipalities in the northern region of Rio Grande do Sul. The information derived from interviews, which have been analyzed by thematic modality. (Lack of) information of women, distance, restricted access to transportation, dependence on the partner and (lack of) attention by professionals to welcome women undergoing violence situation and (non)-articulation of the network are factors that limit the access and, as a consequence, they result in the lack of confrontation of this problem. To bring closer the services which integrate the confrontation network of violence against women and to qualify professionals to welcome these situations are factors that can facilitate the access and adhesion of rural women to the services.

  13. Oral health and access to dental care: a qualitative exploration in rural Quebec.

    Science.gov (United States)

    Emami, Elham; Wootton, John; Galarneau, Chantal; Bedos, Christophe

    2014-01-01

    We sought to explore how rural residents perceive their oral health and their access to dental care. We conducted a qualitative research study in rural Quebec. We used purposeful sampling to recruit study participants. A trained interviewer conducted audio-recorded, semistructured interviews until saturation was reached. We conducted thematic analysis to identify themes. This included interview debriefing, transcript coding, data display and interpretation. Saturation was reached after 15 interviews. Five main themes emerged from the interviews: rural idyll, perceived oral health, access to oral health care, cues to action and access to dental information. Most participants noted that they were satisfied with the rural lifestyle, and that rurality per se was not a threat to their oral health. However, they criticized the limited access to dental care in rural communities and voiced concerns about the impact on their oral health. Participants noted that motivation to seek dental care came mainly from family and friends rather than from dental care professionals. They highlighted the need for better education about oral health in rural communities. Residents' satisfaction with the rural lifestyle may be affected by unsatisfactory oral health care. Health care providers in rural communities should be engaged in tailoring strategies to improve access to oral health care.

  14. Effectiveness of a grant program's efforts to promote synergy within its funded initiatives: perceptions of participants of the Southern Rural Access Program

    Science.gov (United States)

    Pathman, Donald E; Chuang, Emmeline; Weiner, Bryan J

    2008-01-01

    Background Foundations and public agencies commonly fund focused initiatives for individual grantees. These discrete, stand-alone initiatives can risk failure by being carried out in isolation. Fostering synergy among grantees' initiatives is one strategy proposed for promoting the success and impact of grant programs. We evaluate an explicit strategy to build synergy within the Robert Wood Johnson Foundation's Southern Rural Access Program (SRAP), which awarded grants to collaboratives within eight southeastern U.S. states to strengthen basic health care services in targeted rural counties. Methods We interviewed 39 key participants of the SRAP, including the program director within each state and the principal subcontractors heading the program's funded initiatives that supported heath professionals' recruitment, retention and training, made loans to health care providers, and built networks among providers. Interews were recorded and transcribed. Two investigators independently coded the transcripts and a third investigator distilled the main points. Results Participants generally perceived that the SRAP yielded more synergies than other grant programs in which they had participated and that these synergies added to the program's impact. The synergies most often noted were achieved through relationship building among grantees and with outside agencies, sharing information and know-how, sharing resources, combining efforts to yield greater capacity, joining voices to advocate for common goals, and spotting gaps in services offered and then filling these gaps. The SRAP's strategies that participants felt fostered synergy included targeting funding to culturally and geographically similar states, supporting complementary types of initiatives, promoting opportunities to network through semi-annual meetings and regular conference calls, and the advocacy efforts of the program's leadership. Participants noted that synergies were sometimes hindered by turf issues and

  15. Effectiveness of a grant program's efforts to promote synergy within its funded initiatives: perceptions of participants of the Southern Rural Access Program

    Directory of Open Access Journals (Sweden)

    Weiner Bryan J

    2008-12-01

    Full Text Available Abstract Background Foundations and public agencies commonly fund focused initiatives for individual grantees. These discrete, stand-alone initiatives can risk failure by being carried out in isolation. Fostering synergy among grantees' initiatives is one strategy proposed for promoting the success and impact of grant programs. We evaluate an explicit strategy to build synergy within the Robert Wood Johnson Foundation's Southern Rural Access Program (SRAP, which awarded grants to collaboratives within eight southeastern U.S. states to strengthen basic health care services in targeted rural counties. Methods We interviewed 39 key participants of the SRAP, including the program director within each state and the principal subcontractors heading the program's funded initiatives that supported heath professionals' recruitment, retention and training, made loans to health care providers, and built networks among providers. Interews were recorded and transcribed. Two investigators independently coded the transcripts and a third investigator distilled the main points. Results Participants generally perceived that the SRAP yielded more synergies than other grant programs in which they had participated and that these synergies added to the program's impact. The synergies most often noted were achieved through relationship building among grantees and with outside agencies, sharing information and know-how, sharing resources, combining efforts to yield greater capacity, joining voices to advocate for common goals, and spotting gaps in services offered and then filling these gaps. The SRAP's strategies that participants felt fostered synergy included targeting funding to culturally and geographically similar states, supporting complementary types of initiatives, promoting opportunities to network through semi-annual meetings and regular conference calls, and the advocacy efforts of the program's leadership. Participants noted that synergies were sometimes

  16. Mobility and Access for Off-Road Rural Farmers in West-Akim District

    African Journals Online (AJOL)

    Mobility and Access for Off-Road Rural. Farmers in West-Akim District. Esther Yeboah Da11so-Wired11. Abstract. The study is on the rural transportation problem in Ghana and its consequences on the rural people, especially those who live in off road villages (villages that do not have access to regular transportation ...

  17. Rural and Urban Youth Programs.

    Science.gov (United States)

    Backman, Kenneth; And Others

    This publication provides a variety of information on prevention and intervention programs for rural and urban children and adolescents. Drawing from a rural sociological perspective, the introductory paper defines "rural," discusses rural-urban economic and social differences, and lists indicators of risk for rural youth. It discusses the extent…

  18. Rural Bypass of Critical Access Hospitals in Iowa: Do Visiting Surgical Specialists Make a Difference?

    Science.gov (United States)

    Weigel, Paula A M; Ullrich, Fred; Ward, Marcia M

    2018-02-01

    Rural bypass for elective surgical procedures is a challenge for critical access hospitals, yet there are opportunities for rural hospitals to improve local retention of surgical candidates through alternative approaches to developing surgery lines of business. In this study we examine the effect of visiting surgical specialists on the odds of rural bypass. Discharge data from the 2011 State Inpatient Databases and State Ambulatory Surgery Databases for Iowa were linked to outreach data from the Office of Statewide Clinical Education Programs and Iowa Physician Information System to model the effect of surgeon specialist supply on rural patients' decision to bypass rural critical access hospitals. Patients in rural communities with a local general surgeon were more likely to be retained in a community than to bypass. Those in communities with visiting general surgeons were more likely to bypass, as were those in communities with visiting urologists and obstetricians. Patients in communities with visiting ophthalmologists and orthopedic surgeons were at higher odds of being retained for their elective surgeries. In addition to known patient and local hospital factors that have an influence on bypass behavior among rural patients seeking elective surgery, availability of surgeon specialists also plays an important role in whether patients bypass or not. Visiting ophthalmologists and orthopedic surgeons were associated with less bypass, as was having local general surgeons. Visiting general surgeons, urologists, and obstetricians were associated with greater odds of bypass. © 2016 National Rural Health Association.

  19. 78 FR 8353 - Rural Broadband Access Loans and Loan Guarantees

    Science.gov (United States)

    2013-02-06

    ... outsourcing specialized medical procedures. One study of 24 rural hospitals placed the annual cost of not... a key to economic growth. For rural businesses, broadband gives access to national and international...

  20. Putting rural energy access projects into perspective: What lessons are relevant?

    International Nuclear Information System (INIS)

    Vleuten, Frank van der; Stam, Nienke; Plas, Robert-Jan van der

    2013-01-01

    As the Secretary General of the United Nations and the president of the World Bank are calling upon countries to commit themselves to universal access to modern energy services by 2030, and international players such as the International Energy Agency, the EU, and ESMAP are building scenarios how to accomplish this, this article demonstrates the non-linear dynamics of scaling up rural energy access, drawing among others from over 70 energy access projects implemented by the EASE network of national energy and development NGOs in eight countries and on experiences combining microfinance and (clean) energy access. The article shows that scaling up rural energy access demands careful tuning of support to the business models of rural entrepreneurs, in which development finance has only a limited role to play. The article argues for market development approaches that take a programmatic approach, change their intervention model as the market matures, and build on smart use of the limited sector capacity. The ultimate challenge is how to down-tune ambitions and spending power of the development community to match the absorption capacity of rural markets and the reality of entrepreneurs on the ground. - Highlights: • Practitioner's experiences and lessons, based on over 70 implemented projects. • Relevant for “Sustainable Energy for All” high-level initiative. • Match high international ambitions with low capacity of rural energy markets

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

    Science.gov (United States)

    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

  2. Environmental implications of Universal Rural Road Access Program (URRAP roads in Southwestern Ethiopia: The case of Jimma and Buno Bedelle zones

    Directory of Open Access Journals (Sweden)

    Hassen Negesso

    2018-03-01

    Full Text Available Ethiopia has been undertaking numerous development programs and projects with the objective of taking a country to the middle-income countries in the near future. Universal Rural Road Access Program (URRAP roads being constructed in Jimma and Bunno Bedele zones are among the projects in Ethiopia. Although these projects are assumed to bring desirable positive change, there are sometimes negative consequences on environmental issues. Accordingly, the objective of this study was to investigate the negative sides of these projects on environmental elements. Household survey with randomly selected household heads and in-depth interview, focus group discussion (FGD and observation for purposively selected samples were used to collect relevant and required data. Thereby, data were analyzed quantitatively by using Statistical Package for Social Sciences (SPSS and qualitatively through thematic method. The findings from the analyzed data show that rural roads being constructed by URRAP have both positive and negative impacts on plant species, bird species, reptile species, mammal’s species, amphibians’ species, soil, and climate. Finally, URRAP is in dilemma and needs an extensive and frequent supervision, monitoring, inclusive, interdisciplinary and sound strategies and policies by responsible bodies at all expected levels and contexts.

  3. Telecommunication and Access to Information in Rural Areas of ...

    African Journals Online (AJOL)

    One major reason for this has been the differential access to telecommunication infrastructure between the rural and urban areas. The realization of this has prompted many governments in developing countries to extend telecommunication infrastructure to their rural areas. However, relatively little is known about the impact ...

  4. Information generation, access and utilization by rural dwellers for ...

    African Journals Online (AJOL)

    The study was conducted to determine how rural dwellers information access and utilization has affected rural community development in Kwara State. In order to achieve the two objectives three null hypotheses formulated and tested at 0.05 level of significance. The objectives were to: find out the types of information ...

  5. RURAL/URBAN RESIDENCE, ACCESS, AND PERCEIVED NEED FOR TREATMENT AMONG AFRICAN AMERICAN COCAINE USERS

    Science.gov (United States)

    BORDERS, TYRONE F.; BOOTH, BRENDA M.; STEWART, KATHARINE E.; CHENEY, ANN M.; CURRAN, GEOFFREY M.

    2014-01-01

    Objective To examine how rural/urban residence, perceived access, and other factors impede or facilitate perceived need for drug use treatment, a concept closely linked to treatment utilization. Study Design Two hundred rural and 200 urban African American cocaine users who were not receiving treatment were recruited via Respondent-Driven Sampling and completed a structured in-person interview. Bivariate and multivariate analyses were conducted to test the associations between perceived need and rural/urban residence, perceived access, and other predisposing (eg, demographics), enabling (eg, insurance), and health factors (eg, psychiatric distress). Principal Findings In bivariate analyses, rural relative to urban cocaine users reported lower perceived treatment need (37% vs 48%), availability, affordability, overall ease of access, and effectiveness, as well as lower perceived acceptability of residential, outpatient, self-help, and hospital-based services. In multivariate analyses, there was a significant interaction between rural/urban residence and the acceptability of religious counseling. At the highest level of acceptability, rural users had lower odds of perceived need (OR=.23); at the lowest level, rural users had higher odds of perceived need (OR=2.74) than urban users. Among rural users, the acceptability of religious counseling was negatively associated with perceived need (OR=.64). Ease of access was negatively associated (OR=.71) whereas local treatment effectiveness (OR=1.47) and the acceptability of hospital-based treatment (OR=1.29) were positively associated with perceived need among all users. Conclusions Our findings suggest rural/urban disparities in perceived need and access to drug use treatment. Among rural and urban cocaine users, improving perceptions of treatment effectiveness and expanding hospital-based services could promote treatment seeking. PMID:25213603

  6. Knowledge Access in Rural Inter-connected Areas Network ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Knowledge Access in Rural Inter-connected Areas Network (KariaNet) - Phase II ... poor by sharing innovations, best practices and indigenous knowledge using ... A third thematic network - on knowledge management strategies - will play an ...

  7. Socio-economic challenges of rural telecommunication access ...

    African Journals Online (AJOL)

    There has been growing interest on how to provide universal telecommunication access in developing countries. The trend in digital divide between the rural and urban areas for developing countries reveals a growing gap. In this paper, we discussed from a socioeconomic perspective, the various challenges facing the ...

  8. Pharmacy Access to Emergency Contraception in Rural and Frontier Communities

    Science.gov (United States)

    Bigbee, Jeri L.; Abood, Richard; Landau, Sharon Cohen; Maderas, Nicole Monastersky; Foster, Diana Greene; Ravnan, Susan

    2007-01-01

    Context: Timely access to emergency contraception (EC) has emerged as a major public health effort in the prevention of unintended pregnancies. The recent FDA decision to allow over-the-counter availability of emergency contraception for adult women presents important rural health implications. American women, especially those living in rural and…

  9. Area-Based Partnerships in Rural Poland: The Post-Accession Experience

    Science.gov (United States)

    Furmankiewicz, Marek; Thompson, Nicola; Zielinska, Marta

    2010-01-01

    The paper examines the characteristics of area-based partnerships in rural Poland. It is based on the study of partnerships created after the accession to the European Union in 2004. Partnership structures have been rapidly adopted in rural Poland due to opportunities provided by the LEADER+ Pilot Programme. However, the research showed that…

  10. RURAL-URBAN DIFFERENCES IN NURSING HOME ACCESS, QUALITY AND COST

    OpenAIRE

    Yu, Wei; Bradford, Garnett L.

    1995-01-01

    Rural-urban differences in the supply of nursing home services as hypothesized to be jointly affected by competitive and regulatory forces, government policies, and the cost structure. Study findings indicate that rural services are slightly less accessible and lower in quality. A translog cost share function reveals no difference in the operating cost structure of rural and urban homes. Cost shares for nursing care are directly related to the degree of skilled nursing provided by homes. Sign...

  11. Creating a new rural pharmacy workforce: Development and implementation of the Rural Pharmacy Health Initiative.

    Science.gov (United States)

    Scott, Mollie Ashe; Kiser, Stephanie; Park, Irene; Grandy, Rebecca; Joyner, Pamela U

    2017-12-01

    An innovative certificate program aimed at expanding the rural pharmacy workforce, increasing the number of pharmacists with expertise in rural practice, and improving healthcare outcomes in rural North Carolina is described. Predicted shortages of primary care physicians and closures of critical access hospitals are expected to worsen existing health disparities. Experiential education in schools and colleges of pharmacy primarily takes place in academic medical centers and, unlike experiential education in medical schools, rarely emphasizes the provision of patient care in rural U.S. communities, where chronic diseases are prevalent and many residents struggle with poverty and poor access to healthcare. To help address these issues, UNC Eshelman School of Pharmacy developed the 3-year Rural Pharmacy Health Certificate program. The program curriculum includes 4 seminar courses, interprofessional education and interaction with medical students, embedding of each pharmacy student into a specific rural community for the duration of training, longitudinal ambulatory care practice experiences, community engagement initiatives, leadership training, development and implementation of a population health project, and 5 pharmacy practice experiences in rural settings. The Rural Pharmacy Health Certificate program at UNC Eshelman School of Pharmacy seeks to transform rural pharmacy practice by creating a pipeline of rural pharmacy leaders and teaching a unique skillset that will be beneficial to healthcare systems, communities, and patients. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  12. Access to and use of sexual and reproductive health services provided by midwives among rural immigrant women in Spain: midwives’ perspectives

    Science.gov (United States)

    Otero-Garcia, Laura; Goicolea, Isabel; Gea-Sánchez, Montserrat; Sanz-Barbero, Belen

    2013-01-01

    Background There is insufficient information regarding access and participation of immigrant women in Spain in sexual and reproductive health programs. Recent studies show their lower participation rate in gynecological cancer screening programs; however, little is known about the participation in other sexual and reproductive health programs by immigrant women living in rural areas with high population dispersion. Objectives The objective of this study is to explore the perceptions of midwives who provide these services regarding immigrant women's access and participation in sexual and reproductive health programs offered in a rural area. Design A qualitative study was performed, within a larger ethnographic study about rural primary care, with data collection based on in-depth interviews and field notes. Participants were the midwives in primary care serving 13 rural basic health zones (BHZ) of Segovia, a region of Spain with high population dispersion. An interview script was designed to collect information about midwives’ perceptions on immigrant women's access to and use of the healthcare services that they provide. Interviews were recorded and transcribed with participant informed consent. Data were analyzed based on the qualitative content analysis approach and triangulation of results with fieldwork notes. Results Midwives perceive that immigrants in general, and immigrant women in particular, underuse family planning services. This underutilization is associated with cultural differences and gender inequality. They also believe that the number of voluntary pregnancy interruptions among immigrant women is elevated and identify childbearing and childrearing-related tasks and the language barrier as obstacles to immigrant women accessing the available prenatal and postnatal healthcare services. Conclusions Immigrant women's underutilization of midwifery services may be linked to the greater number of unintended pregnancies, pregnancy terminations, and the

  13. Access to and use of sexual and reproductive health services provided by midwives among rural immigrant women in Spain: midwives' perspectives.

    Science.gov (United States)

    Otero-Garcia, Laura; Goicolea, Isabel; Gea-Sánchez, Montserrat; Sanz-Barbero, Belen

    2013-11-08

    There insufficient information regarding access and participation of immigrant women in Spain in sexual and reproductive health programs. Recent studies show their lower participation rate in gynecological cancer screening programs; however, little is known about the participation in other sexual and reproductive health programs by immigrant women living in rural areas with high population dispersion. The objective of this study is to explore the perceptions of midwives who provide these services regarding immigrant women's access and participation in sexual and reproductive health programs offered in a rural area. A qualitative study was performed, within a larger ethnographic study about rural primary care, with data collection based on in-depth interviews and field notes. Participants were the midwives in primary care serving 13 rural basic health zones (BHZ) of Segovia, a region of Spain with high population dispersion. An interview script was designed to collect information about midwives' perceptions on immigrant women's access to and use of the healthcare services that they provide. Interviews were recorded and transcribed with participant informed consent. Data were analyzed based on the qualitative content analysis approach and triangulation of results with fieldwork notes. Midwives perceive that immigrants in general, and immigrant women in particular, underuse family planning services. This underutilization is associated with cultural differences and gender inequality. They also believe that the number of voluntary pregnancy interruptions among immigrant women is elevated and identify childbearing and childrearing-related tasks and the language barrier as obstacles to immigrant women accessing the available prenatal and postnatal healthcare services. Immigrant women's underutilization of midwifery services may be linked to the greater number of unintended pregnancies, pregnancy terminations, and the delay in the first prenatal visit, as discerned by

  14. Access to and use of sexual and reproductive health services provided by midwives among rural immigrant women in Spain: midwives’ perspectives

    Directory of Open Access Journals (Sweden)

    Laura Otero-Garcia

    2013-11-01

    Full Text Available Background: There insufficient information regarding access and participation of immigrant women in Spain in sexual and reproductive health programs. Recent studies show their lower participation rate in gynecological cancer screening programs; however, little is known about the participation in other sexual and reproductive health programs by immigrant women living in rural areas with high population dispersion. Objectives: The objective of this study is to explore the perceptions of midwives who provide these services regarding immigrant women's access and participation in sexual and reproductive health programs offered in a rural area. Design: A qualitative study was performed, within a larger ethnographic study about rural primary care, with data collection based on in-depth interviews and field notes. Participants were the midwives in primary care serving 13 rural basic health zones (BHZ of Segovia, a region of Spain with high population dispersion. An interview script was designed to collect information about midwives’ perceptions on immigrant women's access to and use of the healthcare services that they provide. Interviews were recorded and transcribed with participant informed consent. Data were analyzed based on the qualitative content analysis approach and triangulation of results with fieldwork notes. Results: Midwives perceive that immigrants in general, and immigrant women in particular, underuse family planning services. This underutilization is associated with cultural differences and gender inequality. They also believe that the number of voluntary pregnancy interruptions among immigrant women is elevated and identify childbearing and childrearing-related tasks and the language barrier as obstacles to immigrant women accessing the available prenatal and postnatal healthcare services. Conclusions: Immigrant women's underutilization of midwifery services may be linked to the greater number of unintended pregnancies, pregnancy

  15. Knowledge Access in Rural Inter-connected Areas Network ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Knowledge Access in Rural Inter-connected Areas Network (KariaNet) - Phase II ... and indigenous knowledge using information and communication technologies (ICTs) ... for research proposals on the aforementioned topics, action-research projects, ... Evaluating knowledge-sharing methods to improve land utilization and ...

  16. Electricity access for geographically disadvantaged rural communities--technology and policy insights

    International Nuclear Information System (INIS)

    Chaurey, Akanksha; Ranganathan, Malini; Mohanty, Parimita

    2004-01-01

    The purpose of this paper is to weigh the issues and options for increasing electricity access in remote and geographically challenged villages in interior Rajasthan, the desertstate in Western India where power sector reforms are currently underway. By first providing an overview of reforms and various electrification policy initiatives in India, the paper then analyzes the specific problems as studied at the grass-roots level with respect to rural electricity access and the use of off-grid renewables. Finally, it discusses interventions that could facilitate access to electricity by suggesting a sequential distributed generation (DG)-based approach, wherein consecutive DG schemes--incorporating the requisite technological, financial, and institutional arrangements--are designed depending on the developmental requirements of the community. In essence, this approach fits under the broader need to understand how the three 'Rs'- rural electrification (the process), power sector reforms (the catalyst), and the use of renewable energy technologies (the means) - could potentially converge to meet the needs of India's rural poor

  17. Electricity access for geographically disadvantaged rural communities--technology and policy insights

    Energy Technology Data Exchange (ETDEWEB)

    Chaurey, Akanksha E-mail: akanksha@teri.res.in; Ranganathan, Malini E-mail: malinir@teri.res.in; Mohanty, Parimita

    2004-10-01

    The purpose of this paper is to weigh the issues and options for increasing electricity access in remote and geographically challenged villages in interior Rajasthan, the desertstate in Western India where power sector reforms are currently underway. By first providing an overview of reforms and various electrification policy initiatives in India, the paper then analyzes the specific problems as studied at the grass-roots level with respect to rural electricity access and the use of off-grid renewables. Finally, it discusses interventions that could facilitate access to electricity by suggesting a sequential distributed generation (DG)-based approach, wherein consecutive DG schemes--incorporating the requisite technological, financial, and institutional arrangements--are designed depending on the developmental requirements of the community. In essence, this approach fits under the broader need to understand how the three 'Rs'- rural electrification (the process), power sector reforms (the catalyst), and the use of renewable energy technologies (the means) - could potentially converge to meet the needs of India's rural poor.

  18. Hospital Medicine and Fellowship Program in Rural North Dakota - A Multifaceted Success Story.

    Science.gov (United States)

    Hyder, S S; Amundson, Mary

    2017-11-01

    Recruitment of hospitalists and primary care physicians for Critical Access Hospitals and tertiary care hospitals in North Dakota is difficult. To address this challenge, 2 programs were implemented in Bismarck, North Dakota. St. Alexius Medical Center created a hospitalist fellowship training program in collaboration with the University of North Dakota School of Medicine and Health Sciences and physicians willing to work in Critical Access Hospitals were offered a joint appointment to teach hospitalist fellows and obtain a clinical academic appointment at the university. Since it was created in 2012, 84 physicians have applied for 13 fellowships. Of the 11 fellows who have completed the program, 64% (7/11) remained in North Dakota to practice. Physicians are more likely to work in a rural Critical Access Hospital if they spend time working at a tertiary care center and have clinical academic appointments. Where recruitment is challenging, hospitalist fellowship programs are helpful in meeting the health care workforce demand.

  19. Index of Access: a new innovative and dynamic tool for rural health service and workforce planning.

    Science.gov (United States)

    McGrail, Matthew R; Russell, Deborah J; Humphreys, John S

    2017-10-01

    Objective Improving access to primary health care (PHC) remains a key issue for rural residents and health service planners. This study aims to show that how access to PHC services is measured has important implications for rural health service and workforce planning. Methods A more sophisticated tool to measure access to PHC services is proposed, which can help health service planners overcome the shortcomings of existing measures and long-standing access barriers to PHC. Critically, the proposed Index of Access captures key components of access and uses a floating catchment approach to better define service areas and population accessibility levels. Moreover, as demonstrated through a case study, the Index of Access enables modelling of the effects of workforce supply variations. Results Hypothetical increases in supply are modelled for a range of regional centres, medium and small rural towns, with resulting changes of access scores valuable to informing health service and workforce planning decisions. Conclusions The availability and application of a specific 'fit-for-purpose' access measure enables a more accurate empirical basis for service planning and allocation of health resources. This measure has great potential for improved identification of PHC access inequities and guiding redistribution of PHC services to correct such inequities. What is known about the topic? Resource allocation and health service planning decisions for rural and remote health settings are currently based on either simple measures of access (e.g. provider-to-population ratios) or proxy measures of access (e.g. standard geographical classifications). Both approaches have substantial limitations for informing rural health service planning and decision making. What does this paper add? The adoption of a new improved tool to measure access to PHC services, the Index of Access, is proposed to assist health service and workforce planning. Its usefulness for health service planning is

  20. Unequal access to ART: exploratory results from rural and urban case studies of ART use.

    Science.gov (United States)

    Cleary, Susan May; Birch, Stephen; Moshabela, Mosa; Schneider, Helen

    2012-03-01

    South Africa has the world's largest antiretroviral treatment (ART) programme. While services in the public sector are free at the point of use, little is known about overall access barriers. This paper explores these barriers from the perspective of ART users enrolled in services in two rural and two urban settings. Using a comprehensive framework of access, interviews were conducted with over 1200 ART users to assess barriers along three dimensions: availability, affordability and acceptability. Summary statistics were computed and comparisons of access barriers between sites were explored using multivariate linear and logistic regressions. While availability access barriers in rural settings were found to be mitigated through a more decentralised model of service provision in one site, affordability barriers were considerably higher in rural versus urban settings. 50% of respondents incurred catastrophic healthcare expenditure and 36% borrowed money to cover these expenses in one rural site. On acceptability, rural users were less likely to report feeling respected by health workers. Stigma was reported to be lowest in the two sites with the most decentralised services and the highest coverage of those in need. While results suggest inequitable access to ART for rural relative to urban users, nurse-led services offered through primary healthcare facilities mitigated these barriers in one rural site. This is an important finding given current policy emphasis on decentralised and nurse-led ART in South Africa. This study is one of the first to present comprehensive evidence on access barriers to assist in the design of policy solutions.

  1. Educating Physicians for Rural America: Validating Successes and Identifying Remaining Challenges With the Rural Medical Scholars Program.

    Science.gov (United States)

    Wheat, John R; Leeper, James D; Murphy, Shannon; Brandon, John E; Jackson, James R

    2018-02-01

    To evaluate the Rural Medical Scholars (RMS) Program's effectiveness to produce rural physicians for Alabama. A nonrandomized intervention study compared RMS (1997-2002) with control groups in usual medical education (1991-2002) at the University of Alabama School of Medicine's main and regional campuses. Participants were RMS and others admitted to regular medical education, and the intervention was the RMS Program. Measures assessed the percentage of graduates practicing in rural areas. Odds ratios compared effectiveness of producing rural Alabama physicians. The RMS Program (N = 54), regional campuses (N = 182), and main campus (N = 649) produced 48.1% (odds ratio 6.4, P rural physicians, respectively. The RMS Program, contrasted to other local programs of medical education, was effective in producing rural physicians. These results were comparable to benchmark programs in the Northeast and Midwest USA on which the RMS Program was modeled, justifying the assumption that model programs can be replicated in different regions. However, this positive effect was not shared by a disparate rural minority population, suggesting that models for rural medical education must be adjusted to meet the challenge of such communities for physicians. © 2017 National Rural Health Association.

  2. Transportation constraints to rural health accessibility in Ogun ...

    African Journals Online (AJOL)

    Transportation constraints to rural health accessibility in Ogun Waterside Local Government Area of Ogun State Nigeria. ... Of the 200 questionnaires administered, 182 questionnaires were received for analysis using the Statistical Package for Social Sciences (SPSS). Secondary data was also sourced to serve as ...

  3. Emerging potential for radical e-enabled improvements in rural collaboration and accessibility

    CSIR Research Space (South Africa)

    Naude, AH

    2007-05-01

    Full Text Available volumes, as well as problems associated with limited local human capacities and uncoordinated or misdirected rural development planning; and enhanced accessibility - addressing the typical problems of rural isolation such as inadequated or costly digital...

  4. Electricity access for geographically disadvantaged rural communities - technology and policy insights

    Energy Technology Data Exchange (ETDEWEB)

    Chaurey, A.; Malini Ranganathan [The Energy and Resources Institute, New Delhi (India). India Habitat Centre; Parimita Mohanty [Jadavpur University, Kolkota (India). School of Energy Studies

    2004-10-01

    The purpose of this paper is to weigh the issues and options for increasing electricity access in remote and geographically challenged villages in interior Rajasthan, the desert state in Western India where power sector reforms are currently underway. By first providing an overview of reforms and various electrification policy initiatives in India, the paper then analyzes the specific problems as studied at the grass-roots level with respect to rural electricity access and the use of off-grid renewables. Finally, it discusses interventions that could facilitate access to electricity by suggesting a sequential distributed generation (DG)-based approach, wherein consecutive DG schemes-incorporating the requisite technological, financial, and institutional arrangements-are designed depending on the developmental requirements of the community. In essence, this approach fits under the broader need to understand how the three ''Rs'' - rural electrification (the process), power sector reforms (the catalyst), and the use of renewable energy technologies (the means)- could potentially converge to meet the needs of India's rural poor. (author)

  5. Inequities in coverage of preventive child health interventions: the rural drinking water supply program and the universal immunization program in Rajasthan, India.

    Science.gov (United States)

    Mohan, Pavitra

    2005-02-01

    I assessed whether the Rural Drinking Water Supply Program (RDWSP) and the Universal Immunization Program (UIP) have achieved equitable coverage in Rajasthan, India, and explored program characteristics that affect equitable coverage of preventive health interventions. A total of 2460 children presenting at 12 primary health facilities in one district of Rajasthan were enrolled and classified into economic quartiles based on possession of assets. Immunization coverage and prime source of drinking water were compared across quartiles. A higher access to piped water by wealthier families (P< .001) was compensated by higher access to hand pumps by poorer families (P<.001), resulting in equal access to a safe source (P=.9). Immunization coverage was inequitable, favoring the wealthier children (P<.001). The RDWSP has achieved equitable coverage, while UIP coverage remains highly inequitable. Programs can make coverage more equitable by formulating explicit objectives to ensure physical access to all, promoting the intervention's demand by the poor, and enhancing the support and monitoring of frontline workers who deliver these interventions.

  6. Rural Electrification Program in Indonesia: Comparing SEHEN and SHS Program

    Directory of Open Access Journals (Sweden)

    Maxensius Tri Sambodo

    2015-07-01

    Full Text Available In 2014, the Indonesian government has targets to obtain 80% of electrification ratio and 98.9% of rural electrification ratio. Extending the grid and off-grid connection has been done to obtain the targets. This paper aims to compare two main programs on rural electrification namely Super Extra Energy Saving (Super Ekstra Hemat Energi, SEHEN that is belong to PLN (state owned company in electricity and the Solar Home System (SHS that is financed by the Ministry of Energy and Mineral Resources (MEMR. Indonesia has started the rural electrification program in the late 1950s, but how to provide electricity in a sustainable ways both organizationally and institutionally still become a big challenge. The experiences from East Nusa Tenggara provinces showed that both SEHEN and SHS can instantly improve electrification ratio, but government needs to synchronize the technical, administrative, and financial aspect from the two programs. Without any improvements in designing the program, we argue that the existing program is not sustainable.

  7. Instructional Technology for Rural Schools: Access and Acquisition

    Science.gov (United States)

    Sundeen, Todd H.; Sundeen, Darrelanne M.

    2013-01-01

    Integrating instructional technology into all classrooms has the potential to transform modern education and student learning. However, access to technology is not equally available to all districts or schools. Decreased funding and budgetary restraints have had a direct impact on technology acquisition in many rural school districts. One of the…

  8. Increasing Access to Rural Finance in Bangladesh : The Forgotten "Missing Middle"

    OpenAIRE

    Ferrari, Aurora

    2007-01-01

    Increasing access to rural finance is often the last frontier for financial sector development in developing countries. Financial institutions aiming to operate in rural areas in these countries usually have to deal with high transaction costs, low population densities, remote areas, and a heavy focus on agriculture, with related weather and commodity risks. Although Bangladesh is highly v...

  9. 75 FR 41695 - Rural Microentrepreneur Assistance Program; Correction

    Science.gov (United States)

    2010-07-19

    ... DEPARTMENT OF AGRICULTURE Rural Business-Cooperative Service 7 CFR Part 4280 RIN 0570-AA71 Rural Microentrepreneur Assistance Program; Correction AGENCY: Rural Business-Cooperative Service, USDA. ACTION... of rural microenterprises. This document has an incorrect definition of ``nonprofit entity...

  10. The U.S. Rural Population and Scheduled Intercity Transportation in 2010 : A Five-Year Decline in Transportation Access.

    Science.gov (United States)

    2011-02-01

    Between 2005 and 2010, 3.5 million rural residents lost access to scheduled intercity transportation, increasing the percent of rural residents without access to intercity transportation from 7 to 11 percent. In 2005, 5.4 million rural residents lack...

  11. Mobility and Access for Off-Road Rural Farmers in West-Akim District

    African Journals Online (AJOL)

    The study is on the rural transportation problem in Ghana and its consequences on the rural people, especially those who live in off road villages (villages that do not have access to regular transportation systems). The study specifically discusses the failure of the existing road transport network to provide sufficient services ...

  12. Urban-rural differences in the association between access to healthcare and health outcomes among older adults in China.

    Science.gov (United States)

    Zhang, Xufan; Dupre, Matthew E; Qiu, Li; Zhou, Wei; Zhao, Yuan; Gu, Danan

    2017-07-19

    Studies have shown that inadequate access to healthcare is associated with lower levels of health and well-being in older adults. Studies have also shown significant urban-rural differences in access to healthcare in developing countries such as China. However, there is limited evidence of whether the association between access to healthcare and health outcomes differs by urban-rural residence at older ages in China. Four waves of data (2005, 2008/2009, 2011/2012, and 2014) from the largest national longitudinal survey of adults aged 65 and older in mainland China (n = 26,604) were used for analysis. The association between inadequate access to healthcare (y/n) and multiple health outcomes were examined-including instrumental activities of daily living (IADL) disability, ADL disability, cognitive impairment, and all-cause mortality. A series of multivariate models were used to obtain robust estimates and to account for various covariates associated with access to healthcare and/or health outcomes. All models were stratified by urban-rural residence. Inadequate access to healthcare was significantly higher among older adults in rural areas than in urban areas (9.1% vs. 5.4%; p China. The associations between access to healthcare and health outcomes were generally stronger among older adults in rural areas than in urban areas. Our findings underscore the importance of providing adequate access to healthcare for older adults-particularly for those living in rural areas in developing countries such as China.

  13. Factors associated with access of rural women to technology in ...

    African Journals Online (AJOL)

    A descriptive, correlational study was conducted to: describe the channels through which rural women obtain information regarding technology, and factors promoting access of women to technology; determine the contribution of technology to socio-economic development; and describe the relationships among factors ...

  14. Disparities in the access to primary healthcare in rural areas from the county of Iasi - Romania.

    Science.gov (United States)

    Duma, Olga-Odetta; Roşu, Solange Tamara; Manole, M; Petrariu, F D; Constantin, Brânduşa

    2014-01-01

    To identify the factors that may conduct to various forms of social exclusion of the population from the primary healthcare and to analyze health disparities as population-specific differences in the access to primary healthcare in rural compared to urban residence areas from Iasi, the second biggest county, situated in the North--East region of Romania. This research is a type of inquiry-based opinion survey of the access to primary healthcare in rural compared to urban areas of the county of Iasi. Data were collected by face-to-face interviews. There were taken into account the socioeconomic status (education level in the adult population, employment status, family income, household size) and two temporal variables (the interval of time spent to arrive at the primary healthcare office as a marker for the geographical access and the waiting time for a consultation). The study group consisted of two samples, from rural and urban area, each of 150 patients, all ages, randomly selected, who were waiting at the family doctor's practice. The study has identified disparities related to a poor economic status assessed through the employed status ("not working" 15% in urban and of 20% in rural).The income calculated per member of family and divided in terciles has recorded significant differences for "high" (36.7% urban and 14.7% rural) and "low", respectively (14.6% urban and 56.6% rural). High household size with more than five members represented 22.6% of the total subjects in rural and 15.3% in urban areas. The assessment of the education level in the adult population (> 18 years) revealed that in the rural areas more than a half (56%) of the sample is placed in the category primary and secondary incomplete, whereas the value for secondary complete and postsecondary was 37.3%. The proportion of respondents in the urban areas who have post-secondary education is five times higher than those in rural areas (15.4% vs. 2.7%). The reduced geographical access assessed as

  15. Accessing doctors at times of need-measuring the distance tolerance of rural residents for health-related travel.

    Science.gov (United States)

    McGrail, Matthew Richard; Humphreys, John Stirling; Ward, Bernadette

    2015-05-29

    Poor access to doctors at times of need remains a significant impediment to achieving good health for many rural residents. The two-step floating catchment area (2SFCA) method has emerged as a key tool for measuring healthcare access in rural areas. However, the choice of catchment size, a key component of the 2SFCA method, is problematic because little is known about the distance tolerance of rural residents for health-related travel. Our study sought new evidence to test the hypothesis that residents of sparsely settled rural areas are prepared to travel further than residents of closely settled rural areas when accessing primary health care at times of need. A questionnaire survey of residents in five small rural communities of Victoria and New South Wales in Australia was used. The two outcome measures were current travel time to visit their usual doctor and maximum time prepared to travel to visit a doctor, both for non-emergency care. Kaplan-Meier charts were used to compare the association between increased distance and decreased travel propensity for closely-settled and sparsely-settled areas, and ordinal multivariate regression models tested significance after controlling for health-related travel moderating factors and town clustering. A total of 1079 questionnaires were completed with 363 from residents in closely-settled locations and 716 from residents in sparsely-settled areas. Residents of sparsely-settled communities travel, on average, 10 min further than residents of closely-settled communities (26.3 vs 16.9 min, p time prepared to travel (54.1 vs 31.9 min, p time remained significant after controlling for demographic and other constraints to access, such as transport availability or difficulties getting doctor appointments, as well as after controlling for town clustering and current travel times. Improved geographical access remains a key issue underpinning health policies designed to improve the provision of rural primary health care

  16. Hydrokinetic power for energy access in rural Ghana

    Energy Technology Data Exchange (ETDEWEB)

    Miller, Veronica B.; Schaefer, Laura A. [Energy Systems Laboratory, Department of Mechanical Engineering and Materials Science, Mascaro Center for Sustainable Innovation, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA (United States); Ramde, Emmanuel W. [Department of Mechanical Engineering, Kwame Nkrumah University of Science and Technology, Kumasi (Ghana); Gradoville, Robert T. Jr. [Sustainability and Green Design, Department of Civil and Environmental Engineering, Mascaro Center for Sustainable Innovation, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA (United States)

    2011-02-15

    Approximately half of Ghana's overall population has access to electricity and, of this, much of it is in urban areas. Often in regions where modern energy is not available, kerosene lamps, for example, are used for indoor lighting. This produces harmful emissions, leading to poor respiratory effects. Implementation of hydrokinetic power (HKP) within nearby streams can provide low impact, robust energy to rural communities. Such a system lends itself to a simple design with ease of maintenance, which can be used as a stand alone power system (SAPS). With Ghana's renewable energy policies coming to fruition, it is sought to establish the economic viability and sustainability of this technology. This paper discusses site selection and the HKP technology in rural areas of Ghana. (author)

  17. A Community-Supported Clinic-Based Program for Prevention of Violence against Pregnant Women in Rural Kenya

    Directory of Open Access Journals (Sweden)

    Janet M. Turan

    2013-01-01

    Full Text Available Objective. Pregnant women are especially vulnerable to adverse outcomes related to HIV infection and gender-based violence (GBV. We aimed at developing a program for prevention and mitigation of the effects of GBV among pregnant women at an antenatal clinic in rural Kenya. Methods. Based on formative research with pregnant women, male partners, and service providers, we developed a GBV program including comprehensive clinic training, risk assessments in the clinic, referrals supported by community volunteers, and community mobilization. To evaluate the program, we analyzed data from risk assessment forms and conducted focus groups (n=2 groups and in-depth interviews (n=25 with healthcare workers and community members. Results. A total of 134 pregnant women were assessed during a 5-month period: 49 (37% reported violence and of those 53% accepted referrals to local support resources. Qualitative findings suggested that the program was acceptable and feasible, as it aided pregnant women in accessing GBV services and raised awareness of GBV. Community collaboration was crucial in this low-resource setting. Conclusion. Integrating GBV programs into rural antenatal clinics has potential to contribute to both primary and secondary GBV prevention. Following further evaluation, this model may be deemed applicable for rural communities in Kenya and elsewhere in East Africa.

  18. Social Networks and Health: Understanding the Nuances of Healthcare Access between Urban and Rural Populations.

    Science.gov (United States)

    Amoah, Padmore Adusei; Edusei, Joseph; Amuzu, David

    2018-05-13

    Communities and individuals in many sub-Saharan African countries often face limited access to healthcare. Hence, many rely on social networks to enhance their chances for adequate health care. While this knowledge is well-established, little is known about the nuances of how different population groups activate these networks to improve access to healthcare. This paper examines how rural and urban dwellers in the Ashanti Region in Ghana distinctively and systematically activate their social networks to enhance access to healthcare. It uses a qualitative cross-sectional design, with in-depth interviews of 79 primary participants (28 urban and 51 rural residents) in addition to the views of eight community leaders and eight health personnel. It was discovered that both intimate and distanced social networks for healthcare are activated at different periods by rural and urban residents. Four main stages of social networks activation, comprising different individuals and groups were observed among rural and urban dwellers. Among both groups, physical proximity, privacy, trust and sense of fairness, socio-cultural meaning attached to health problems, and perceived knowledge and other resources (mainly money) held in specific networks inherently influenced social network activation. The paper posits that a critical analysis of social networks may help to tailor policy contents to individuals and groups with limited access to healthcare.

  19. Rural providers' access to online resources: a randomized controlled trial

    Science.gov (United States)

    Hall, Laura J.; McElfresh, Karen R.; Warner, Teddy D.; Stromberg, Tiffany L.; Trost, Jaren; Jelinek, Devin A.

    2016-01-01

    Objective The research determined the usage and satisfaction levels with one of two point-of-care (PoC) resources among health care providers in a rural state. Methods In this randomized controlled trial, twenty-eight health care providers in rural areas were stratified by occupation and region, then randomized into either the DynaMed or the AccessMedicine study arm. Study participants were physicians, physician assistants, and nurses. A pre- and post-study survey measured participants' attitudes toward different information resources and their information-seeking activities. Medical student investigators provided training and technical support for participants. Data analyses consisted of analysis of variance (ANOVA), paired t tests, and Cohen's d statistic to compare pre- and post-study effects sizes. Results Participants in both the DynaMed and the AccessMedicine arms of the study reported increased satisfaction with their respective PoC resource, as expected. Participants in both arms also reported that they saved time in finding needed information. At baseline, both arms reported too little information available, which increased to “about right amounts of information” at the completion of the study. DynaMed users reported a Cohen's d increase of +1.50 compared to AccessMedicine users' reported use of 0.82. DynaMed users reported d2 satisfaction increases of 9.48 versus AccessMedicine satisfaction increases of 0.59 using a Cohen's d. Conclusion Participants in the DynaMed arm of the study used this clinically oriented PoC more heavily than the users of the textbook-based AccessMedicine. In terms of user satisfaction, DynaMed users reported higher levels of satisfaction than the users of AccessMedicine. PMID:26807050

  20. Free Access to Point of Care Resource Results in Increased Use and Satisfaction by Rural Healthcare Providers

    Directory of Open Access Journals (Sweden)

    Lindsay Alcock

    2016-12-01

    Full Text Available A Review of: Eldredge, J. D., Hall, L. J., McElfresh, K. R., Warner, T. D., Stromberg, T. L., Trost, J. T., & Jelinek, D. A. (2016. Rural providers’ access to online resources: A randomized controlled trial. Journal of the Medical Library Association, 104(1, 33-41. http://dx.doi.org/10.3163/1536-5050.104.1.005 Objective – To determine whether free access to the point of care (PoC resource Dynamed or the electronic book collection AccessMedicine was more useful to rural health care providers in answering clinical questions in terms of usage and satisfaction. Design – Randomized controlled trial. Setting – Rural New Mexico. Subjects – Twenty-eight health care providers (physicians, nurses, physician assistants, and pharmacists with no reported access to PoC resources, (specifically Dynamed and AccessMedicine or electronic textbook collections prior to enrollment.

  1. The power of light: socio-economic and environmental implications of a rural electrification program in Brazil

    Science.gov (United States)

    Borges da Silveira Bezerra, Paula; Ludovique Callegari, Camila; Ribas, Aline; Lucena, André F. P.; Portugal-Pereira, Joana; Koberle, Alexandre; Szklo, Alexandre; Schaeffer, Roberto

    2017-09-01

    Universal access to electricity is deemed critical for improving living standards and indispensable for eradicating poverty and achieving sustainable development. In 2003, the ‘Luz para Todos’ (LpT—Light for All) program was launched aiming to universalize access to electricity in Brazil. The program focused on rural and isolated areas, also targeting to bring development to those regions along with electrification. This paper evaluates the results of the LpT program in improving socio-economic development in the poorest regions of Brazil. After an initial qualitative analysis, an empirical quantitative assessment of the influence of increased electrification rates on the components of the Human Development Index (HDI) is performed. The empirical results of this study showed that electrification had a positive influence on all dimensions of the HDI, with the education component having the strongest effect. Although complementary policies were needed to achieve this, results show that electricity access is a major requirement to improve quality of life.

  2. Strength training in community settings: impact of lay leaders on program access and sustainability for rural older adults.

    Science.gov (United States)

    Washburn, Lisa T; Cornell, Carol E; Phillips, Martha; Felix, Holly; Traywick, LaVona

    2014-09-01

    The effect of volunteer lay leaders on availability and sustainability of strength-training programs for older adults has not been well explored. We describe implementation of the StrongWomen strength training program by the Arkansas Cooperative Extension Service, and report on the relationship between delivery approach (agent-led, lay-led, or combination of agent- and lay-led) and program access and sustainability. All state Extension agents (n = 66) were surveyed on program implementation, continuance, and use of lay leaders. Program records were used to identify the number of trained lay leaders. Regression models were used to examine the relationship between delivery approach and group availability. Counties using lay leaders had twice as many groups as counties using only agents. There was a significant, positive relationship between the number of lay leaders and the number of groups. Counties using lay leaders were 8.3 times more likely to have continuing groups compared with counties not using lay leaders. Program continuance was significantly and positively associated with lay leader use. Lay delivery expanded access to strength training programs and increased the likelihood that programs would continue. This approach can be used to increase access to and sustainability of strength training programs, particularly in resource-constrained areas.

  3. The Chinese electricity access model for rural electrification: Approach, experience and lessons for others

    International Nuclear Information System (INIS)

    Bhattacharyya, Subhes C.; Ohiare, Sanusi

    2012-01-01

    The economic and infrastructural disparities between the rural and urban communities of most developing countries in general and in terms of energy access in particular are quite glaring. China presents a good example of a developing country that has successfully embarked on rural electrification projects over the last few decades and achieved a great feat of almost 100% electrification rate (. World Energy Outlook, 2009, International Energy Agency, Paris (see IEA website at (http://www.worldenergyoutlook.org/electricity.asp).)). The purpose of this paper is to find out how China has achieved this feat; how China’s rural energy projects were financed and whether China provides lessons for other countries to follow. The above questions are examined through an extensive literature review and the paper finds that unlike many other countries following the top-down approach to rural electrification, China has preferred to use a phased development through a bottom-up approach where local resources, and village level development and empowerment played an important role. While the state provided the overall guidance and financial support, the integrated rural development approach has produced local-level solutions that are subsequently integrated to produce an alternative development pathway. Strong government commitment, active local participation, technological flexibility and diversity, strong emphasis on rural development through agricultural and industrial activities and an emphasis on capacity building and training have also played an important role in the success. However, despite achieving the universal access objective, China still faces a number of issues related to rural electricity use, especially in terms of regional use patterns, long-term sustainability of supply and commercial operation of the systems. The Chinese model could serve as an inspiration for other developing countries trying to ensure universal electricity access. - Highlights: ► It

  4. Integrating indigenous knowledge systems (IKS) in improving rural accessibility and mobility (in support of the comprehensive rural development programme in South Africa)

    CSIR Research Space (South Africa)

    Nhemachena, C

    2011-07-01

    Full Text Available INDIGENOUS KNOWLEDGE SYSTEMS (IKS) IN IMPROVING RURAL ACCESSIBILITY AND MOBILITY (IN SUPPORT OF THE COMPREHENSIVE RURAL DEVELOPMENT PROGRAMME IN SOUTH AFRICA) CHARLES NHEMACHENA1, JAMES CHAKWIZIRA2, SIPHO DUBE1, GOODHOPE MAPONYA1, REMINA RASHOPOLA3... of Environmental Sciences, Private Bag X5050, Thohoyandou, 0950 3 Department of Rural Development and Land Reform, PO Box X833, Pretoria 0001 ABSTRACT This study discusses opportunities and challenges for integrating local knowledge in improving...

  5. Effects of a proposed rural dental school on regional dental workforce and access to care.

    Science.gov (United States)

    Wanchek, Tanya N; Rephann, Terance J

    2013-01-01

    Southwest Virginia is a rural, low-income region with a relatively small dentist workforce and poor oral health outcomes. The opening of a dental school in the region has been proposed by policy-makers as one approach to improving the size of the dentist workforce and oral health outcomes. A policy simulation was conducted to assess how a hypothetical dental school in rural Southwest Virginia would affect the availability of dentists and utilization levels of dental services. The simulation focuses on two channels through which the dental school would most likely affect the region. First, the number of graduates who are expected to remain in the region was varied, based on the extensiveness of the education pipeline used to attract local students. Second, the number of patients treated in the dental school clinic under different dental school clinical models, including the traditional model, a patient-centered clinic model and a community-based clinic model, was varied in the simulation to obtain a range of additional dentists and utilization rates under differing dental school models. Under a set of plausible assumptions, the low yield scenario (ie private school with a traditional clinic) would result in three additional dentists residing in the region and a total of 8090 additional underserved patients receiving care. Under the high yield scenario (ie dental pipeline program with community based clinics) nine new dentists would reside in the region and as many as 18 054 underserved patients would receive care. Even with the high yield scenario and the strong assumption that these patients would not otherwise access care, the utilization rate increases to 68.9% from its current 60.1%. While the new dental school in Southwest Virginia would increase the dentist workforce and utilization rates, the high cost combined with the continued low rate of dental utilization suggests that there may be more effective alternatives to improving oral health in rural areas

  6. 43 CFR 404.3 - What is the Reclamation Rural Water Supply Program?

    Science.gov (United States)

    2010-10-01

    ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false What is the Reclamation Rural Water Supply... RECLAMATION, DEPARTMENT OF THE INTERIOR RECLAMATION RURAL WATER SUPPLY PROGRAM Overview § 404.3 What is the Reclamation Rural Water Supply Program? This program addresses domestic, municipal, and industrial water...

  7. Rural providers’ access to online resources: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Jonathan D. Eldredge

    2016-01-01

    Full Text Available Objective: The research determined the usage and satisfaction levels with one of two point-of-care (PoC resources among health care providers in a rural state. Methods: In this randomized controlled trial, twenty-eight health care providers in rural areas were stratified by occupation and region, then randomized into either the DynaMed or the AccessMedicine study arm. Study participants were physicians, physician assistants, and nurses. A pre- and post-study survey measured participants’ attitudes toward different information resources and their information-seeking activities. Medical student investigators provided training and technical support for participants. Data analyses consisted of analysis of variance (ANOVA, paired t tests, and Cohen’s d statistic to compare pre- and post-study effects sizes. Results: Participants in both the DynaMed and the AccessMedicine arms of the study reported increased satisfaction with their respective PoC resource, as expected. Participants in both arms also reported that they saved time in finding needed information. At baseline, both arms reported too little information available, which increased to ‘‘about right amounts of information’’ at the completion of the study. DynaMed users reported a Cohen’s d increase of þ1.50 compared to AccessMedicine users’ reported use of 0.82. DynaMed users reported d2 satisfaction increases of 9.48 versus AccessMedicine satisfaction increases of 0.59 using a Cohen’s d. Conclusion: Participants in the DynaMed arm of the study used this clinically oriented PoC more heavily than the users of the textbook-based AccessMedicine. In terms of user satisfaction, DynaMed users reported higher levels of satisfaction than the users of AccessMedicine.

  8. Scaling-up access to antiretroviral therapy for children: A cohort study evaluating care and treatment at mobile and hospital-affiliated HIV clinics in rural Zambia

    NARCIS (Netherlands)

    J.H. van Dijk (Janneke); W.J. Moss (William); F. Hamangaba (Francis); B. Munsanje (Bornface); C.G. Sutcliffe (Catherine)

    2014-01-01

    textabstractBackground: Travel time and distance are barriers to care for HIV-infected children in rural sub-Saharan Africa. Decentralization of care is one strategy to scale-up access to antiretroviral therapy (ART), but few programs have been evaluated. We compared outcomes for children receiving

  9. An evaluation of rural health care research.

    Science.gov (United States)

    Kane, R; Dean, M; Solomon, M

    1979-05-01

    Reviews the state of the art of rural health research and evaluation in the U.S. with particular emphasis on the questions of access, health personnel, and financing. The current state of knowledge both in the published and unpublished literature in each area is summarized and a series of unresolved issues is proposed. A strategy for further research to include the various types of rural health care programs is described. Major findings suggest that, although rural populations do have somewhat less access to care than do urban populations, our ability to quantify precisely the extent and importance of this discrepancy is underdeveloped. Despite a substantial investment in a variety of rural health care programs there is inadequate information as to their effectiveness. Programs designed to increase the supply of health personnel to rural areas have met with mixed success. Sites staffed by National Health Service Corps personnel show consistently lower productivity than do sites under other sponsorship. Nonphysician personnel (physician assistants and nurse practitioners) offer a promising source of primary care for rural areas: recent legislation that reimburses such care should increase their utilization. A persistent problem is the expectation (often a mandate) incorporated into many rural health care demonstration efforts that the programs become financially self-sufficient in a finite period of time. Self-sufficiency is a function of utilization, productivity, and the ability to recover charges for services. In many instances stringent enforcement of the self-sufficiency requirement may mean those who need services most will be least likely to receive them.

  10. Barriers and Facilitators to Adoption of a Lay-Delivered Community-Based Strength Training Program for Women in Rural Areas

    Science.gov (United States)

    Washburn, Lisa T.; Cornell, Carol E.; Traywick, LaVona; Felix, Holly C.; Phillips, Martha E.

    2017-01-01

    Background: Limited access to fitness programs for rural older adults make lay or volunteer delivery approaches potentially desirable to extend reach. However, factors affecting adoption of such approaches are not well explored. Purpose: This study sought to identify barriers and facilitators affecting adoption of a volunteer lay delivery approach…

  11. 77 FR 66052 - Program Access Rules

    Science.gov (United States)

    2012-10-31

    ... delivered, cable-affiliated RSNs in the 2010 Program Access Order. 3. With respect to the first element (the... exclusive contract involving a cable-affiliated RSN is an ``unfair act.'' In the 2010 Program Access Order... Agreements 18. ACA also urges the Commission to revise the program access rules to prohibit cable-affiliated...

  12. Rural women's access to health care in Bangladesh: swimming against the tide?

    Science.gov (United States)

    Hossen, Md Abul; Westhues, Anne

    2011-01-01

    Large segments of the population in developing countries are deprived of a fundamental right: access to basic health care. The problem of access to health care is particularly acute in Bangladesh. One crucial determinant of health seeking among rural women is the accessibility of medical care and barriers to care that may develop because of location, financial requirements, bureaucratic responses to the patient, social distance between client and provider, and the sex of providers. This article argues that to increase accessibility fundamental changes are required not only in resource allocation but also in the very structure of health services delivery.

  13. Estimating rural populations without access to electricity in developing countries through night-time light satellite imagery

    International Nuclear Information System (INIS)

    Doll, Christopher N.H.; Pachauri, Shonali

    2010-01-01

    A lack of access to energy and, in particular, electricity is a less obvious manifestation of poverty but arguably one of the most important. This paper investigates the extent to which electricity access can be investigated using night-time light satellite data and spatially explicit population datasets to compare electricity access between 1990 and 2000. We present here the first satellite derived estimates of rural population without access to electricity in developing countries to draw insights on issues surrounding the delivery of electricity to populations in rural areas. The paper provides additional evidence of the slow progress in expansion of energy access to households in Sub-Saharan Africa and shows how this might be ascribed in part due to the low population densities in rural areas. The fact that this is a continent with some of the lowest per-capita income levels aggravates the intrinsic difficulties associated with making the investments needed to supply electricity in areas with low population density and high dispersion. Clearly, these spatial dimensions of the distributions of the remaining unelectrified populations in the world have an impact on what options are considered the most appropriate in expanding access to these households and the relative attractiveness of decentralized options.

  14. Youth access to indoor tanning salons in urban versus rural/suburban communities.

    Science.gov (United States)

    Nahar, Vinayak K; Rosenthal, Meagen; Lemon, Stephenie C; Kane, Kevin; Cheng, Jie; Oleski, Jessica L; Li, Wenjun; Hillhouse, Joel J; Pagoto, Sherry L

    2018-03-01

    Research suggests that youth proximity to tanning salons may promote use; however, little is known about tanning salon proximity to schools. We assessed the proximity of tanning salons to schools in urban versus rural/suburban communities across Worcester County, Massachusetts (population > 800K). To put findings in context, we compared school proximity to tanning salons to school proximity to McDonald's restaurants, a large franchise that also caters to young people. Accessibility was measured by ArcGIS 10.2 Network Analyzer (ESRI, Redlands, CA, USA) and the most current road network data layer from Massachusetts Department of Transportation (MassDOT). A total of 145 schools were observed in the study area, of which about 39% of schools were within 1 mile from a tanning salon. Urban schools (53.41%) had a higher proportion within 1 mile of a tanning salon than rural/suburban schools (17.54%; P < .001). More schools (39.31%) were within 1 mile of a tanning salon than schools within 1 mile of a McDonald's (22.70%; P < .001). Schools may be particularly impactful for implementing skin cancer prevention programing. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. Free open access medical education can help rural clinicians deliver 'quality care, out there'.

    Science.gov (United States)

    Leeuwenburg, Tim J; Parker, Casey

    2015-01-01

    Rural clinicians require expertise across a broad range of specialties, presenting difficulty in maintaining currency of knowledge and application of best practice. Free open access medical education is a new paradigm in continuing professional education. Use of the internet and social media allows a globally accessible crowd-sourced adjunct, providing inline (contextual) and offline (asynchronous) content to augment traditional educational principles and the availability of relevant resources for life-long learning. This markedly reduces knowledge translation (the delay from inception of a new idea to bedside implementation) and allows rural clinicians to further expertise by engaging in discussion of cutting edge concepts with peers worldwide.

  16. Rural maternity care.

    Science.gov (United States)

    Miller, Katherine J; Couchie, Carol; Ehman, William; Graves, Lisa; Grzybowski, Stefan; Medves, Jennifer

    2012-10-01

    To provide an overview of current information on issues in maternity care relevant to rural populations. Medline was searched for articles published in English from 1995 to 2012 about rural maternity care. Relevant publications and position papers from appropriate organizations were also reviewed. This information will help obstetrical care providers in rural areas to continue providing quality care for women in their communities. Recommendations 1. Women who reside in rural and remote communities in Canada should receive high-quality maternity care as close to home as possible. 2. The provision of rural maternity care must be collaborative, woman- and family-centred, culturally sensitive, and respectful. 3. Rural maternity care services should be supported through active policies aligned with these recommendations. 4. While local access to surgical and anaesthetic services is desirable, there is evidence that good outcomes can be sustained within an integrated perinatal care system without local access to operative delivery. There is evidence that the outcomes are better when women do not have to travel far from their communities. Access to an integrated perinatal care system should be provided for all women. 5. The social and emotional needs of rural women must be considered in service planning. Women who are required to leave their communities to give birth should be supported both financially and emotionally. 6. Innovative interprofessional models should be implemented as part of the solution for high-quality, collaborative, and integrated care for rural and remote women. 7. Registered nurses are essential to the provision of high-quality rural maternity care throughout pregnancy, birth, and the postpartum period. Maternity nursing skills should be recognized as a fundamental part of generalist rural nursing skills. 8. Remuneration for maternity care providers should reflect the unique challenges and increased professional responsibility faced by providers in

  17. Rural wood consumption patterns of local and immigrant households with differentiated access to resources in Xishuangbanna, Yunnan, China

    International Nuclear Information System (INIS)

    Mertens, Charlotte Filt; Bruun, Thilde Bech; Schmidt-Vogt, Dietrich; He, Jun; Neergaard, Andreas de

    2015-01-01

    In Xishuangbanna, China, rubber production has spread rapidly, resulting in extensive land use changes and an increasing influx of migrant workers who have come to find work on the plantations. These migrant workers have limited access to subsidies and the local collective forest due to the household registration system in China called hukou. To assess how these policy-based restrictions on access affect wood consumption and local communities, a case study was conducted in Manlin village, Xishuangbanna, undertaking a household and weight survey with local and immigrant households. The results show no significant difference in firewood consumption between the subpopulations, despite predominantly more local than immigrant households have access to subsidised alternative energy sources. On the other hand, limited access to the collective forest is found to influence the choice of housing materials and living standards in immigrant households as they cannot access timber or afford brick houses. This paper highlights rural issues connected to the hukou system and suggests that rural energy and resource policies should take the growing population of immigrant workers into consideration in future to expand the reach of the polices to the de facto and not only de jure rural population and thus optimise policy efficiency. - Highlights: • The hukou system directly affects rural wood access and consumption. • Immigrant households have little or no access to timber. • Registration status does not have a significant effect on firewood consumption. • Excluding immigrant households will limit policy outreach and efficiency

  18. Rural Health Care Information Access and the Use of the Internet: Opportunity for University Extension

    Science.gov (United States)

    Das, Biswa R.; Leatherman, John C.; Bressers, Bonnie M.

    2015-01-01

    The Internet has potential for improving health information delivery and strengthening connections between rural populations and local health service providers. An exploratory case study six rural health care markets in Kansas showed that about 70% of adults use the Internet, with substantial use for accessing health information. While there are…

  19. Access to ICT education for girls and women in rural South Africa: a case study

    CSIR Research Space (South Africa)

    Dlodlo, N

    2009-05-01

    Full Text Available This paper describes the impact of socio-economic factors on girls and women’s access to Information and Communication Technology (ICT) education and training in a rural South African environment and recommends strategies for improved access to ICT...

  20. Facilitators of prenatal care access in rural Appalachia.

    Science.gov (United States)

    Phillippi, Julia C; Myers, Carole R; Schorn, Mavis N

    2014-12-01

    There are many providers and models of prenatal care, some more effective than others. However, quantitative research alone cannot determine the reasons beneficial models of care improve health outcomes. Perspectives of women receiving care from effective clinics can provide valuable insight. We surveyed 29 women receiving care at a rural, Appalachian birth center in the United States with low rates of preterm birth. Semi-structured interviews and demographic questionnaires were analyzed using conventional qualitative content analysis of manifest content. Insurance was the most common facilitator of prenatal access. Beneficial characteristics of the provider and clinic included: personalized care, unrushed visits, varied appointment times, short waits, and choice in the type and location of care. There is a connection between compassionate and personalized care and positive birth outcomes. Women were willing to overcome barriers to access care that met their needs. To facilitate access to prenatal care and decrease health disparities, healthcare planners, and policy makers need to ensure all women can afford to access prenatal care and allow women a choice in their care provider. Clinic administrators should create a welcoming clinic environment with minimal wait time. Unrushed, woman-centered prenatal visits can increase access to and motivation for care and are easily integrated into prenatal care with minimal cost. Copyright © 2014 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  1. Rural and remote young people's health career decision making within a health workforce development program: a qualitative exploration.

    Science.gov (United States)

    Kumar, Koshila; Jones, Debra; Naden, Kathryn; Roberts, Chris

    2015-01-01

    One strategy aimed at resolving ongoing health workforce shortages in rural and remote settings has been to implement workforce development initiatives involving the early activation and development of health career aspirations and intentions among young people in these settings. This strategy aligns with the considerable evidence showing that rural background is a strong predictor of rural practice intentions and preferences. The Broken Hill Regional Health Career Academy Program (BHRHCAP) is an initiative aimed at addressing local health workforce challenges by helping young people in the region develop and further their health career aspirations and goals. This article reports the factors impacting on rural and remote youths' health career decision-making within the context of a health workforce development program. Data were collected using interviews and focus groups with a range of stakeholders involved in the BHRHCAP including local secondary school students, secondary school teachers, career advisors, school principals, parents, and pre-graduate health students undertaking a clinical placement in Broken Hill, and local clinicians. Data interpretation was informed by the theoretical constructs articulated within socio cognitive career theory. Young people's career decision-making in the context of a local health workforce development program was influenced by a range of personal, contextual and experiential factors. These included personal factors related to young people's career goals and motivations and their confidence to engage in career decision-making, contextual factors related to BHRHCAP program design and structure as well as the visibility and accessibility of health career pathways in a rural setting, and experiential factors related to the interaction and engagement between young people and role models or influential others in the health and education sectors. This study provided theoretical insight into the broader range of interrelating and

  2. Alaska Native Villages and Rural Communities Water Grant Program

    Science.gov (United States)

    Significant human health and water quality problems exist in Alaska Native Village and other rural communities in the state due to lack of sanitation. To address these issues, EPA created the Alaska Rural and Native Villages Grant Program.

  3. 75 FR 30113 - Rural Microentrepreneur Assistance Program

    Science.gov (United States)

    2010-05-28

    ...)); Removing ``socially-disadvantaged'' and clarifying that the percentage of rural entrepreneurs that received... entrepreneurs that have not received a microloan from an MDO under this program would not be able to receive... the Agency is easier to implement and consistent with other program regulations. The Agency, therefore...

  4. Level of access to social capital and its predictors among rural ...

    African Journals Online (AJOL)

    Level of access to social capital and its predictors among rural farming households ... The combined effects of all the variables explained 98.21% of the total variation in social capital ... This will consolidate and deepen interaction among members, and enable them build greater trust, and enjoy benefits of social networks in ...

  5. Meeting EFA: Bangladesh Rural Advancement Committee (BRAC) Primary Schools. Case Study

    Science.gov (United States)

    Chaboux, Collette

    2006-01-01

    This case study describes the Bangladesh Rural Advancement Committee (BRAC), which was formed to explore ways to help children from its rural development program gain access to improved education. Working mainly in rural areas, BRAC focused on improved quality through improved education service delivery, management detail, and finance. While…

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

    Directory of Open Access Journals (Sweden)

    Briggs Andrew M

    2012-10-01

    Full Text Available Abstract 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

  7. 2014 Rural Clinical School Training and Support Program Snapshot survey.

    Science.gov (United States)

    Mendis, Kumara; Greenhill, Jennene; Walker, Judi; Bailey, Jannine; Croft, Amanda; Doyle, Zelda; McCrossin, Timothy; Stevens, Wendy

    2015-01-01

    The Rural Clinical Training and Support (RCTS) program is an Australian Government initiative to address the shortage of medical practitioners within rural and remote Australia. There is a large amount of published information about the RCTS program and rural medical student cohorts who have undertaken short- and long-term rotations. However, very little is known about the academic and professional staff involved in the program, a knowledge gap that may impact workforce and succession planning. To address this, the Federation of Rural Australian Medical Educators (FRAME) initiated the pilot 2014 RCTS Snapshot survey to obtain data on the current RCTS workforce. All professional, academic and clinical academic staff (fixed-term and continuing, regardless of fraction) employed through the RCTS program were invited to complete a short, web-based survey. The survey was conducted from March to June 2014. The quantitative variables in the survey included demographics (age and gender), rural background and exposure, employment history in rural/regional areas and at rural clinical schools (RCS), experience and expertise, reasons for working at RCS, and future employment intentions. The last three questions also were of a qualitative open-ended format to allow respondents to provide additional details regarding their reasons for working at RCSs and their future intentions. The estimated total RCTS workforce was 970. A total of 413 responses were received and 316 (40.9%) complete responses analysed. The majority of respondents were female (71%), the 40-60-year age group was predominant (28%), and professional staff constituted the majority (62%). The below 40-year age group had more professionals than academics (21% vs 12%) and more than 62% of academics were aged above 50 years. Notably, there were no academics aged less than 30 years. The percentage of professional staff with a rural background was higher (62%) than that of academics with a rural background (42%). However

  8. A Profile of Agricultural Education Teachers with Exemplary Rural Agricultural Entrepreneurship Education Programs

    Science.gov (United States)

    Heinert, Seth B.; Roberts, T. Grady

    2017-01-01

    Rural entrepreneurship education programs may be a great tool for enhancing rural livelihoods and reducing rural outmigration. Entrepreneurship has received attention in school based agricultural education, primarily through implementation of Supervised Agricultural Experience (SAE) programs. Very little research has looked at the teaching of…

  9. Recruitment of rural healthcare professionals for live continuing education

    OpenAIRE

    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 sequentia...

  10. Sexual abuse and access to justice for rural women in West Africa ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    More specifically, this project will involve the African Network for Integrated Development (ANID) and its partners taking a participatory research-action approach, and combining qualitative and quantitative methods to produce a knowledge base regarding sexual abuse and the constraints on access to justice in rural areas.

  11. Barriers to accessing termination of pregnancy in a remote and rural setting: a qualitative study.

    Science.gov (United States)

    Heller, R; Purcell, C; Mackay, L; Caird, L; Cameron, S T

    2016-09-01

    To explore the experiences of women from a remote and rural setting who had a termination of pregnancy (TOP), in relation to any barriers they may have experienced trying to access TOP. Qualitative interview study. Scottish Highlands and Western Isles. Women who had undergone TOP in the Scottish Highlands National Health Service between October 2014 and May 2015. Sixteen semi-structured, audio-recorded telephone interviews were conducted by a researcher with women who had consented to be interviewed at their initial assessment. Six stages of thematic analysis were followed to explore themes in and across participant accounts. Themes derived from interview transcripts. Four themes emerged relating to barriers to access and experience: (1) the impact of travel for TOP, (2) temporal factors unique to this population and how they affected women, (3) the attitude of health professionals, notably general practitioners, as a result of local culture, and (4) stigma surrounding TOP and the expectation that abortion will be traumatising. Women in remote and rural areas experience barriers to accessing TOP. Prompt referrals, more providers of TOP and tackling stigma associated with TOP could make delivery of this service more equitable and improve women's journey through TOP. Women in remote and rural areas of Scotland face multiple barriers to accessing termination of pregnancy. © 2016 Royal College of Obstetricians and Gynaecologists.

  12. Improving Maternal Healthcare Access and Neonatal Survival through a Birthing Home Model in Rural Haiti

    Directory of Open Access Journals (Sweden)

    Elizabeth Wickstrom

    2007-10-01

    Full Text Available High neonatal mortality in Haiti is sustained by limited access to essential maternity services, particularly for Haiti’s rural population. We investigated the feasibility of a rural birthing home model to provide basic prenatal, delivery, and neonatal services for women with uncomplicated pregnancies while simultaneously providing triage and transport of women with pregnancy related complications. The model included consideration of the local context, including women’s perceptions of barriers to healthcare access and available resources to implement change. Evaluation methods included the performance of a baseline community census and collection of pregnancy histories from 791 women living in a defined area of rural Haiti. These retrospective data were compared with pregnancy outcome for 668 women subsequently receiving services at the birthing home. Of 764 reported most recent pregnancies in the baseline survey, 663(87% occurred at home with no assistance from skilled health staff. Of 668 women followed after opening of the birthing home, 514 (77% subsequently gave birth at the birthing home, 94 (14% were referred to a regional hospital for delivery, and only 60 (9% delivered at home or on the way to the birthing home. Other measures of clinical volume and patient satisfaction also indicated positive changes in health care seeking. After introduction of the birthing home, fewer neonates died than predicted by historical information or national statistics. The present experience points out the feasibility of a rural birthing home model to increase access to essential maternity services.

  13. The Effect of Infrastructure Access and Quality on Non-farm Employment and Income in Rural Indonesia

    OpenAIRE

    Olivia, Susan; Gibson, John

    2008-01-01

    There is growing interest in the rural non-farm sector in developing countries as a contributor to economic growth, employment generation, livelihood diversification and poverty reduction. Access to infrastructure is identified in some studies as a factor that affects non-farm rural employment and income but less attention has been paid to the constraints imposed by poor quality infrastructure. In this paper we use data from 4000 households in rural Indonesia to show that the quality of two k...

  14. A review of characteristics and outcomes of Australia's undergraduate medical education rural immersion programs.

    Science.gov (United States)

    O'Sullivan, Belinda G; McGrail, Matthew R; Russell, Deborah; Chambers, Helen; Major, Laura

    2018-01-31

    A key strategy for increasing the supply of rural doctors is rurally located medical education. In 2000, Australia introduced a national policy to increase rural immersion for undergraduate medical students. This study aims to describe the characteristics and outcomes of the rural immersion programs that were implemented in Australian medical schools. Information about 19 immersion programs was sourced in 2016 via the grey and published literature. A scoping review of the published peer-reviewed studies via Ovid MEDLINE and Informit (2000-2016) and direct journal searching included studies that focused on outcomes of undergraduate rural immersion in Australian medical schools from 2000 to 2016. Programs varied widely by selection criteria and program design, offering between 1- and 6-year immersion. Based on 26 studies from 10 medical schools, rural immersion was positively associated with rural practice in the first postgraduate year (internship) and early career (first 10 years post-qualifying). Having a rural background increased the effects of rural immersion. Evidence suggested that longer duration of immersion also increases the uptake of rural work, including by metropolitan-background students, though overall there was limited evidence about the influence of different program designs. Most evidence was based on relatively weak, predominantly cross-sectional research designs and single-institution studies. Many had flaws including small sample sizes, studying internship outcomes only, inadequately controlling for confounding variables, not using metropolitan-trained controls and providing limited justification as to the postgraduate stage at which rural practice outcomes were measured. Australia's immersion programs are moderately associated with an increased rural supply of early career doctors although metropolitan-trained students contribute equal numbers to overall rural workforce capacity. More research is needed about the influence of student interest

  15. Retrospective chart review for obesity and associated interventions among rural Mexican-American adolescents accessing healthcare services.

    Science.gov (United States)

    Champion, Jane Dimmitt; Collins, Jennifer L

    2013-11-01

    To report a retrospective analysis of data routinely collected in the course of healthcare services at a rural health clinic and to assess obesity incidence and associated interventions among rural Mexican-American adolescents. Two hundred and twelve charts reviewed; 98 (46.2%) males and 114 (53.8%) females. Data extracted included Medicaid exams conducted at the clinic within 5 years. Equal overweight or obese (n = 105, 49.5%), versus normal BMI categorizations (n = 107, 50.5%) documented overall and by gender. Female obesity higher (25.4%) than national norms (17.4%); male rates (25.5%) were within national norm. Interventions provided by nurse practitioners (94%) for 34.8%-80% of overweight/obese had limited follow-up (4%). Obesity incidence markedly increased between 13 and 18 years of age without associated interventions; 51.4%-75.6% without interventions. Obesity is a healthcare problem among rural Mexican-American adolescents accessing care at the rural health clinic. Obesity intervention and follow-up was suboptimal within this setting. Rural and ethnic minority adolescents experience health disparities concerning obesity prevalence and remote healthcare access. Obesity prevention and treatment during adolescence is a national health priority given physiologic and psychological tolls on health and potential for obesity into adulthood. Obesity assessment and translation of evidence-based interventions for rural Mexican-American adolescents at rural health clinics is implicated. ©2013 The Author(s) ©2013 American Association of Nurse Practitioners.

  16. The Impact of Expanding Access to Early Childhood Education Services in Rural Indonesia

    NARCIS (Netherlands)

    Brinkman, S.A.; Hasan, A.; Jung, H.; Kinnell, A.; Pradhan, M.

    2017-01-01

    This paper examines the effects of an intervention that expanded access to low-cost, government-sponsored, community-based playgroups in rural Indonesia. Instrumental variables and difference-in-differences models indicate that while the intervention raised enrollment rates and durations of

  17. The impact of expanding access to early childhood education services in rural Indonesia

    NARCIS (Netherlands)

    Brinkman, Sally Anne; Hasan, Amer; Jung, Haeil; Kinnell, Angela; Pradhan, M.P.

    2017-01-01

    This paper examines the effects of an intervention that expanded access to low-cost, government-sponsored, community-based playgroups in rural Indonesia. Instrumental variables and difference-in-differences models indicate that while the intervention raised enrollment rates and durations of

  18. Bringing Produce to the People: Implementing a Social Marketing Food Access Intervention in Rural Food Deserts.

    Science.gov (United States)

    Ramirez, A Susana; Diaz Rios, Lillian K; Valdez, Zulema; Estrada, Erendira; Ruiz, Ariana

    2017-02-01

    This study describes and evaluates the process of implementing a social marketing food access intervention for food desert communities in rural California. A case study approach used mixed-methods data from nationwide market comparisons, environmental assessment, and community informants. Lessons learned demonstrate room for improvement in implementing such strategies and underscore the importance of involving community in decision making; the strategic importance of operational decisions relating to intervention design, site and product selection, and distribution models; and the need to reconsider the problem of access in rural areas. Copyright © 2016 Society for Nutrition Education and Behavior. All rights reserved.

  19. Improving access to antiretrovirals in rural South Africa – a call to ...

    African Journals Online (AJOL)

    Improving access to antiretrovirals in rural South Africa – a call to action. South Africa (SA) already has the world's biggest antiretroviral (ARV) programme. With the introduction of extended criteria for initiating ARVs, the National Department of Health (NDoH) wishes to increase the number of people on ARVs by around.

  20. Barriers in health care access faced by children with intellectual disabilities living in rural Uttar Pradesh

    Directory of Open Access Journals (Sweden)

    Jubin Varghese

    2015-09-01

    Full Text Available Purpose: People with disability in rural India face multiple barriers accessing healthcare; our hypothesis is that children with intellectual disability suffer the same but little is known about the barriers faced by them. The objectives of the study were to identify the health seeking behaviours of families with children with intellectual disabilities and the barriers they faced accessing healthcare. Methods: This qualitative study involved interviewing caregivers of children with intellectual disability from a pre-existing community development project in the Sahadoli Kadim block of rural Uttar Pradesh. Semi-structured interviews were also conducted with the local practitioners frequented by these caregivers. Results: Barriers identified were grouped under cognitive, structural and financial barriers which were found to be consistent with the Health Care Access Barrier Model (Carrillo, et al., 2011; WHO, 2011. Cognitive barriers included caregivers being unable to identify the complex health needs of their children. Caregivers lacked appropriate knowledge of intellectual disability, with doctors failing to educate them. Structural and financial barriers encompassed poor availability of healthcare providers and contributed to poor access to specialists. Caregivers had no information about government financial aid and healthcare providers did not refer them to these. Conclusion: Children with intellectual disabilities are forced to live with a poor quality of life because of cognitive, structural and financial barriers they face in accessing health care. Results are specific to children with intellectual disability in rural Sahadoli Kadim and could be used to inform policies and strategies to reduce disparities in health care access for these children.

  1. [Fresno County Library Rural Literacy Outreach Program. Final Performance Report, 1988-1989.

    Science.gov (United States)

    Walling, Joyce

    The Library Rural Literacy Outreach Program targeted to ten rural communities in the Fresno County, California, Free Library district is reported. The sites were chosen based on inquiries from volunteers in those communities and support for the program by the branch library staff. Goals of the program were to provide literacy services to adult…

  2. Two-Step Optimization for Spatial Accessibility Improvement: A Case Study of Health Care Planning in Rural China

    Directory of Open Access Journals (Sweden)

    Jing Luo

    2017-01-01

    Full Text Available A recent advancement in location-allocation modeling formulates a two-step approach to a new problem of minimizing disparity of spatial accessibility. Our field work in a health care planning project in a rural county in China indicated that residents valued distance or travel time from the nearest hospital foremost and then considered quality of care including less waiting time as a secondary desirability. Based on the case study, this paper further clarifies the sequential decision-making approach, termed “two-step optimization for spatial accessibility improvement (2SO4SAI.” The first step is to find the best locations to site new facilities by emphasizing accessibility as proximity to the nearest facilities with several alternative objectives under consideration. The second step adjusts the capacities of facilities for minimal inequality in accessibility, where the measure of accessibility accounts for the match ratio of supply and demand and complex spatial interaction between them. The case study illustrates how the two-step optimization method improves both aspects of spatial accessibility for health care access in rural China.

  3. Towards equitable access to medicines for the rural poor: analyses of insurance claims reveal rural pharmacy initiative triggers price competition in Kyrgyzstan.

    Science.gov (United States)

    Waning, Brenda; Maddix, Jason; Tripodis, Yorghos; Laing, Richard; Leufkens, Hubert Gm; Gokhale, Manjusha

    2009-12-14

    A rural pharmacy initiative (RPI) designed to increase access to medicines in rural Kyrgyzstan created a network of 12 pharmacies using a revolving drug fund mechanism in 12 villages where no pharmacies previously existed. The objective of this study was to determine if the establishment of the RPI resulted in the unforeseen benefit of triggering medicine price competition in pre-existing (non-RPI) private pharmacies located in the region. We conducted descriptive and multivariate analyses on medicine insurance claims data from Kyrgyzstan's Mandatory Health Insurance Fund for the Jumgal District of Naryn Province from October 2003 to December 2007. We compared average quarterly medicine prices in competitor pharmacies before and after the introduction of the rural pharmacy initiative in October 2004 to determine the RPI impact on price competition. Descriptive analyses suggest competitors reacted to RPI prices for 21 of 30 (70%) medicines. Competitor medicine prices from the quarter before RPI introduction to the end of the study period decreased for 17 of 30 (57%) medicines, increased for 4 of 30 (13%) medicines, and remained unchanged for 9 of 30 (30%) medicines. Among the 9 competitor medicines with unchanged prices, five initially decreased in price but later reverted back to baseline prices. Multivariate analyses on 19 medicines that met sample size criteria confirm these findings. Fourteen of these 19 (74%) competitor medicines changed significantly in price from the quarter before RPI introduction to the quarter after RPI introduction, with 9 of 19 (47%) decreasing in price and 5 of 19 (26%) increasing in price. The RPI served as a market driver, spurring competition in medicine prices in competitor pharmacies, even when they were located in different villages. Initiatives designed to increase equitable access to medicines in rural regions of developing and transitional countries should consider the potential to leverage medicine price competition as a means

  4. Towards equitable access to medicines for the rural poor: analyses of insurance claims reveal rural pharmacy initiative triggers price competition in Kyrgyzstan

    Directory of Open Access Journals (Sweden)

    Leufkens Hubert GM

    2009-12-01

    Full Text Available Abstract Background A rural pharmacy initiative (RPI designed to increase access to medicines in rural Kyrgyzstan created a network of 12 pharmacies using a revolving drug fund mechanism in 12 villages where no pharmacies previously existed. The objective of this study was to determine if the establishment of the RPI resulted in the unforeseen benefit of triggering medicine price competition in pre-existing (non-RPI private pharmacies located in the region. Methods We conducted descriptive and multivariate analyses on medicine insurance claims data from Kyrgyzstan's Mandatory Health Insurance Fund for the Jumgal District of Naryn Province from October 2003 to December 2007. We compared average quarterly medicine prices in competitor pharmacies before and after the introduction of the rural pharmacy initiative in October 2004 to determine the RPI impact on price competition. Results Descriptive analyses suggest competitors reacted to RPI prices for 21 of 30 (70% medicines. Competitor medicine prices from the quarter before RPI introduction to the end of the study period decreased for 17 of 30 (57% medicines, increased for 4 of 30 (13% medicines, and remained unchanged for 9 of 30 (30% medicines. Among the 9 competitor medicines with unchanged prices, five initially decreased in price but later reverted back to baseline prices. Multivariate analyses on 19 medicines that met sample size criteria confirm these findings. Fourteen of these 19 (74% competitor medicines changed significantly in price from the quarter before RPI introduction to the quarter after RPI introduction, with 9 of 19 (47% decreasing in price and 5 of 19 (26% increasing in price. Conclusions The RPI served as a market driver, spurring competition in medicine prices in competitor pharmacies, even when they were located in different villages. Initiatives designed to increase equitable access to medicines in rural regions of developing and transitional countries should consider the

  5. Chronic disease patients' experiences with accessing health care in rural and remote areas: a systematic review and qualitative meta-synthesis.

    Science.gov (United States)

    Brundisini, F; Giacomini, M; DeJean, D; Vanstone, M; Winsor, S; Smith, A

    2013-01-01

    Rurality can contribute to the vulnerability of people with chronic diseases. Qualitative research can identify a wide range of health care access issues faced by patients living in a remote or rural setting. To systematically review and synthesize qualitative research on the advantages and disadvantages rural patients with chronic diseases face when accessing both rural and distant care. This report synthesizes 12 primary qualitative studies on the topic of access to health care for rural patients with chronic disease. Included studies were published between 2002 and 2012 and followed adult patients in North America, Europe, Australia, and New Zealand. Qualitative meta-synthesis was used to integrate findings across primary research studies. Three major themes were identified: geography, availability of health care professionals, and rural culture. First, geographic distance from services poses access barriers, worsened by transportation problems or weather conditions. Community supports and rurally located services can help overcome these challenges. Second, the limited availability of health care professionals (coupled with low education or lack of peer support) increases the feeling of vulnerability. When care is available locally, patients appreciate long-term relationships with individual clinicians and care personalized by familiarity with the patient as a person. Finally, patients may feel culturally marginalized in the urban health care context, especially if health literacy is low. A culture of self-reliance and community belonging in rural areas may incline patients to do without distant care and may mitigate feelings of vulnerability. Qualitative research findings are not intended to generalize directly to populations, although meta-synthesis across a number of qualitative studies builds an increasingly robust understanding that is more likely to be transferable. Selected studies focused on the vulnerability experiences of rural dwellers with chronic

  6. 77 FR 36001 - Draft Report Assessing Rural Water Activities and Related Programs

    Science.gov (United States)

    2012-06-15

    ... of the authorized rural water projects identified above; (3) The demand for new rural water supply projects; (4) The rural water programs within other agencies; (5) The extent of the demand that can be met... DEPARTMENT OF THE INTERIOR Bureau of Reclamation Draft Report Assessing Rural Water Activities and...

  7. 76 FR 38352 - Notice of Funding Availability: Rural Development Voucher Program

    Science.gov (United States)

    2011-06-30

    ... available to low income tenants of Rural Development-financed multifamily properties where the Section 515... Development's Section 515 Rural Rental Housing Program (515 property) who may be subject to economic hardship through prepayment of the Rural Development mortgage. When the owner of a 515 property pays off the loan...

  8. The Rural Alabama Pregnancy and Infant Health (RAPIH) Program.

    Science.gov (United States)

    Leeper, J. D.; And Others

    The impact of the Rural Alabama Pregnancy and Infant Health (RAPIH) Program was evaluated in relation to prenatal care, birth outcome measures, and several child health and home environment outcomes. Begun in 1983, RAPIH targets poor rural blacks in three of west-central Alabama's poorest counties, where economic conditions and infant mortality…

  9. Evaluating waterpoint sustainability and access implications of revenue collection approaches in rural Kenya

    Science.gov (United States)

    Foster, T.; Hope, R.

    2017-02-01

    Water policies in many sub-Saharan African countries stipulate that rural communities are responsible for self-financing their waterpoint's operation and maintenance. In the absence of policy consensus or evidence on optimal payment models, rural communities adopt a diversity of approaches to revenue collection. This study empirically assesses waterpoint sustainability and access outcomes associated with different revenue collection approaches on the south coast of Kenya. The analysis draws on a unique data set comprising financial records spanning 27 years and 100 communities, operational performance indicators for 200 waterpoints, and water source choices for more than 2000 households. Results suggest communities collecting pay-as-you-fetch fees on a volumetric basis generate higher levels of revenue and experience better operational performance than communities charging flat fees. In both cases, financial flows mirror seasonal rainfall peaks and troughs. These outcomes are tempered by evidence that households are more likely to opt for an unimproved drinking water source when a pay-as-you-fetch system is in place. The findings illuminate a possible tension between financial sustainability and universal access. If the Sustainable Development Goal of "safe water for all" is to become a reality, policymakers and practitioners will need to address this issue and ensure rural water services are both sustainable and inclusive.

  10. Factors affecting access to healthcare services by intermarried Filipino women in rural Tasmania: a qualitative study.

    Science.gov (United States)

    Hannah, Chona T; Lê, Quynh

    2012-10-01

    Access to health care services is vital for every migrant's health and wellbeing. However, migrants' cultural health beliefs and views can hinder their ability to access available services. This study examined factors affecting access to healthcare services for intermarried Filipino women in rural Tasmania, Australia. A qualitative approach using semi-structured interviews was employed to investigate the factors affecting access to healthcare services for 30 intermarried Filipino women in rural Tasmania. The study used grounded theory and thematic analysis for its data analysis. Nvivo v8 (www.qsrinternational.com) was also used to assist the data coding process and analysis. Five influencing factors were identified: (1) language or communication barriers; (2) area of origin in the Philippines; (3) cultural barriers; (4) length of stay in Tasmania; and (5) expectations of healthcare services before and after migration. Factors affecting intermarried Filipino women in accessing healthcare services are shaped by their socio-demographic and cultural background. The insights gained from this study are useful to health policy-makers, healthcare professionals and to intermarried female migrants. The factors identified can serve as a guide to improve healthcare access for Filipino women and other migrants.

  11. Making basic health care accessible to rural communities: a case study of Kiang West district in rural Gambia.

    Science.gov (United States)

    Sanneh, Edward Saja; Hu, Allen H; Njai, Modou; Ceesay, Omar Malleh; Manjang, Buba

    2014-01-01

    This study focuses on lack of access to basic health care, which is one of the hindrances to the development of the poor, and subjects them to the poverty penalty. It also focuses on contributing to the Bottom of the Pyramid in a general sense, in addition to meeting the health needs of communities where people live on less than $1 a day. Strengthened multistakeholder responses and better-targeted, low-cost prevention, and care strategies within health systems are suggested to address the health burdens of poverty-stricken communities. In this study, a multistakeholder model which includes the government, World Health Organization, United Nations Children Emergency Fund, and the Medical Research Council was created to highlight the collaborative approach in rural Gambia. The result shows infant immunization and antenatal care coverage were greatly improved which contributes to the reduction in mortality. This case study also finds that strategies addressing health problems in rural communities are required to achieve 'Millennium Development Goals'. In particular, actual community visits to satellite villages within a district (area of study) are extremely vital to making health care accessible. © 2013 Wiley Periodicals, Inc.

  12. Utilisation of a direct access echocardiography service by general practitioners in a remote and rural area--distance and rurality are not barriers to referral.

    Science.gov (United States)

    Choo, Wai K; McGeary, Katie; Farman, Colin; Greyling, Andre; Cross, Stephen J; Leslie, Stephen J

    2014-01-01

    This study aimed to examine whether general practitioner (GP) practice locations in remote and rural areas affected the pattern of direct access echocardiography referral and to assess any variations in echocardiographic findings. All referrals made by all GP practices in the Scottish Highlands over a 36-month period were analysed. Referral patterns were examined according to distance and rurality based on the Scottish Government's Urban-Rural Classification. Reasons for referral and cardiac abnormality detection rates were also examined. In total, 1188 referrals were made from 49 different GP practices; range of referral rates was 0.3-20.1 per 1000 population with a mean of 6.5 referrals per 1000 population. Referral rates were not significantly different between urban and rural practices after correction for population size. There was no correlation between the referral rates and the distance from the centre (r2=0.004, p=0.65). The most common reason for referral was the presence of new murmur (46%). The most common presenting symptom was breathlessness (44%). Overall, 28% of studies had significant abnormal findings requiring direct input from a cardiologist. There was no clear relationship between referral rates and cardiac abnormality detection rates (r2=0.07, p=0.37). The average cardiac abnormality detection rate was 56%, (range 52-60%), with no variation based on rurality (p=0.891). In this cohort, rurality and distance were not barriers to an equitable direct access echocardiography service. Cardiac abnormality detection rates are consistent with that of other studies.

  13. 77 FR 2954 - Notice of Stakeholder Meetings on Rural Energy for America Program

    Science.gov (United States)

    2012-01-20

    ... DEPARTMENT OF AGRICULTURE Rural Business-Cooperative Service Notice of Stakeholder Meetings on... stakeholders focusing on Rural Development's Rural Energy for America Program implemented under the Food... meetings will be hosted by Rural Development State Directors. Stakeholders must contact the appropriate...

  14. Who Decided College Access in Chinese Secondary Education? Rural-Urban Inequality of Basic Education in Contemporary China

    Science.gov (United States)

    Li, Jian

    2016-01-01

    This paper investigates the rural-urban inequalities in basic education of contemporary China. The China Education Panel Survey (2013-2014) (CEPS) was utilized to analyze the gaps between rural and urban inequality in junior high schools in terms of three domains, which include the equalities of access, inputs, and outcomes. From the sociocultural…

  15. Notified Access: Extending Remote Memory Access Programming Models for Producer-Consumer Synchronization

    KAUST Repository

    Belli, Roberto; Hoefler, Torsten

    2015-01-01

    Remote Memory Access (RMA) programming enables direct access to low-level hardware features to achieve high performance for distributed-memory programs. However, the design of RMA programming schemes focuses on the memory access and less on the synchronization. For example, in contemporary RMA programming systems, the widely used producer-consumer pattern can only be implemented inefficiently, incurring in an overhead of an additional round-trip message. We propose Notified Access, a scheme where the target process of an access can receive a completion notification. This scheme enables direct and efficient synchronization with a minimum number of messages. We implement our scheme in an open source MPI-3 RMA library and demonstrate lower overheads (two cache misses) than other point-to-point synchronization mechanisms for each notification. We also evaluate our implementation on three real-world benchmarks, a stencil computation, a tree computation, and a Colicky factorization implemented with tasks. Our scheme always performs better than traditional message passing and other existing RMA synchronization schemes, providing up to 50% speedup on small messages. Our analysis shows that Notified Access is a valuable primitive for any RMA system. Furthermore, we provide guidance for the design of low-level network interfaces to support Notified Access efficiently.

  16. Notified Access: Extending Remote Memory Access Programming Models for Producer-Consumer Synchronization

    KAUST Repository

    Belli, Roberto

    2015-05-01

    Remote Memory Access (RMA) programming enables direct access to low-level hardware features to achieve high performance for distributed-memory programs. However, the design of RMA programming schemes focuses on the memory access and less on the synchronization. For example, in contemporary RMA programming systems, the widely used producer-consumer pattern can only be implemented inefficiently, incurring in an overhead of an additional round-trip message. We propose Notified Access, a scheme where the target process of an access can receive a completion notification. This scheme enables direct and efficient synchronization with a minimum number of messages. We implement our scheme in an open source MPI-3 RMA library and demonstrate lower overheads (two cache misses) than other point-to-point synchronization mechanisms for each notification. We also evaluate our implementation on three real-world benchmarks, a stencil computation, a tree computation, and a Colicky factorization implemented with tasks. Our scheme always performs better than traditional message passing and other existing RMA synchronization schemes, providing up to 50% speedup on small messages. Our analysis shows that Notified Access is a valuable primitive for any RMA system. Furthermore, we provide guidance for the design of low-level network interfaces to support Notified Access efficiently.

  17. 76 FR 30904 - Rural Utilities Service Telecommunications Loan and Loan Guarantee Program

    Science.gov (United States)

    2011-05-27

    ..., this new approach will give our customers increased flexibility to find and deploy technology that... DEPARTMENT OF AGRICULTURE Rural Utilities Service Rural Utilities Service Telecommunications Loan and Loan Guarantee Program AGENCY: Rural Utilities Service, USDA. ACTION: Notice of elimination of the...

  18. The Impact of Rural Electrification. Challenges and Ways Forward

    International Nuclear Information System (INIS)

    Torero, Maximo; Vincent, Nicolas

    2015-05-01

    Rigorous impact evaluation that includes appropriately selected control groups must be a part of rural electrification program designs. Budgeting evaluation activities and engaging with evaluators at an early stage improves to likelihood of having a high quality evaluation design; plus, if deviations occur after the design stage, the evaluators are better prepared to adjust the design so that the impact results remain informative to policy makers and future program designers. Another take-away is to use unified framework to specify the expected outcomes and the plausible sizes of impacts. If done at the beginning of the program, this will provide context to the kind of discussion that policy makers should engage in (e.g. if they should focus on health benefits or the potential to diffuse information campaigns to rural households). These points focus mostly on internal validity, but we also need to focus on external validity as well. Large scale rural electrification programs will provide an opportunity to test if the results from small scale impact evaluations translate to other settings. Something we have not stressed so far but that is important to keep in mind are the complementarities in the provision of different type of infrastructure. Large projects can provide an opportunity to explore complementarities with other infrastructure programs, such as mobile telephony, road access, and improved water and sanitation access. They can shed light on what are the most welfare-enhancing policy options when deciding what types of infrastructure to provide in rural areas, and especially to poor rural households. Finally, we reiterate the need to use an objective function that casts a wider net when deciding where to place electrification programs. Focusing solely on cost minimization can result in missed opportunities. When deciding where to deploy the electric grid in rural areas it is imperative to take into account the potential profits, specifically the agricultural

  19. A rural, community-based suicide awareness and intervention program.

    Science.gov (United States)

    Jones, Sharon; Walker, Coralanne; Miles, Alison C J; De Silva, Eve; Zimitat, Craig

    2015-01-01

    Suicide is a prominent public health issue in rural Australia and specifically in Tasmania, which has one of the highest suicide rates in the country. The Community Response to Eliminating Suicide (CORES) program was developed in rural Tasmania in response to a significant number of suicides over a short period of time. CORES is unique in that it is both a community-based and gatekeeper education model. CORES aims to build and empower communities to take ownership of suicide prevention strategies. It also aims to increase the individual community member's interpersonal skills and awareness of suicide risks, while building peer support and awareness of suicide prevention support services within the community itself. Pre- and post-test surveys after the CORES 1-day suicide awareness and intervention program (SAIP) showed significant increases in levels of comfort and confidence in discussing suicide with those who may be contemplating that action. CORES builds community capital through establishing new connections within communities. Establishment of local executive groups, funding and SAIP are key activities of successful CORES programs in communities around Australia. Over half of the initial leaders are still actively involved after a decade, which reflects positively on the quality and outcomes of the program. This study supports CORES as a beneficial and feasible community-based suicide intervention program for rural communities.

  20. Access to and Usage of Information among Rural Communities: a Case Study of Kilosa District Morogoro Region in Tanzania

    Directory of Open Access Journals (Sweden)

    Wulystan Pius Mtega

    2012-05-01

    Full Text Available The study investigated how rural communities in Kilosa District of Morogoro region in Tanzania accessed and used information. Specifically the study identified the information needs of rural people; determined the factors influencing the choice of information sources; and the appropriateness of the information sources basing on usefulness and preference. Three divisions were involved in the study area, choice of the study area was based on the availability of multiple information sources/channels information seekers could consulted. Simple random sampling technique was employed in selecting villages to be investigated and respondents to be interviewed. Findings showed that almost all people needed information of all types. Most of the information needed related to day to day problems. Information was accessed mainly through radio, television sets, newspapers and magazines, and also through cell phones and face to face communication. Choice of information sources was influenced by the respondents’ level of education, income, sex, age, occupation and distance from the information seeker’s residence to the information sources. Findings showed further that people accessed and used information for solving day to day problems and for leisure purposes. The study recommends that it is important to have frequent rural information needs assessments before providing information services to rural areas. Information providers should repackage information in appropriate forms suitable for rural communities. Moreover, radio and television stations should have enough rural related programmes which should be broadcasted during appropriate time.

  1. Educational Access Is Educational Quality: Indigenous Parents' Perceptions of Schooling in Rural Guatemala

    Science.gov (United States)

    Ishihara-Brito, Reiko

    2013-01-01

    This paper presents the findings and implications of a qualitative study conducted in Guatemala, which focused on rural, indigenous parents' perceptions of their children's schooling and educational quality. For these parents, the simple fact that their children had improved access to school signifies a satisfactory educational accomplishment;…

  2. Characteristics of LEADER program for rural development in Romania

    Directory of Open Access Journals (Sweden)

    Klára - Dalma POLGÁR (DESZKE

    2015-06-01

    Full Text Available The LEADER program is the fourth axis of European Agricultural Fund for Rural Development (EAFRD. The paper presents its time scheduling, the importance for development of the rural areas in European Union and in Romania, the measures of financing and its double role as a component fund of EAFRD, and also as a delivery mechanism for measures of the other three axes of EAFRD. The paper shows the way of implementing LEADER program in Romania, during 2007-2013. The state of implementing of the Romanian contribution from EAFRD is presented for the entire period and until the end of 2014.

  3. Distance, accessibility and costs. Decision-making during childbirth in rural Sierra Leone: A qualitative study.

    Directory of Open Access Journals (Sweden)

    Laura Treacy

    Full Text Available Sierra Leone has one of the highest maternal mortality ratios in the world. Efforts to reduce maternal mortality have included initiatives to encourage more women to deliver at health facilities. Despite the introduction of the free health care initiative for pregnant women, many women still continue to deliver at home, with few having access to a skilled birth attendant. In addition, inequalities between rural and urban areas in accessing and utilising health facilities persist. Further insight into how and why women make decisions around childbirth will help guide future plans and initiatives in improving maternal health in Sierra Leone. The objective of this study was to explore the perceptions and decision-making processes of women and their communities during childbirth in rural Sierra Leone.Data were collected through seven focus group discussions and 22 in-depth interviews with recently pregnant women and their community members in two rural villages. Data were analysed using systematic text condensation. Findings revealed that decision-making processes during childbirth are dynamic, intricate and need to be understood within the broader social context that they take place. Factors such as distance and lack of transport, perceived negative behaviour of hospital staff, direct and indirect financial obstacles, as well as the position of women in society all interact and influence how and what decisions are made.Pregnant women face multiple interacting vulnerabilities that influence their healthcare-seeking decisions during pregnancy and childbirth. Future initiatives to improve access and utilisation of safe healthcare services for pregnant women need to be based on adequate knowledge of structural constraints and health inequities that affect women in rural Sierra Leone.

  4. Effect of medicare payment on rural health care systems.

    Science.gov (United States)

    McBride, Timothy D; Mueller, Keith J

    2002-01-01

    Medicare payments constitute a significant share of patient-generated revenues for rural providers, more so than for urban providers. Therefore, Medicare payment policies influence the behavior of rural providers and determine their financial viability. Health services researchers need to contribute to the understanding of the implications of changes in fee-for-service payment policy, prospects for change because of the payment to Medicare+Choice risk plans, and implications for rural providers inherent in any restructuring of the Medicare program. This article outlines the basic policy choices, implications for rural providers and Medicare beneficiaries, impacts of existing research, and suggestions for further research. Topics for further research include implications of the Critical Access Hospital program, understanding how changes in payment to rural hospitals affect patient care, developing improved formulas for paying rural hospitals, determining the payment-to-cost ratio for physicians, measuring the impact of changes in the payment methodology used to pay for services delivered by rural health clinics and federally qualified health centers, accounting for the reasons for differences in historical Medicare expenditures across rural counties and between rural and urban counties, explicating all reasons for Medicare+Choice plans withdrawing from some rural areas and entering others, measuring the rural impact of proposals to add a prescription drug benefit to the Medicare program, and measuring the impact of Medicare payment policies on rural economies.

  5. Access to primary care for socio-economically disadvantaged older people in rural areas: A qualitative study.

    Science.gov (United States)

    Ford, John A; Turley, Rachel; Porter, Tom; Shakespeare, Tom; Wong, Geoff; Jones, Andy P; Steel, Nick

    2018-01-01

    We aim to explore the barriers to accessing primary care for socio-economically disadvantaged older people in rural areas. Using a community recruitment strategy, fifteen people over 65 years, living in a rural area, and receiving financial support were recruited for semi-structured interviews. Four focus groups were held with rural health professionals. Interviews and focus groups were audio-recorded and transcribed. Thematic analysis was used to identify barriers to primary care access. Older people's experience can be understood within the context of a patient perceived set of unwritten rules or social contract-an individual is careful not to bother the doctor in return for additional goodwill when they become unwell. However, most found it difficult to access primary care due to engaged telephone lines, availability of appointments, interactions with receptionists; breaching their perceived social contract. This left some feeling unwelcome, worthless or marginalised, especially those with high expectations of the social contract or limited resources, skills and/or desire to adapt to service changes. Health professionals' described how rising demands and expectations coupled with service constraints had necessitated service development, such as fewer home visits, more telephone consultations, triaging calls and modifying the appointment system. Multiple barriers to accessing primary care exist for this group. As primary care is re-organised to reduce costs, commissioners and practitioners must not lose sight of the perceived social contract and models of care that form the basis of how many older people interact with the service.

  6. Access to chlamydia testing in remote and rural Scotland.

    Science.gov (United States)

    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

  7. Rural Community Development Strategy beyond the Access to Information

    DEFF Research Database (Denmark)

    Akther, Farzana

    2012-01-01

    Telecenters is one of the promising models recognized by the United Nations (UN) to achieve the global access of ICTs. This paper provides insight in the role and usages of Information and Communication Technology for Development (ICT4D) projects with a specific focus of telecenters in developing...... the policy and actual practices of rural community with respect of ICT development.......Telecenters is one of the promising models recognized by the United Nations (UN) to achieve the global access of ICTs. This paper provides insight in the role and usages of Information and Communication Technology for Development (ICT4D) projects with a specific focus of telecenters in developing...... country Bangladesh. This study covers four aspects of the functioning of telecenters grounded in social, economical and action resources: ‘situated success’, ‘information culture and tradition’, ‘typology of resources’ and ‘functioning’. The study contributes to the theory and practice of ICT...

  8. Off-Grid Electricity Access and its Impact on Micro-Enterprises: Evidence from Rural Uganda

    Science.gov (United States)

    Muhoro, Peter N.

    The history of development shows convincingly that no country has substantially reduced poverty without massively increasing the use of electricity. The development of micro-enterprises in rural areas of Uganda is linked with increased access and use of electricity services. In this study, I combine quantitative and qualitative methods, including informal surveys, intra-business energy allocation studies and historical analysis, to analyze off-grid electricity access among micro-enterprises in rural western Uganda. I explore the linkages between of grid electricity access and the influence it has on micro- enterprises. Data is obtained from 56 micro-enterprises located in 11 village-towns within 3 districts in Uganda. In studying the micro-enterprises. the focus is on the services that are provided by electricity from modern energy carriers. The type of equipment used, forms of transportation, technical support, level of understanding and education of the entrepreneur, financing for energy equipment, and the role of donors are discussed in this thesis. Qualitative methods are used to allow for new insights and prioritization of concepts to emerge from the field rattier than from theory. Micro-enterprises in rural Uganda create income for the poor; they are resources for poverty reduction. With price adjustments, it becomes possible for those who live below the poverty line, nominally less than $1 a day, to afford the products and services and therefore mitigating the vicious cycle of poverty. Energy consumption among the micro-enterprises is at an average of 0.13kWh/day. The cost of accessing this amount of electricity attributes to about 50% of total revenue. I find that the "practices" used in off-grid electricity access lead to situations where the entrepreneurs have to evaluate pricing and output of products and services to generate higher profits. Such numbers indicate the need for appropriate technologies and profitable policies to be implemented. The data

  9. Effects of scale and efficiency of rural traffic calming on safety, accessibility and wildlife

    NARCIS (Netherlands)

    Jaarsma, C.F.; Langevelde, van F.

    2011-01-01

    This paper examines the effects of scale and efficiency of regional traffic calming on traffic safety, rural accessibility, and survival of wildlife. We distinguish by the scale of road networks affected and considered the efficiencies of various bundling of traffic flows on designated routes.

  10. The Management Education of the Rural Entrepreneur

    Directory of Open Access Journals (Sweden)

    Eugen Bruno Ştefan

    2014-08-01

    Full Text Available The Bureau of Social Research, within a strategic EU project– Rural Entrepreneur (2011 – coordinated by the National Foundation of Young Managers, analyzed in 2001 the needs of developing management and consultancy programs in order to improve the knowledge, skills, and managerial behaviour of the small and prospective entrepreneurs from the rural area of Romania. This study has revealed that three quarters of the rural entrepreneurs and over 85% of the prospective entrepreneurs have never been trained in management development. Their managerial education is often poor and usually acquired after starting the business up. The majority does not even consider that a prior training is necessary because business opportunities in the rural area are rare and the access of European funding is difficult. Over 90% of the new businesses fail in the first year. The managerial training programs and entrepreneurial consultancy can significantly reduce this percentage.

  11. 76 FR 49787 - Rural Water Supply Program Approved Appraisal Reports; Availability

    Science.gov (United States)

    2011-08-11

    ... DEPARTMENT OF THE INTERIOR Bureau of Reclamation Rural Water Supply Program Approved Appraisal...: Reclamation provides assistance for appraisal investigations and feasibility studies for rural water supply... the findings and conclusions of the appraisal investigations that identified the water supply problems...

  12. Understanding and improving access to prompt and effective malaria treatment and care in rural Tanzania: the ACCESS Programme.

    Science.gov (United States)

    Hetzel, Manuel W; Iteba, Nelly; Makemba, Ahmed; Mshana, Christopher; Lengeler, Christian; Obrist, Brigit; Schulze, Alexander; Nathan, Rose; Dillip, Angel; Alba, Sandra; Mayumana, Iddy; Khatib, Rashid A; Njau, Joseph D; Mshinda, Hassan

    2007-06-29

    Prompt access to effective treatment is central in the fight against malaria. However, a variety of interlinked factors at household and health system level influence access to timely and appropriate treatment and care. Furthermore, access may be influenced by global and national health policies. As a consequence, many malaria episodes in highly endemic countries are not treated appropriately. The ACCESS Programme aims at understanding and improving access to prompt and effective malaria treatment and care in a rural Tanzanian setting. The programme's strategy is based on a set of integrated interventions, including social marketing for improved care seeking at community level as well as strengthening of quality of care at health facilities. This is complemented by a project that aims to improve the performance of drug stores. The interventions are accompanied by a comprehensive set of monitoring and evaluation activities measuring the programme's performance and (health) impact. Baseline data demonstrated heterogeneity in the availability of malaria treatment, unavailability of medicines and treatment providers in certain areas as well as quality problems with regard to drugs and services. The ACCESS Programme is a combination of multiple complementary interventions with a strong evaluation component. With this approach, ACCESS aims to contribute to the development of a more comprehensive access framework and to inform and support public health professionals and policy-makers in the delivery of improved health services.

  13. Infection prevention needs assessment in Colorado hospitals: rural and urban settings.

    Science.gov (United States)

    Reese, Sara M; Gilmartin, Heather; Rich, Karen L; Price, Connie S

    2014-06-01

    The purpose of our study was to conduct a needs assessment for infection prevention programs in both rural and urban hospitals in Colorado. Infection control professionals (ICPs) from Colorado hospitals participated in an online survey on training, personnel, and experience; ICP time allocation; and types of surveillance. Responses were evaluated and compared based on hospital status (rural or urban). Additionally, rural ICPs participated in an interview about resources and training. Surveys were received from 62 hospitals (77.5% response); 33 rural (75.0% response) and 29 urban (80.6% response). Fifty-two percent of rural ICPs reported multiple job responsibilities compared with 17.2% of urban ICPs. Median length of experience for rural ICPs was 4.0 years compared with 11.5 years for urban ICPs (P = .008). Fifty-one percent of rural ICPs reported no access to infectious disease physicians (0.0% urban) and 81.8% of rural hospitals reported no antimicrobial stewardship programs (31.0% urban). Through the interviews it was revealed that priorities for rural ICPs were training and communication. Our study revealed numerous differences between infection prevention programs in rural versus urban hospitals. An infection prevention outreach program established in Colorado could potentially address the challenges faced by rural hospital infection prevention departments. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  14. A Rural Special Education Teacher Training Program: Successful Adaptations.

    Science.gov (United States)

    Prater, Greg; And Others

    The Rural Special Education Program (RSEP), a partnership between Northern Arizona University (NAU) and Kayenta Unified School District (KUSD), provides training for preservice special education teachers to work with Native American students and their families. To date, the program has provided training for 63 preservice special education…

  15. Access to primary care for socio-economically disadvantaged older people in rural areas: A qualitative study

    Science.gov (United States)

    Turley, Rachel; Porter, Tom; Shakespeare, Tom; Wong, Geoff; Jones, Andy P.; Steel, Nick

    2018-01-01

    Objective We aim to explore the barriers to accessing primary care for socio-economically disadvantaged older people in rural areas. Methods Using a community recruitment strategy, fifteen people over 65 years, living in a rural area, and receiving financial support were recruited for semi-structured interviews. Four focus groups were held with rural health professionals. Interviews and focus groups were audio-recorded and transcribed. Thematic analysis was used to identify barriers to primary care access. Findings Older people’s experience can be understood within the context of a patient perceived set of unwritten rules or social contract–an individual is careful not to bother the doctor in return for additional goodwill when they become unwell. However, most found it difficult to access primary care due to engaged telephone lines, availability of appointments, interactions with receptionists; breaching their perceived social contract. This left some feeling unwelcome, worthless or marginalised, especially those with high expectations of the social contract or limited resources, skills and/or desire to adapt to service changes. Health professionals’ described how rising demands and expectations coupled with service constraints had necessitated service development, such as fewer home visits, more telephone consultations, triaging calls and modifying the appointment system. Conclusion Multiple barriers to accessing primary care exist for this group. As primary care is re-organised to reduce costs, commissioners and practitioners must not lose sight of the perceived social contract and models of care that form the basis of how many older people interact with the service. PMID:29509811

  16. 49 CFR 28.149 - Program accessibility: Discrimination prohibited.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false Program accessibility: Discrimination prohibited... § 28.149 Program accessibility: Discrimination prohibited. Except as otherwise provided in § 28.150, no... otherwise be subjected to discrimination under any program or activity conducted by the Department. ...

  17. 32 CFR 1699.149 - Program accessibility: discrimination prohibited.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 6 2010-07-01 2010-07-01 false Program accessibility: discrimination prohibited... CONDUCTED BY SELECTIVE SERVICE SYSTEM § 1699.149 Program accessibility: discrimination prohibited. Except as... participation in, or otherwise be subject to discrimination under any program or activity conducted by the...

  18. Implementing a Comprehensive Program for the Prevention of Conduct Problems in Rural Communities: The Fast Track Experience1

    Science.gov (United States)

    Bierman, Karen L.

    2012-01-01

    Childhood conduct problems are predictive of a number of serious long-term difficulties (e.g., school failure, delinquent behavior, and mental health problems), making the design of effective prevention programs a priority. The Fast Track Program is a demonstration project currently underway in four demographically diverse areas of the United States, testing the feasibility and effectiveness of a comprehensive, multicomponent prevention program targeting children at risk for conduct disorders. This paper describes some lessons learned about the implementation of this program in a rural area. Although there are many areas of commonality in terms of program needs, program design, and implementation issues in rural and urban sites, rural areas differ from urban areas along the dimensions of geographical dispersion and regionalism, and community stability and insularity. Rural programs must cover a broad geographical area and must be sensitive to the multiple, small and regional communities that constitute their service area. Small schools, homogeneous populations, traditional values, limited recreational, educational and mental health services, and politically conservative climates are all more likely to emerge as characteristics of rural rather than urban sites (Sherman, 1992). These characteristics may both pose particular challenges to the implementation of prevention programs in rural areas, as well as offer particular benefits. Three aspects of program implementation are described in detail: (a) community entry and program initiation in rural areas, (b) the adaptation of program components and service delivery to meet the needs of rural families and schools, and (c) issues in administrative organization of a broadly dispersed tricounty rural prevention program. PMID:9338956

  19. Access to primary care for socioeconomically disadvantaged older people in rural areas: a realist review.

    Science.gov (United States)

    Ford, John A; Wong, Geoff; Jones, Andy P; Steel, Nick

    2016-05-17

    The aim of this review is to identify and understand the contexts that effect access to high-quality primary care for socioeconomically disadvantaged older people in rural areas. A realist review. MEDLINE and EMBASE electronic databases and grey literature (from inception to December 2014). Broad inclusion criteria were used to allow articles which were not specific, but might be relevant to the population of interest to be considered. Studies meeting the inclusion criteria were assessed for rigour and relevance and coded for concepts relating to context, mechanism or outcome. An overarching patient pathway was generated and used as the basis to explore contexts, causal mechanisms and outcomes. 162 articles were included. Most were from the USA or the UK, cross-sectional in design and presented subgroup data by age, rurality or deprivation. From these studies, a patient pathway was generated which included 7 steps (problem identified, decision to seek help, actively seek help, obtain appointment, get to appointment, primary care interaction and outcome). Important contexts were stoicism, education status, expectations of ageing, financial resources, understanding the healthcare system, access to suitable transport, capacity within practice, the booking system and experience of healthcare. Prominent causal mechanisms were health literacy, perceived convenience, patient empowerment and responsiveness of the practice. Socioeconomically disadvantaged older people in rural areas face personal, community and healthcare barriers that limit their access to primary care. Initiatives should be targeted at local contextual factors to help individuals recognise problems, feel welcome, navigate the healthcare system, book appointments easily, access appropriate transport and have sufficient time with professional staff to improve their experience of healthcare; all of which will require dedicated primary care resources. Published by the BMJ Publishing Group Limited. For

  20. Difficulties in accessing and availing of public health care systems among rural population in Chittoor District, Andhra Pradesh

    OpenAIRE

    Geetha Lakshmi Sreerama; Sai Varun Matavalum; Paraiveedu Arumugam Chandresekharan; Veronica Thunga

    2015-01-01

    Context: Despite policies to make health care accessible to all, it is not universally accessible. Frequent evaluation of barriers to accessibility of health care services paves path for improvement. Hence, present study is undertaken to evaluate the factors and public health policies influencing health care access to rural people in Chittoor District, Andhra Pradesh, which can be interpolated for other regions. Aims: To assess knowledge, perceptions, availing of public health care services, ...

  1. Investigating GEAR-Up College Readiness Program's Influence on Postsecondary Decisions of Rural Hispanic Youth

    Science.gov (United States)

    Boydstun, Kelli Dawn

    2016-01-01

    This qualitative case study investigated how the GEAR-Up college readiness program influenced the postsecondary decisions of Hispanic students who participated in the GEAR-Up program for the recommended six-year period in a rural school district in Texas. It was not known how long-term participation in the GEAR-Up program at a rural school…

  2. Evidence to service gap: cardiac rehabilitation and secondary prevention in rural and remote Western Australia.

    Science.gov (United States)

    Hamilton, Sandra; Mills, Belynda; McRae, Shelley; Thompson, Sandra

    2018-01-30

    Cardiovascular disease (CVD), a leading cause of morbidity and mortality, has similar incidence in metropolitan and rural areas but poorer cardiovascular outcomes for residents living in rural and remote Australia. Cardiac Rehabilitation (CR) is an evidence-based intervention that helps reduce subsequent cardiovascular events and rehospitalisation. Unfortunately CR attendance rates are as low as 10-30% with rural/remote populations under-represented. This in-depth assessment investigated the provision of CR and secondary prevention services in Western Australia (WA) with a focus on rural and remote populations. CR and Aboriginal Community Controlled Health Services were identified through the Directory of Western Australian Cardiac Rehabilitation and Secondary Prevention Services 2012. Structured interviews with CR coordinators included questions specific to program delivery, content, referral and attendance. Of the 38 CR services identified, 23 (61%) were located in rural (n = 11, 29%) and remote (n = 12, 32%) regions. Interviews with coordinators from 34 CR services (10 rural, 12 remote, 12 metropolitan) found 77% of rural/remote services were hospital-based, with no service providing a comprehensive home-based or alternative method of program delivery. The majority of rural (60%) and remote (80%) services provided CR through chronic condition exercise programs compared with 17% of metropolitan services; only 27% of rural/remote programs provided education classes. Rural/remote coordinators were overwhelmingly physiotherapists, and only 50% of rural and 33% of remote programs had face-to-face access to multidisciplinary support. Patient referral and attendance rates differed greatly across WA and referrals to rural/remote services generally numbered less than 5 per month. Program evaluation was reported by 33% of rural/remote coordinators. Geography, population density and service availability limits patient access to CR services in rural/remote WA. Current

  3. Accessible Transportation, Geographic Elevation, and Masticatory Ability Among Elderly Residents of a Rural Area.

    Science.gov (United States)

    Hamano, Tsuyoshi; Tominaga, Kazumichi; Takeda, Miwako; Sundquist, Kristina; Nabika, Toru

    2015-06-26

    Given that public transportation networks are often worse in rural areas than in urban areas, rural residents who do not drive can find it difficult to access health-promoting goods, services, and resources related to masticatory ability. Moreover, geographical location, assessed by elevation, could modify this association. The aim of this study was to test whether the association between access to transportation and masticatory ability varied by elevation. Data were collected from a cross-sectional study conducted in Mizuho and Iwami counties, Japan. Objective masticatory ability was evaluated using a test gummy jelly and elevation was estimated by the geographic information systems according to the participant's address. After excluding subjects with missing data, 672 subjects (Mizuho = 401 and Iwami = 271) were analyzed. After adjustment for potential confounders, being a driver was not significantly associated with masticatory ability among elderly people living at low elevation (≤313 m) in Mizuho county. However, after the same adjustment, being a driver remained significantly associated with increased masticatory ability among elderly at high elevations. Similar findings were observed in Iwami county. Accessible transportation was significantly associated with increased mastication ability in elderly people living at high elevations, but not in those living at low elevations.

  4. Accessible Transportation, Geographic Elevation, and Masticatory Ability Among Elderly Residents of a Rural Area

    Directory of Open Access Journals (Sweden)

    Tsuyoshi Hamano

    2015-06-01

    Full Text Available Given that public transportation networks are often worse in rural areas than in urban areas, rural residents who do not drive can find it difficult to access health-promoting goods, services, and resources related to masticatory ability. Moreover, geographical location, assessed by elevation, could modify this association. The aim of this study was to test whether the association between access to transportation and masticatory ability varied by elevation. Data were collected from a cross-sectional study conducted in Mizuho and Iwami counties, Japan. Objective masticatory ability was evaluated using a test gummy jelly and elevation was estimated by the geographic information systems according to the participant’s address. After excluding subjects with missing data, 672 subjects (Mizuho = 401 and Iwami = 271 were analyzed. After adjustment for potential confounders, being a driver was not significantly associated with masticatory ability among elderly people living at low elevation (≤313 m in Mizuho county. However, after the same adjustment, being a driver remained significantly associated with increased masticatory ability among elderly at high elevations. Similar findings were observed in Iwami county. Accessible transportation was significantly associated with increased mastication ability in elderly people living at high elevations, but not in those living at low elevations.

  5. Scaling-up access to antiretroviral therapy for children: a cohort study evaluating care and treatment at mobile and hospital-affiliated HIV clinics in rural Zambia.

    Directory of Open Access Journals (Sweden)

    Janneke H van Dijk

    Full Text Available Travel time and distance are barriers to care for HIV-infected children in rural sub-Saharan Africa. Decentralization of care is one strategy to scale-up access to antiretroviral therapy (ART, but few programs have been evaluated. We compared outcomes for children receiving care in mobile and hospital-affiliated HIV clinics in rural Zambia.Outcomes were measured within an ongoing cohort study of HIV-infected children seeking care at Macha Hospital, Zambia from 2007 to 2012. Children in the outreach clinic group received care from the Macha HIV clinic and transferred to one of three outreach clinics. Children in the hospital-affiliated clinic group received care at Macha HIV clinic and reported Macha Hospital as the nearest healthcare facility.Seventy-seven children transferred to the outreach clinics and were included in the analysis. Travel time to the outreach clinics was significantly shorter and fewer caretakers used public transportation, resulting in lower transportation costs and fewer obstacles accessing the clinic. Some caretakers and health care providers reported inferior quality of service provision at the outreach clinics. Sixty-eight children received ART at the outreach clinics and were compared to 41 children in the hospital-affiliated clinic group. At ART initiation, median age, weight-for-age z-scores (WAZ and CD4(+ T-cell percentages were similar for children in the hospital-affiliated and outreach clinic groups. Children in both groups experienced similar increases in WAZ and CD4(+ T-cell percentages.HIV care and treatment can be effectively delivered to HIV-infected children at rural health centers through mobile ART teams, removing potential barriers to uptake and retention. Outreach teams should be supported to increase access to HIV care and treatment in rural areas.

  6. Understanding and improving access to prompt and effective malaria treatment and care in rural Tanzania: the ACCESS Programme

    Directory of Open Access Journals (Sweden)

    Alba Sandra

    2007-06-01

    Full Text Available Abstract Background Prompt access to effective treatment is central in the fight against malaria. However, a variety of interlinked factors at household and health system level influence access to timely and appropriate treatment and care. Furthermore, access may be influenced by global and national health policies. As a consequence, many malaria episodes in highly endemic countries are not treated appropriately. Project The ACCESS Programme aims at understanding and improving access to prompt and effective malaria treatment and care in a rural Tanzanian setting. The programme's strategy is based on a set of integrated interventions, including social marketing for improved care seeking at community level as well as strengthening of quality of care at health facilities. This is complemented by a project that aims to improve the performance of drug stores. The interventions are accompanied by a comprehensive set of monitoring and evaluation activities measuring the programme's performance and (health impact. Baseline data demonstrated heterogeneity in the availability of malaria treatment, unavailability of medicines and treatment providers in certain areas as well as quality problems with regard to drugs and services. Conclusion The ACCESS Programme is a combination of multiple complementary interventions with a strong evaluation component. With this approach, ACCESS aims to contribute to the development of a more comprehensive access framework and to inform and support public health professionals and policy-makers in the delivery of improved health services.

  7. Water sanitation, access, use and self-reported diarrheal disease in rural Honduras.

    Science.gov (United States)

    Halder, Gabriela E; Bearman, Gonzalo; Sanogo, Kakotan; Stevens, Michael P

    2013-01-01

    Only 79% of individuals living in rural Honduras use improved water sources. Inadequate drinking water quality is related to diarrheal illness, which in Honduras contributes to 18.6 episodes of diarrhea per child year in children under five years of age. The purpose of this study was to examine and compare access to drinking water and sanitation, as well as self-reported diarrheal disease incidence among three proximal communities in the Department of Yoro area of Honduras. An 11-item language-specific, interviewer-administered, anonymous questionnaire was administered to 263 randomly selected adults attending a June 2011 medical brigade held in the communities of Coyoles, La Hicaca, and Lomitas. Chi-square with Fisher exact tests were utilized to compare water access, sanitation, and self-reported diarrheal incidence among these communities. Coyoles and La Hicaca used private faucets as their primary water sources. Coyoles had the greatest use of bottled water. Lomitas used rivers as their primary water source, and did not use bottled water. Mostly, females were responsible for acquiring water. Usage of multiple water sanitation methods was most common in Coyoles, while no sanitation method was most common in Lomitas. In Lomitas and La Hicaca, water filters were mostly provided via donation by non-governmental organizations. Lomitas had the highest reported incidence of diarrhea among self and other household members. Critical differences in water access, sanitation, and self-reported diarrheal incidence among three geographically distinct, yet proximal, communities highlights the need for targeted interventions even in geographically proximal rural areas.

  8. Public Sector Education Institution's Analysis: A Way Forward to Curtail Rural-Regional Education Accessibility Problems

    Directory of Open Access Journals (Sweden)

    Mir Aftab Hussain Talpur

    2014-10-01

    Full Text Available The availability of accessible educational facilities is essential for the better rural education. However, because of the huge population, lack of resources and absence of proper policy plans; the distance between educational facilities and rural communities is mounting as time progresses. These sorts of problematic circumstances put damaging effects on education standards and become responsible for the declining literacy rate. Hence, the goal of this research is to investigate the lack of educational institutions with respect to indigenous standards. Therefore, in this study, the dearth of education institutions was determined for the one of the most deprived sub-regions of Pakistan, i.e. Badin. The data were collected through observations, questionnaire survey, and from secondary sources, like census report and other pertinent public sector documents. The outcome of this study can be taken as an input to develop policy plans, targeting the education accessibility issues of backward communities. This research could show a guiding-path to local planning agencies, as these can come-up with the policy plans to trounce the education accessibility issues from the bucolic sub-regions of developing countries

  9. Listening to the Patient: Women Veterans' Insights About Health Care Needs, Access, and Quality in Rural Areas.

    Science.gov (United States)

    Brooks, Elizabeth; Dailey, Nancy K; Bair, Byron D; Shore, Jay H

    2016-09-01

    Many work to ensure that women veterans receive appropriate and timely health care, yet the needs of those living in rural areas are often ignored. This is a critical oversight given the multitude of reports documenting rural access problems and health disparities. Lacking this, we are unable to plan for and evaluate appropriate care for this specific group. In this project, we spoke with rural women veterans to document service needs and quality of care from their perspective. Rural women veterans' views about health care access and quality were ascertained in a series of five, semistructured focus groups (n = 35) and completion of a demographic questionnaire. Content analysis documented focus-group themes. Participants said that local dental, mental health, and gender-specific care options were needed, as well as alternative healing options. Community-based support for women veterans and interaction with female peers were absent. Participants' support for telehealth was mixed, as were requests for gender-specific care. Personal experiences in the military impacted participants' current service utilization. Action by both Veterans Affairs and the local community is vital to improving the health of women veterans. Service planning should consider additional Veterans Affairs contracts, mobile health vans, peer support, and enhanced outreach. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

  10. Subdividing the digital divide: differences in internet access and use among rural residents with medical limitations.

    Science.gov (United States)

    Wang, Jong-Yi; Bennett, Kevin; Probst, Janice

    2011-03-03

    Access to health care is often contingent upon an individual's ability to travel for services. Certain groups, such as those with physical limitations and rural residents, have more travel barriers than other groups, reducing their access to services. The use of the Internet may be a way for these groups to seek care or information to support their health care needs. The purpose of this study was to examine Internet use among those whose are, for medical reasons, limited in their ability to travel. We also examined disparities in Internet use by race/ethnicity and rural residence, particularly among persons with medical conditions. We used data from the 2001 National Household Travel Survey (NHTS), a nationally representative sample of US households, to examine Internet use among individuals with medical conditions, rural residents, and minority populations. Internet use was defined as any use within the past 6 months; among users, frequency of use and location of use were explored. Control variables included sociodemographics, family life cycle, employment status, region, and job density in the community. All analyses were weighted to reflect the complex NHTS sampling frame. Individuals with medical conditions were far less likely to report Internet use than those without medical conditions (32.6% vs 70.3%, P digital divide between urban and rural residents. Internet use and frequency was also lower among those reporting a medical condition than among those without a condition. After we controlled for many factors, however, African Americans and Hispanics were still less likely to use the Internet, and to use it less often, than whites. Policy makers should look for ways to improve the access to, and use of, the Internet among these populations.

  11. Energy services and energy poverty for sustainable rural development

    International Nuclear Information System (INIS)

    Kaygusuz, K.

    2011-01-01

    In many rural areas, poor people still depend on wood and other biomass fuels for most of their household and income-generating activities. The difficult, time-consuming work of collecting and managing traditional fuels is widely viewed as women's responsibility, which is a factor in women's disproportionate lack of access to education and income, and inability to escape from poverty. Therefore, it is important for energy access programs to have a special focus on women. New options for energy access and sustainable livelihoods, like small-scale biofuels production, can have dramatic benefits for rural women, and their families and communities. Energy development, as both a driving force and a consequence of such tremendous changes, has had profound impact on economic, social, and environmental development. Rural energy has always been a critical issue due to years of energy shortage for both households and industries. Biomass, for long time, has been the only available fuel in many rural areas. The situation in rural areas is even more critical as local demand for energy outstrips availability and the vast majority of people depend on non-commercial energy supplies. Energy is needed for household uses, such as cooking, lighting, heating; for agricultural uses, such as tilling, irrigation and post-harvest processing; and for rural industry uses, such as milling and mechanical energy and process heat. Energy is also an input to water supply, communication, commerce, health, education and transportation in rural areas. (author)

  12. Secular trends in pediatric antiretroviral treatment programs in rural and urban Zambia: a retrospective cohort study.

    Science.gov (United States)

    Sutcliffe, Catherine G; Bolton-Moore, Carolyn; van Dijk, Janneke H; Cotham, Matt; Tambatamba, Bushimbwa; Moss, William J

    2010-07-30

    Since 2003 pediatric antiretroviral treatment (ART) programs have scaled-up in sub-Saharan Africa and should be evaluated to assess progress and identify areas for improvement. We evaluated secular trends in the characteristics and treatment outcomes of children in three pediatric ART clinics in urban and rural areas in Zambia. Routinely collected data were analyzed from three ART programs in rural (Macha and Mukinge) and urban (Lusaka) Zambia between program implementation and July 2008. Data were obtained from electronic medical record systems and medical record abstraction, and were categorized by year of program implementation. Characteristics of all HIV-infected and exposed children enrolled in the programs and all children initiating treatment were compared by year of implementation. Age decreased and immunologic characteristics improved in all groups over time in both urban and rural clinics, with greater improvement observed in the rural clinics. Among children both eligible and ineligible for ART at clinic enrollment, the majority started treatment within a year. A high proportion of children, particularly those ineligible for ART at clinic enrollment, were lost to follow-up prior to initiating ART. Among children initiating ART, clinical and immunologic outcomes after six months of treatment improved in both urban and rural clinics. In the urban clinics, mortality after six months of treatment declined with program duration, and in the rural clinics, the proportion of children defaulting by six months increased with program duration. Treatment programs are showing signs of progress in the care of HIV-infected children, particularly in the rural clinics where scale-up increased rapidly over the first three years of program implementation. However, continued efforts to optimize care are needed as many children continue to enroll in ART programs at a late stage of disease and thus are not receiving the full benefits of treatment.

  13. 76 FR 8334 - Inviting Applications for the Rural Economic Development Loan and Grant Program for Fiscal Year 2011

    Science.gov (United States)

    2011-02-14

    ... Economic Development Loan and Grant Program for Fiscal Year 2011 AGENCY: Rural Business-Cooperative Service... Rural Economic Development Loan and Grant (REDLG) program pursuant to 7 CFR part 4280, subpart A for... Federal Agency: Rural Business-Cooperative Service. Funding Opportunity Type: Rural Economic Development...

  14. Themes of rural health and aging from a program of research.

    Science.gov (United States)

    Congdon, J G; Magilvy, J K

    2001-01-01

    The culture and diversity of rural life and limitations of rural health systems to meet the changing health needs of an aging population lead to problems of obtaining appropriate care in rural America. In a program of nursing research involving three ethnographic studies in rural Colorado, transitions of older adults across differing levels of heath care were explored. The sample totaled 425 participants, of whom 25% were Hispanic. Five major themes emerged: circles of formal and informal care; integration of faith, spirituality, and family with health status; crisis nature of health care transitions; nursing homes as a housing option; and changing spirit of traditional rural nursing. Recommendations for providers included making their practices congruent with rural culture, being fully informed of available resources, facilitating acceptable health care decisions, and integrating physical, mental, and spiritual health care for elders and their families.

  15. The Digitally Disadvantaged: Access to Digital Communication Technologies among First Year Students at a Rural South African University

    Science.gov (United States)

    Oyedemi, Toks; Mogano, Saki

    2018-01-01

    Considering the importance of digital skills in university education, this article reports on a study which examined access to technology among first year students at a rural South African university. The study focused on the digital readiness of students prior to their admission to the university, since many universities provide access to…

  16. Widening access to medicine may improve general practitioner recruitment in deprived and rural communities: survey of GP origins and current place of work.

    Science.gov (United States)

    Dowell, J; Norbury, M; Steven, K; Guthrie, B

    2015-10-01

    Widening access to medicine in the UK is a recalcitrant problem of increasing political importance, with associated strong social justice arguments but without clear evidence of impact on service delivery. Evidence from the United States suggests that widening access may enhance care to underserved communities. Additionally, rural origin has been demonstrated to be the factor most strongly associated with rural practice. However the evidence regarding socio-economic and rural background and subsequent practice locations in the UK has not been explored. The aim of this study was to investigate the association between general practitioners' (GPs) socio-economic and rural background at application to medical school and demographic characteristics of their current practice. The study design was a cross-sectional email survey of general practitioners practising in Scotland. Socio-economic status of GPs at application to medical school was assessed using the self-coded National Statistics Socio-Economic Classification. UK postcode at application was used to define urban-rural location. Current practice deprivation and remoteness was measured using NHS Scotland defined measures based on registered patients' postcodes. A survey was sent to 2050 Scottish GPs with a valid accessible email address, with 801 (41.5 %) responding. GPs whose parents had semi-routine or routine occupations had 4.3 times the odds of working in a deprived practice compared to those with parents from managerial and professional occupations (95 % CI 1.8-10.2, p = 0.001). GPs from remote and rural Scottish backgrounds were more likely to work in remote Scottish practices, as were GPs originating from other UK countries. This study showed that childhood background is associated with the population GPs subsequently serve, implying that widening access may positively affect service delivery in addition to any social justice rationale. Longitudinal research is needed to explore this association and the

  17. Reproductive Health of Women in Rural Areas of East Azerbaijan – Iran, before and after Implementation of rural Family Physician Program: an Ecologic Study

    Science.gov (United States)

    Alizadeh, Mahasti; Jabbari Birami, Hossein; Moradi, Siavash

    2015-01-01

    Introduction: Implementation of rural family physician program in Iran in 2005 has been evaluated and shown that this program has been led to some improvements in health indicators. In this study, some reproductive health (RH) indicators were compared before and after implementation of this program in rural areas of East Azerbaijan, Iran. Methods: In this ecologic- time trend study, the data of 191075 births of rural women of East Azerbaijan from 2001 to 2010 was extracted from vital horoscope (ZIJ) and used for calculation of 20 important RH indicators. The paired t-test and correlation analysis wear used for data analysis. Results: Some indicators such as adolescent marriage rate, adolescent birth and over 35 year olds birth rate were increased after rural family physician program implementation in 2005. Also stillbirth rate and unsafe delivery were decreased during this period. There was a significant correlation between increasing adolescent birth rate and increasing low birth weight deliveries (r= 0.911, P= 0.031) and also between increasing over 35 year olds birth rate and increasing neonatal mortality rate in term of prematurity and congenital malformations (r= 0.912, P= 0.031) after program implementation. Conclusion: Perinatal care and safe delivery even for pregnancies outside the typical child-bearing ages are promoting after implementation of rural family physician program in East Azerbaijan. Also decreasing unsafe delivery and stillbirth rate can be considered as achievements of running this program in this province. PMID:26744731

  18. Reproductive Health of Women in Rural Areas of East Azerbaijan – Iran, before and after Implementation of rural Family Physician Program: an Ecologic Study

    Directory of Open Access Journals (Sweden)

    Mahasti Alizadeh

    2015-12-01

    Full Text Available Introduction: Implementation of rural family physician program in Iran in 2005 has been evaluated and shown that this program has been led to some improvements in health indicators. In this study, some reproductive health (RH indicators were compared before and after implementation of this program in rural areas of East Azerbaijan, Iran. Methods: In this ecologic- time trend study, the data of 191075 births of rural women of East Azerbaijan from 2001 to 2010 was extracted from vital horoscope (ZIJ and used for calculation of 20 important RH indicators. The paired t-test and correlation analysis wear used for data analysis. Results: Some indicators such as adolescent marriage rate, adolescent birth and over 35 year olds birth rate were increased after rural family physician program implementation in 2005. Also stillbirth rate and unsafe delivery were decreased during this period. There was a significant correlation between increasing adolescent birth rate and increasing low birth weight deliveries (r= 0.911, P= 0.031 and also between increasing over 35 year olds birth rate and increasing neonatal mortality rate in term of prematurity and congenital malformations (r= 0.912, P= 0.031 after program implementation. Conclusion: Perinatal care and safe delivery even for pregnancies outside the typical child-bearing ages are promoting after implementation of rural family physician program in East Azerbaijan. Also decreasing unsafe delivery and stillbirth rate can be considered as achievements of running this program in this province.

  19. Assessing the Impact of Leveraging Traditional Leadership on Access to Sanitation in Rural Zambia.

    Science.gov (United States)

    Tiwari, Amy; Russpatrick, Scott; Hoehne, Alexandra; Matimelo, Selma M; Mazimba, Sharon; Nkhata, Ilenga; Osbert, Nicolas; Soloka, Geoffrey; Winters, Anna; Winters, Benjamin; Larsen, David A

    2017-11-01

    Open defecation is practiced by more than one billion people throughout the world and leads to significant public health issues including infectious disease transmission and stunted growth in children. Zambia implemented community-led total sanitation (CLTS) as an intervention to eliminate open defecation in rural areas. To support CLTS and the attainment of open defecation free communities, chiefs were considered key agents of change and were empowered to drive CLTS and improve sanitation for their chiefdom. Chiefs were provided with data on access to sanitation in the chiefdom during chiefdom orientations prior to the initiation of CLTS within each community and encouraged to make goals of universal sanitation access within the community. Using a survival regression, we found that where chiefs were orientated and mobilized in CLTS, the probability that a village would achieve 100% coverage of adequate sanitation increased by 23% (hazard ratio = 1.263, 95% confidence interval = 1.080-1.478, P = 0.003). Using an interrupted time series, we found a 30% increase in the number of individuals with access to adequate sanitation following chiefdom orientations (95% confidence interval = 28.8-32.0%). The mobilization and support of chiefs greatly improved the uptake of CLTS, and empowering them with increased CLTS knowledge and authority of the program in their chiefdom allowed chiefs to closely monitor village sanitation progress and follow-up with their headmen/headwomen. These key agents of change are important facilitators of public health goals such as the elimination of open defecation in Zambia by 2020.

  20. Health Service Accessibility and Risk in Cervical Cancer Prevention: Comparing Rural Versus Nonrural Residence in New Mexico

    Science.gov (United States)

    McDonald, Yolanda J.; Goldberg, Daniel W.; Scarinci, Isabel C.; Castle, Philip E.; Cuzick, Jack; Robertson, Michael; Wheeler, Cosette M.

    2018-01-01

    Purpose Multiple intrapersonal and structural barriers, including geography, may prevent women from engaging in cervical cancer preventive care such as screening, diagnostic colposcopy, and excisional precancer treatment procedures. Geographic accessibility, stratified by rural and nonrural areas, to necessary services across the cervical cancer continuum of preventive care is largely unknown. Methods Health care facility data for New Mexico (2010-2012) was provided by the New Mexico Human Papillomavirus Pap Registry (NMHPVPR), the first population-based statewide cervical cancer screening registry in the United States. Travel distance and time between the population-weighted census tract centroid to the nearest facility providing screening, diagnostic, and excisional treatment services were examined using proximity analysis by rural and nonrural census tracts. Mann-Whitney test (P < .05) was used to determine if differences were significant and Cohen's r to measure effect. Findings Across all cervical cancer preventive health care services and years, women who resided in rural areas had a significantly greater geographic accessibility burden when compared to nonrural areas (4.4 km vs 2.5 km and 4.9 minutes vs 3.0 minutes for screening; 9.9 km vs 4.2 km and 10.4 minutes vs 4.9 minutes for colposcopy; and 14.8 km vs 6.6 km and 14.4 minutes vs 7.4 minutes for precancer treatment services, all P < .001). Conclusion Improvements in cervical cancer prevention should address the potential benefits of providing the full spectrum of screening, diagnostic and precancer treatment services within individual facilities. Accessibility, assessments distinguishing rural and nonrural areas are essential when monitoring and recommending changes to service infrastructures (eg, mobile versus brick and mortar). PMID:27557124

  1. Food access and consumption in a rural settlement in Castanhal, PA, Brazil

    Directory of Open Access Journals (Sweden)

    Riziane Duarte PORTAL

    2016-01-01

    Full Text Available Abstract The study aimed to assess the food accessibility and consumption among families in the Cupiúba rural settlement, in the city of Castanhal, Pará, Brazil. It was found that the access to food is worrying and indicated that most families are in food insecurity conditions. Moreover, income and food safety level were associated. The consumption of the settler families comprises mainly high-energy, low-nutrient content foods, characterized by the low intake of fruits and vegetables and the introduction of processed foods with high energy density and sugar-added beverages, although the traditional dietary habits (rice and beans are still present. This configures a diet at risk for important nutritional deficits, obesity, and many non-communicable chronic diseases.

  2. The Regional and Local Distribution of Funds Allocated by the European Agricultural Fund for Rural Development in Romania

    Directory of Open Access Journals (Sweden)

    ALINA-MIRELA MARCU

    2013-01-01

    Full Text Available The objective of this study is to present and analyze the regional and local distribution of the funds allocated by the European Agricultural Fund for Rural Development (EAFRD, European fund that finances rural development in Romania, in the post-accession period. This financing instrument was created by the European Union with the order to continue the main directions of investment of Special Pre-Accession Programme for Agriculture and Rural Development (SAPARD. As a member state of the European Union, Romania observes the principles of the Common Agricultural Policy (CAP while the development of the Romanian rural area for the programming period 2007-2013 is supported by the European Community through the National Rural Development Programme (RDP. This approach pays special attention to improving the quality of life in rural areas and the diversification of the rural economy because local communities in Romania have experienced some changes in this period, while accessing EAFRD funds contributed to increased regional disparities between developed and poor areas.

  3. 45 CFR 2490.150 - Program accessibility: Existing facilities.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Program accessibility: Existing facilities. 2490.150 Section 2490.150 Public Welfare Regulations Relating to Public Welfare (Continued) JAMES MADISON... ACTIVITIES CONDUCTED BY THE JAMES MADISON MEMORIAL FELLOWSHIP FOUNDATION § 2490.150 Program accessibility...

  4. Rural male suicide in Australia.

    Science.gov (United States)

    Alston, Margaret

    2012-02-01

    The rate of suicide amongst Australia's rural men is significantly higher than rural women, urban men or urban women. There are many explanations for this phenomenon including higher levels of social isolation, lower socio-economic circumstances and ready access to firearms. Another factor is the challenge of climate transformation for farmers. In recent times rural areas of Australia have been subject to intense climate change events including a significant drought that has lingered on for over a decade. Climate variability together with lower socio-economic conditions and reduced farm production has combined to produce insidious impacts on the health of rural men. This paper draws on research conducted over several years with rural men working on farms to argue that attention to the health and well-being of rural men requires an understanding not only of these factors but also of the cultural context, inequitable gender relations and a dominant form of masculine hegemony that lauds stoicism in the face of adversity. A failure to address these factors will limit the success of health and welfare programs for rural men. Copyright © 2010 Elsevier Ltd. All rights reserved.

  5. Access to Investigational Drugs: FDA Expanded Access Programs or "Right-to-Try" Legislation?

    Science.gov (United States)

    Holbein, M E Blair; Berglund, Jelena P; Weatherwax, Kevin; Gerber, David E; Adamo, Joan E

    2015-10-01

    The Food and Drug Administration Expanded Access (EA) program and "Right-to-Try" legislation aim to provide seriously ill patients who have no other comparable treatment options to gain access to investigational drugs and biological agents. Physicians and institutions need to understand these programs to respond to questions and requests for access. FDA EA programs and state and federal legislative efforts to provide investigational products to patients by circumventing FDA regulations were summarized and compared. The FDA EA program includes Single Patient-Investigational New Drug (SP-IND), Emergency SP-IND, Intermediate Sized Population IND, and Treatment IND. Approval rates for all categories exceed 99%. Approval requires FDA and Institutional Review Board (IRB) approval, and cooperation of the pharmaceutical partner is essential. "Right-to-Try" legislation bypasses some of these steps, but provides no regulatory or safety oversight. The FDA EA program is a reasonable option for patients for whom all other therapeutic interventions have failed. The SP-IND not only provides patient access to new drugs, but also maintains a balance between immediacy and necessary patient protection. Rather than circumventing existing FDA regulations through proposed legislation, it seems more judicious to provide the knowledge and means to meet the EA requirements. © 2015 Wiley Periodicals, Inc.

  6. Bringing Produce to the People: Implementing a social marketing food access intervention in rural food deserts

    Science.gov (United States)

    Ramirez, A. Susana; Diaz Rios, Lillian K.; Valdez, Zulema; Estrada, Erendira; Ruiz, Ariana

    2017-01-01

    To describe and evaluate the process of implementation of a social marketing food access intervention for food desert communities in rural California. Case study approach used mixed-methods data from nationwide market comparisons, environmental assessment, and community informants. Lessons learned demonstrate room for improvement in the implementation of such strategies and underscore the importance of community involvement in decision-making; the strategic importance of operational decisions relating to intervention design, site and product selection, and distribution models; and a reconsideration of the problem of “access” in rural areas. PMID:27956000

  7. 43 CFR 404.51 - Are proposed projects under the Rural Water Supply Program reviewed by the Administration?

    Science.gov (United States)

    2010-10-01

    ... Water Supply Program reviewed by the Administration? 404.51 Section 404.51 Public Lands: Interior... SUPPLY PROGRAM Feasibility Studies § 404.51 Are proposed projects under the Rural Water Supply Program... the Reclamation's Rural Water Supply Program. This includes review under Executive Order 12322 to...

  8. Expanding access to off-grid rural electrification in Africa: An analysis of community-based micro-grids in Kenya

    Science.gov (United States)

    Kirubi, Charles Gathu

    Community micro-grids have played a central role in increasing access to off-grid rural electrification (RE) in many regions of the developing world, notably South Asia. However, the promise of community micro-grids in sub-Sahara Africa remains largely unexplored. My study explores the potential and limits of community micro-grids as options for increasing access to off-grid RE in sub-Sahara Africa. Contextualized in five community micro-grids in rural Kenya, my study is framed through theories of collective action and combines qualitative and quantitative methods, including household surveys, electronic data logging and regression analysis. The main contribution of my research is demonstrating the circumstances under which community micro-grids can contribute to rural development and the conditions under which individuals are likely to initiate and participate in such projects collectively. With regard to rural development, I demonstrate that access to electricity enables the use of electric equipment and tools by small and micro-enterprises, resulting in significant improvement in productivity per worker (100--200% depending on the task at hand) and a corresponding growth in income levels in the order of 20--70%, depending on the product made. Access to electricity simultaneously enables and improves delivery of social and business services from a wide range of village-level infrastructure (e.g. schools, markets, water pumps) while improving the productivity of agricultural activities. Moreover, when local electricity users have an ability to charge and enforce cost-reflective tariffs and electricity consumption is closely linked to productive uses that generate incomes, cost recovery is feasible. By their nature---a new technology delivering highly valued services by the elites and other members, limited local experience and expertise, high capital costs---community micro-grids are good candidates for elite-domination. Even so, elite control does not necessarily

  9. Geographic and socio-economic barriers to rural electrification: New evidence from Indian villages

    International Nuclear Information System (INIS)

    Dugoua, Eugenie; Liu, Ruinan; Urpelainen, Johannes

    2017-01-01

    The International Energy Agency estimates that more than a billion people remain without household electricity access. However, countries such as India have recently made major progress in rural electrification. Who has benefited from these achievements? We focus on 714 villages in six energy-poor states of northern and eastern India to investigate trends in electricity access. We use data both from the 2011 Census of India and an original energy access survey conducted in 2014 and 2015. During the three years that separated the surveys, distance to the nearest town and land area lose their power as predictors of the percentage of households in the village that has access to electricity. In this regard, the Indian government's flagship rural electrification program seems to have managed to overcome a major obstacle to grid extension. On the other hand, socio-economic inequalities between villages related to caste status and household expenditure remain strong predictors. These findings highlight the importance of socio-economic barriers to rural electricity access and alleviate concerns about remoteness and population density as obstacles to grid extension. - Highlights: • Empirical analysis of rural electrification progress in India. • Geographic differences across villages no longer explain electricity access. • Social and economic inequities remain stark. • Future policy should focus on household electrification within villages.

  10. Substance Use Prevention among At-Risk Rural Youth: Piloting the Social Ecological "One Life" Program

    Science.gov (United States)

    Williams, Ronald D., Jr.; Barnes, Jeremy T.; Holman, Thomas; Hunt, Barry P.

    2014-01-01

    Substance use among youth is a significant health concern in the rural United States, particularly among at-risk students. While evidence-based programs are available, literature suggests that an underdeveloped rural health prevention workforce often limits the adoption of such programs. Additionally, population-size restrictions of national…

  11. Factors Influencing Food Choices Among Older Adults in the Rural Western USA.

    Science.gov (United States)

    Byker Shanks, Carmen; Haack, Sarah; Tarabochia, Dawn; Bates, Kate; Christenson, Lori

    2017-06-01

    Nutrition is an essential component in promoting health and quality of life into the older adults years. The purpose of this qualitative research is to explore how the rural food environment influences food choices of older adults. Four focus groups were conducted with 33 older adults (50 years of age and older) residing in rural Montana communities. Four major themes related to factors influencing food choices among rural older adults emerged from this study: perception of the rural community environment, support as a means of increasing food access, personal access to food sources, and dietary factors. The findings from this current study warrant further research and promotion of specifically tailored approaches that influence the food choices of older adults in the rural western USA, including the developing and expanding public transportation systems, increasing availability of local grocers with quality and affordable food options, increasing awareness and decreasing stigma surrounding community food programs, and increasing nutrition education targeting senior health issues.

  12. Rural electrification: benefits in different spheres; Eletrificacao rural: beneficios em diferentes esferas

    Energy Technology Data Exchange (ETDEWEB)

    Cruz, Cassiano N.P. [Universidade Estadual de Campinas (UNICAMP), SP (Brazil). Eletrovento Ltda, Incubadora de Empresas de Base Tecnologica], e-mail: cassiano@eletrovento.com.br; Mourad, Anna L. [Instituto de Tecnologia de Alimentos (ITAL) Campinas, SP (Brazil). Centro de Tecnologia de Embalagem], e-mail: anna@ital.sp.gov.br; Morinigo, Marcos A. [Comissao de Servicos Publicos de Energia do Estado de Sao Paulo (CSPE), SP (Brazil)], e-mail: mmorinigo@sp.gov.br; Sanga, Godfrey [Universidade Estadual de Campinas (UNICAMP), SP (Brazil). Fac. de Engenharia Mecanica], e-mail: godfrey@fem.unicamp.br

    2004-07-01

    In the last few decades, there has been a constant migration of rural population to urban areas looking for employment and better quality of life. During the same period, industrial sector grew significantly and became economically more important than the rural sector. Consequently, the industrial sector became government's first development priority. In addition, the energy system was focused on large power plants energy production and high potentials long distance transmissions to large energy consumers, urban centers and industries. Limited efforts were done to provide energy to small and dispersed rural consumers as it seemed to be economically less attractive. This article, therefore, shows the importance of rural electrification over human, economical and social development including its impact across the rural communities' boundaries. While regarded as an important factor for development, rural electrification is, however, a function of many input factors in a mutual dependence relationships, reinforcement and feedback loops. Besides of the evident benefits of increased comfort and satisfaction levels to the rural population, other benefits of rural electrification includes improved access to information and communication media, agricultural mechanization and consequent improvement of the agricultural productivity. Agricultural sector is an important part of the industrial production chain: each R$ 1,00 invested in rural electrification generates R$ 3,00 along the production chain and increases the consumption of durable goods, Word Bank, Gazeta Mercantil (1999). For the population and urbanization control, rural electrification creates favorable conditions to maintain people in the rural areas as such reducing government expenditures for urban infrastructure which is more expensive than the rural one. Moreover, this reduces incidences of unemployment in big cities as it generates jobs in the rural sector. Implementation of a combined rural

  13. Rural African women and development.

    Science.gov (United States)

    Kabadaki, K

    1994-01-01

    70-90% of Africans still live in rural areas, and 25-30% of rural households are headed by women. Standards of living in rural areas are lower than in urban areas. Rural African women's involvement in development is in its initial stages, and social development for women is likely to be slow. Increasing women's opportunities for education is a means of promoting social justice and fairness. Schools should offer courses of practical value for those not planning on higher education and special programs and career counseling for gifted girls. Women's organizations, African leaders, and other influential parties should aggressively create awareness about the oppressive aspects of traditional attitudes, beliefs, and views about women. Laws on ownership of property, inheritance, access to credit, and employment must be equitable and enforced. Consciousness-raising among rural women is an effective means of encouraging rural women to seek and assume new roles and for questioning unreasonable expectations and norms. Women's professional associations serve important functions and fulfill the need for role models. The quality of rural women's life is effectively improved through formulation of policies relevant to women's needs and problems and improve rural conditions. Women should have fair representation at local and national levels of government. Women's role in agriculture is likely to be enhanced through improved transportation systems, electricity supply, and introduction of intermediate technology. This assessment of rural African women's contributions to economic growth emphasizes women's involvement in farming and the informal sector and their lack of equal remuneration or low wages. Illiteracy places women in a disadvantaged position when competing for employment in the formal sector. Lack of access to credit and limits on credit are other obstacles in the informal sector. The reduced participation of rural women in the formal and informal sector is due to lack of

  14. Light for all? Evaluating Brazil's rural electrification progress, 2000–2010

    International Nuclear Information System (INIS)

    Slough, Tara; Urpelainen, Johannes; Yang, Joonseok

    2015-01-01

    In an ideal world, rural electrification would serve the goal of socio-economic development. Improved electricity access can power rural industries, enhance agricultural productivity, and provide households with more productive time for study and work at night. Brazil's national rural electrification program has promised to target poor and remote rural communities, but has this goal been met? We analyze statistically representative data from Brazil's Census of 2000 and 2010. While Brazil has reached municipalities with low initial electricity access rates, rural electrification has not targeted the least developed municipalities. Furthermore, we find that the government has not reached the most remote and sparsely populated rural communities. Primary policy implications include more precise targeting of the least developed municipalities, complementary interventions to promote rural development, and increasing investments into distributed energy, such as off-grid solar power. With these strategies, Brazil and other countries facing similar issues can enhance the socio-economic benefit of rural electrification. - Highlights: • Progress of rural electrification in Brazil, 2000–2010. • Low initial electrification rates predict high achievement. • Lack of socio-economic development predicts neither high nor low achievement. • Remoteness predicts low achievement.

  15. A pilot project to improve access to telepsychotherapy at rural clinics.

    Science.gov (United States)

    Adler, Geri; Pritchett, Lonique R; Kauth, Michael R; Nadorff, Danielle

    2014-01-01

    The U.S. Department of Veterans Affairs (VA) has pioneered telemental health (TMH) with over 500,000 TMH encounters over the past decade. VA community-based outpatient clinics were established to improve accessibility of mental healthcare for rural Veterans. Despite these clinics clinics and increased availability of TMH, many rural Veterans have difficulty receiving mental healthcare, particularly psychotherapy. Twelve therapists participated in a pilot project using TMH technologies to improve mental healthcare service delivery to rural Veterans treated at six community clinics. Therapists completed online training, and study staff communicated with them monthly and clinical leaders every other month. Therapists completed two questionnaires: before training and 10 months later. This article describes barriers and facilitators to the implementation of the project, as well as therapists' knowledge, confidence, and motivation regarding TMH. Two clinicians were offering telepsychotherapy after 10 months. At all six sites, unanticipated organizational constraints and administrative barriers delayed implementation; establishing organizational practices and therapists' motivation helped facilitate the process. Adopters of the project reported more positive views of the modality and did not worry about staffing, a concern of nonadopters. Despite barriers to implementation, lessons learned from this pilot project have led to improvements and changes in TMH processes. Results from the pilot showed that therapists providing telepsychotherapy had increased confidence, knowledge, and motivation. As TMH continues to expand, formalized decision-making with clinical leaders regarding project goals, better matching of therapists with this modality, and assessment of medical center and clinic readiness are recommended.

  16. A novel IPTV program multiplex access system to EPON

    Science.gov (United States)

    Xu, Xian; Liu, Deming; He, Wei; Lu, Xi

    2007-11-01

    With the rapid development of high speed networks, such as Ethernet Passive Optical Network (EPON), traffic patterns in access networks have evolved from traditional text-oriented service to the mixed text-, voice- and video- based services, leading to so called "Triple Play". For supporting IPTV service in EPON access network infrastructure, in this article we propose a novel IPTV program multiplex access system to EPON, which enables multiple IPTV program source servers to seamlessly access to IPTV service access port of optical line terminal (OLT) in EPON. There are two multiplex schemes, namely static multiplex scheme and dynamic multiplex scheme, in implementing the program multiplexing. Static multiplex scheme is to multiplex all the IPTV programs and forward them to the OLT, regardless of the need of end-users. While dynamic multiplex scheme can dynamically multiplex and forward IPTV programs according to what the end-users actually demand and those watched by no end-user would not be multiplexed. By comparing these two schemes, a reduced traffic of EPON can be achieved by using dynamic multiplex scheme, especially when most end-users are watching the same few IPTV programs. Both schemes are implemented in our system, with their hardware and software designs described.

  17. A comparison of rural speech-language pathologists' and residents' access to and attitudes towards the use of technology for speech-language pathology service delivery.

    Science.gov (United States)

    Dunkley, Carolyn; Pattie, Lydelle; Wilson, Linda; McAllister, Lindy

    2010-08-01

    This paper reports results and implications of two related studies which investigated (a) access of residents and speech-language pathologists (SLPs) of rural Australia to information and communication technologies (ICT) and (b) their attitudes towards the use of ICT for delivery of speech-language pathology services. Both studies used mail out questionnaires, followed by interviews with a subset of those who completed the questionnaires. Data were obtained from 43 questionnaires from rural residents and 10 interviews with a subset of those residents, and from questionnaires returned by 49 SLPs and 4 interviews with a subset of those SLPs. Results show a mismatch between rural residents' and SLPs' access to and attitudes towards use of ICT for speech-language pathology service delivery. Rural residents had better access and more positive attitudes to the use of ICT for speech-language pathology service delivery than expected by SLPs. The results of this study have important implications for education and professional development of SLPs and for research into the use of ICT for telespeech-language pathology.

  18. Access to Investigational Drugs: FDA Expanded Access Programs or “Right‐to‐Try” Legislation?

    Science.gov (United States)

    Berglund, Jelena P.; Weatherwax, Kevin; Gerber, David E.; Adamo, Joan E.

    2015-01-01

    Abstract Purpose The Food and Drug Administration Expanded Access (EA) program and “Right‐to‐Try” legislation aim to provide seriously ill patients who have no other comparable treatment options to gain access to investigational drugs and biological agents. Physicians and institutions need to understand these programs to respond to questions and requests for access. Methods FDA EA programs and state and federal legislative efforts to provide investigational products to patients by circumventing FDA regulations were summarized and compared. Results The FDA EA program includes Single Patient‐Investigational New Drug (SP‐IND), Emergency SP‐IND, Intermediate Sized Population IND, and Treatment IND. Approval rates for all categories exceed 99%. Approval requires FDA and Institutional Review Board (IRB) approval, and cooperation of the pharmaceutical partner is essential. “Right‐to‐Try” legislation bypasses some of these steps, but provides no regulatory or safety oversight. Conclusion The FDA EA program is a reasonable option for patients for whom all other therapeutic interventions have failed. The SP‐IND not only provides patient access to new drugs, but also maintains a balance between immediacy and necessary patient protection. Rather than circumventing existing FDA regulations through proposed legislation, it seems more judicious to provide the knowledge and means to meet the EA requirements. PMID:25588691

  19. Outcome of treatment seeking rural gamblers attending a nurse-led cognitive-behaviour therapy service: A pilot study

    Directory of Open Access Journals (Sweden)

    Barry Tolchard

    2016-03-01

    Full Text Available Objectives: Little is known about the differences between urban and rural gamblers in Australia, in terms of comorbidity and treatment outcome. Health disparities exist between urban and rural areas in terms of accessibility, availability, and acceptability of treatment programs for problem gamblers. However, evidence supporting cognitive-behaviour therapy as the main treatment for problem gamblers is strong. This pilot study aimed to assess the outcome of a Cognitive-Behavioural Therapy (CBT treatment program offered to urban and rural treatment-seeking gamblers. Methods: People who presented for treatment at a nurse-led Cognitive-Behavioural Therapy (CBT gambling treatment service were invited to take part in this study. A standardised clinical assessment and treatment service was provided to all participants. A series of validated questionnaires were given to all participants at (a assessment, (b discharge, (c at a one-month, and (d at a 3-month follow-up visit. Results: Differences emerged between urban and rural treatment-seeking gamblers. While overall treatment outcomes were much the same at three months after treatment, rural gamblers appeared to respond more rapidly and to have sustained improvements over time. Conclusion: This study suggests that rural problem gamblers experience different levels of co-morbid anxiety and depression from their urban counterparts, but once in treatment appear to respond quicker. ACBT approach was found to be effective in treating rural gamblers and outcomes were maintained. Ensuring better availability and access to such treatment in rural areas is important. Nurses are in a position as the majority health professional in rural areas to provide such help. Keywords: Evidence based health care, Health program evaluation, Models of care, Rural health services delivery, Rural mental health

  20. DESIGNING E-LEARNING PROGRAMS FOR RURAL SOCIAL TRANSFORMATION AND POVERTY REDUCTION

    Directory of Open Access Journals (Sweden)

    C. S. H. N.MURTHY

    2008-01-01

    Full Text Available ABSTRACTWhile the conventional education system with different forms of E-learning and rigid academic instructive curriculum could not bring desired changes in specified timeframe work at rural level in the targeted communities and groups, a multipronged sociological approach with a sociable and flexible curriculum in new E-Learning programs becomes need of hour. The impact of socializing influence of these E-Learning programs should be properly exploited to motivate and inspire the rural target groups. The benefits of E-learning then become extensive and soon integrate with the needs of the lower strata of the society in order for achieving a rapid social transformation in the lives of the farmers, vocational groups, artisans and small income self help groups comprising women, girls and physically challenged. The paper suggests a number of new generation E-Learning programs as strategies of development communication with a promise of high returns for the industry for its investment in these programs with socially relevant messages and media convergence.

  1. 76 FR 9588 - Announcement of Funding Awards for the Rural Housing and Economic Development Program; Fiscal...

    Science.gov (United States)

    2011-02-18

    ... Awards for the Rural Housing and Economic Development Program; Fiscal Year 2009 AGENCY: Office of the... Housing and Economic Development, Office of Community Planning and Development, 451 Seventh Street, SW... Rural Housing and Economic Development program was authorized by the Department of Veterans Affairs...

  2. Transformation of the rural PV market through the National Rural Water Service Delivery Program

    International Nuclear Information System (INIS)

    2009-03-01

    The primary objective of the project is to reduce the country's energy-related Co2 emissions by substituting solar Pv to fossil fuels to provide basic water pumping services to the non-electrified rural communities in the Middle-South region. A secondary objective is to institutionalize the use of solar Pv for low-head irrigation and basic domestic (lighting, Tv) and community (health clinics, telecom, schools) uses in rural areas as a substitute for fossil fuel-based energy sources (paraffin, diesel and LPG). The activities proposed in the project are designed to: (I) remove barriers to the wide-scale utilization of solar Pv for solar pumping; (II) meet the basic energy needs of community based organizations; and (III) reinforce public-private partnerships in promoting solar Pv technology. This project will assist with the introduction of solar Pv in the Government rural water program - which is a unique opportunity to tap a sizable Pv market within the country - and will ensure sustain ability through the involvement of the private sector in the provision of water services

  3. A situational analysis methodology to inform comprehensive HIV prevention and treatment programming, applied in rural South Africa.

    Science.gov (United States)

    Treves-Kagan, Sarah; Naidoo, Evasen; Gilvydis, Jennifer M; Raphela, Elsie; Barnhart, Scott; Lippman, Sheri A

    2017-09-01

    Successful HIV prevention programming requires engaging communities in the planning process and responding to the social environmental factors that shape health and behaviour in a specific local context. We conducted two community-based situational analyses to inform a large, comprehensive HIV prevention programme in two rural districts of North West Province South Africa in 2012. The methodology includes: initial partnership building, goal setting and background research; 1 week of field work; in-field and subsequent data analysis; and community dissemination and programmatic incorporation of results. We describe the methodology and a case study of the approach in rural South Africa; assess if the methodology generated data with sufficient saturation, breadth and utility for programming purposes; and evaluate if this process successfully engaged the community. Between the two sites, 87 men and 105 women consented to in-depth interviews; 17 focus groups were conducted; and 13 health facilities and 7 NGOs were assessed. The methodology succeeded in quickly collecting high-quality data relevant to tailoring a comprehensive HIV programme and created a strong foundation for community engagement and integration with local health services. This methodology can be an accessible tool in guiding community engagement and tailoring future combination HIV prevention and care programmes.

  4. Patient and Nurse Experiences in a Rural Chronic Disease Management Program: A Qualitative Evaluation.

    Science.gov (United States)

    Davisson, Erica A; Swanson, Elizabeth A

    Rural status confounds chronic disease self-management. The purpose of this qualitative, descriptive study was to evaluate the nurse-led "Living Well" chronic disease management program reporting patient recruitment and retention issues since program initiation in 2013. The Chronic Care Model (CCM) was the guiding framework used to reinforce that interdisciplinary teams must have productive patient interactions for their program(s) to be sustainable. A rural, Midwest county clinic's chronic disease management program. Observations, interviews, and within- and across-case coding were used. Patients' responses were analyzed to identify (1) reasons for recruitment and retention problems and (2) program elements that were viewed as successful or needing improvement. A convenience sample of 6 rural, English-speaking adults (65 years or older, with no severe cognitive impairment) with at least one chronic condition was recruited and interviewed. Themes emerged related to nurse knowledge, availability, and value; peer support; overcoming barriers; adherence enhancement; and family/friends' involvement. Patients reported engagement in self-management activities because of program elements such as support groups and productive nurse-patient interactions. Interdisciplinary communication, commitment, and patient referral processes were identified as reasons for recruitment and retention issues. Findings substantiated that certain elements must be present and improved upon for future rural programs to be successful. Interdisciplinary communication may need to be improved to address recruitment and retention problems. It was clear from patient interviews that the nurse coordinators played a major role in patients' self-management adherence and overall satisfaction with the program. This is important to case management because results revealed the need for programs of this nature that incorporate the vital role of nurse coordinators and align with the CCM value of providing a

  5. Child and youth telepsychiatry in rural and remote primary care.

    Science.gov (United States)

    Pignatiello, Antonio; Teshima, John; Boydell, Katherine M; Minden, Debbie; Volpe, Tiziana; Braunberger, Peter G

    2011-01-01

    Young people with psychological or psychiatric problems are managed largely by primary care practitioners, many of whom feel inadequately trained, ill equipped, and uncomfortable with this responsibility. Accessing specialist pediatric and psychological services, often located in and near large urban centers, is a particular challenge for rural and remote communities. Live interactive videoconferencing technology (telepsychiatry) presents innovative opportunities to bridge these service gaps. The TeleLink Mental Health Program at The Hospital for Sick Children in Toronto offers a comprehensive, collaborative model of enhancing local community systems of care in rural and remote Ontario using videoconferencing. With a focus on clinical consultation, collaborative care, education and training, evaluation, and research, ready access to pediatric psychiatrists and other specialist mental health service providers can effectively extend the boundaries of the medical home. Medical trainees in urban teaching centers are also expanding their knowledge of and comfort level with rural mental health issues, various complementary service models, and the potentials of videoconferencing in providing psychiatric and psychological services. Committed and enthusiastic champions, a positive attitude, creativity, and flexibility are a few of the necessary attributes ensuring viability and integration of telemental health programs. Copyright © 2011 Elsevier Inc. All rights reserved.

  6. The development of accessibility indicators for distance learning programs

    Directory of Open Access Journals (Sweden)

    Sheryl Burgstahler

    2006-12-01

    Full Text Available A study was undertaken to explore program policies and practices related to the accessibility of American distance learning courses to qualified students with disabilities. A literature review was conducted, a draft list of accessibility indicators was created, examples of applications of the indicators in existing distance learning programs were collected, the indicators were systematically applied to one distance learning program, input from a variety of distance learning programs was used to further refine the indicators, and these programs were encouraged to adopt the indicators and make use of resources provided by the project. Results of this exploratory work suggest that incorporating accessibility considerations into policies, procedures and communications of a program requires consideration of the unique needs of students, course designers, instructors and evaluators; involves approval and implementation at a variety of administrative levels; and is an ongoing process that may be implemented in incremental steps.

  7. Hybrid Terrestrial-Satellite DVB/IP Infrastructure in Overlay Constellations for Triple-Play Services Access in Rural Areas

    Directory of Open Access Journals (Sweden)

    E. Pallis

    2010-01-01

    Full Text Available This paper discusses the convergence of digital broadcasting and Internet technologies, by elaborating on the design, implementation, and performance evaluation of a hybrid terrestrial/satellite networking infrastructure, enabling triple-play services access in rural areas. At local/district level, the paper proposes the exploitation of DVB-T platforms in regenerative configurations for creating terrestrial DVB/IP backhaul between the core backbone (in urban areas and a number of intermediate communication nodes distributed within the DVB-T broadcasting footprint (in rural areas. In this way, triple play services that are available at the core backbone, are transferred via the regenerative DVB-T/IP backhaul to the entire district and can be accessed by rural users via the corresponding intermediate node. On the other hand, at regional/national level, the paper proposes the exploitation of a satellite interactive digital video broadcasting platform (DVB S2/RCS as an overlay network that interconnects the regenerative DVB-T/IP platforms, as well as individual users, and services providers, to each other. Performance of the proposed hybrid terrestrial/satellite networking environment is validated through experimental tests that were conducted under real transmission/reception conditions (for the terrestrial segment and via simulation experiments (for the satellite segment at a prototype network infrastructure.

  8. Task-sharing or public finance for the expansion of surgical access in rural Ethiopia: an extended cost-effectiveness analysis.

    Science.gov (United States)

    Shrime, Mark G; Verguet, Stéphane; Johansson, Kjell Arne; Desalegn, Dawit; Jamison, Dean T; Kruk, Margaret E

    2016-07-01

    Despite a high burden of surgical disease, access to surgical services in low- and middle-income countries is often limited. In line with the World Health Organization's current focus on universal health coverage and equitable access to care, we examined how policies to expand access to surgery in rural Ethiopia would impact health, impoverishment and equity. An extended cost-effectiveness analysis was performed. Deterministic and stochastic models of surgery in rural Ethiopia were constructed, utilizing pooled estimates of costs and probabilities from national surveys and published literature. Model calibration and validation were performed against published estimates, with sensitivity analyses on model assumptions to check for robustness. Outcomes of interest were the number of deaths averted, the number of cases of poverty averted and the number of cases of catastrophic expenditure averted for each policy, divided across wealth quintiles. Health benefits, financial risk protection and equity appear to be in tension in the expansion of access to surgical care in rural Ethiopia. Health benefits from each of the examined policies accrued primarily to the poor. However, without travel vouchers, many policies also induced impoverishment in the poor while providing financial risk protection to the rich, calling into question the equitable distribution of benefits by these policies. Adding travel vouchers removed the impoverishing effects of a policy but decreased the health benefit that could be bought per dollar spent. These results were robust to sensitivity analyses. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  9. Health Service Accessibility and Risk in Cervical Cancer Prevention: Comparing Rural Versus Nonrural Residence in New Mexico.

    Science.gov (United States)

    McDonald, Yolanda J; Goldberg, Daniel W; Scarinci, Isabel C; Castle, Philip E; Cuzick, Jack; Robertson, Michael; Wheeler, Cosette M

    2017-09-01

    Multiple intrapersonal and structural barriers, including geography, may prevent women from engaging in cervical cancer preventive care such as screening, diagnostic colposcopy, and excisional precancer treatment procedures. Geographic accessibility, stratified by rural and nonrural areas, to necessary services across the cervical cancer continuum of preventive care is largely unknown. Health care facility data for New Mexico (2010-2012) was provided by the New Mexico Human Papillomavirus Pap Registry (NMHPVPR), the first population-based statewide cervical cancer screening registry in the United States. Travel distance and time between the population-weighted census tract centroid to the nearest facility providing screening, diagnostic, and excisional treatment services were examined using proximity analysis by rural and nonrural census tracts. Mann-Whitney test (P brick and mortar). © 2016 National Rural Health Association.

  10. A population-based analysis of injury-related deaths and access to trauma care in rural-remote Northwest British Columbia.

    Science.gov (United States)

    Simons, Richard; Brasher, Penelope; Taulu, Tracey; Lakha, Nasira; Molnar, Nadine; Caron, Nadine; Schuurman, Nadine; Evans, David; Hameed, Morad

    2010-07-01

    Injury rates and injury mortality rates are generally higher in rural and remote communities compared with urban jurisdictions as has been shown to be the case in the rural-remote area of Northwest (NW) British Columbia (BC). The purpose of study was to identify: (1) the place and timing of death following injury in NW BC, (2) access to and quality of local trauma services, and (3) opportunities to improve trauma outcomes. Quantitative data from demographic and geographic databases, the BC Trauma Registry, Hospital discharge abstract database, and the BC Coroner's Office, along with qualitative data from chart reviews of selected major trauma cases, and interviews with front-line trauma care providers were collated and analyzed for patients sustaining injury in NW BC from April 2001 to March 2006. The majority of trauma deaths (82%) in NW BC occur prehospital. Patients arriving alive to NW hospitals have low hospital mortality (1.0%), and patients transferring from NW BC to tertiary centers have better outcomes than matched patients achieving direct entry into the tertiary center by way of geographic proximity. Access to local trauma services was compromised by: incident discovery, limited phone service (land lines/cell), incomplete 911 emergency medical services system access, geographical and climate challenges compounded by limited transportation options, airport capabilities and paramedic training level, dysfunctional hospital no-refusal policies, lack of a hospital destination policies, and lack of system leadership and coordination. Improving trauma outcomes in this rural-remote jurisdiction requires a systems approach to address root causes of delays in access to care, focusing on improved access to emergency medical services, hospital bypass and destination protocols, improved transportation options, advanced life support transfer capability, and designated, coordinated local trauma services.

  11. Second Life®: A 3D Virtual Immersive Environment for Teacher Preparation Courses in a Distance Education Program

    Science.gov (United States)

    Hartley, Melissa D.; Ludlow, Barbara L.; Duff, Michael C.

    2015-01-01

    Many colleges and universities rely upon online programs to support distance delivery of personnel preparation programs in special education and related services. These distance education programs enable individuals who live or work in rural communities to access training programs to earn teaching certification and assist rural schools in…

  12. Towards universal access to skilled birth attendance: the process of transforming the role of traditional birth attendants in Rural China.

    Science.gov (United States)

    Jiang, Hong; Qian, Xu; Chen, Lili; Li, Jian; Escobar, Erin; Story, Mary; Tang, Shenglan

    2016-03-21

    Institution-based childbirth, with the ultimate goal of universal access to skilled birth attendance (SBA), has been selected as a key strategy to reduce the maternal mortality rate in many developing countries. However, the question of how to engage traditional birth attendants (TBAs) in the advocacy campaign for SBA poses a number of challenges. This paper aims to demonstrate how TBAs in rural regions of China have been integrated into the health system under a policy of institutional delivery. Research was conducted through literature and document reviews and individual in-depth interviews with stakeholders of the safe motherhood program in rural Guangxi Zhuang Autonomous Region, China. A total of 33 individual interviews were conducted with regional and local politicians, policy makers, health managers, health providers, civil society members, village cadres for women affairs, former TBAs, village maternal health workers, mothers and their mother-in-laws. Since 1998, TBA's traditional role of providing in-home care during childbirth has been restructured and their social role has been strengthened in rural Guangxi. TBAs were redesigned to function as the linkage between women and the health system. A new policy in 1999 shifted the role of TBAs to village maternal health workers whose responsibilities were mainly to promote perinatal care and institution-based delivery of pregnant women. This successful transformation involved engaging with government and other actors, training TBAs for their new role, and providing incentives and sanctions for human resources management. The China experience of transforming the role of TBAs in Guangxi rural area is an example of successfully engaging TBAs in promoting institution-based childbirth.

  13. Assessment of access to electricity and the socio-economic impacts in rural areas of developing countries

    International Nuclear Information System (INIS)

    Kanagawa, Makoto; Nakata, Toshihiko

    2008-01-01

    The purpose of this study is to reveal relations between access to electricity and advancement in a socio-economic condition in rural areas of developing countries. Recently, multi-dimensional aspects of poverty, for example, economy, education, and health, has been increasingly focused on, and access to modern energy such as electricity is one possible solution. As a case study, we have analyzed unelectrified rural areas in Assam state, India. We have developed an energy-economic model in order to analyze the possibility of electrification through dissemination of electric lighting appliances as well as applied multiple regression analysis to estimate the socio-economic condition, a literacy rate above 6 years old, in the areas. As a result of the case study, the household electrification rate, the 1000 km 2 road density, and sex ratio have been chosen as the explanatory variables of the literacy rate. Moreover, the model analysis shows that complete household electrification will be achieved by the year 2012. In combination with the multiple regression and model analysis, the literacy rate in Assam may increase to 74.4% from 63.3%

  14. Examining Internet Access and Social Media Application Use for Online Nutrition Education in SNAP-Ed Participants in Rural Illinois.

    Science.gov (United States)

    Loehmer, Emily; Smith, Sylvia; McCaffrey, Jennifer; Davis, Jeremy

    2018-01-01

    To examine Internet access and interest in receiving nutrition education via social media applications among low-income adults participating in the Supplemental Nutrition Assistance Program Education (SNAP-Ed). A cross-sectional survey was distributed during 25 SNAP-Ed classes throughout the 16 southernmost counties of Illinois. From 188 responses, the majority of participants had Internet access (76%). Among participants aged 18-32 years (n = 51), 92% owned a smartphone with Internet access and 57% indicated that they would use online nutrition education, with most interest in e-mail (41%), Facebook (40%), and text messaging (35%). There was little interest in using blogs, Vine, Twitter, Tumblr, and Pinterest. Overall, 49% of middle-aged adults aged 33-64 years and 87% of seniors aged ≥65 years reported they would not use online nutrition education. Results indicated similar Internet accessibility in southern Illinois among low-income populations compared with national rural rates. Interest in using online nutrition education varied among SNAP-Ed participants according to age. Young adults appeared to be the most captive audience regarding online nutrition education. Results may be useful to agencies implementing SNAP-Ed to supplement current curriculum with online nutrition education for audiences aged ≤32 years. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

  15. 75 FR 34941 - Review of the Commission's Program Access Rules and Examination of Programming Tying Arrangements

    Science.gov (United States)

    2010-06-21

    ... Commission's Program Access Rules and Examination of Programming Tying Arrangements AGENCY: Federal... Program Access Rules and Examination of Programming Tying Arrangements, MB Docket No. 07-198, FCC 10-17... information collection is contained in Sections 4(i), 303(r), and 628 of the Communications Act of 1934, as...

  16. Comparisons of Contraceptive Use between Rural and Urban Teens.

    Science.gov (United States)

    Geske, Savannah; Quevillon, Randal; Struckman-Johnson, Cindy; Hansen, Keith

    2016-02-01

    The purpose of the study was to determine if barriers in rural areas might decrease an adolescent's likelihood of obtaining effective contraception. Previous studies have reported mixed results in comparisons of rural and urban contraception use. Electronic survey. Midwestern Public University. Undergraduate and graduate women. Questionnaire. Participants retrospectively recalled their contraceptive use and barriers to contraceptive use between the 9th and 12th grades. A Barriers to Contraception Use Scale was created using exploratory factor analysis and yielded 31 questions with 1 underlying factor: barriers. Participants were identified as rural or urban using the Office of Management and Budget (OMB) definition and the participant's self-identification. Overall, rural participants endorsed more barriers to accessing contraceptives than urban participants using the OMB definition (χ(2) (2; n = 388) = 2.04; P .05. The Barriers to Contraception Use Scale total score predicted whether an individual would have a prescription for contraceptives 70.5% of the time compared to the base rate of 54.1%. Although no rural-urban differences in actual contraception use were found, rural participants reported more barriers to accessing contraception, and those who endorsed more barriers were less likely to obtain contraceptives while in high school. Pregnancy prevention programs should thus take these barriers into account when developing future interventions. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  17. What Explains Divorced Women's Poorer Health? The Mediating Role of Health Insurance and Access to Health Care in a Rural Iowan Sample

    Science.gov (United States)

    Lavelle, Bridget; Lorenz, Frederick O.; Wickrama, K. A. S.

    2012-01-01

    Economic restructuring in rural areas in recent decades has been accompanied by rising marital instability. To examine the implications of the increase in divorce for the health of rural women, we examine how marital status predicts adequacy of health insurance coverage and health care access, and whether these factors help to account for the…

  18. Renewable energy policy in remote rural areas of Western China. Implementation and socio-economic benefits

    Energy Technology Data Exchange (ETDEWEB)

    Shyu, Chian-Woei

    2010-05-19

    Electricity is essential for rural development. In 2005, 1.6 billion people, around a quarter of the world's population, living mostly in rural areas of developing countries, had no access to electricity. In general, remote rural areas in developing countries have little prospect of having access to grid-based electricity, which usually only extends to densely populated urban areas, where a large customer base justifies heavy expenditure for electricity infrastructure. One option for electrification in remote rural areas is to decentralize electricity systems based on renewable energy sources. However, such an option is not universally agreed upon. This dissertation examines a renewable energy-based rural electrification program, the 'Township Electrification Program', launched by the Chinese government in 2002. The Program was implemented in 1013 non-electrified townships in remote rural areas of 11 western provinces, providing electricity for 300,000 households and 1.3 million people. And at the time of research, the Program was known as the world's largest renewable energy-based rural electrification program in terms of investment volume ever carried out by a country. Two townships, Saierlong Township in Qinghai Province and Namcuo Township in Tibet Autonomous Region, were selected as cases for an in-depth examination of rural electrification practices in remote rural areas of western China. Both qualitative (interviews, observations, mapping, and transition walk) and quantitative (household survey) methods were applied in the field to collect data. The main findings of the study are summarized as follows: First, political leaders' concern over the unequal economic development of eastern and western China, as well as rural and urban areas, was the main factor triggering inclusion of the policy issue, electricity access in remote rural areas of western China, in the government's policy agenda. Second, like other energy policies, the formulation and adoption of

  19. Systematic Review of Palliative Care in the Rural Setting.

    Science.gov (United States)

    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.

  20. Initiative for 100% rural electrification in developing countries: Case study of Senegal

    International Nuclear Information System (INIS)

    Diouf, Boucar; Pode, Ramchandra; Osei, Rita

    2013-01-01

    Sub-Saharan Africa has the lowest access to electricity in the World. In Senegal, less than 25% of the rural population benefit of electricity service. Solar energy offers an important potential to Senegal with over 3000 h of sunlight a year. This is a real opportunity to generalize the access to electricity. But, the efforts to bridge the gap must be diversified and completed. We approach the problem of rural electrification with a different point of view. Grid expansion and centralized solutions may be adequate for villages with a population organized in high-density of habitations. Small size villages or those with highly dispersed population may need different propositions because of cost. These regions will not be the priority of electrification programs. Furthermore, this rural population is characterized by its low income and saving. Such a conjuncture suggests the opportunity of a service based fees model for access to electricity. On the basis of a fees-for-service model, individual standalone photovoltaic systems may be a more appropriate solution to cover the priority needs of lighting and mobile phones battery charge for telecommunication. We present a pilot project in a village of Senegal to support the model and demonstrate its feasibility. - Highlights: • Rural electrification in developing countries. • Problems of access to electricity in rural areas. • Fees-for-service solution for small villages/highly dispersed population villages. • Situation of Senegal. • Presentation of a pilot project in a small village of Senegal

  1. Culturally-adapted and audio-technology assisted HIV/AIDS awareness and education program in rural Nigeria: a cohort study

    Directory of Open Access Journals (Sweden)

    Lennox Jeffrey L

    2010-02-01

    Full Text Available Abstract Background HIV-awareness programs tailored toward the needs of rural communities are needed. We sought to quantify change in HIV knowledge in three rural Nigerian villages following an integrated culturally adapted and technology assisted educational intervention. Methods A prospective 14-week cohort study was designed to compare short-term changes in HIV knowledge between seminar-based education program and a novel program, which capitalized on the rural culture of small-group oral learning and was delivered by portable digital-audio technology. Results Participants were mostly Moslem (99%, male (53.5%, with no formal education (55%. Baseline HIV knowledge was low ( Conclusions Baseline HIV-awareness was low. Culturally adapted, technology-assisted HIV education program is a feasible cost-effective method of raising HIV awareness among low-literacy rural communities.

  2. Assessment of factors influencing retention in the Philippine National Rural Physician Deployment Program

    Directory of Open Access Journals (Sweden)

    Leonardia Juan

    2012-11-01

    Full Text Available Abstract Background The ‘Doctors to the Barrios’ (DTTB Program was launched in 1993 in response to the shortage of doctors in remote communities in the Philippines. While the Program has attracted physicians to work in such areas for the prescribed 2-year period, ongoing monitoring shows that very few chose to remain there for longer and be absorbed by their Local Government Unit (LGU. This assessment was carried out to explore the reasons for the low retention rates and to propose possible strategies to reverse the trend. Methods A mixed methods approach was used comprising a self-administered questionnaire for members of the current cohort of DTTBs, and oral interviews with former DTTBs. Results Among former DTTBs, the wish to serve rural populations was the most widely cited motivation. By comparison, among the current cohort of DTTBs, more than half joined the Program due to return of service obligations; a quarter to help rural populations, and some out of an interest in public health. Those who joined the Program to return service experienced significantly less satisfaction, whilst those who joined out of an interest in public health were significantly more satisfied with their rural work. Those who graduated from medical schools in the National Capital Region were significantly more critical about their compensation and perceived there to be fewer options for leisure in rural areas. With regard to the factors impeding retention, lack of support from the LGU was most frequently mentioned, followed by concerns about changes in compensation upon absorption by the LGU, family issues and career advancement. Conclusions Through improved collaboration with the Department of Health, LGUs need to strengthen the support provided to DTTBs. Priority could be given to those acting out of a desire to help rural populations or having an interest in public health, and those who have trained outside of the National Capital Region. Whether physicians

  3. ROLE OF ICTS IN IMPROVING FOOD ACCESSIBILITY OF IRAN'S ...

    African Journals Online (AJOL)

    BARTH EKWUEME

    2009-09-22

    Sep 22, 2009 ... point of view, the situation of food accessibility in Iran's rural households was ... oriented programs and content of old technologies were determined to account for 69% of the variance of food ... all people, at all times, have physical and economic ... market communication, improving market profitability,.

  4. Nigeria: Positioning Rural Economy for Implementation of Sustainable Development Goals

    Directory of Open Access Journals (Sweden)

    Akinbode Michael Okunola

    2016-09-01

    Full Text Available Nigeria as nation has over the years engaged in lots of developmental activities without actions which makes achievements to elude the people. Development of societies doesn’t happen in the vacuum. Thus, the adoption of Structural Adjustment Program, SAP, by Nigeria leading to the neglect of the custom periodic National Plan at a time when Nigeria had no structure for development was the beginning of journey to widened inequality and large poverty incidence, depth and severity. To close the gap between the rich and the poor, the Nigeria government had designed and implemented some programs and policies whose implementation has not solved the inherent problems. In year 2000, the world leaders subscribed to the Millennium Development Goals to ensure synergized global approach to solving the poverty menace. Programs designed in Nigeria to achieve the MDGs focused on the urban centers thereby relegating the rural areas which are responsible for the feeding of the teeming population of the urban dwellers. Farming households and the general rural communities do not have access to clean water, quality education and health facilities, good feeder roads, affordable and safe energy as well as other socioeconomic and socio-infrastructural facilities that would ensure sustainable living for the people whose contribution to the national economy cannot be overemphasized. This study therefore looks at the structural actions the Nigeria government should embarked upon to ensure that the rural dweller have access to life. As the government would be developing programs and policies to achieve the Sustainable Development Goals whose priority is the end poverty in all forms and everywhere by 2030, this study reveals how to position the rural economy for developmental attention from the policy makers.

  5. A new systems paradigm for the rural electrification program, Philippines

    Energy Technology Data Exchange (ETDEWEB)

    Roxas, Fernando; Santiago, Andrea

    2010-09-15

    The Philippines has pushed rural electrification for two decades. Recently, the government achieved 100% electrification at the village level. Despite the significant recent economic growth, poverty has increased in some areas. These are usually agricultural and have many un-electrified areas. The multilaterals have launched programs that couple electricity with livelihood projects. The authors argue this is insufficient to guarantee sustainability. A systems view of rural poverty suggests that several components must be designed to work together. In addition to the electricity and livelihood, skills, attitudes, management and markets must be incorporated to make a lasting impact on poverty.

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

    Science.gov (United States)

    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…

  7. Multinational Experiment 7. Protecting Access to Space: Presentation to Senior Leaders

    Science.gov (United States)

    2013-07-08

    Multinational Experiment 7: Outcome 3: Space Access Briefing to SLS 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d...operations Consequence management Ship status during search & rescue Tele-medicine Broadband internet TV signal distribution Satellite radio Rural...military-usage • Significant economic & societal consequences Access to space at risk • Current approach unsustainable • Broad range of threats

  8. The development of rural area residence based on participatory planning case study: A rural residential area of Pucungrejo village, Magelang through "neighborhood development" program

    Science.gov (United States)

    KP, R. M. Bambang Setyohadi; Wicaksono, Dimas

    2018-03-01

    The poverty is one of the prevailing problems in Indonesia until now. Even a change of the era of governance has not succeeded in eradicating the problem of poverty. The program of poverty alleviation program has always been a focus in the budget allocation in all era of leadership in Indonesia. Those programs were strategic because it prepared the foundation of community self-reliance in the form of representative, entrenched and conducive community leadership institutions to develop of social capital of society in the future. Developing an area of the village requires an integrated planning (Grand Design) to figure out the potential and the problems existing in the rural area as well as the integration of the rural area surrounding. In addition, the grand design needs to be synchronized to the more comprehensive spatial plan with a hierarchical structure such as RTBL, RDTRK / RRTRK, RTRK, and RTRW. This rural area management plan can be oriented or refer to the pattern developed from neighborhood Development program which is part of the PNPM Mandiri program. The neighborhood development program is known as residential area development plan whose process involves of the entire community. Therefore, the regional development up to the scale of the environment requires the planning phase. Particularly, spatial planning which emphasizes the efforts to optimize sectorial development targets to be integrated into an integrated development process must be conducted, in addition to taking into consideration the opportunities, potentials and limitations of the resources, the level of interconnection with the central government within the district and between sub-districts and rural areas.

  9. Energy access: Lessons learned in Brazil and perspectives for replication in other developing countries

    International Nuclear Information System (INIS)

    Coelho, Suani T.; Goldemberg, José

    2013-01-01

    Energy access has been singled out by the AGECC in 2010 as one of the important problems to be tackled in the next few decades in a world where 1.3 billion people do not have access to electricity and 2.7 use primitive fuels – mainly fuel wood – for cooking and heating. To solve such problems, innumerous small scale projects have been implemented around the world either on the improvement of cooking stoves, biogas and others, as well as in generating electricity in decentralized systems. We discuss here the “large scale approach” to solve these problems in Brazil through the introduction of LPG (liquid petroleum gas) in Brazil 70 years ago, all over the country, as a cooking fuel that replaced significantly the use of fuel wood in rural areas. In addition to that, we describe the governmental program (Luz para Todos – LPT – Light for all) introduced more recently to extend the electricity grid to around 10 million people, reducing considerably the number of people without access to electricity in the rural areas of the country. Such experiences and the corresponding lessons learned could be replicated in other developing countries, contributing significantly to poverty alleviation. - Highlights: • Energy access is one important problem for 1.3 billion people not having access to electricity and 2.7 billion using primitive fuels for cooking-heating. • We discuss the approach introduced in Brazil through the introduction of LPG as a cooking fuel that replaced significantly the use of fuel wood in rural areas. • We describe the program introduced to supply electricity, reducing the number of people without access to electricity in rural areas. • Lessons learned could be replicated in other DCs, contributing to poverty alleviation

  10. Financing and disseminating small energy systems in rural areas

    International Nuclear Information System (INIS)

    Waddle, D.B.; Perlack, R.D.

    1992-01-01

    The viability of small energy systems, primarily photovoltaic systems, is discussed as an alternative for rural electrification via traditional grid extension. A dissemination model that incorporates financing to allow access to a much larger population of users and technology support (e.g. training for sales and service and small business development) is described. The experience of two successful programs is presented to illustrate the keys to effective program development and implementation. (author)

  11. The social service divide: service availability and accessibility in rural versus urban counties and impact on child welfare outcomes.

    Science.gov (United States)

    Belanger, Kathleen; Stone, Warren

    2008-01-01

    An empirical study of 75 counties in a state found that social services are more available and accessible in urban versus rural counties, signaling a need for public policy addressing service allocation. The study also found a relationship between the accessibility of intensive family preservation services and reentry into foster care, a child welfare outcome. Implications for achieving outcomes affecting safety, permanence, and well-being of children are discussed.

  12. [Evaluation of nutritional status of school-age children after implementation of "Nutrition Improvement Program" in rural area in Hunan, China].

    Science.gov (United States)

    Deng, Zhu-Juan; Mao, Guang-Xu; Wang, Yu-Jun; Liu, Li; Chen, Yan

    2016-09-01

    To investigate the nutritional status of school-age children in rural area in Hunan, China from 2012 to 2015 and to evaluate the effectiveness of the "Nutrition Improvement Program for Compulsory Education Students in Rural Area" (hereinafter referred to as "Nutrition Improvement Program"). The nutritional status of school-age children aged 6-14 years was evaluated after the implementation of the "Nutrition Improvement Program" and the changing trend of the children's nutritional status was analyzed. The statistical analysis was performed on the monitoring data of the school-age children aged 6-14 years in rural area in Hunan, China from 2012 to 2015, which came from "The Nutrition and Health Status Monitoring and Evaluation System of Nutrition Improvement Program for Compulsory Education Students in Rural Area". In 2015, female students aged 6-7 years in rural area in Hunan, China had a significantly greater body length than the rural average in China (PNutrition Improvement Program", the prevalence rate of growth retardation decreased (PNutrition Improvement Program" has achieved some success, but the nutritional status of school-age children has not improved significantly. Overweight/obesity and malnutrition are still present. Therefore, to promote the nutritional status of school-age children it is recommended to improve the measures for the "Nutrition Improvement Program".

  13. Disparities in Alcohol, Drug Use, and Mental Health Condition Prevalence and Access to Care in Rural, Isolated, and Reservation Areas: Findings From the South Dakota Health Survey.

    Science.gov (United States)

    Davis, Melinda M; Spurlock, Margaret; Dulacki, Kristen; Meath, Thomas; Li, Hsin-Fang Grace; McCarty, Dennis; Warne, Donald; Wright, Bill; McConnell, K John

    2016-06-01

    Research on urban/rural disparities in alcohol, drug use, and mental health (ADM) conditions is inconsistent. This study describes ADM condition prevalence and access to care across diverse geographies in a predominantly rural state. Multimodal cross-sectional survey in South Dakota from November 2013 to October 2014, with oversampling in rural areas and American Indian reservations. Measures assessed demographic characteristics, ADM condition prevalence using clinical screenings and participant self-report, perceived need for treatment, health service usage, and barriers to obtaining care. We tested for differences among urban, rural, isolated, and reservation geographic areas, controlling for participant age and gender. We analyzed 7,675 surveys (48% response rate). Generally, ADM condition prevalence rates were not significantly different across geographies. However, respondents in isolated and reservation areas were significantly less likely to have access to primary care. Knowledge of treatment options was significantly lower in isolated regions and individuals in reservation areas had significantly lower odds of reporting receipt of all needed care. Across the sample there was substantial discordance between ADM clinical screenings and participant self-reported need; 98.1% of respondents who screened positive for alcohol or drug misuse and 63.8% of respondents who screened positive for a mental health condition did not perceive a need for care. In a predominantly rural state, geographic disparities in ADM conditions are related to differences in access as opposed to prevalence, particularly for individuals in isolated and reservation areas. Educational interventions about ADM condition characteristics may be as important as improving access to care. © 2015 National Rural Health Association.

  14. Variation in access to sugar-sweetened beverages in vending machines across rural, town and urban high schools.

    Science.gov (United States)

    Adachi-Mejia, A M; Longacre, M R; Skatrud-Mickelson, M; Li, Z; Purvis, L A; Titus, L J; Beach, M L; Dalton, M A

    2013-05-01

    The 2010 Dietary Guidelines for Americans include reducing consumption of sugar-sweetened beverages. Among the many possible routes of access for youth, school vending machines provide ready availability of sugar-sweetened beverages. The purpose of this study was to determine variation in high school student access to sugar-sweetened beverages through vending machines by geographic location - urban, town or rural - and to offer an approach for analysing school vending machine content. Cross-sectional observational study. Between October 2007 and May 2008, trained coders recorded beverage vending machine content and machine-front advertising in 113 machines across 26 schools in New Hampshire and Vermont, USA. Compared with town schools, urban schools were significantly less likely to offer sugar-sweetened beverages (P = 0.002). Rural schools also offered more sugar-sweetened beverages than urban schools, but this difference was not significant. Advertisements for sugar-sweetened beverages were highly prevalent in town schools. High school students have ready access to sugar-sweetened beverages through their school vending machines. Town schools offer the highest risk of exposure; school vending machines located in towns offer up to twice as much access to sugar-sweetened beverages in both content and advertising compared with urban locations. Variation by geographic region suggests that healthier environments are possible and some schools can lead as inspirational role models. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  15. Listening to rural Hispanic immigrants in the Midwest: a community-based participatory assessment of major barriers to health care access and use.

    Science.gov (United States)

    Cristancho, Sergio; Garces, D Marcela; Peters, Karen E; Mueller, Benjamin C

    2008-05-01

    Hispanic immigrants are increasingly residing in rural communities, including in the midwestern United States. Limitations in the ability of rural Hispanics to access and utilize health care contribute to patterns of poor health and health disparity. A conceptual model of "vulnerability" guides this community-based participatory assessment project designed to explore rural Hispanics' perceived barriers to accessing and utilizing health care. Findings from a series of 19 focus groups with 181 participants from three communities in the upper Midwest identified perceived barriers at the individual and health care system levels. The most commonly perceived barriers were the lack of and limitations in health insurance coverage, high costs of health care services, communication issues involving patients and providers, legal status/discrimination, and transportation concerns. Findings imply that these barriers could be addressed using multiple educational and health service delivery policy-related strategies that consider the vulnerable nature of this growing population.

  16. Mental health academics in rural and remote Australia.

    Science.gov (United States)

    Pierce, David; Little, Fiona; Bennett-Levy, James; Isaacs, Anton N; Bridgman, Heather; Lutkin, Sarah J; Carey, Timothy A; Schlicht, Kate G; McCabe-Gusta, Zita P; Martin, Elizabeth; Martinez, Lee A

    2016-01-01

    The significant impact of mental ill health in rural and remote Australia has been well documented. Included among innovative approaches undertaken to address this issue has been the Mental Health Academic (MHA) project, established in 2007. Funded by the Australian Government (Department of Health), this project was established as a component of the University Departments of Rural Health (UDRH) program. All 11 UDRHs appointed an MHA. Although widely geographically dispersed, the MHAs have collaborated in various ways. The MHA project encompasses a range of activities addressing four key performance indicators. These activities, undertaken in rural and remote Australia, aimed to increase access to mental health services, promote awareness of mental health issues, support students undertaking mental health training and improve health professionals' capacity to recognise and address mental health issues. MHAs were strategically placed within the UDRHs across the country, ensuring an established academic base for the MHAs' work was available immediately. Close association with each local rural community was recognised as important. For most MHAs this was facilitated by having an established clinical role in their local community and actively engaging with the community in which they worked. In common with other rural health initiatives, some difficulties were experienced in the recruitment of suitable MHAs, especially in more remote locations. The genesis of this article was a national meeting of the MHAs in 2014, to identify and map the different types of activities MHAs had undertaken in their regions. These activities were analysed and categorised by the MHAs. These categories have been used as a guiding framework for this article. The challenge to increase community access to mental health services was addressed by (i) initiatives to address specific access barriers, (ii) supporting recruitment and retention of rural mental health staff, (iii) developing the

  17. Programming and Technology for Accessibility in Geoscience

    Science.gov (United States)

    Sevre, E.; Lee, S.

    2013-12-01

    Many people, students and professors alike, shy away from learning to program because it is often believed to be something scary or unattainable. However, integration of programming into geoscience education can be a valuable tool for increasing the accessibility of content for all who are interested. It is my goal to dispel these myths and convince people that: 1) Students with disabilities can use programming to increase their role in the classroom, 2) Everyone can learn to write programs to simplify daily tasks, 3) With a deep understanding of the task, anyone can write a program to do a complex task, 4) Technology can be combined with programming to create an inclusive environment for all students of geoscience, and 5) More advanced knowledge of programming and technology can lead geoscientists to create software to serve as assistive technology in the classroom. It is my goal to share my experiences using technology to enhance the classroom experience as a way of addressing the aforementioned issues. Through my experience, I have found that programming skills can be included and learned by all to enhance the content of courses without detracting from curriculum. I hope that, through this knowledge, geoscience courses can become more accessible for people with disabilities by including programming and technology to the benefit of all involved.

  18. Access to Productive Resources: The Catalyst to Rural Women's ...

    African Journals Online (AJOL)

    However, rural women in post-apartheid South Africa are experiencing hardships in laying hold of such resources. The pertinent questions the article seeks to interrogate are: who should determine the resource needs of rural women? Are the one size fit all programmes ideal for alleviating rural women's poverty. This article ...

  19. Decentralization and Educational Performance: Evidence from the PROHECO Community School Program in Rural Honduras

    Science.gov (United States)

    Di Gropello, Emanuela; Marshall, Jeffery H.

    2011-01-01

    We analyze the effectiveness of the Programa Hondureno de Educacion Comunitaria (PROHECO) community school program in rural Honduras. The data include standardized tests and extensive information on school, teacher, classroom and community features for 120 rural schools drawn from 15 states. Using academic achievement decompositions we find that…

  20. JASPAR RESTful API: accessing JASPAR data from any programming language.

    Science.gov (United States)

    Khan, Aziz; Mathelier, Anthony

    2018-05-01

    JASPAR is a widely used open-access database of curated, non-redundant transcription factor binding profiles. Currently, data from JASPAR can be retrieved as flat files or by using programming language-specific interfaces. Here, we present a programming language-independent application programming interface (API) to access JASPAR data using the Representational State Transfer (REST) architecture. The REST API enables programmatic access to JASPAR by most programming languages and returns data in eight widely used formats. Several endpoints are available to access the data and an endpoint is available to infer the TF binding profile(s) likely bound by a given DNA binding domain protein sequence. Additionally, it provides an interactive browsable interface for bioinformatics tool developers. This REST API is implemented in Python using the Django REST Framework. It is accessible at http://jaspar.genereg.net/api/ and the source code is freely available at https://bitbucket.org/CBGR/jaspar under GPL v3 license. aziz.khan@ncmm.uio.no or anthony.mathelier@ncmm.uio.no. Supplementary data are available at Bioinformatics online.

  1. Nine years of publications on strengths and weaknesses of Family Physician Program in rural area of Iran: A systematic review

    Directory of Open Access Journals (Sweden)

    Saber Azami-Aghdash

    2016-12-01

    Full Text Available Introduction: One of the most important duties of a family physician is to provide primary health care. This is completely considered in the Family Physician Program for a target population. The aim of this study was to systematically review the Family Physician and Referral System strength and weakness in rural area of Iran. Methods: In this systematic review, Scientific Information Database (SID, Science Direct, and PubMed databases were searched and Google search engine was employed using key words such as family medicine, family physician, and referral system for the period of January 2005 to June 2013, both in English and Persian. For identifying duplicated references, Endnote Software was used and for summarizing results of fully assessed articles extraction table was employed. Results: Strengths and weaknesses of Family Physician Program and referral system in rural areas of Iran were extracted from 28 studies. In total, 115 weaknesses (3.96 per study and 103 strengths (3.55 per study were obtained. Content analysis was used and 218 items were summarized into 29 items. Strengths of Family Physician Program were: access of villagers to health services, filling health document for clients, improving services for pregnant mothers, and family planning; while its obvious weaknesses included repeated unnecessary referral of clients as well as lack of providing job stability. Conclusion: Results of studies conducted in Iran showed that Family Physician and Referral System in rural area of Iran could not be successful enough and has many shortcomings. Therefore, a growing body of effective changes must be made for a better performance and to obtain better outcomes.

  2. Increasing access to emergency contraception through online prescription requests.

    Science.gov (United States)

    Averbach, Sarah; Wendt, Jacqueline Moro; Levine, Deborah K; Philip, Susan S; Klausner, Jeffrey D

    2010-01-01

    To describe a pilot program, Plan B Online Prescription Access, to provide easy access to prescriptions for emergency contraception via the Internet. We measured electronic prescriptions for Plan B (Duramed Pharmaceuticals, Cincinnati, Ohio) by month over time. Pharmacists faxed patient-generated prescriptions back to the Department of Public Health for confirmation. Despite no marketing, within the first 18 months of the program, 152 electronic prescriptions for Plan B were requested by 128 female San Francisco residents. Seventy-eight prescriptions were filled (51%) by pharmacists. If correctly marketed, online prescriptions for Plan B have the potential to be an effective means of increasing emergency contraception access in both urban and rural settings across the United States. Further user-acceptability studies are warranted.

  3. Universal Prevention Program Outcomes: Safe Schools Healthy Students in a Rural, Multicultural Setting

    Science.gov (United States)

    Harris, Elizabeth; McFarland, Joyce; Siebold, Wendi; Aguilar, Rafael; Sarmiento, Ana

    2007-01-01

    The Idaho Consortium for Safe Schools Healthy Students consists of three school districts in rural North Central Idaho and the Nez Perce Tribe's Students for Success Program. Universal prevention programs implemented in the elementary schools include Second Step and the middle schools implemented the Life Skills program. Each of the three…

  4. Hub and spoke model: making rural healthcare in India affordable, available and accessible.

    Science.gov (United States)

    Devarakonda, Srichand

    2016-01-01

    Quality health care should be within everyone's reach, especially in a developing country. While India has the largest private health sector in the world, only one-fifth of healthcare expenditure is publically financed; it is mostly an out-of-pocket expense. About 70% of Indians live in rural areas making about $3 per day, and a major portion of that goes towards food and shelter and, thus, not towards health care. Transportation facilities in rural India are poor, making access to medical facilities difficult, and infrastructure facilities are minimal, making the available medical care insufficient. The challenge presented to India was to provide health care that was accessible, available and affordable to people in rural areas and the low-income bracket. The intent of this article is to determine whether the hub and spoke model (HSM), when implemented in the healthcare industry, can expand the market reach and increase profits while reducing costs of operations for organizations and, thereby, cost to customers. This article also discusses the importance of information and communications technologies (ICT) in the HSM approach, which the handful of published articles in this topic have failed to discuss. This article opts for an exploratory study, including review of published literature, web articles, viewpoints of industry experts, published journals, and in-depth interviews. This article will discuss how and why the HSM works in India's healthcare industry while isolating its strengths and weaknesses, and analyzing the impact of India's success. India's HSM implementation has become a paramount example of an acceptable model that, while exceeding the needs and expectations of its patients, is cost-effective and has obtained operational and health-driven results. Despite being an emerging nation, India takes the top spot in terms of affordability of ICT as well as for having the highest number of computer-literate graduates and healthcare workers in the world

  5. Self-reported morbidity and health service utilization in rural Tamil Nadu, India.

    Science.gov (United States)

    Dodd, Warren; King, Nia; Humphries, Sally; Little, Matthew; Dewey, Cate

    2016-07-01

    In Tamil Nadu, India, improvements have been made toward developing a high-quality, universally accessible healthcare system. However, some rural residents continue to confront significant barriers to obtaining healthcare. The primary objective of this study was to investigate self-reported morbidity, health literacy, and healthcare preferences, utilization, and experiences in order to identify priority areas for government health policies and programs. Drawing on 66 semi-structured interviews and 300 household surveys (including 1693 individuals), administered in 26 rural villages in Tamil Nadu's Krishnagiri district, we found that the prevalence of self-reported major health conditions was 22.3%. There was a large burden of non-communicable and chronic diseases, and the most common major morbidities were: connective tissue problems (7.6%), nervous system and sense organ diseases (5.0%), and circulatory and respiratory diseases (2.5%). Increased age and decreased education level were associated with higher odds of reporting most diseases. Low health literacy levels resulted in individuals seeking care only once pain interfered with daily activities. As such, individuals' health-seeking behaviour depended on which strategy was believed to result in the fastest return to work using the fewest resources. Although government facilities were the most common healthcare access point, they were mistrusted; 48.8% and 19.2% of respondents perceived inappropriate treatment protocols and corruption, respectively, at public facilities. Conversely, 93.3% of respondents reported high treatment cost as the main barrier to accessing private facilities. Our results highlight that addressing the chronic and non-communicable disease burdens amongst rural populations in this context will require health policies and village-level programs that address the low health literacy and the issues of rural healthcare accessibility and acceptability. Copyright © 2016 Elsevier Ltd. All rights

  6. Assessment of access to electricity and the socio-economic impacts in rural areas of developing countries

    Energy Technology Data Exchange (ETDEWEB)

    Kanagawa, Makoto; Nakata, Toshihiko [Department of Management Science and Technology, Graduate School of Engineering, Tohoku University, Aoba-Yama 6-6-11-815, Sendai 980-8579 (Japan)

    2008-06-15

    The purpose of this study is to reveal relations between access to electricity and advancement in a socio-economic condition in rural areas of developing countries. Recently, multi-dimensional aspects of poverty, for example, economy, education, and health, has been increasingly focused on, and access to modern energy such as electricity is one possible solution. As a case study, we have analyzed unelectrified rural areas in Assam state, India. We have developed an energy-economic model in order to analyze the possibility of electrification through dissemination of electric lighting appliances as well as applied multiple regression analysis to estimate the socio-economic condition, a literacy rate above 6 years old, in the areas. As a result of the case study, the household electrification rate, the 1000 km{sup 2} road density, and sex ratio have been chosen as the explanatory variables of the literacy rate. Moreover, the model analysis shows that complete household electrification will be achieved by the year 2012. In combination with the multiple regression and model analysis, the literacy rate in Assam may increase to 74.4% from 63.3%. (author)

  7. Renewable energy policy in remote rural areas of Western China. Implementation and socio-economic benefits

    Energy Technology Data Exchange (ETDEWEB)

    Shyu, Chian-Woei

    2010-05-19

    Electricity is essential for rural development. In 2005, 1.6 billion people, around a quarter of the world's population, living mostly in rural areas of developing countries, had no access to electricity. In general, remote rural areas in developing countries have little prospect of having access to grid-based electricity, which usually only extends to densely populated urban areas, where a large customer base justifies heavy expenditure for electricity infrastructure. One option for electrification in remote rural areas is to decentralize electricity systems based on renewable energy sources. However, such an option is not universally agreed upon. This dissertation examines a renewable energy-based rural electrification program, the 'Township Electrification Program', launched by the Chinese government in 2002. The Program was implemented in 1013 non-electrified townships in remote rural areas of 11 western provinces, providing electricity for 300,000 households and 1.3 million people. And at the time of research, the Program was known as the world's largest renewable energy-based rural electrification program in terms of investment volume ever carried out by a country. Two townships, Saierlong Township in Qinghai Province and Namcuo Township in Tibet Autonomous Region, were selected as cases for an in-depth examination of rural electrification practices in remote rural areas of western China. Both qualitative (interviews, observations, mapping, and transition walk) and quantitative (household survey) methods were applied in the field to collect data. The main findings of the study are summarized as follows: First, political leaders' concern over the unequal economic development of eastern and western China, as well as rural and urban areas, was the main factor triggering inclusion of the policy issue, electricity access in remote rural areas of western China, in the government's policy agenda. Second, like other energy policies, the

  8. How climate compatible are livelihood adaptation strategies and development programs in rural Indonesia?

    Directory of Open Access Journals (Sweden)

    R.M. Wise

    2016-01-01

    Full Text Available Achieving climate compatible development (CCD is a necessity in developing countries, but there are few examples of requisite planning processes, or manifestations of CCD. This paper presents a multi-stakeholder, participatory planning process designed to screen and prioritise rural livelihood adaptation strategies against nine CCD criteria. The process also integrated three principles of adaptation pathways: interventions should be (1 ‘no regrets’ and maintain reversibility to avoid mal-adaptation; (2 address both proximate and underlying systemic drivers of community vulnerability; and (3 linked across spatial scales and jurisdictional levels to promote coordination. Using examples of two rural sub-districts in Indonesia, we demonstrate the process and resulting CCD strategies. Priority strategies varied between the sub-districts but all reflected standard development interventions: water management, intensification or diversification of agriculture and aquaculture, education, health, food security and skills-building for communities. Strategies delivered co-benefits for human development and ecosystem services and hence adaptive capacity, but greenhouse mitigation co-benefits were less significant. Actions to deliver the strategies’ objectives were screened for reversibility, and a minority were potentially mal-adaptive (i.e. path dependent, disproportionately burdening the most vulnerable, reducing incentives to adapt, or increasing greenhouse gas emissions yet highly feasible. These related to infrastructure, which paradoxically is necessary to deliver ‘soft’ adaptation benefits (i.e. road access to health services. Only a small minority of transformative strategies addressed the systemic (i.e. institutional and political drivers of vulnerability. Strategies were well-matched by development programs, suggesting that current interventions mirror CCD. However, development programs tackled fewer systemic drivers, were poorly

  9. 77 FR 12792 - Inviting Applications for the Rural Economic Development Loan and Grant Program for Fiscal Year 2012

    Science.gov (United States)

    2012-03-02

    ... Economic Development Loan and Grant Program for Fiscal Year 2012 AGENCY: Rural Business-Cooperative Service... Rural Economic Development Loan and Grant (REDLG) program pursuant to 7 CFR part 4280, subpart A for... Economic Development Loans and Grants. Announcement Type: Initial Announcement. Catalog of Federal Domestic...

  10. 41 CFR 105-8.152 - Program accessibility: Assignment of space.

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Program accessibility: Assignment of space. 105-8.152 Section 105-8.152 Public Contracts and Property Management Federal Property...-8.152 Program accessibility: Assignment of space. (a) When GSA assigns or reassigns space to an...

  11. Geographic distribution of need and access to health care in rural population: an ecological study in Iran

    Directory of Open Access Journals (Sweden)

    Najafi Behzad

    2011-09-01

    Full Text Available Abstract Introduction Equity in access to and utilization of health services is a common goal of policy-makers in most countries. The current study aimed to evaluate the distribution of need and access to health care services among Iran's rural population between 2006 and 2009. Methods Census data on population's characteristics in each province were obtained from the Statistical Centre of Iran and National Organization for civil registration. Data about the Rural Health Houses (RHHs were obtained from the Ministry of Health. The Health Houses-to-rural population ratio (RHP, crude birth rate (CBR and crude mortality rate (CMR in rural population were calculated in order to compare their distribution among the provinces. Lorenz curves of RHHs, CMR and CBR were plotted and their decile ratio, Gini Index and Index of Dissimilarity were calculated. Moreover, Spearman rank-order correlation was used to examine the relation between RHHs and CMR and CBR. Results There were substantial differences in RHHs, CMR and CBR across the provinces. CMR and CBR experienced changes toward more equal distributions between 2006 and 2009, while inverse trend was seen for RHHs. Excluding three provinces with markedly changes in data between 2006 and 2009 as outliers, did not change observed trends. Moreover; there was a significant positive relationship between CMR and RHP in 2009 and a significant negative association between CBR and RHP in 2006 and 2009. When three provinces with outliers were excluded, these significant associations were disappeared. Conclusion Results showed that there were significant variations in the distribution of RHHs, CMR and CBR across the country. Moreover, the distribution of RHHs did not reflect the needs for health care in terms of CMR and CBR in the study period.

  12. Mapping the availability and accessibility of healthy food in rural and urban New Zealand--Te Wai o Rona: Diabetes Prevention Strategy.

    Science.gov (United States)

    Wang, Jing; Williams, Margaret; Rush, Elaine; Crook, Nic; Forouhi, Nita G; Simmons, David

    2010-07-01

    Uptake of advice for lifestyle change for obesity and diabetes prevention requires access to affordable 'healthy' foods (high in fibre/low in sugar and fat). The present study aimed to examine the availability and accessibility of 'healthy' foods in rural and urban New Zealand. We identified and visited ('mapped') 1230 food outlets (473 urban, 757 rural) across the Waikato/Lakes areas (162 census areas within twelve regions) in New Zealand, where the Te Wai O Rona: Diabetes Prevention Strategy was underway. At each site, we assessed the availability of 'healthy' foods (e.g. wholemeal bread) and compared their cost with those of comparable 'regular' foods (e.g. white bread). Healthy foods were generally more available in urban than rural areas. In both urban and rural areas, 'healthy' foods were more expensive than 'regular' foods after adjusting for the population and income level of each area. For instance, there was an increasing price difference across bread, meat, poultry, with the highest difference for sugar substitutes. The weekly family cost of a 'healthy' food basket (without sugar) was 29.1% more expensive than the 'regular' basket ($NZ 176.72 v. $NZ 136.84). The difference between the 'healthy' and 'regular' basket was greater in urban ($NZ 49.18) than rural areas ($NZ 36.27) in adjusted analysis. 'Healthy' foods were more expensive than 'regular' choices in both urban and rural areas. Although urban areas had higher availability of 'healthy' foods, the cost of changing to a healthy diet in urban areas was also greater. Improvement in the food environment is needed to support people in adopting healthy food choices.

  13. Programa único o diferenciado: especificidad curricular de la escuela rural uruguaya - Common or differentiated school programs: uruguayan rural school curriculum specificity

    Directory of Open Access Journals (Sweden)

    Limber Elbio Santos, Uruguay

    2014-05-01

    Full Text Available O artigo se refere ao fenômeno da especificidade curricular que as escolas rurais uruguaias têm tido durante mais de um século e à ruptura histórica registrada em 2009 quando se começou a aplicar uma estrutura curricular comum a escolas urbanas e rurais. Analisam-se as circunstâncias históricas da pedagogia rural e, em particular, uma de suas materialidades simbolicamente mais potentes constituída pelo Programa para Escolas Rurais de 1949. Assim mesmo, refere-se ao peso que essa pedagogia continua tendo atualmente e da maneira como influi na gestão curricular do programa único. As especificidades social e didática da escola rural têm efeitos evidentes sobre o programa curricular no seu sentido mais amplo, com alcances muito mais extensos que os relativos ao currículo prescrito. No entanto, o desafio da escola rural atual de abordar a nova estrutura curricular de caráter único não é tão diferente do que se registrou historicamente: dialogar com o meio de igual para igual e maximizar o potencial de aprendizagem proporcionado pela instituição educacional, pela comunidade e estrutura multidisciplinar do grupo.Palavras-chave: escola rural, currículo, programa, pedagogia rural. COMMON OR DIFFERENTIATED SCHOOL PROGRAMS: URUGUAYAN RURAL SCHOOL CURRICULUM SPECIFICITY AbstractThe paper refers to the phenomenon of the Curriculum specificity to which the Rural Schools had for more than a century inUruguayand to the historic rupture registered in 2009 when a common Curriculum for Rural and Urban schools was introduced. The paper analyses the historic circumstances of the Rural Pedagogy and, in particular, one of its most potent symbolic materiality constituted of the 1949 program for Rural Education. The analysis show that the challenge to current Rural Education is not that different to that registered historically: to dialogue with the environment and take maximum advantage of the potential to learn which is provided by the

  14. An Impact Evaluation of a Rural Youth Drug Education Program.

    Science.gov (United States)

    Sarvela, Paul D.; McClendon, E. J.

    1987-01-01

    Examined effects of mixed affective-cognitive drug education program on rural northern Michigan and northeastern Wisconsin sixth and seventh graders' (N=265) substance use health beliefs and behaviors. Alcohol use in this population was determined to be much higher than national average for similar age groups while marijuana, cigarette, and…

  15. A Comparison of the J-1 Visa Waiver and Loan Repayment Programs in the Recruitment and Retention of Physicians in Rural Nebraska.

    Science.gov (United States)

    Opoku, Samuel T; Apenteng, Bettye A; Lin, Ge; Chen, Li-Wu; Palm, David; Rauner, Thomas

    2015-01-01

    There is a dearth of literature evaluating the effectiveness of programs aimed at recruiting and retaining physicians in rural Nebraska. Taking advantage of the Nebraska Health Professional Tracking System, this study attempts to comparatively assess the effectiveness of the J-1 visa waiver and state loan repayment programs in the recruitment and retention of physicians in rural Nebraska. A mixed methods approach was used. We tracked 240 physicians who enrolled in the J-1 visa waiver and state loan repayment programs between 1996 and 2012 until 2013. In addition, key informant interviews were conducted to obtain perspectives on the recruitment and retention of physicians in rural Nebraska through the 2 programs. Results from multilevel survival regression analysis indicated that physicians enrolled in the J-1 visa waiver program were more likely to leave rural Nebraska when compared with those enrolled in the state loan repayment program. Participants in the qualitative study, however, cautioned against declaring one program as superior over the other, given that the 2 programs addressed different needs for different communities. In addition, results suggested that fostering the integration of physicians and their families into rural communities might be a way of enhancing retention, regardless of program. The findings from this study highlight the complexity of recruitment and retention issues in rural Nebraska and suggest the need for more holistic and family-centered approaches to addressing these issues. © 2015 National Rural Health Association.

  16. Access to CD4 Testing for Rural HIV Patients: Findings from a Cohort Study in Zimbabwe.

    Directory of Open Access Journals (Sweden)

    Florian Vogt

    Full Text Available CD4 cell count measurement remains an important diagnostic tool for HIV care in developing countries. Insufficient laboratory capacity in rural Sub-Saharan Africa is frequently mentioned but data on the impact at an individual patient level are lacking. Urban-rural discrepancies in CD4 testing have not been quantified to date. Such evidence is crucial for public health planning and to justify new yet more expensive diagnostic procedures that could circumvent access constraints in rural areas.To compare CD4 testing among rural and urban HIV patients during the first year of treatment.Records from 2,145 HIV positive adult patients from a Médecins sans Frontières (Doctors without Borders HIV project in Beitbridge, Zimbabwe, during 2011 and 2012 were used for a retrospective cohort analysis. Covariate-adjusted risk ratios were calculated to estimate the effects of area of residence on CD4 testing at treatment initiation, six and 12 months among rural and urban patients.While the proportion of HIV patients returning for medical consultations at six and 12 months decreased at a similar rate in both patient groups, CD4 testing during consultations dropped to 21% and 8% for urban, and 2% and 1% for rural patients at six and 12 months, respectively. Risk ratios for missing CD4 testing were 0.8 (95% CI 0.7-0.9, 9.2 (95% CI 5.5-15.3, and 7.6 (95% 3.7-17.1 comparing rural versus urban patients at treatment initiation, six and 12 months, respectively.CD4 testing was low overall, and particularly poor in rural patients. Difficulties with specimen transportation were probably a major factor underlying this difference and requires new diagnostic approaches. Our findings point to severe health system constraints in providing CD4 testing overall that need to be addressed if effective monitoring of HIV patients is to be achieved, whether by alternative CD4 diagnostics or newly-recommended routine viral load testing.

  17. Using the community-based health planning and services program to promote skilled delivery in rural Ghana: socio-demographic factors that influence women utilization of skilled attendants at birth in northern Ghana.

    Science.gov (United States)

    Sakeah, Evelyn; Doctor, Henry V; McCloskey, Lois; Bernstein, Judith; Yeboah-Antwi, Kojo; Mills, Samuel

    2014-04-10

    The burden of maternal mortality in sub-Saharan Africa is enormous. In Ghana the maternal mortality ratio was 350 per 100,000 live births in 2010. Skilled birth attendance has been shown to reduce maternal deaths and disabilities, yet in 2010 only 68% of mothers in Ghana gave birth with skilled birth attendants. In 2005, the Ghana Health Service piloted an enhancement of its Community-Based Health Planning and Services (CHPS) program, training Community Health Officers (CHOs) as midwives, to address the gap in skilled attendance in rural Upper East Region (UER). The study determined the extent to which CHO-midwives skilled delivery program achieved its desired outcomes in UER among birthing women. We conducted a cross-sectional household survey with women who had ever given birth in the three years prior to the survey. We employed a two stage sampling techniques: In the first stage we proportionally selected enumeration areas, and the second stage involved random selection of households. In each household, where there is more than one woman with a child within the age limit, we interviewed the woman with the youngest child. We collected data on awareness of the program, use of the services and factors that are associated with skilled attendants at birth. A total of 407 households/women were interviewed. Eighty three percent of respondents knew that CHO-midwives provided delivery services in CHPS zones. Seventy nine percent of the deliveries were with skilled attendants; and over half of these skilled births (42% of total) were by CHO-midwives. Multivariate analyses showed that women of the Nankana ethnic group and those with uneducated husbands were less likely to access skilled attendants at birth in rural settings. The implementation of the CHO-midwife program in UER appeared to have contributed to expanded skilled delivery care access and utilization for rural women. However, women of the Nankana ethnic group and uneducated men must be targeted with health

  18. Food access and perceptions of the community and household food environment as correlates of fruit and vegetable intake among rural seniors.

    Science.gov (United States)

    Sharkey, Joseph R; Johnson, Cassandra M; Dean, Wesley R

    2010-06-02

    Although the importance of fruit and vegetable consumption to health has been well established, few studies have focused on access to fruits and vegetables in rural areas; even fewer examined the relationship between food access and fruit and vegetable consumption among seniors. To examine the spatial challenges to good nutrition faced by seniors who reside in rural areas and how spatial access influences fruit and vegetable intake. A cross-sectional analysis using data from the 2006 Brazos Valley Health Assessment (mailsurvey) for 582 rural seniors (60-90 years), who were recruited by random digit dialing; food store data from the 2006-2007 Brazos Valley Food Environment Project that used ground-truthed methods to identify, geocode, and inventory fruit and vegetables in all food stores. Few of the BVHA seniors consumed the recommended intakes of fruits or vegetables; women consumed more servings of fruit (1.49 +/- 0.05 vs. 1.29 +/- 0.07, p = 0.02), similar servings of vegetables (2.18 +/- 0.04 vs. 2.09 +/- 0.07, p = 0.28), and more combined fruit and vegetables (3.67 +/- 0.08 vs. 3.38 +/- 0.12, p = 0.04) than men. The median distances to fresh fruit and vegetables were 5.5 miles and 6.4 miles, respectively. When canned and frozen fruit and vegetables were included in the measurement of overall fruit or vegetables, the median distance for a good selection of fruit or vegetables decreased to 3.4 miles for overall fruit and 3.2 miles for overall vegetables. Almost 14% reported that food supplies did not last and there was not enough money to buy more. Our analyses revealed that objective and perceived measures of food store access--increased distance to the nearest supermarket, food store with a good variety of fresh and processed fruit, or food store with a good variety of fresh and processed vegetables--were associated with decreased daily consumption of fruit, vegetables, and combined fruit and vegetables, after controlling for the influence of individual

  19. Psychiatric treatment of children and adolescents in rural communities. Myths and realities.

    Science.gov (United States)

    Cook, A D; Copans, S A; Schetky, D H

    1998-07-01

    Rural child and adolescent psychiatry offers many challenges, a varied and interesting practice, and the satisfaction of performing needed and important work in an environment in which one's presence is valued. The successful psychiatrist can expect to be an integrated and appreciated member of the community. The fit is not a good one for every practitioner, however. Not only are incomes lower, although the cost of living is low as well, but practitioners may find they have only exchanged urban stresses for rural pressures. The characteristics important for the child and adolescent psychiatrist are the same for rural and urban settings: flexibility, creativity and innovation, competence, self confidence, a good sense of boundaries, a good balance between personal and private life, supportive personal relationships, and a sense of humor. One must be a child advocate, have a willingness to give of one's self and one's time, and be down to earth, comfortable with oneself, and capable of self entertainment. Training programs with access to rural populations can introduce residents to rural child and adolescent psychiatry while supporting those who are already in practice. The authors hope that this article will promote a dialogue with psychiatrists considering relocation to a rural area and encourage training programs to prepare residents for rural practice.

  20. Use of Free, Open Access Medical Education and Perceived Emergency Medicine Educational Needs Among Rural Physicians in Southwestern Ontario.

    Science.gov (United States)

    Folkl, Alex; Chan, Teresa; Blau, Elaine

    2016-09-21

    Free, open access medical education (FOAM) has the potential to revolutionize continuing medical education, particularly for rural physicians who practice emergency medicine (EM) as part of a generalist practice. However, there has been little study of rural physicians' educational needs since the advent of FOAM. We asked how rural physicians in Southwestern Ontario obtained their continuing EM education. We asked them to assess their perceived level of comfort in different areas of EM. To understand how FOAM resources might serve the rural EM community, we compared their responses with urban emergency physicians. Responses were collected via survey and interview. There was no significant difference between groups in reported use of FOAM resources. However, there was a significant difference between rural and urban physicians' perceived level of EM knowledge, with urban physicians reporting a higher degree of confidence for most knowledge categories, particularly those related to critical care and rare procedures. This study provides the first description of EM knowledge and FOAM resource utilization among rural physicians in Southwestern Ontario. It also highlights an area of educational need -- that is, critical care and rare procedures. Future work should address whether rural physicians are using FOAM specifically to improve their critical care and procedural knowledge. As well, because of the generalist nature of rural practice, future work should clarify whether there is an opportunity cost to rural physicians' knowledge of other clinical domains if they chose to focus more time on continuing education in critical care EM.

  1. Participating in a Food-Assisted Maternal and Child Nutrition and Health Program in Rural Guatemala Alters Household Dietary Choices.

    Science.gov (United States)

    Jensen, Melissa L; Frongillo, Edward A; Leroy, Jef L; Blake, Christine E

    2016-08-01

    Food assistance programs may alter food choices, but factors determining households' decisions regarding food acquisition, preparation, and consumption in the context of food aid are not well understood. This study aimed to understand how the Programa Comunitario Materno Infantil de Diversificación Alimentaria (Mother-Child Community Food Diversification Program; PROCOMIDA), a food-assisted maternal and child health and nutrition program in rural Alta Verapaz, Guatemala, altered household food choices. We conducted semistructured interviews and focus groups with 63 households in 3 participating (n = 32 households) and 3 control (n = 31) villages. A last-day food recall (without estimating quantities) and food-frequency questionnaire that used food cards assessed dietary choices. Qualitative analysis used thematic a priori and emergent coding; food group consumption frequencies were analyzed by using 2-level, logistic, mixed modeling, and chi-square testing while accounting for community clustering. Compared with control households, PROCOMIDA changed household food choices through a combination of providing food resources (with monthly food rations) and new knowledge and skills related to health and food (in the program's behavior change communication component) while reinforcing existing knowledge and beliefs. PROCOMIDA families consumed rice, red beans, and oil more frequently than did control families (differences of 2.20 (P foods were in the rations. PROCOMIDA families also ate chicken, local plants, and some vegetables more frequently. The importance of these foods was emphasized in the behavioral change communication component; these foods may have been more accessible because provision of food rations freed resources. Our findings suggest that if a program provides food free of cost to rural indigenous families in the context of a maternal and child nutrition and health program, it may be important to include a well-designed behavioral change communication

  2. Ocean Drilling Program: Web Site Access Statistics

    Science.gov (United States)

    web site ODP/TAMU Science Operator Home Ocean Drilling Program Web Site Access Statistics* Overview See statistics for JOIDES members. See statistics for Janus database. 1997 October November December

  3. The convergence of HIV/AIDS and customary tenure on women's access to land in rural Malawi.

    Science.gov (United States)

    Tschirhart, Naomi; Kabanga, Lucky; Nichols, Sue

    2015-01-01

    This paper examines the convergence of HIV/AIDS and the social processes through which women access customary land in rural Malawi. Data were collected from focus group discussions with women in patrilineal and matrilineal communities. Women's land tenure is primarily determined through kinship group membership, customary inheritance practices and location of residence. In patrilineal communities, land is inherited through the male lineage and women access land through relationships with male members who are the rightful heirs. Conversely in matrilineal matrilocal communities, women as daughters directly inherit the land. This research found that in patrilineal communities, HIV/AIDS, gendered inequalities embedded in customary inheritance practices and resource shortages combine to affect women's access to land. HIV/AIDS may cause the termination of a woman's relationship with the access individual due to stigma or the individual's death. Termination of such relationships increases tenure insecurity for women accessing land in a community where they do not have inheritance rights. In contrast to the patrilineal patrilocal experience, research on matrilineal matrilocal communities demonstrates that where women are the inheritors of the land and have robust land tenure rights, they are not at risk of losing their access to land due to HIV/AIDS.

  4. Determination of the Factors Affecting The Use of the Support Program of the Enterprises Benefiting from the Rural Development Investments Program in the Western Mediterranean Region

    Directory of Open Access Journals (Sweden)

    Yavuz Taşcıoğlu

    2017-07-01

    Full Text Available With industrialization, change has taken place in the world and development efforts have concentrated in urban areas. This has affected the rural area negatively and the increase in rural development studies has increased with the emergence of interregional economic imbalances. With the planned period, rural development studies in Turkey have increased and strategies, projects and programs have begun to be developed. One of these activities is the Rural Development Investment Support Program (RDISP, which entered into force in 2006. The aim of the program is to increase the level of rural area income, to ensure integration of agricultural production and agricultural industry, to strengthen food safety, to create alternative income sources in the rural area. In this study, it was aimed to determine the attitudes and behaviors of program beneficiaries in the Western Mediterranean Region within the framework of the RDISP applied in Turkey, and the factors affecting their utilization from the program. In the study, a total of 96 enterprises provided interviews based on face to face interviews. In this study, Factor Analysis was applied to determine the factors that affect the preferences of the enterprises and to determine the factors affecting the investments of the enterprises. In the study, 12 variables that were effective in factor analysis in the utilization of this support were combined into 3 factors. These factors have been found to be “support for local support and information about support”, “employment support for support” and “environmental sensitivity for support”.

  5. Rural territorial dynamics in Latin America

    Directory of Open Access Journals (Sweden)

    Manuel Chiriboga

    2013-09-01

    Full Text Available This article draws from the preliminary findings of an ongoing appliedresearch program on rural territorial dynamics carried out by the Latin American Center for Rural Development (RIMISP. The article provides some initial findings on 4 territories, of the 11 territories that are part of the overall study. The case studies include the island of Chiloé in southern Chile, the province of Tungurahua in Ecuador, a dairy farm region of Santo Tomás Nicaragua and Cuatro Lagunas near Cuzco Perú. Rural areas in Latin America are characterized by their dual nature with agro-exporting enclaves linked to global value chains alongside impoverished peasant economies, leading to differentiated policy recommendations. The research attempts to find relationships between reduced poverty and inequality in winning regions, measured by three variables, with issues of access to resources, human capital, political empowerment, markets and institutions, with particular attention to innovative social coalitions.

  6. Access to health and human services for drug users: an urban/rural community systems perspective.

    Science.gov (United States)

    Rivers, J E; Komaroff, E; Kibort, A C

    1999-01-01

    Publicly funded drug-user treatment programs in both urban and rural areas are under unprecedented pressure to adapt to multiple perspectives of their mission, reduced governmental funding, diminished entitlement program resources for clients, managed care reforms, and continuing unmet need for services. This article describe an ongoing health services research study that is investigating how these and related health and human service programs currently serve and cross-refer chronic drug users and how they perceive and are reacting to systemic pressures. Interim analysis on intra-agency diversity and managed care perceptions are reported.

  7. Evaluation of a rural demonstration program to increase seat belt use in the Great Lakes Region.

    Science.gov (United States)

    2009-03-01

    Six States in the Great Lakes Region (Region 5) participated in a Rural Demonstration Program to increase seat belt : use in rural areas and among high-risk occupants, such as young males and occupants of pickup trucks. These : efforts, which include...

  8. Supporting nurses' transition to rural healthcare environments through mentorship.

    Science.gov (United States)

    Rohatinsky, Noelle K; Jahner, Sharleen

    2016-01-01

    The global shortage of rural healthcare professionals threatens the access these communities have to adequate healthcare resources. Barriers to recruitment and retention of nurses in rural facilities include limited resources, professional development opportunities, and interpersonal ties to the area. Mentorship programs have been used to successfully recruit and retain rural nurses. This study aimed to explore (i) employee perceptions of mentorship in rural healthcare organizations, (ii) the processes involved in creating mentoring relationships in rural healthcare organizations, and (iii) the organizational features supporting and inhibiting mentorship in rural healthcare organizations. This study was conducted in one rural health region in Saskatchewan, Canada. Volunteer participants who were employed at one rural healthcare facility were interviewed. A semi-structured interview guide that focused on exploring and gaining an understanding of participants' perceptions of mentorship in rural communities was employed. Data were analyzed using interpretive description methodology, which places high value on participants' subjective perspective and knowledge of their experience. All seven participants were female and employed as registered nurses or licensed practical nurses. Participants recognized that the rural environment offered unique challenges and opportunities for the transition of nurses new to rural healthcare. Participants believed mentorships facilitated this transition and were vital to the personal and professional success of new employees. Specifically, their insights indicated that this transition was influenced by three factors: rural community influences, organizational influences, and mentorship program influences. Facilitators for mentorships hinged on the close working relationships that facilitated the development of trust. Barriers to mentorship included low staff numbers, limited selection of volunteer mentors, and lack of mentorship

  9. Conceptual Evolution and Importance of Andragogy towards the Scope Optimization of University Academic Rural Development Programs and Projects

    Directory of Open Access Journals (Sweden)

    José Bernal Azofeifa-Bolaños

    2016-12-01

    Full Text Available This study was carried out with the objective of describing the evolution and importance of andragogical processes in the search of rural profiles committed to the university work in the development and implementation of programs and projects. Among its main contributions, the importance of knowing and teaching processes applied strictly for adults by university coordinators of programs and projects stands out. The relevance of applying this kind of knowledge will allow efficient use of institutional financial resources, particularly for the real commitment of the rural adult community towards the implementation of field activities and accomplishing, in a shorter term, the expected academic achievement. A successful project experience is described in which some andragogical strategies were applied through extension, and which produced a better participation and engagement from rural people with the projects developed by the University. Consequently, applicability of these concepts in the programs and projects of rural development promoted through universities must lay the foundation for regional rural development strategies with the ultimate goal of finding ways to improve the quality of life of people in particular scenarios.

  10. Parenting Education: An Exemplary Program for Rural/Migrant Youth and Adults. Final Report.

    Science.gov (United States)

    Baum, Rosemere; And Others

    Designed for use in a parenting education course for rural/migrant youth and adults, this parenting education learning kit consists of a coordinator's manual and bilingual instructional materials for seven course sessions. Issues addressed in the coordinator's manual include program content, program format, orientation for experienced parents,…

  11. Rural patients' access to mobile phones and willingness to receive mobile phone-based pharmacy and other health technology services: a pilot study.

    Science.gov (United States)

    Sankaranarayanan, Jayashri; Sallach, Rory E

    2014-02-01

    This pilot study explores the patient-centered demand for mobile phone-based health (mobile health [m-health]) services in the rural United States by documenting rural patients' access to mobile phones and patients' willingness to receive m-health services. An anonymous institutional review board-approved survey was completed by patients visiting two rural pharmacies in Nebraska from August to October 2011. Patients who volunteered to complete the survey provided their demographic data, disease state information, health status, mobile phone access, and willingness to receive (in terms of using and giving time to) m-health services. The majority of the 24 survey respondents were 19-40 years old (52%), female (88%), married (63%), with excellent to very good health status (63%), with no comorbidities (83%), with ≤$100 monthly medication expenses (80%), with private insurance (78%), living within 5 miles of their pharmacy (71%), and reporting that m-health services are important to them (75%; 12/16). Approximately 95%, 81%, 73%, and 55% of respondents reported access to a mobile phone, voice mails, text messaging, and mobile phone applications, respectively. Of the respondents, 65%, 57%, 52%, and 48% were willing to receive prerecorded messages for appointment reminders from the doctor, disease information, medication use/self-care information, and symptom monitoring information, respectively. In total, 70%, 63%, 61%, 54%, and 50% were willing to receive prerecorded messages from the pharmacist containing contact requests, new/refill prescription reminders, information on medication problems, reviewing/monitoring of medication use, and medication self-management/preventive screenings/immunizations, respectively. Of 44% (7/16) respondents willing to give time for m-health services, 83% were willing to give 15 min, and 17% were willing to give 30 min every month. By demonstrating rural patients' demand for m-health (including pharmacy) services, this is one of the

  12. Creating community-based access to primary healthcare for the uninsured through strategic alliances and restructuring local health department programs.

    Science.gov (United States)

    Scotten, E Shirin L; Absher, Ann C

    2006-01-01

    In 2003, the Wilkes County Health Department joined with county healthcare providers to develop the HealthCare Connection, a coordinated and continuous system of low-cost quality care for uninsured and low-income working poor. Through this program, local providers of primary and specialty care donate specialty care or ancillary services not provided by the Health Department, which provides case management for the program. Basing their methods on business models learned through the UNC Management Academy for Public Health, planners investigated the best practices for extending healthcare coverage to the underinsured and uninsured, analyzed operational costs, discovered underutilized local resources, and built capacity within the organization. The HealthCare Connection is an example of how a rural community can join together in a common business practice to improve healthcare access for uninsured and/or low-income adults.

  13. Core II Materials for Rural Agriculture Programs. Units E-H.

    Science.gov (United States)

    Biondo, Ron; And Others

    This curriculum guide includes teaching packets for 21 problem areas to be included in a core curriculum for 10th grade students enrolled in a rural agricultural program. Covered in the four units included in this volume are crop science (harvesting farm crops and growing small grains); soil science and conservation of natural resources…

  14. Providing Cardiology Care in Rural Areas Through Visiting Consultant Clinics.

    Science.gov (United States)

    Gruca, Thomas S; Pyo, Tae-Hyung; Nelson, Gregory C

    2016-06-30

    Workforce experts predict a future shortage of cardiologists that is expected to impact rural areas more severely than urban areas. However, there is little research on how rural patients are currently served through clinical outreach. This study examines the impact of cardiology outreach in Iowa, a state with a large rural population, on participating cardiologists and on patient access. Outreach clinics are tracked annually in the Office of Statewide Clinical Education Programs Visiting Medical Consultant Database (University of Iowa Carver College of Medicine). Data from 2014 were analyzed. In 2014, an estimated 5460 visiting consultant clinic days were provided in 96 predominantly rural cities by 167 cardiologists from Iowa and adjoining states. Forty-five percent of Iowa cardiologists participated in rural outreach. Visiting cardiologists from Iowa and adjoining states drive an estimated 45 000 miles per month. Because of monthly outreach clinics, the average driving time to the nearest cardiologist falls from 42.2±20.0 to 14.7±11.0 minutes for rural Iowans. Cardiology outreach improves geographic access to office-based cardiology care for more than 1 million Iowans out of a total population of 3 million. Direct travel costs and opportunity costs associated with physician travel are estimated to be more than $2.1 million per year. Cardiologists in Iowa and adjoining states have expanded access to office-based cardiology care from 18 to 89 of the 99 counties in Iowa. In these 71 counties without a full-time cardiologist, visiting consultant clinics can accommodate more than 50% of office visits in the patients' home county. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  15. Evaluating the Influence of the Revised Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Food Allocation Package on Healthy Food Availability, Accessibility, and Affordability in Texas.

    Science.gov (United States)

    Lu, Wenhua; McKyer, E Lisako J; Dowdy, Diane; Evans, Alexandra; Ory, Marcia; Hoelscher, Deanna M; Wang, Suojin; Miao, Jingang

    2016-02-01

    The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) was implemented to improve the health of pregnant women and children of low socioeconomic status. In 2009, the program was revised to provide a wider variety of healthy food choices (eg, fresh fruits, vegetables, and whole-grain items). The purpose of this study was to evaluate (1) the impact of the revised WIC Nutrition Program's food allocation package on the availability, accessibility, and affordability of healthy foods in WIC-authorized grocery stores in Texas; and (2) how the impact of the policy change differed by store types and between rural and urban regions. WIC-approved stores (n=105) across Texas were assessed using a validated instrument (88 items). Pre- (June-September 2009) and post-new WIC package implementation (June-September 2012) audits were conducted. Paired-sample t tests were conducted to compare the differences between pre- and post-implementation audits on shelf width and number of varieties (ie, availability), visibility (ie, accessibility), and inflation-adjusted price (ie, affordability). Across the 105 stores, post-implementation audits showed increased availability in terms of shelf space for most key healthy food options, including fruit (PFood visibility increased for fresh juices (Pfoods such as fruits (Pbread (Pbread (Pfood availability and visibility were observed in stores of different types and in different locations, although smaller or fewer effects were noted in small stores and stores in rural regions. Implementation of the revised WIC food package has generally improved availability and accessibility, but not affordability, of healthy foods in WIC-authorized stores in Texas. Future studies are needed to explore the impact of the revised program on healthy food option purchases and consumption patterns among Texas WIC participants. Copyright © 2016 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

  16. A Multicenter Performance Improvement Program Uses Rural Trauma Filters for Benchmarking: An Evaluation of the Findings.

    Science.gov (United States)

    Coniglio, Ray; McGraw, Constance; Archuleta, Mike; Bentler, Heather; Keiter, Leigh; Ramstetter, Julie; Reis, Elizabeth; Romans, Cristi; Schell, Rachael; Ross, Kelli; Smith, Rachel; Townsend, Jodi; Orlando, Alessandro; Mains, Charles W

    Colorado requires Level III and IV trauma centers to conduct a formal performance improvement program (PI), but provides limited support for program development. Trauma program managers and coordinators in rural facilities rarely have experience in the development or management of a PI program. As a result, rural trauma centers often face challenges in evaluating trauma outcomes adequately. Through a multidisciplinary outreach program, our Trauma System worked with a group of rural trauma centers to identify and define seven specific PI filters based on key program elements of rural trauma centers. This retrospective observational project sought to develop and examine these PI filters so as to enhance the review and evaluation of patient care. The project included 924 trauma patients from eight Level IV and one Level III trauma centers. Seven PI filters were retrospectively collected and analyzed by quarter in 2016: prehospital managed airway for patients with a Glasgow Coma Scale (GCS) score of less than 9; adherence to trauma team activation criteria; evidence of physician team leader presence within 20 min of activation; patient with a GCS score less than 9 in the emergency department (ED): intubated in less than 20 min; ED length of stay (LOS) less than 4 hr from patient arrival to transfer; adherence to admission criteria; documentation of GCS on arrival, discharge, or with change of status. There was a significantly increasing compliance trend toward appropriate documentation of GCS (p trend used to develop compliance thresholds, to identify areas for improvement, and create corrective action plans as necessary.

  17. Environmental Research Division's Data Access Program (ERDDAP)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — ERDDAP (the Environmental Research Division's Data Access Program) is a data server that gives you a simple, consistent way to download subsets of scientific...

  18. Decreasing dialysis catheter rates by creating a multidisciplinary dialysis access program.

    Science.gov (United States)

    Rosenberry, Patricia M; Niederhaus, Silke V; Schweitzer, Eugene J; Leeser, David B

    2018-03-01

    Centers for Medicare and Medicaid Services have determined that chronic dialysis units should have 45%. A multidisciplinary program was established with goals of decreasing catheter rates in order to decrease central line-associated bloodstream infections, decrease mortality associated with central line-associated bloodstream infection, decrease hospital days, and provide savings to the healthcare system. We collected the catheter rates within three dialysis centers served over a 5-year period. Using published data surrounding the incidence and related costs of central line-associated bloodstream infection and mortality per catheter day, the number of central line-associated bloodstream infection events, the costs, and the related mortality could be determined prior to and after the initiation of the dialysis access program. An organized dialysis access program resulted in a 82% decrease in the number of central venous catheter days which lead to a concurrent reduction in central line-associated bloodstream infection and deaths. As a result of creating an access program, central venous catheter rates decreased from an average rate of 45% to 8%. The cost savings related to the program was calculated to be over US$5 million. The decrease in the number of mortalities is estimated to be between 13 and 27 patients. We conclude that a formalized access program decreases catheter rates, central line-associated bloodstream infection, and the resultant hospitalizations, mortality, and costs. Areas with high hemodialysis catheter rates should develop access programs to better serve their patient population.

  19. Barriers to access to antiretroviral treatment in Mozambique, as perceived by patients and health workers in urban and rural settings.

    NARCIS (Netherlands)

    Posse, M.E.; Baltussen, R.M.P.M.

    2009-01-01

    This study identifies, ranks, and compares factors perceived as barriers to accessing antiretroviral treatment (ART) in urban and rural settings in Mozambique. Data were collected between March and July 2008. It consisted of 13 focus group discussions and a structured questionnaire administered to

  20. 49 CFR 28.150 - Program accessibility: Existing facilities.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false Program accessibility: Existing facilities. 28.150 Section 28.150 Transportation Office of the Secretary of Transportation ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE DEPARTMENT OF TRANSPORTATION § 28...

  1. Cognitive Access to TVWS in India

    DEFF Research Database (Denmark)

    Patil, Kishor P.; Skouby, Knud Erik; Prasad, Ramjee

    2013-01-01

    The digital transition of TV transmission will make available some TV frequencies which are to be geographically unused called as TV White Spaces. The important regulatory trend in the context of Dynamic Spectrum Access (DSA) is the Cognitive access of TV white Spaces. In this context, we have pe...... of India, we have proposed wireless broadband access to rural areas using TV White Spaces (TVWSs). This will help in bridging the digital divide by offering governance, banking, and health services online in the rural areas.......The digital transition of TV transmission will make available some TV frequencies which are to be geographically unused called as TV White Spaces. The important regulatory trend in the context of Dynamic Spectrum Access (DSA) is the Cognitive access of TV white Spaces. In this context, we have...... performed spectrum measurements of TV band in Pune, India. Our result shows poor spectrum utilization in TV band, and good potential for Cognitive radio operation. Digital switchover in India will generate golden opportunity for empowering rural India. As majority of India’s population lives in rural part...

  2. When Cultural Norms Discourage Talking to Babies: Effectiveness of a Parenting Program in Rural Senegal

    Science.gov (United States)

    Weber, Ann; Fernald, Anne; Diop, Yatma

    2017-01-01

    In some areas of rural Africa, long-standing cultural traditions and beliefs may discourage parents from verbally engaging with their young children. This study assessed the effectiveness of a parenting program designed to encourage verbal engagement between caregivers and infants in Wolof-speaking villages in rural Senegal. Caregivers (n = 443)…

  3. 'Poorly defined': unknown unknowns in New Zealand Rural Health.

    Science.gov (United States)

    Fearnley, David; Lawrenson, Ross; Nixon, Garry

    2016-08-05

    There is a considerable mismatch between the population that accesses rural healthcare in New Zealand and the population defined as 'rural' using the current statistics New Zealand rural and urban categorisations. Statistics New Zealand definitions (based on population size or density) do not accurately identify the population of New Zealanders who actually access rural health services. In fact, around 40% of people who access rural health services are classified as 'urban' under the Statistics New Zealand definition, while a further 20% of people who are currently classified as 'rural' actually have ready access to urban health services. Although there is some recognition that current definitions are suboptimal, the extent of the uncertainty arising from these definitions is not widely appreciated. This mismatch is sufficient to potentially undermine the validity of both nationally-collated statistics and also any research undertaken using Statistics New Zealand data. Under these circumstances it is not surprising that the differences between rural and urban health care found in other countries with similar health services have been difficult to demonstrate in New Zealand. This article explains the extent of this mismatch and suggests how definitions of rural might be improved to allow a better understanding of New Zealand rural health.

  4. Medical abortion: understanding perspectives of rural and marginalized women from rural South India.

    Science.gov (United States)

    Sri, B Subha; Ravindran, T K Sundari

    2012-09-01

    To understand how rural and other groups of marginalized women define safe abortion; their perspectives and concerns regarding medical abortion (MA); and what factors affect their access to safe abortion. Focus group discussions were held with various groups of rural and marginalized women in Tamil Nadu to understand their perspectives and concerns on abortion, especially MA. Nearly a decade after mifepristone was approved for abortion in India, most study participants had never heard of MA. When they learned of the method, most preferred it over other methods of abortion. The women also had questions and concerns about the method and recommendations on how services should be provided. Their definition of a "safe abortion" included criteria beyond medical safety. They placed a high priority on "social safety," including confidentiality and privacy. In their view, factors affecting access to safe abortion and choice of provider included cost, assurance of secrecy, promptness of service provision, and absence of provider gatekeeping and provider-imposed conditions for receiving services. Women's preference for MA shows the potential of this technology to address the problem of unsafe abortion in India. Women need better access to information and services to realize this potential, however. Women's preferences regarding information dissemination and service provision need to be taken into account if policies and programs are to be truly responsive to the needs of marginalized women. Copyright © 2012. Published by Elsevier Ireland Ltd.

  5. Multidisciplinary chronic pain management in a rural Canadian setting.

    Science.gov (United States)

    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.

  6. Project HOPE: A Career Education Program for Rural Middle School Students

    Science.gov (United States)

    Hoffman, Tina D.

    2013-01-01

    A critical psychology perspective (Prilleltensky and Nelson, 2002) advocates for research that focuses on social change, the mutual participation of community stakeholders, and the empowerment of those served. The current study applies this critical psychology perspective to career education programming in a multiculturally diverse rural high…

  7. Technological Innovation and Cooperation for Foreign Information Access Program

    Science.gov (United States)

    Office of Postsecondary Education, US Department of Education, 2012

    2012-01-01

    The Technological Innovation and Cooperation for Foreign Information Access (TICFIA) Program supports projects focused on developing innovative technologies for accessing, collecting, organizing, preserving, and disseminating information from foreign sources to address the U.S.' teaching and research needs in international education and foreign…

  8. Neighborhood deprivation, vehicle ownership, and potential spatial access to a variety of fruits and vegetables in a large rural area in Texas

    Directory of Open Access Journals (Sweden)

    Horel Scott

    2010-05-01

    Full Text Available Abstract Objective There has been limited study of all types of food stores, such as traditional (supercenters, supermarkets, and grocery stores, convenience stores, and non-traditional (dollar stores, mass merchandisers, and pharmacies as potential opportunities for purchase of fresh and processed (canned and frozen fruits and vegetables, especially in small-town or rural areas. Methods Data from the Brazos Valley Food Environment Project (BVFEP are combined with 2000 U.S. Census data for 101 Census block groups (CBG to examine neighborhood access to fruits and vegetables. BVFEP data included identification and geocoding of all food stores (n = 185 in six rural counties in Texas, using ground-truthed methods and on-site assessment of the availability and variety of fresh and processed fruits and vegetables in all food stores. Access from the population-weighted centroid of each CBG was measured using proximity (minimum network distance and coverage (number of shopping opportunities for a good selection of fresh and processed fruits and vegetables. Neighborhood inequalities (deprivation and vehicle ownership and spatial access for fruits and vegetables were examined using Wilcoxon matched-pairs signed-rank test and multivariate regression models. Results The variety of fruits or vegetables was greater at supermarkets compared with grocery stores. Among non-traditional and convenience food stores, the largest variety was found at dollar stores. On average, rural neighborhoods were 9.9 miles to the nearest supermarket, 6.7 miles and 7.4 miles to the nearest food store with a good variety of fresh fruits and vegetables, respectively, and 4.7 miles and 4.5 miles to a good variety of fresh and processed fruits or vegetables. High deprivation or low vehicle ownership neighborhoods had better spatial access to a good variety of fruits and vegetables, both in the distance to the nearest source and in the number of shopping opportunities. Conclusion

  9. Rural migration and health care

    DEFF Research Database (Denmark)

    Svendsen, Gunnar Lind Haase; Jensen, Marit Vatn

    This literature study focuses on possible links between access to health services and migration in rural areas. Why do people move to or from rural areas or why do they stay? What determines where people settle? And, in this context, do local health care services play an important or minor role......, or no role at all? First, the paper reports on key findings from rural migration studies, in order to shed light on two migration trends: urbanization and counter-urbanization. Then we take a closer look on settlement preferences in rural areas, including the impact of health care facilities. Finally, we end...... up with a more deepgoing review of the relatively small number of studies, which explicitly deal with settlement preferences related to access to health care....

  10. Revealed access to haemodialysis facilities in northeastern Iran: Factors that matter in rural and urban areas.

    Science.gov (United States)

    Kiani, Behzad; Bagheri, Nasser; Tara, Ahmad; Hoseini, Benyamin; Tabesh, Hamed; Tara, Mahmood

    2017-11-07

    Poor access to haemodialysis facilities is associated with high mortality and morbidity rates. This study investigated factors affecting revealed access to the haemodialysis facilities considering patients living in rural and urban areas without any haemodialysis facility (Group A) and those living urban areas with haemodialysis facilities (Group B). This study is based on selfreported Actual Access Time (AAT) to referred haemodialysis facilities and other information regarding travel to haemodialysis facilities from patients. All significant variables on univariate analysis were entered into a univariate general linear model in order to identify factors associated with AAT. Both spatial (driving time and distance) and non-spatial factors (sex, income level, caregivers, transportation mode, education level, ethnicity and personal vehicle ownership) influenced the revealed access identified in Group A. The non-spatial factors for Group B patients were the same as for Group A, but no spatial factor was identified in Group B. It was found that accessibility is strongly underestimated when driving time is chosen as accessibility measure to haemodialysis facilities. Analysis of revealed access determinants provides policymakers with an appropriate decision base for making appropriate decisions and finding solutions to decrease the access time for patients under haemodialysis therapy. Driving time alone is not a good proxy for measuring access to haemodialysis facilities as there are many other potential obstacles, such as women's special travel problems, poor other transportation possibilities, ethnicity disparities, low education levels, low caregiver status and low-income.

  11. 76 FR 2686 - Video Programming and Emergency Access Advisory Committee; Announcement of Establishment and...

    Science.gov (United States)

    2011-01-14

    ... FEDERAL COMMUNICATIONS COMMISSION [DA 10-2320] Video Programming and Emergency Access Advisory... appointment of members of the Video Programming and Emergency Access Advisory Committee (``Committee'' or... change of the Committee's popular name to the Video Programming Accessibility Advisory Committee (``VPAAC...

  12. Does the Medicare Part D Decision-Making Experience Differ by Rural/Urban Location?

    Science.gov (United States)

    Henning-Smith, Carrie; Casey, Michelle; Moscovice, Ira

    2017-01-01

    Although much has been written about Medicare Part D enrollment, much less is known about beneficiaries' personal experiences with choosing a Part D plan, especially among rural residents. This study sought to address this gap by examining geographic differences in Part D enrollees' perceptions of the plan decision-making process, including their confidence in their choice, their knowledge about the program, and their satisfaction with available information. We used data from the 2012 Medicare Current Beneficiary Survey and included adults ages 65 and older who were enrolled in Part D at the time of the survey (n = 3,706). We used ordered logistic regression to model 4 outcomes based on beneficiaries' perceptions of the Part D decision-making and enrollment process, first accounting only for differences by rurality, then adjusting for sociodemographic, health, and coverage characteristics. Overall, half of all beneficiaries were not very confident in their Part D knowledge. Rural beneficiaries had lower odds of being confident in the plan they chose and in being satisfied with the amount of information available to them during the decision-making process. After adjusting for all covariates, micropolitan residents continued to have lower odds of being confident in the plan that they chose. Policy-makers should pay particular attention to making information about Part D easily accessible for all beneficiaries and to addressing unique barriers that rural residents have in accessing information while making decisions, such as reduced Internet availability. Furthermore, confidence in the decision-making process may be improved by simplifying the Part D program. © 2016 National Rural Health Association.

  13. 12 CFR 410.150 - Program accessibility: Existing facilities.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Program accessibility: Existing facilities. 410.150 Section 410.150 Banks and Banking EXPORT-IMPORT BANK OF THE UNITED STATES ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY EXPORT-IMPORT BANK OF THE UNITED...

  14. 12 CFR 410.149 - Program accessibility: Discrimination prohibited.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Program accessibility: Discrimination prohibited. 410.149 Section 410.149 Banks and Banking EXPORT-IMPORT BANK OF THE UNITED STATES ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY EXPORT-IMPORT BANK OF THE UNITED...

  15. 77 FR 6113 - Video Programming and Accessibility Advisory Committee; Announcement of Date of Next Meeting

    Science.gov (United States)

    2012-02-07

    ... FEDERAL COMMUNICATIONS COMMISSION [DA 12-15] Video Programming and Accessibility Advisory.... SUMMARY: This document announces the next meeting of the Video Programming Accessibility Advisory... Commission regarding the provision of video description, access to emergency programming, and access to user...

  16. Critical Access Hospitals (CAH)

    Science.gov (United States)

    ... for Success Am I Rural? Evidence-based Toolkits Economic Impact Analysis Tool Community Health Gateway Sustainability Planning ... hospitals and improve access to healthcare by keeping essential services in rural communities. To accomplish this goal, ...

  17. Does Improved Water Access Increase Child School Attendance? A Quasi-Experimental Approach From Rural Ethiopia

    Science.gov (United States)

    Masuda, Y.; Cook, J.

    2012-12-01

    This paper analyzes the impact of improved water access on child school attendance using two years of primary panel data from a quasi-experimental study in Oromiya, Ethiopia. A predominant form of child labor in rural poor households in least developed countries is water collection. Girls are often the primary water collectors for households, and because of the time intensive nature of water collection improved water access may allow for time to be reallocated to schooling (Rosen and Vincent 1999; Nankhuni and Findeis 2004). Understanding how improved water access may increase schooling for girls has important development policy implications. Indeed, abundant research on returns to education suggests increased schooling for girls is tied to improved future child and maternal health, economic opportunities, and lower fertility rates (Handa 1996; Schultz 1998; Michaelowa 2000). The literature to date finds that improved water access leads to increased schooling; however, there still exists a clear gap in the literature for understanding this relationship for two reasons. First, only four studies have directly examined the relationship between improved water access and schooling in sub-Saharan Africa, and analyses have been limited due to the use of cross-sectional data and research designs (Nankhuni and Findeis 2004; Koolwal and Van de Walle 2010; Ndiritu and Nyangan 2011; Nauges and Strand 2011). Indeed, only two studies have attempted to control for the endogenous nature of water access. Second, all studies use a binary school enrollment indicator from household surveys, which may suffer from response bias and may be an imperfect measure for actual schooling. Respondents may feel pressured to report that their children are enrolled in school if, like in Ethiopia, there are compulsory education laws. This may result in an overestimation of school enrollment. In addition, most children from rural poor households combine work and school, and a binary indicator does

  18. Rural electrification policy and institutional linkages

    International Nuclear Information System (INIS)

    Haanyika, Charles Moonga

    2006-01-01

    Some of the problems that have besieged rural electrification in most developing countries include inadequate policies, weak institutional frameworks and limited financing. In the last two decades, governments in developing countries have been making various efforts both at the policy level and in financing to facilitate increased levels of rural electrification. However, the introduction of market-based reforms in the power sector in the last decade has affected the institutional and financing arrangements for rural electrification. The reforms have also affected the rate of electrification and affordability of electricity. There is need therefore to establish the extent to which the reforms have affected access and affordability of electricity in rural areas and to develop appropriate policy and the supporting institutional structures to align rural electrification with reformed power sectors. It is cardinal to establish how privatised and commercialised power companies in a reformed power sector could contribute to rural electrification and the role of governments and government agents in facilitating expanded access to electricity in rural areas

  19. Food Access and Perceptions of the Community and Household Food Environment as Correlates of Fruit and Vegetable Intake among Rural Seniors

    Directory of Open Access Journals (Sweden)

    Johnson Cassandra M

    2010-06-01

    Full Text Available Abstract Background Although the importance of fruit and vegetable consumption to health has been well established, few studies have focused on access to fruits and vegetables in rural areas; even fewer examined the relationship between food access and fruit and vegetable consumption among seniors. Methods To examine the spatial challenges to good nutrition faced by seniors who reside in rural areas and how spatial access influences fruit and vegetable intake. A cross-sectional analysis using data from the 2006 Brazos Valley Health Assessment (mailsurvey for 582 rural seniors (60-90 years, who were recruited by random digit dialing; food store data from the 2006-2007 Brazos Valley Food Environment Project that used ground-truthed methods to identify, geocode, and inventory fruit and vegetables in all food stores. Results Few of the BVHA seniors consumed the recommended intakes of fruits or vegetables; women consumed more servings of fruit (1.49 ± 0.05 vs. 1.29 ± 0.07, p = 0.02, similar servings of vegetables (2.18 ± 0.04 vs. 2.09 ± 0.07, p = 0.28, and more combined fruit and vegetables (3.67 ± 0.08 vs. 3.38 ± 0.12, p = 0.04 than men. The median distances to fresh fruit and vegetables were 5.5 miles and 6.4 miles, respectively. When canned and frozen fruit and vegetables were included in the measurement of overall fruit or vegetables, the median distance for a good selection of fruit or vegetables decreased to 3.4 miles for overall fruit and 3.2 miles for overall vegetables. Almost 14% reported that food supplies did not last and there was not enough money to buy more. Our analyses revealed that objective and perceived measures of food store access - increased distance to the nearest supermarket, food store with a good variety of fresh and processed fruit, or food store with a good variety of fresh and processed vegetables - were associated with decreased daily consumption of fruit, vegetables, and combined fruit and vegetables, after

  20. 77 FR 77005 - Subsistence Management Program for Public Lands in Alaska; Rural Determination Process

    Science.gov (United States)

    2012-12-31

    ...-R7-SM-2012-N248;FXFR13350700640-134-FF07J00000] Subsistence Management Program for Public Lands in Alaska; Rural Determination Process AGENCIES: Forest Service, Agriculture; Fish and Wildlife Service... the Interior initiated a review of the Federal Subsistence Management Program. An ensuing directive...

  1. Community food environments and healthy food access among older adults: A review of the evidence for the Senior Farmers' Market Nutrition Program (SFMNP).

    Science.gov (United States)

    O'Dare Wilson, Kellie

    2017-04-01

    Although an array of federal, state, and local programs exist that target food insecurity and the specific nutritional needs of seniors, food insecurity among older adults in the United States remains a persistent problem, particularly in minority and rural populations. Food insecurity is highly predictive of inadequate fresh fruit and vegetable (FFV) consumption in particular. The Senior Farmers' Market Nutrition Program (SFMNP) is a community-based program to help seniors purchase FFVs at farmer's markets in their neighborhoods. The SFMNP continues to grow; however, little is known about the effectiveness of the program. The purposes of this article are to (1) highlight the importance of community and neighborhood based food insecurity programs, specifically emphasizing the importance of FFV access for seniors, (2) review the current state of the evidence on the SFMNP, and (3) provide recommendations for researchers and policy-makers wishing to continue to advance the knowledge base in neighborhood-based food security among older adults.

  2. Designing E-Learning Programs for Rural Social Transformation and Poverty Reduction

    Science.gov (United States)

    Murthy, C. S. H. N.; Mathur, Gaurav

    2008-01-01

    While the conventional education system with different forms of E-learning and rigid academic instructive curriculum could not bring desired changes in specified timeframe work at rural level in the targeted communities and groups, a multipronged sociological approach with a sociable and flexible curriculum in new E-Learning programs becomes need…

  3. An independent investigation into the deployment of the federal communications commissions' rural health care pilot program.

    Science.gov (United States)

    Whitten, Pamela; Holtz, Bree; Laplante, Carolyn; Alverson, Dale; Krupinski, Elizabeth

    2010-12-01

    the goal of this study was to provide an independent and objective evaluation of the implementation of the Federal Communications Commission's Rural Health Care Pilot Program. thirty-nine of the programs that were provided funding through this program were interviewed and asked about their project deployment, network planning, and the involvement of their state in implementation. RESULTS showed that programs recruited project team members from a variety of fields to fulfill different roles. Network partners were often chosen because they were stakeholders in the outcome of the project and because they had a past working relationship with the grant-receiving programs. In terms of deployment, many programs had made progress in filling out necessary paperwork and were tracking milestones, but had experienced changes since first receiving funding, such as losing participants. Additionally, many encountered challenges that inhibited deployment, such as coping with rule fluctuations. Many of the programs received support from their respective state governments in project development, often through matching funds, but few states were involved in the actual management of projects. as rural healthcare facilities often lack the information technology infrastructure compared with many urban facilities, it is important to understand the implementation process for programs such as the Rural Health Care Pilot Program and to examine what contributes to progress, stagnation, or disintegration. Although the programs reported some success, almost all had encountered challenges that inhibited implementation. A follow-up study is planned to further investigate deployment and determine the implications of Federal Communications Commission funding.

  4. Perceptions of oral health, preventive care, and care-seeking behaviors among rural adolescents.

    Science.gov (United States)

    Dodd, Virginia J; Logan, Henrietta; Brown, Cameron D; Calderon, Angela; Catalanotto, Frank

    2014-12-01

    An asymmetrical oral disease burden is endured by certain population subgroups, particularly children and adolescents. Reducing oral health disparities requires understanding multiple oral health perspectives, including those of adolescents. This qualitative study explores oral health perceptions and dental care behaviors among rural adolescents. Semistructured individual interviews with 100 rural, minority, low socioeconomic status adolescents revealed their current perceptions of oral health and dental care access. Respondents age ranged from 12 to 18 years. The sample was 80% black and 52% male. Perceived threat from dental disease was low. Adolescents perceived regular brushing and flossing as superseding the need for preventive care. Esthetic reasons were most often cited as reasons to seek dental care. Difficulties accessing dental care include finances, transportation, fear, issues with Medicaid coverage and parental responsibility. In general, adolescents and their parents are in need of information regarding the importance of preventive dental care. Findings illuminate barriers to dental care faced by low-income rural adolescents and counter public perceptions of government-sponsored dental care programs as being "free" or without cost. The importance of improved oral health knowledge, better access to care, and school-based dental care is discussed. © 2014, American School Health Association.

  5. Institutional delivery in rural India: the relative importance of accessibility and economic status.

    Science.gov (United States)

    Kesterton, Amy J; Cleland, John; Sloggett, Andy; Ronsmans, Carine

    2010-06-06

    Skilled attendance at delivery is an important indicator in monitoring progress towards Millennium Development Goal 5 to reduce the maternal mortality ratio by three quarters between 1990 and 2015. In addition to professional attention, it is important that mothers deliver their babies in an appropriate setting, where life saving equipment and hygienic conditions can also help reduce the risk of complications that may cause death or illness to mother and child. Over the past decade interest has grown in examining influences on care-seeking behavior and this study investigates the determinants of place of delivery in rural India, with a particular focus on assessing the relative importance of community access and economic status. A descriptive analysis of trends in place of delivery using data from two national representative sample surveys in 1992 and 1998 is followed by a two-level (child/mother and community) random-effects logistical regression model using the second survey to investigate the determinants. In this investigation of institutional care seeking for child birth in rural India, economic status emerges as a more crucial determinant than access. Economic status is also the strongest influence on the choice between a private-for-profit or public facility amongst institutional births. Greater availability of obstetric services will not alone solve the problem of low institutional delivery rates. This is particularly true for the use of private-for-profit institutions, in which the distance to services does not have a significant adjusted effect. In the light of these findings a focus on increasing demand for existing services seems the most rational action. In particular, financial constraints need to be addressed, and results support current trials of demand side financing in India.

  6. Prevalence and Predictors of Food Insecurity among People Living with HIV Enrolled in Antiretroviral Therapy and Livelihood Programs in Two Rural Zambian Hospitals

    Science.gov (United States)

    Masa, Rainier; Chowa, Gina; Nyirenda, Victor

    2018-01-01

    The objective of this study was to examine the prevalence and predictors of food insecurity among people living with HIV (PLHIV) in two rural communities in Zambia. A cross-sectional sample of 101 PLHIV was surveyed using the Household Food Insecurity Access Scale. In multivariable linear regression models, income, household possessions, and perceived coping strategies were significantly associated with decreased food insecurity. Debt and perceived mental distress were significantly associated with increased food insecurity. Programs that tackle economic disadvantage and its adverse effect on stress may be an appropriate strategy to improve food security of PLHIV in low-resource communities. PMID:28418728

  7. Equitable access: Remote and rural communities 'transport needs'

    OpenAIRE

    White, Peter

    2011-01-01

    Transport in rural and remote regions receives considerable attention in research, but this is often focussed on specific means of resolving problems in those regions - for example, the role of demand-responsive bus services, or scope for attracting users to rail services. The aim of this paper is to take a broader view, firstly in defining what constitute rural and remote regions, and secondly in considering a wide range of public transport options available. Experience in Britain will be ta...

  8. AN INVESTIGATION OF VISION PROBLEMS AND THE VISION CARE SYSTEM IN RURAL CHINA.

    Science.gov (United States)

    Bai, Yunli; Yi, Hongmei; Zhang, Linxiu; Shi, Yaojiang; Ma, Xiaochen; Congdon, Nathan; Zhou, Zhongqiang; Boswell, Matthew; Rozelle, Scott

    2014-11-01

    This paper examines the prevalence of vision problems and the accessibility to and quality of vision care in rural China. We obtained data from 4 sources: 1) the National Rural Vision Care Survey; 2) the Private Optometrists Survey; 3) the County Hospital Eye Care Survey; and 4) the Rural School Vision Care Survey. The data from each of the surveys were collected by the authors during 2012. Thirty-three percent of the rural population surveyed self-reported vision problems. Twenty-two percent of subjects surveyed had ever had a vision exam. Among those who self-reported having vision problems, 34% did not wear eyeglasses. Fifty-four percent of those with vision problems who had eyeglasses did not have a vision exam prior to receiving glasses. However, having a vision exam did not always guarantee access to quality vision care. Four channels of vision care service were assessed. The school vision examination program did not increase the usage rate of eyeglasses. Each county-hospital was staffed with three eye-doctors having one year of education beyond high school, serving more than 400,000 residents. Private optometrists often had low levels of education and professional certification. In conclusion, our findings shows that the vision care system in rural China is inadequate and ineffective in meeting the needs of the rural population sampled.

  9. Barriers to Access and Adoption of Pre-Exposure Prophylaxis for the Prevention of HIV Among Men Who Have Sex With Men (MSM) in a Relatively Rural State.

    Science.gov (United States)

    Hubach, Randolph D; Currin, Joseph M; Sanders, Carissa A; Durham, André R; Kavanaugh, Katherine E; Wheeler, Denna L; Croff, Julie M

    2017-08-01

    Biomedical intervention approaches, including antiretroviral pre-exposure prophylaxis (PrEP), have been demonstrated to reduce HIV incidence among several at-risk populations and to be cost effective. However, there is limited understanding of PrEP access and uptake among men who have sex with men (MSM) residing in relatively rural states. Twenty semistructured interviews were conducted (August-November 2016) to assess opinions of and perceived barriers to accessing and adopting PrEP among MSM residing in Oklahoma. Participants perceived substantial barriers to accessing PrEP including a stigmatizing environment and less access to quality, LGBT-sensitive medical care. Overall, geographic isolation limits access to health providers and resources that support sexual health for Oklahoma MSM. Addressing stigma situated across ecological levels in an effort to increase adoption of PrEP by MSM residing in rural states remains necessary. Without this, social determinants may continue to negatively influence PrEP adoption and sexual health outcomes.

  10. Telehealth clinics increase access to care for adults with cystic fibrosis living in rural and remote Western Australia.

    Science.gov (United States)

    Wood, Jamie; Mulrennan, Siobhain; Hill, Kylie; Cecins, Nola; Morey, Sue; Jenkins, Sue

    2017-08-01

    Introduction A significant proportion (15%, n = 28) of the adults with cystic fibrosis (CF) in Western Australia (WA) live in rural and remote areas and have difficulty accessing specialist care at the state adult CF centre, located in Perth. We aimed to increase access by offering telehealth clinics, and evaluate the impact on health outcomes. Methods Telehealth clinics were offered via videoconference over a 12-month period, with uptake and satisfaction measured at the end of the intervention. Participants could still attend in person clinics at the CF centre if requested. Other outcomes comprised healthcare utilisation (HCU), spirometry, weight and health-related quality of life. Results In 21 participants, total clinic visits increased from 46 (median (range) per participant 2 (0-6)) in the 12-month period preceding the study to 100 (5 (2-8), p vitality domain of the Cystic Fibrosis Questionnaire - Revised ( p < 0.05). Discussion Telehealth had good uptake and increased clinic attendance in adults with CF living in rural and remote WA, and had high satisfaction amongst participants. The increase in HCU, resulting from increased detection and treatment of exacerbations, may improve long-term outcomes in this population.

  11. Adaptation of intensive mental health intensive case management to rural communities in the Veterans Health Administration.

    Science.gov (United States)

    Mohamed, Somaia

    2013-03-01

    There has been increasing concern in recent years about the availability of mental health services for people with serious mental illness in rural areas. To meet these needs the Department of Veterans Affairs (VA) implemented the Rural Access Networks for Growth Enhancement (RANGE) program, in 2007, modeled on the Assertive Community Treatment (ACT) model. This study uses VA administrative data from the RANGE program (N = 343) to compare client characteristics at program entry, patterns of service delivery, and outcomes with those of Veterans who received services from the general VA ACT-like program (Mental Health Intensive Case Management (MHICM) (N = 3,077). Veterans in the rural program entered treatment with similar symptom severity, less likelihood of being diagnosed with schizophrenia and having had long-term hospitalization, but significantly higher suicidality index scores and greater likelihood of being dually diagnosed compared with those in the general program. RANGE Veterans live further away from their treatment teams but did not differ significantly in measures of face-to-face treatment intensity. Similar proportions of RANGE and MHICM Veterans were reported to have received rehabilitation services, crisis intervention and substance abuse treatment. The rural programs had higher scores on overall satisfaction with VA mental health care than general programs, slightly poorer outcomes on quality of life and on the suicidality index but no significant difference on other outcomes. These data demonstrate the clinical need, practical feasibility and potential effectiveness of providing intensive case management through small specialized case management teams in rural areas.

  12. Access to energy sources in the face of climate change: Challenges faced by women in rural communities

    Directory of Open Access Journals (Sweden)

    Mphemelang J. Ketlhoilwe

    2018-04-01

    Full Text Available Access to energy is a challenge to rural communities, especially among women who are the prime household energy users. This article is based on research carried out in the Tswapong villages in Botswana where energy sources particularly wood, are slowly getting depleted while electricity connection costs remain unaffordable for the poor. The article provides constructivist analysis of experiences in real-life situations among women. Data were generated through observations, documents analysis, interviews and focus group discussions. It has emerged from the research that majority of the respondents use firewood as energy source. Firewood and gas are mainly used for cooking while electricity is mainly used for lighting. The demand for firewood has led to firewood commercialisation, the depletion of preferred firewood tree species and increase in the impact of climate change. The article recommends economic diversification and subsidies to empower the majority of the rural poor to connect to the national electric grid and reduce on firewood dependence. These could be complemented by harnessing of solar energy and low-cost, energy-saving technologies. Subsidies to enable women access to energy services would contribute immensely to the decade of Sustainable Energy for All and to the attainment of the post 2015 sustainable development goal on energy.

  13. Rural Student Vocational Program (RSVP) [and] Housing Guide for Parents and Students [and] Work Supervisor's Guide.

    Science.gov (United States)

    Rural Student Vocational Program, Wasilla, AK.

    The purpose of the Rural Student Vocational Program (RSVP) is to provide rural high school vocational students with work and other experiences related to their career objective. Students from outlying schools travel to Anchorage, Fairbanks, or Juneau (Alaska) to participate in two weeks of work experience with cooperating agencies and businesses.…

  14. Barriers facing junior doctors in rural practice.

    Science.gov (United States)

    Smith, Deborah M

    2005-01-01

    Early postgraduate, or junior doctors, are still required to practise in rural and remote communities, and they continue to face numerous issues and difficulties. Within the hospital setting, exposure to rural practice appears to be very limited during internship, and also to some extent, during the second postgraduate year and beyond. This is a major issue for those required to undertake country relieving, rural terms or who will be bonded to rural and remote practice for several years after internship. This research investigated the current issues and difficulties faced by junior doctors, required to undertake rural and remote practice in Queensland, Australia. An exploratory study was undertaken. Primary data were collected through semi-structured interviews held with key stakeholders. Stakeholders included: directors of clinical training; medical educators; junior doctors; rural practitioners; academic rural practitioners; and medical administrators. Of the 23 people approached, a total of 19 agreed to be interviewed. The response rate was 82.6%. Similar to the issues identified in the literature, there are currently a number of barriers influencing the ability of junior doctors to practise competently and confidently when undertaking practice in rural and remote communities. Minimal clinical experience, lack of supervision and on-site support, inadequate orientation and uninformed expectations, limited access to relevant education, and the influence of isolation, results in an overall lack of preparation both professionally and personally. When asked, respondents supported the identification of core skills and knowledge, and integration of these and other issues affecting rural practice, into their hospital-based programs. Current hospital-based education and training programs were not adequately preparing junior doctors for rural and remote practice. It was commented that orientation and education, with a rural emphasis, could assist junior doctors in their

  15. A program to enhance k-12 science education in ten rural New York school districts.

    Science.gov (United States)

    Goodell, E; Visco, R; Pollock, P

    1999-04-01

    The Rural Partnership for Science Education, designed by educators and scientists in 1991 with funding from the National Institutes of Health, works in two rural New York State counties with students and their teachers from kindergarten through grade 12 to improve pre-college science education. The Partnership is an alliance among ten rural New York school districts and several New York State institutions (e.g., a regional academic medical center; the New York Academy of Sciences; and others), and has activities that involve around 4,800 students and 240 teachers each year. The authors describe the program's activities (e.g., summer workshops for teachers; science exploration camps for elementary and middle-school students; enrichment activities for high school students). A certified science education specialist directs classroom demonstrations throughout the academic year to support teachers' efforts to integrate hands-on activities into the science curriculum. A variety of evaluations over the years provides strong evidence of the program's effectiveness in promoting students' and teachers' interest in science. The long-term goal of the Partnership is to inspire more rural students to work hard, learn science, and enter the medical professions.

  16. Rural electrification policy and institutional linkages

    International Nuclear Information System (INIS)

    Haanyika, C.M.

    2006-01-01

    Some of the problems that have besieged rural electrification in most developing countries include inadequate policies, weak institutional frameworks and limited financing. In the last two decades, governments in developing countries have been making various efforts both at the policy level and in financing to facilitate increased levels of rural electrification. However, the introduction of market-based reforms in the power sector in the last decade has affected the institutional and financing arrangements for rural electrification. The reforms have also affected the rate of electrification and affordability of electricity. There is need therefore to establish the extent to which the reforms have affected access and affordability of electricity in rural areas and to develop appropriate policy and the supporting institutional structures to align rural electrification with reformed power sectors. It is cardinal to establish how privatised and commercialised power companies in a reformed power sector could contribute to rural electrification and the role of governments and government agents in facilitating expanded access to electricity in rural areas. (author)

  17. The walk out of the rural kitchen : towards planning energy services for sustainable rural livelihoods in Sudan

    NARCIS (Netherlands)

    Ahmed, Nouralla

    2008-01-01

    This thesis is about rural energy services, the problems with accessibility and the consequences of their inaccessibility on rural livelihoods in the traditional rural areas of Sudan. The thesis is organised in six chapters. Chapter 1 starts by providing a background to the political and economic

  18. Financial Performance of Rural Medicare ACOs.

    Science.gov (United States)

    Nattinger, Matthew C; Mueller, Keith; Ullrich, Fred; Zhu, Xi

    2018-12-01

    The Centers for Medicare & Medicaid Services (CMS) has facilitated the development of Medicare accountable care organizations (ACOs), mostly through the Medicare Shared Savings Program (MSSP). To inform the operation of the Center for Medicare & Medicaid Innovation's (CMMI) ACO programs, we assess the financial performance of rural ACOs based on different levels of rural presence. We used the 2014 performance data for Medicare ACOs to examine the financial performance of rural ACOs with different levels of rural presence: exclusively rural, mostly rural, and mixed rural/metropolitan. Of the ACOs reporting performance data, we identified 97 ACOs with a measurable rural presence. We found that successful rural ACO financial performance is associated with the ACO's organizational type (eg, physician-based) and that 8 of the 11 rural ACOs participating in the Advanced Payment Program (APP) garnered savings for Medicare. Unlike previous work, we did not find an association between ACO size or experience and rural ACO financial performance. Our findings suggest that rural ACO financial success is likely associated with factors unique to rural environments. Given the emphasis CMS has placed on rural ACO development, further research to identify these factors is warranted. © 2016 National Rural Health Association.

  19. Development of a New South Dakota Rural Family Medicine Residency Program.

    Science.gov (United States)

    Heisler, Jean; Huber, Thomas; Huntington, Mark K

    2017-11-01

    The healthcare workforce is a priority in South Dakota. It has been estimated that 8,000 additional healthcare workers beyond those in practice in 2010 will be needed by 2020. In 2016, the South Dakota Department of Health included in its budget funds for the development of a new Rural Family Medicine Residency Training Program as one of the steps toward addressing the physician component of these workforce needs. This new program has just received its accreditation and is recruiting the inaugural class of resident physicians for the spring of 2018. This article provides a concise overview of the program's initial development. Copyright© South Dakota State Medical Association.

  20. Area Health Education Center (AHEC) programs for rural and underrepresented minority students in the Alabama Black Belt.

    Science.gov (United States)

    Patel, Ashruta; Knox, Regina J; Logan, Alicia; Summerville, Katie

    2017-01-01

    This paper evaluated the implementation West Central Alabama Area Health Education Center programs for high school students in grades 9-12 through participant-reported evaluations and feedback during the  September 1st, 2013 to August 31st, 2014 fiscal year. The programs targeted racial/ethnic minorities and/or rural individuals interested in pursuing a career as a healthcare provider in medically underserved counties of Alabama. Students participated in enrichment activities related to prospective health careers that included: successful college preparedness, knowledge about health careers, and the types of primary care health professions that are needed in underserved Alabama communities. The curriculum studied 593 (ACT preparation: n  = 172, AHEC 101: n  = 56, FAFSA: n  = 109, Health Career Exploration: n  = 159, College Career Readiness: n  = 67, Dixie Scholars NERD: n  = 30) baseline measures for the programs to evaluate effectiveness when rated by participants both quantitatively and qualitatively. Interactive activities with video incorporation, hands-on experiences, and group discussions paired with student motivation and interest in specific health career-related activities provided the highest program ratings. It is important to use a variety of successful program strategies when forming healthcare workforce development interventions. Student evaluations can help adapt methods for future program implementation to ultimately achieve strategies for health professional recruitment, training, and retention in areas that lack access to quality healthcare.

  1. Measuring participant rurality in Web-based interventions

    Directory of Open Access Journals (Sweden)

    McKay H Garth

    2007-08-01

    Full Text Available Abstract Background 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. Methods 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. Results 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. Conclusion 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.

  2. Connecting rural-urban economies?

    DEFF Research Database (Denmark)

    Larsen, Marianne Nylandsted; Birch-Thomsen, Torben; Lazaro, Evelyn

    The interlinked relationships between urban settlements and their rural hinterlands in Sub-Saharan Africa are perceived crucial in enhancing possibilities for livelihood diversification and poverty reduction. Urban settlements provide opportunities for investment in more remunerative economic...... activities, job/employment opportunities that retain potential migrants in the area, and access to services for the rural hinterlands. This paper examines the role of emerging urban centres (EUCs) as ‘drivers’ of rural development based on a study of two EUCs and their rural hinterlands in Tanzania. Findings...... and poverty reduction....

  3. A qualitative examination of the role of small, rural worksites in obesity prevention.

    Science.gov (United States)

    Escoffery, Cam; Kegler, Michelle C; Alcantara, Iris; Wilson, Mark; Glanz, Karen

    2011-07-01

    The prevalence of overweight and obesity in the United States is highest in rural counties. We explored social support, policies, and programmatic resources that encourage more healthful diets and participation in physical activity among employees of small, rural worksites. We conducted in-depth interviews with 33 employed adults aged 50 years or older in rural Georgia about access to healthful foods and opportunities for physical activity at work; conversations about exercise, weight loss, and eating healthfully in general; and worksite nutrition and physical activity programs; and we asked for suggestions for making the worksite more healthful. The research team developed a codebook, and 2 coders coded each transcript. Data were analyzed and reports were generated for thematic analyses. Participants from rural worksites, most with fewer than 50 employees, cited lack of vending machines and cafeterias, health promotion programs to address healthful eating and exercise, and facilities for physical activity as barriers to eating healthfully and engaging in physical activity at work. Many participants reported conversations with coworkers about how to eat more healthfully by making more nutritious choices or preparing food more healthfully. Participants also discussed the importance of engaging in physical activity on their own and gave suggestions on ways to incorporate exercise into their routines. Participants' access to healthful foods at work varied, but barriers such as being too busy, worksite location, and no worksite cafeteria were noted. Some workers reported engaging in physical activity at work, and others reported a heavy workload and lack of time as barriers. Building on the social environment and implementing policies for healthful eating and participation in physical activity may help address obesity prevention in rural workplaces.

  4. Rural Communatcation: legitimizing digital inclusion in rural field

    Directory of Open Access Journals (Sweden)

    Juliana Correa Bernardes

    2016-03-01

    Full Text Available Through contemporary analysis, it was noted that the countryside of São Paulo experienced drastic transformation and demanded rural family farmers to adapt themselves to technological innovations, where the most striking is the use of the internet in search of information to the sustainable development of rural property.  The research adopted a methodological way of exploratory, through the case study, which analyzed the general objective the dissemination and usability of information and communication technologies in rural areas in the interior of forms-based applied to farmers in the family farms belonging to theAssociation of banana growers of Tupã. In seeking to achieve this goal, reflected on the use of internet in rural areas and measured-factors that enhance digital communication barriers in rural addressing the digital divide becomes a limiting factor to access. In this sense, the rural communication emerges as relational link mediating solutions and incorporating the diffusion of innovations in the pursuit of digital literacy of farmers contributing to the democratization of society in the information age.

  5. 77 FR 24301 - Revision of the Commission's Program Access Rules

    Science.gov (United States)

    2012-04-23

    ... afforded to multichannel video programming distributors by the program access rules--the prohibition on exclusive contracts involving satellite- delivered, cable-affiliated programming. The current exclusive... sections 4(i), 303(r), 616, and 628 of the Communications Act of 1934, as amended. Total Annual Burden: 43...

  6. How rural and urban parents describe convenience in the context of school-based influenza vaccination: a qualitative study.

    Science.gov (United States)

    Lind, Candace; Russell, Margaret L; Collins, Ramona; MacDonald, Judy; Frank, Christine J; Davis, Amy E

    2015-01-22

    Seasonal influenza vaccine uptake among school-age children has been low, particularly among rural children, even in jurisdictions in Canada where this immunization is publicly funded. Providing this vaccination at school may be convenient for parents and might contribute to increased vaccine uptake, particularly among rural children. We explore the construct of convenience as an advantage of school based influenza vaccination. We also explore for rural urban differences in this construct. Participants were parents of school-aged children from Alberta, Canada. We qualitatively analyzed focus group data from rural parents using a thematic template that emerged from prior work with urban parents. Both groups of parents had participated in focus groups to explore their perspectives on the acceptability of adding an annual influenza immunization to the immunization program that is currently delivered in Alberta schools. Data from within the theme of 'convenience' from both rural and urban parents were then further explored for sub-themes within convenience. Data were obtained from nine rural and nine urban focus groups. The template of themes that had arisen from prior analysis of the urban data applied to the rural data. Convenience was a third level theme under Advantages. Five fourth level themes emerged from within convenience. Four of the five sub-themes were common to both rural and urban participants: reduction of parental burden to schedule, reduction in parental lost time, decrease in parental stress and increase in physical access points for influenza immunization. The fifth subtheme, increases temporal access to influenza immunization, emerged uniquely from the rural data. Both rural and urban parents perceived that convenience would be an advantage of adding an annual influenza immunization to the vaccinations currently given to Alberta children at school. Improving temporal access to such immunization may be a more relevant aspect of convenience to rural

  7. Stellar Atmospheric Modelling for the ACCESS Program

    Science.gov (United States)

    Morris, Matthew; Kaiser, Mary Elizabeth; Bohlin, Ralph; Kurucz, Robert; ACCESS Team

    2018-01-01

    A goal of the ACCESS program (Absolute Color Calibration Experiment for Standard Stars) is to enable greater discrimination between theoretical astrophysical models and observations, where the comparison is limited by systematic errors associated with the relative flux calibration of the targets. To achieve these goals, ACCESS has been designed as a sub-orbital rocket borne payload and ground calibration program, to establish absolute flux calibration of stellar targets at flight candidates, as well as a selection of A and G stars from the CALSPEC database. Stellar atmosphere models were generated using Atlas 9 and Atlas 12 Kurucz stellar atmosphere software. The effective temperature, log(g), metallicity, and redenning were varied and the chi-squared statistic was minimized to obtain a best-fit model. A comparison of these models and the results from interpolation between grids of existing models will be presented. The impact of the flexibility of the Atlas 12 input parameters (e.g. solar metallicity fraction, abundances, microturbulent velocity) is being explored.

  8. 76 FR 21741 - Twenty-First Century Communications and Video Programming Accessibility Act; Announcement of Town...

    Science.gov (United States)

    2011-04-18

    ... equipment distribution program for people who are deaf-blind. In addition, the law will fill accessibility... Programming Accessibility Act; Announcement of Town Hall Meeting AGENCY: Federal Communications Commission... The Twenty-First Century Communications and Video Programming Accessibility Act (the Act or CVAA...

  9. Factors affecting domestic water consumption in rural households upon access to improved water supply: insights from the Wei River Basin, China.

    Science.gov (United States)

    Fan, Liangxin; Liu, Guobin; Wang, Fei; Geissen, Violette; Ritsema, Coen J

    2013-01-01

    Comprehensively understanding water consumption behavior is necessary to design efficient and effective water use strategies. Despite global efforts to identify the factors that affect domestic water consumption, those related to domestic water use in rural regions have not been sufficiently studied, particularly in villages that have gained access to improved water supply. To address this gap, we investigated 247 households in eight villages in the Wei River Basin where three types of improved water supply systems are implemented. Results show that domestic water consumption in liters per capita per day was significantly correlated with water supply pattern and vegetable garden area, and significantly negatively correlated with family size and age of household head. Traditional hygiene habits, use of water appliances, and preference for vegetable gardening remain dominant behaviors in the villages with access to improved water supply. Future studies on rural domestic water consumption should pay more attention to user lifestyles (water appliance usage habits, outdoor water use) and cultural backgrounds (age, education).

  10. Factors affecting domestic water consumption in rural households upon access to improved water supply: insights from the Wei River Basin, China.

    Directory of Open Access Journals (Sweden)

    Liangxin Fan

    Full Text Available Comprehensively understanding water consumption behavior is necessary to design efficient and effective water use strategies. Despite global efforts to identify the factors that affect domestic water consumption, those related to domestic water use in rural regions have not been sufficiently studied, particularly in villages that have gained access to improved water supply. To address this gap, we investigated 247 households in eight villages in the Wei River Basin where three types of improved water supply systems are implemented. Results show that domestic water consumption in liters per capita per day was significantly correlated with water supply pattern and vegetable garden area, and significantly negatively correlated with family size and age of household head. Traditional hygiene habits, use of water appliances, and preference for vegetable gardening remain dominant behaviors in the villages with access to improved water supply. Future studies on rural domestic water consumption should pay more attention to user lifestyles (water appliance usage habits, outdoor water use and cultural backgrounds (age, education.

  11. Program of active aging in a rural Mexican community: a qualitative approach

    Directory of Open Access Journals (Sweden)

    Mendoza-Núñez Víctor

    2007-10-01

    Full Text Available Abstract Background Education is one of the key elements in the promotion of a thorough paradigm for active aging. The aim of this study is to analyze factors that contribute the empowerment of older adults in a rural Mexican community and, thus, promote active aging. Methods The study was conducted in a rural Mexican community (Valle del Mezquital, based on an action-research paradigm. One hundred and fifty-five elderly subjects with elementary school education participated in a formal training program promoting gerontological development and health education. Participants in turn became coordinators of mutual-help groups (gerontological nucleus in Mexico. In-depth interviews were carried out to assess the empowerment after training for active aging. Results It was found that there was an increasing feeling of empowerment, creativity and self-fulfillment among participants. Among the main factors that positively influenced training of the elderly toward active aging were the teaching of gerontology topics themselves; besides, their motivation, the self-esteem, the increased undertaking of responsibility, the feeling of belonging to the group, and the sharing of information based on personal experience and on gerontological knowledge. Conclusion The main factors that contribute to empowerment of older adults in a rural Mexican community for participate in active aging programs are the training and teaching of gerontology topics themselves; besides, their interest, experience and involvement.

  12. Program of active aging in a rural Mexican community: a qualitative approach.

    Science.gov (United States)

    de la Luz Martínez-Maldonado, María; Correa-Muñoz, Elsa; Mendoza-Núñez, Víctor Manuel

    2007-10-03

    Education is one of the key elements in the promotion of a thorough paradigm for active aging. The aim of this study is to analyze factors that contribute the empowerment of older adults in a rural Mexican community and, thus, promote active aging. The study was conducted in a rural Mexican community (Valle del Mezquital), based on an action-research paradigm. One hundred and fifty-five elderly subjects with elementary school education participated in a formal training program promoting gerontological development and health education. Participants in turn became coordinators of mutual-help groups (gerontological nucleus) in Mexico. In-depth interviews were carried out to assess the empowerment after training for active aging. It was found that there was an increasing feeling of empowerment, creativity and self-fulfillment among participants. Among the main factors that positively influenced training of the elderly toward active aging were the teaching of gerontology topics themselves; besides, their motivation, the self-esteem, the increased undertaking of responsibility, the feeling of belonging to the group, and the sharing of information based on personal experience and on gerontological knowledge. The main factors that contribute to empowerment of older adults in a rural Mexican community for participate in active aging programs are the training and teaching of gerontology topics themselves; besides, their interest, experience and involvement.

  13. The geographic accessibility of pharmacies in Nova Scotia.

    Science.gov (United States)

    Law, Michael R; Heard, Deborah; Fisher, Judith; Douillard, Jay; Muzika, Greg; Sketris, Ingrid S

    2013-01-01

    Geographic proximity is an important component of access to primary care and the pharmaceutical services of community pharmacies. Variations in access to primary care have been found between rural and urban areas in Canadian and international jurisdictions. We studied access to community pharmacies in the province of Nova Scotia. We used information on the locations of 297 community pharmacies operating in Nova Scotia in June 2011. Population estimates at the census block level and network analysis were used to study the number of Nova Scotia residents living within 800 m (walking) and 2 km and 5 km (driving) distances of a pharmacy. We then simulated the impact of pharmacy closures on geographic access in urban and rural areas. We found that 40.3% of Nova Scotia residents lived within walking distance of a pharmacy; 62.6% and 78.8% lived within 2 km and 5 km, respectively. Differences between urban and rural areas were pronounced: 99.2% of urban residents lived within 5 km of a pharmacy compared with 53.3% of rural residents. Simulated pharmacy closures had a greater impact on geographic access to community pharmacies in rural areas than urban areas. The majority of Nova Scotia residents lived within walking or short driving distance of at least 1 community pharmacy. While overall geographic access appears to be lower than in the province of Ontario, the difference appears to be largely driven by the higher proportion of rural dwellers in Nova Scotia. Further studies should examine how geographic proximity to pharmacies influences patients' access to traditional and specialized pharmacy services, as well as health outcomes and adherence to therapy. Can Pharm J 2013;146:39-46.

  14. Building the Foundation for a Health Education Program for Rural Older Adults

    Science.gov (United States)

    Jung, Seung Eun; Parker, Stephany; Hermann, Janice; Phelps, Joshua; Shin, Yeon Ho

    2018-01-01

    We explored rural older adults perceptions of health to inform health promotion program development, using social marketing as our framework. Participants in seven focus groups viewed independence and holistic health as indicators of health and identified healthful eating and physical activity as actions to promote health. Barriers to these…

  15. A Remote Collaborative Care Program for Patients with Depression Living in Rural Areas: Open-Label Trial.

    Science.gov (United States)

    Rojas, Graciela; Guajardo, Viviana; Martínez, Pablo; Castro, Ariel; Fritsch, Rosemarie; Moessner, Markus; Bauer, Stephanie

    2018-04-30

    In the treatment of depression, primary care teams have an essential role, but they are most effective when inserted into a collaborative care model for disease management. In rural areas, the shortage of specialized mental health resources may hamper management of depressed patients. The aim was to test the feasibility, acceptability, and effectiveness of a remote collaborative care program for patients with depression living in rural areas. In a nonrandomized, open-label (blinded outcome assessor), two-arm clinical trial, physicians from 15 rural community hospitals recruited 250 patients aged 18 to 70 years with a major depressive episode (DSM-IV criteria). Patients were assigned to the remote collaborative care program (n=111) or to usual care (n=139). The remote collaborative care program used Web-based shared clinical records between rural primary care teams and a specialized/centralized mental health team, telephone monitoring of patients, and remote supervision by psychiatrists through the Web-based shared clinical records and/or telephone. Depressive symptoms, health-related quality of life, service use, and patient satisfaction were measured 3 and 6 months after baseline assessment. Six-month follow-up assessments were completed by 84.4% (221/250) of patients. The remote collaborative care program achieved higher user satisfaction (odds ratio [OR] 1.94, 95% CI 1.25-3.00) and better treatment adherence rates (OR 1.81, 95% CI 1.02-3.19) at 6 months compared to usual care. There were no statically significant differences in depressive symptoms between the remote collaborative care program and usual care. Significant differences between groups in favor of remote collaborative care program were observed at 3 months for mental health-related quality of life (beta 3.11, 95% CI 0.19-6.02). Higher rates of treatment adherence in the remote collaborative care program suggest that technology-assisted interventions may help rural primary care teams in the management

  16. SELCO: A model for solar rural electrification in India

    Science.gov (United States)

    Hande, H. Harish

    1999-11-01

    The following thesis presents the concept of a Rural Energy Service Company in India, known as SELCO. The model is being set up as a sustainable proposition for the implementation of solar photovoltaics as a viable alternative to provide reliable home lighting in the rural areas of India. The SELCO approach has already achieved noteworthy social and commercial results. Institutional, policy and operational problems have long plagued the rural electrification programs in India, resulting in thousands of villages without access to electricity. SELCO is a solar energy service company operating in Southern India since 1995, focusing on the enormous untapped market for home lighting where thousands of households have no access to electricity and severe power shortages face those already connected to the electric grid. The Company has installed nearly 2,000 solar home lighting systems. From a modest two employees company in 1995, it has grown to 35 in 1997 and from one office to eight. The hypothesis to be tested in this study is that in rural India, in a market not subsidized by the government, a solar service company with available loans from local banks and cooperatives and with sales, installation, and maintenance personnel in the villages can be successful in introducing photovoltaic systems to provide basic amenities such as lighting and water pumping for the improvement of the quality of life, public health, and the environment. The initial success of SELCO lends considerable evidence to the acceptance of the hypothesis. To accomplish its mission, SELCO works with commercial, retail, and rural development banks with large rural branch networks to stimulate loans to SELCO's customers based on a standard set of attractive financing terms. SELCO through its successful model has convinced the policy makers that a way to increase rural families' access to consumer financing for solar home lighting systems is through the existing financial network available in the

  17. 47 CFR 76.1507 - Competitive access to satellite cable programming.

    Science.gov (United States)

    2010-10-01

    ... programming. 76.1507 Section 76.1507 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST... access to satellite cable programming. (a) Any provision that applies to a cable operator under §§ 76... provides video programming on its open video system, except as limited by paragraph (a) (1)-(3) of this...

  18. Leadership development for rural health.

    Science.gov (United States)

    Size, Tim

    2006-01-01

    Leadership is the capacity to help transform a vision of the future into reality. Individuals who can and will exercise leadership are like a river's current--a part past where we now stand, a part yet to come. We have an ongoing need to remember and to look toward the next "generation." A key responsibility of those here now, is to mentor and to create structures for mentoring, in order to maximize the flow and effectiveness of tomorrow's leaders. When recruiting organizational leaders, the recruitment and interview process must seek individuals who in addition to technical competence, also have demonstrated leadership in their prior work and activities. To exercise effective leadership, we must work to know who we are, how we relate to others, and the environment around us. "Servant leadership" is a perspective held by many throughout the rural health community and offers a key set attributes of leadership useful to rural health. To implement the Institute of Medicine's recommendations in Through Collaboration: the Future of Rural Health, we must develop leaders skilled in collaboration, both internal to their organization and across organizations. The National Advisory Committee on Rural Health and Human Services had it right when they said to the Secretary and to the rest of us, "the best way to honor Jim is to consciously work to help develop the next generation of rural health leaders." There are, of course, a multitude of leadership institutes, programs, and courses throughout America; this is not a call for yet another separate entity. But it is a call to each of us in rural health to assure that we are deliberate in how we identify "emerging leaders from and for rural communities and provide them with the training and resources to play a lead role in ensuring access to quality healthcare in their states and communities." Let's get started.

  19. Costs and Cost-Effectiveness of Hypertension Screening and Treatment in Adults with Hypertension in Rural Nigeria in the Context of a Health Insurance Program.

    Directory of Open Access Journals (Sweden)

    Nicole T A Rosendaal

    Full Text Available High blood pressure is a leading risk factor for death and disability in sub-Saharan Africa (SSA. We evaluated the costs and cost-effectiveness of hypertension care provided within the Kwara State Health Insurance (KSHI program in rural Nigeria.A Markov model was developed to assess the costs and cost-effectiveness of population-level hypertension screening and subsequent antihypertensive treatment for the population at-risk of cardiovascular disease (CVD within the KSHI program. The primary outcome was the incremental cost per disability-adjusted life year (DALY averted in the KSHI scenario compared to no access to hypertension care. We used setting-specific and empirically-collected data to inform the model. We defined two strategies to assess eligibility for antihypertensive treatment based on 1 presence of hypertension grade 1 and 10-year CVD risk of >20%, or grade 2 hypertension irrespective of 10-year CVD risk (hypertension and risk based strategy and 2 presence of hypertension in combination with a CVD risk of >20% (risk based strategy. We generated 95% confidence intervals around the primary outcome through probabilistic sensitivity analysis. We conducted one-way sensitivity analyses across key model parameters and assessed the sensitivity of our results to the performance of the reference scenario.Screening and treatment for hypertension was potentially cost-effective but the results were sensitive to changes in underlying assumptions with a wide range of uncertainty. The incremental cost-effectiveness ratio for the first and second strategy respectively ranged from US$ 1,406 to US$ 7,815 and US$ 732 to US$ 2,959 per DALY averted, depending on the assumptions on risk reduction after treatment and compared to no access to antihypertensive treatment.Hypertension care within a subsidized private health insurance program may be cost-effective in rural Nigeria and public-private partnerships such as the KSHI program may provide opportunities

  20. Reflexões acerca dos programas de inclusão digital a partir da análise do Acessa São Paulo em assentamentos rurais │ Reflections on digital inclusion programs based on a case-study of Access São Paulo in rural settlements

    Directory of Open Access Journals (Sweden)

    Cátia Regina Muniz

    2013-11-01

    Full Text Available Resumo A proposta deste artigo é destacar algumas reflexões realizadas sobre o programa de inclusão digital denominado Acessa SP, do governo do Estado de São Paulo, tendo por base os dados coletados em pesquisa de pós-doutorado, em dois assentamentos rurais: Haroldina, no município de Mirante do Paranapanema, e Gleba XV de Novembro, no município de Rosana. A pesquisa de campo se fundamentou na metodologia etnográfica. O resultado da pesquisa mostrou que há muitos desafios a serem enfrentados para que se atinjam as metas do programa, ou seja, promover melhoria nas condições de vida dos usuários, por meio das tecnologias. Palavras-chave inclusão digital, assentamentos rurais, Acessa SP, tecnologias, desafios. Abstract The purpose of this article is to highlight some reflections made on the digital inclusion program called Access SP, by the state government of São Paulo, based on data collected in postdoctoral research in two rural settlements: Haroldina, in the municipality of Mirante do Paranapanema, and Gleba XV Novembro, in the city of Rosana. The field research was based on ethnographic methodology. The results showed that there are many challenges to be faced for the achievement of program goals, i.e. to promote improvement in the living conditions of users through technologies. Keywords digital inclusion, rural settlements, Acessa SP, technologies, challenges.

  1. Governance for territorial development: from conception to action – the case of Para Rural Program

    Directory of Open Access Journals (Sweden)

    Sérgio Cardoso de Moraes

    2016-08-01

    Full Text Available It is to analyze the proposal of a public policy of Para State Government (GEP, as its design and actions, presents towards territorial development. In rural areas the Amazon of Para, the GEP has designed a public policy that aims to reduce poverty in poor rural ones. With loan agreement of resources between GEP and World Bank, the Para Rural Program, investing in productive projects without ordering the territory, having despised territorial governance processes that were one of his instruments, in which public policy is carried out in violation of importance of people and the environment which, projecting the policy, resulting interests of governments than of State.

  2. Ensuring safe access to medication for palliative care while preventing prescription drug abuse: innovations for American inner cities, rural areas, and communities overwhelmed by addiction

    Directory of Open Access Journals (Sweden)

    Francoeur RB

    2011-09-01

    Full Text Available Richard B FrancoeurSchool of Social Work, Adelphi University, Garden City, NY, USA; Center for the Psychosocial Study of Health and Illness, Columbia University, New York, NY, USAAbstract: This article proposes and develops novel components of community-oriented programs for creating and affording access to safe medication dispensing centers in existing retail pharmacies and in permanent or travelling pharmacy clinics that are guarded by assigned or off-duty police officers. Pharmacists at these centers would work with police, medical providers, social workers, hospital administrators, and other professionals in: planning and overseeing the safe storage of controlled substance medications in off-site community safe-deposit boxes; strengthening communication and cooperation with the prescribing medical provider; assisting the prescribing medical provider in patient monitoring (checking the state prescription registry, providing pill counts and urine samples; expanding access to lower-cost, and in some cases, abuse-resistant formulations of controlled substance medications; improving transportation access for underserved patients and caregivers to obtain prescriptions; and integrating community agencies and social networks as resources for patient support and monitoring. Novel components of two related community-oriented programs, which may be hosted outside of safe medication dispensing centers, are also suggested and described: (1 developing medication purchasing cooperatives (ie, to help patients, families, and health institutions afford the costs of medications, including tamper- or abuse-resistant/deterrent drug formulations; and (2 expanding the role of inner-city methadone maintenance treatment programs in palliative care (ie, to provide additional patient monitoring from a second treatment team focusing on narcotics addiction, and potentially, to serve as an untapped source of opioid medication for pain that is less subject to abuse

  3. Medicaid and Rural Health

    Science.gov (United States)

    ... State Guides Rural Data Visualizations Rural Data Explorer Chart Gallery Maps Case Studies & Conversations Rural Health Models & ... services provided by state Medicaid programs might include dental care, physical therapy, home and community-based services, ...

  4. Recruitment of rural healthcare professionals for live continuing education.

    Science.gov (United States)

    Holuby, Ronnie Scott; Pellegrin, Karen L; Barbato, Anna; Ciarleglio, Anita

    2015-01-01

    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. 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. 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. 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.

  5. Reliability of Self-Reported Mobile Phone Ownership in Rural North-Central Nigeria: Cross-Sectional Study.

    Science.gov (United States)

    Menson, William Nii Ayitey; Olawepo, John Olajide; Bruno, Tamara; Gbadamosi, Semiu Olatunde; Nalda, Nannim Fazing; Anyebe, Victor; Ogidi, Amaka; Onoka, Chima; Oko, John Okpanachi; Ezeanolue, Echezona Edozie

    2018-03-01

    mHealth practitioners seek to leverage the ubiquity of the mobile phone to increase the impact and robustness of their interventions, particularly in resource-limited settings. However, data on the reliability of self-reported mobile phone access is minimal. We sought to ascertain the reliability of self-reported ownership of and access to mobile phones among a population of rural dwellers in north-central Nigeria. We contacted participants in a community-based HIV testing program by phone to determine actual as opposed to self-reported mobile phone access. A phone script was designed to conduct these calls and descriptive analyses conducted on the findings. We dialed 349 numbers: 110 (31.5%) were answered by participants who self-reported ownership of the mobile phone; 123 (35.2%) of the phone numbers did not ring at all; 28 (8.0%) rang but were not answered; and 88 (25.2%) were answered by someone other than the participant. We reached a higher proportion of male participants (68/133, 51.1%) than female participants (42/216, 19.4%; Pphones in rural and low-income areas in north-central Nigeria is higher than actual access. This has implications for mHealth programming, particularly for women's health. mHealth program implementers and researchers need to be cognizant of the low reliability of self-reported mobile phone access. These observations should therefore affect sample-size calculations and, where possible, alternative means of reaching research participants and program beneficiaries should be established. ©William Nii Ayitey Menson, John Olajide Olawepo, Tamara Bruno, Semiu Olatunde Gbadamosi, Nannim Fazing Nalda, Victor Anyebe, Amaka Ogidi, Chima Onoka, John Okpanachi Oko, Echezona Edozie Ezeanolue. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 01.03.2018.

  6. Object oriented programming techniques applied to device access and control

    International Nuclear Information System (INIS)

    Goetz, A.; Klotz, W.D.; Meyer, J.

    1992-01-01

    In this paper a model, called the device server model, has been presented for solving the problem of device access and control faced by all control systems. Object Oriented Programming techniques were used to achieve a powerful yet flexible solution. The model provides a solution to the problem which hides device dependancies. It defines a software framework which has to be respected by implementors of device classes - this is very useful for developing groupware. The decision to implement remote access in the root class means that device servers can be easily integrated in a distributed control system. A lot of the advantages and features of the device server model are due to the adoption of OOP techniques. The main conclusion that can be drawn from this paper is that 1. the device access and control problem is adapted to being solved with OOP techniques, 2. OOP techniques offer a distinct advantage over traditional programming techniques for solving the device access problem. (J.P.N.)

  7. Availability and accessibility of subsidized mammogram screening program in peninsular Malaysia: A preliminary study using travel impedance approach.

    Science.gov (United States)

    Mahmud, Aidalina; Aljunid, Syed Mohamed

    2018-01-01

    Access to healthcare is essential in the pursuit of universal health coverage. Components of access are availability, accessibility (spatial and non-spatial), affordability and acceptability. Measuring spatial accessibility is common approach to evaluating access to health care. This study aimed to determine the availability and spatial accessibility of subsidised mammogram screening in Peninsular Malaysia. Availability was determined from the number and distribution of facilities. Spatial accessibility was determined using the travel impedance approach to represent the revealed access as opposed to potential access measured by other spatial measurement methods. The driving distance of return trips from the respondent's residence to the facilities was determined using a mapping application. The travel expenditure was estimated by multiplying the total travel distance by a standardised travel allowance rate, plus parking fees. Respondents in this study were 344 breast cancer patients who received treatment at 4 referral hospitals between 2015 and 2016. In terms of availability, there were at least 6 major entities which provided subsidised mammogram programs. Facilities with mammogram involved with these programs were located more densely in the central and west coast region of the Peninsula. The ratio of mammogram facility to the target population of women aged 40-74 years ranged between 1: 10,000 and 1:80,000. In terms of accessibility, of the 3.6% of the respondents had undergone mammogram screening, their mean travel distance was 53.4 km (SD = 34.5, range 8-112 km) and the mean travel expenditure was RM 38.97 (SD = 24.00, range RM7.60-78.40). Among those who did not go for mammogram screening, the estimated travel distance and expenditure had a skewed distribution with median travel distance of 22.0 km (IQR 12.0, 42.0, range 2.0-340.0) and the median travel cost of RM 17.40 (IQR 10.40, 30.00, range 3.40-240.00). Higher travel impedance was noted among those who

  8. Characteristics of mobile phone access and usage in rural and urban Guatemala: assessing feasibility of text message reminders to increase childhood immunizations.

    Science.gov (United States)

    Domek, Gretchen J; Contreras-Roldan, Ingrid L; Asturias, Edwin J; Bronsert, Michael; Bolaños Ventura, Guillermo Antonio; O'Leary, Sean T; Kempe, Allison; Bull, Sheana

    2018-01-01

    Despite efforts to promote vaccination in low- and middle-income countries (LMICs), over 20 million infants remain under-immunized and at risk for unnecessary morbidity and mortality. Mobile health technologies, such as Short Message Service (SMS) texts, have tremendous and untapped potential for disease management. Patient reminder systems are an important mechanism for improving childhood vaccination coverage and can be easily adapted to SMS platforms. However, current research lacks an understanding of the barriers and facilitators to mHealth program design, implementation, and scale in LMICs. We analyzed survey data collected March-November 2016 at the enrollment visit from a randomized controlled trial conducted at public health clinics in urban and rural Guatemala. Participants included eligible infants 6 weeks to 6 months of age receiving the first dose of the primary immunization series. At least one parent needed to own a mobile phone and be capable of deciphering SMS. Chi-square or Fisher's exact and Student's t-test were used to assess significance levels in demographic differences to describe factors that contribute to the feasibility of using an SMS-based vaccination reminder system. Of 1,088 families approached for enrollment, 871 were eligible and 720 (82.7%) participated with equal numbers of urban and rural children enrolled; 54 parents did not own a mobile phone with SMS capability and three parents could not use SMS. There was no significant difference between urban and rural maternal mobile phone ownership (94.4% vs. 93.3%, P=0.53), but more urban fathers owned mobile phones (72.8% vs. 47.1%, Pphones (93.9% vs. 61.1%, Pphones present in the home (Pphone access, usage, and preferences for voice and text communication across rural and urban populations of an LMIC that can be used to inform future mHealth interventions. Our findings suggest that offering a combination of more traditional communication methods with newer, modern technologies may be

  9. Faculty of health sciences, walter sisulu university: training doctors from and for rural South african communities.

    Science.gov (United States)

    Iputo, Jehu E

    2008-10-01

    Introduction The South African health system has disturbing inequalities, namely few black doctors, a wide divide between urban and rural sectors, and also between private and public services. Most medical training programs in the country consider only applicants with higher-grade preparation in mathematics and physical science, while most secondary schools in black communities have limited capacity to teach these subjects and offer them at standard grade level. The Faculty of Health Sciences at Walter Sisulu University (WSU) was established in 1985 to help address these inequities and to produce physicians capable of providing quality health care in rural South African communities. Intervention Access to the physician training program was broadened by admitting students who obtained at least Grade C (60%) in mathematics and physical science at standard grade, and who demonstrated appropriate personal attributes. An innovative curriculum, combining problem-based learning with community-based education (PBL/CBE) in small tutorial group settings, was also adopted. This approach was aimed at educating and graduating a broader cohort of students, while training future doctors to identify, analyze, and treat health problems in the rural South African context. Outcomes To date, 745 doctors (72% black Africans) have graduated from the program, and 511 students (83% black Africans) are currently enrolled. After the PBL/CBE curriculum was adopted, the attrition rate for black students dropped from 23% to 80%, and the proportion of students graduating within the minimum period rose from 55% to >70%. Many graduates are still completing internships or post-graduate training, but preliminary research shows that 36% percent of graduates practice in small towns and rural settings. Further research is underway to evaluate the impact of their training on health services in rural Eastern Cape Province and elsewhere in South Africa. Conclusions The WSU program increased access to

  10. Reaching Rural Handicapped Children: The Transportation Situation in Rural Service Delivery. Making It Work in Rural Communities. A Rural Network Monograph.

    Science.gov (United States)

    Tucker, Jamie; And Others

    Almost everyone who responded to three transportation surveys of rural Handicapped Children's Early Education Program (HCEEP) projects identified transportation as a critical problem in the delivery of services to handicapped children in rural areas. Transportation problems encountered were attributed to environmental/geographic factors,…

  11. 76 FR 57989 - Video Programming and Accessibility Advisory Committee; Announcement of Date of Next Meeting

    Science.gov (United States)

    2011-09-19

    ... FEDERAL COMMUNICATIONS COMMISSION [DA 11-1527] Video Programming and Accessibility Advisory.... SUMMARY: This document announces the next meeting of the Video Programming Accessibility Advisory... programming, and the interoperability and user interface of the equipment used to deliver video programming...

  12. 47 CFR 76.1004 - Applicability of program access rules to common carriers and affiliates.

    Science.gov (United States)

    2010-10-01

    ... Cable Programming § 76.1004 Applicability of program access rules to common carriers and affiliates. (a... 47 Telecommunication 4 2010-10-01 2010-10-01 false Applicability of program access rules to common carriers and affiliates. 76.1004 Section 76.1004 Telecommunication FEDERAL COMMUNICATIONS COMMISSION...

  13. Impact of rural residence and health system structure on quality of liver care.

    Directory of Open Access Journals (Sweden)

    Catherine Rongey

    Full Text Available Specialist physician concentration in urban areas can affect access and quality of care for rural patients. As effective drug treatment for hepatitis C (HCV becomes increasingly available, the extent to which rural patients needing HCV specialists face access or quality deficits is unknown. We sought to determine the influence of rural residency on access to HCV specialists and quality of liver care.The study used a national cohort of 151,965 Veterans Health Administration (VHA patients with HCV starting in 2005 and followed to 2009. The VHA's constant national benefit structure reduces the impact of insurance as an explanation for observed disparities. Multivariate cox proportion regression models for each quality indicator were performed.Thirty percent of VHA patients with HCV reside in rural and highly rural areas. Compared to urban residents, highly rural (HR 0.70, CI 0.65-0.75 and rural (HR 0.96, CI 0.94-0.97 residents were significantly less likely to access HCV specialty care. The quality indicators were more mixed. While rural residents were less likely to receive HIV screening, there were no significant differences in hepatitis vaccinations, endoscopic variceal and hepatocellular carcinoma screening between the geographic subgroups. Of note, highly rural (HR 1.31, CI 1.14-1.50 and rural residents (HR 1.06, CI 1.02-1.10 were more likely to receive HCV therapy. Of those treated for HCV, a third received therapy from a non-specialist provider.Rural patients have less access to HCV specialists, but this does not necessarily translate to quality deficits. The VHA's efforts to improve specialty care access, rural patient behavior and decentralization of HCV therapy beyond specialty providers may explain this contradiction. Lessons learned within the VHA are critical for US healthcare systems restructuring into accountable care organizations that acquire features of integrated systems.

  14. The positive impact of 'Luz do Campo' program in a rural area: the sericulture in Ribeirao Claro, Parana, Brazil; O impacto positivo do programa 'Luz do campo' na extensao rural: a sericicultura em Ribeirao Claro, Parana, Brazil

    Energy Technology Data Exchange (ETDEWEB)

    Carmo, Jose R. do; Marques, Rui Manuel B.S.; Betiol Junior, Genesio [Universidade de Sao Paulo (USP), SP (Brazil). Inst. de Eletrotecnica e Energia. Programa Interunidades de Pos-Graduacao e Energia], e-mail: jrcarmo@iee.usp.br, e-mail: rmanuel@iee.usp.br, e-mail: genesio.betiol@poli.usp.br; Ribeiro, Fernando Selles [Universidade de Sao Paulo (USP), SP (Brazil). Escola Politecnica de Engenharia], e-mail: fribeiro@pea.usp.br

    2004-07-01

    The 'Luz do Campo' program has created positive and favorable impact to the opening of opportunities in the rural area. It has contributed to facilitate the access of workers to energetic facilities and has contributed to providing them with better social and economical conditions. As a consequence after the accomplishment of the rural electrification process in the settlements of 'Anhumas' and 'Maria Neto' implanted in Ribeirao Claro in Parana, it was possible to come to terms with two projects of Sericiculture in that location. The energy consumption of these projects has not been only restricted to human comfort, but has also been aimed at the production. As a result, the economical success achieved in those settlements in less than a year's time, is due to the transformation actions in the countryside that have lowered poverty and raised the perspectives of better life quality to the settlers. (author)

  15. 34 CFR 395.12 - Access to program and financial information.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 2 2010-07-01 2010-07-01 false Access to program and financial information. 395.12... information. Each blind vendor under this part shall be provided access to all financial data of the State... annual financial reports, provided that such disclosure does not violate applicable Federal or State laws...

  16. Librarian-initiated HIV/AIDS prevention intervention program outcome in rural communities in Oyo State, Nigeria.

    Science.gov (United States)

    Ajuwon, G A; Komolafe-Opadeji, H O; Ikhizama, B

    2013-01-01

    The objective of this study was to meet the HIV/AIDS information and service needs of citizens living in selected rural, underserved communities in Oyo State, Nigeria. This was a librarian-initiated intervention program (pre-post) study of heads of rural households in Oyo State. A questionnaire was used for pre- and post-intervention assessment. The education covered knowledge about HIV/AIDS, routes of transmission, prevention strategies, and attitude toward persons living with HIV. It increased participants' knowledge about AIDS and improved attitude toward those living with HIV. Provision and dissemination of information on HIV/AIDS through librarians to rural settlers is an important prevention strategy and librarians can make major contributions.

  17. Challenges and opportunities in building a sustainable rural primary care workforce in alignment with the Affordable Care Act: the WWAMI program as a case study.

    Science.gov (United States)

    Allen, Suzanne M; Ballweg, Ruth A; Cosgrove, Ellen M; Engle, Kellie A; Robinson, Lawrence R; Rosenblatt, Roger A; Skillman, Susan M; Wenrich, Marjorie D

    2013-12-01

    The authors examine the potential impact of the Patient Protection and Affordable Care Act (ACA) on a large medical education program in the Northwest United States that builds the primary care workforce for its largely rural region. The 42-year-old Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) program, hosted by the University of Washington School of Medicine, is one of the nation's most successful models for rural health training. The program has expanded training and retention of primary care health professionals for the region through medical school education, graduate medical education, a physician assistant training program, and support for practicing health professionals.The ACA and resulting accountable care organizations (ACOs) present potential challenges for rural settings and health training programs like WWAMI that focus on building the health workforce for rural and underserved populations. As more Americans acquire health coverage, more health professionals will be needed, especially in primary care. Rural locations may face increased competition for these professionals. Medical schools are expanding their positions to meet the need, but limits on graduate medical education expansion may result in a bottleneck, with insufficient residency positions for graduating students. The development of ACOs may further challenge building a rural workforce by limiting training opportunities for health professionals because of competing demands and concerns about cost, efficiency, and safety associated with training. Medical education programs like WWAMI will need to increase efforts to train primary care physicians and increase their advocacy for student programs and additional graduate medical education for rural constituents.

  18. Making rural and remote communities more age-friendly: experts' perspectives on issues, challenges, and priorities.

    Science.gov (United States)

    Menec, Verena; Bell, Sheri; Novek, Sheila; Minnigaleeva, Gulnara A; Morales, Ernesto; Ouma, Titus; Parodi, Jose F; Winterton, Rachel

    2015-01-01

    With the growing interest worldwide in making communities more age-friendly, it is becoming increasingly important to understand the factors that help or hinder communities in attaining this goal. In this article, we focus on rural and remote communities and present perspectives of 42 experts in the areas of aging, rural and remote issues, and policy who participated in a consensus conference on age-friendly rural and remote communities. Discussions highlighted that strengths in rural and remote communities, such as easy access to local leaders and existing partnerships, can help to further age-friendly goals; however, addressing major challenges, such as lack of infrastructure and limited availability of social and health services, requires regional or national government buy-in and funding opportunities. Age-friendly work in rural and remote communities is, therefore, ideally embedded in larger age-friendly initiatives and supported by regional or national policies, programs, and funding sources.

  19. Hand Society and Matching Program Web Sites Provide Poor Access to Information Regarding Hand Surgery Fellowship.

    Science.gov (United States)

    Hinds, Richard M; Klifto, Christopher S; Naik, Amish A; Sapienza, Anthony; Capo, John T

    2016-08-01

    The Internet is a common resource for applicants of hand surgery fellowships, however, the quality and accessibility of fellowship online information is unknown. The objectives of this study were to evaluate the accessibility of hand surgery fellowship Web sites and to assess the quality of information provided via program Web sites. Hand fellowship Web site accessibility was evaluated by reviewing the American Society for Surgery of the Hand (ASSH) on November 16, 2014 and the National Resident Matching Program (NRMP) fellowship directories on February 12, 2015, and performing an independent Google search on November 25, 2014. Accessible Web sites were then assessed for quality of the presented information. A total of 81 programs were identified with the ASSH directory featuring direct links to 32% of program Web sites and the NRMP directory directly linking to 0%. A Google search yielded direct links to 86% of program Web sites. The quality of presented information varied greatly among the 72 accessible Web sites. Program description (100%), fellowship application requirements (97%), program contact email address (85%), and research requirements (75%) were the most commonly presented components of fellowship information. Hand fellowship program Web sites can be accessed from the ASSH directory and, to a lesser extent, the NRMP directory. However, a Google search is the most reliable method to access online fellowship information. Of assessable programs, all featured a program description though the quality of the remaining information was variable. Hand surgery fellowship applicants may face some difficulties when attempting to gather program information online. Future efforts should focus on improving the accessibility and content quality on hand surgery fellowship program Web sites.

  20. Medical education for rural areas: Opportunities and challenges for information and communications technologies

    Directory of Open Access Journals (Sweden)

    Sargeant Joan

    2005-01-01

    Full Text Available Resources in medical education are not evenly distributed and access to education can be more problematic in rural areas. Similar to telemedicine′s positive influence on health care access, advances in information and communications technologies (ICTs increase opportunities for medical education. This paper provides a descriptive overview of the use of ICTs in medical education and suggests a conceptual model for reviewing ICT use in medical education, describes specific ICTs and educational interventions, and discusses opportunities and challenges of ICT use, especially in rural areas. The literature review included technology and medical education, 1996-2005. Using an educational model as a framework, the uses of ICTs in medical education are, very generally, to link learners, instructors, specific course materials and/or information resources in various ways. ICTs range from the simple (telephone, audio-conferencing to the sophisticated (virtual environments, learning repositories and can increase access to medical education and enhance learning and collaboration for learners at all levels and for institutions. While ICTs are being used and offer further potential for medical education enhancement, challenges exist, especially for rural areas. These are technological (e.g., overcoming barriers like cost, maintenance, access to telecommunications infrastructure, educational (using ICTs to best meet learners′ educational priorities, integrating ICTs into educational programs and social (sensitivity to remote needs, resources, cultures. Finally, there is need for more rigorous research to more clearly identify advantages and disadvantages of specific uses of ICTs in medical education.

  1. Critical access hospital informatics: how two rural Iowa hospitals overcame challenges to achieve IT excellence.

    Science.gov (United States)

    Bahensky, James A; Moreau, Brian; Frieden, Rob; Ward, Marcia M

    2008-01-01

    Critical access hospitals often have limited financial and personnel resources to implement today's healthcare IT solutions. Two CAHs in rural Iowa overcame these obstacles and found innovative ways to implement information technology. These hospitals earned recognition from Hospitals & Health Network's Most Wired Magazine for excellence in business processes, customer service, safety and quality, work force management, and public health and safety. Though the hospitals come from different environments-one is part of a system and the other is independent-both exemplify best practices on how to use healthcare IT solutions; engage clinicians from a community setting in informatics decisions; integrate technology into an organization's strategic directions; and support healthcare IT environments.

  2. Broadband provision to underprivileged rural communities

    CSIR Research Space (South Africa)

    Makitla, I

    2010-09-01

    Full Text Available Providing access to remote rural areas presents a unique set of technical and non-technical challenges. These challenges are key issues that arise when deploying wireless networks to remote rural areas in developing countries; long distances between...

  3. 75 FR 9691 - Review of the Commission's Program Access Rules and Examination of Programming Tying Arrangements

    Science.gov (United States)

    2010-03-03

    ... involving programming they own, that impede competition in the video distribution market. See H.R. Rep. No... availability of programming and charging discriminatory prices to non- cable technologies.'' H.R. Rep. No. 102... Access Rules and Examination of Programming Tying Arrangements; Final Rule #0;#0;Federal Register / Vol...

  4. Multi-objective assessment of rural electrification in remote areas with poverty considerations

    International Nuclear Information System (INIS)

    Silva, Diego; Nakata, Toshihiko

    2009-01-01

    Rural electrification with renewable energy technologies (RETs) offers several benefits to remote areas where diesel generation is unsuitable due to fuel supply constraints. Such benefits include environmental and social aspects, which are linked to energy access and poverty reduction in less-favored areas of developing countries. In this case, multi-objective methods are suitable tools for planning in rural areas. In this study, assessment of rural electrification with renewable energy systems is conducted by means of goal programming towards fuel substitution. The approach showed that, in the Non-Interconnected Zones of Colombia, substitution of traditional biomass with an electrification scheme using renewable energy sources provides significant environmental benefits, measured as land use and avoided emissions, as well as higher employment generation rates than diesel generation schemes. Nevertheless, fuel substitution is constrained by the elevated cost of electricity compared to traditional biomass, which raises households' energy expenditures between twofold to five times higher values. The present approach, yet wide in scope, is still limited for quantifying the impact of energy access improvements on poverty reduction, as well as for the assessment of energy system's technical feasibility.

  5. Learning Preferences and Impacts of Education Programs in Dog Health Programs in Five Rural and Remote Australian Indigenous Communities

    Science.gov (United States)

    Constable, Sophie; Dixon, Roselyn; Dixon, Robert

    2011-01-01

    As part of strategies to improve dog and community health in rural and remote Indigenous communities, this study investigated preferences and impacts of dog health education programs. Semistructured interviews with 63 residents from five communities explored learning preferences. Though each community differed, on average yarning was preferred by…

  6. A hospital-randomized controlled trial of a formal quality improvement educational program in rural and small community Texas hospitals: one year results.

    Science.gov (United States)

    Filardo, Giovanni; Nicewander, David; Herrin, Jeph; Edwards, Janine; Galimbertti, Percy; Tietze, Mari; McBride, Susan; Gunderson, Julie; Collinsworth, Ashley; Haydar, Ziad; Williams, Josie; Ballard, David J

    2009-08-01

    To investigate the effectiveness of a quality improvement educational program in rural hospitals. Hospital-randomized controlled trial. A total of 47 rural and small community hospitals in Texas that had previously received a web-based benchmarking and case-review tool. The 47 hospitals were randomized either to receive formal quality improvement educational program or to a control group. The educational program consisted of two 2-day didactic sessions on continuous quality improvement techniques, followed by the design, implementation and reporting of a local quality improvement project, with monthly coaching conference calls and annual follow-up conclaves. Performance on core measures for community-acquired pneumonia and congestive heart failure were compared between study groups to evaluate the impact of the educational program. No significant differences were observed between the study groups on any measures. Of the 23 hospitals in the intervention group, only 16 completed the didactic program and 6 the full training program. Similar results were obtained when these groups were compared with the control group. While the observed results suggest no incremental benefit of the quality improvement educational program following implementation of a web-based benchmarking and case-review tool in rural hospitals, given the small number of hospitals that completed the program, it is not conclusive that such programs are ineffective. Further research incorporating supporting infrastructure, such as physician champions, financial incentives and greater involvement of senior leadership, is needed to assess the value of quality improvement educational programs in rural hospitals.

  7. Clinical decision-making of rural novice nurses.

    Science.gov (United States)

    Seright, T J

    2011-01-01

    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.

  8. Access to Employee Wellness Programs and Use of Preventive Care Services Among U.S. Adults.

    Science.gov (United States)

    Isehunwa, Oluwaseyi O; Carlton, Erik L; Wang, Yang; Jiang, Yu; Kedia, Satish; Chang, Cyril F; Fijabi, Daniel; Bhuyan, Soumitra S

    2017-12-01

    There is little research at the national level on access to employee wellness programs and the use of preventive care services. This study examined the use of seven preventive care services among U.S working adults with access to employee wellness programs. The study population comprised 17,699 working adults aged ≥18 years, obtained from the 2015 National Health Interview Survey. Multivariate logistic regression models examined the relationship between access to employee wellness programs and use of seven preventive care services: influenza vaccination, blood pressure check, diabetes check, cholesterol check, Pap smear test, mammogram, and colon cancer screening. Data analysis began in Fall 2016. Overall, 46.6% of working adults reported having access to employee wellness programs in 2015. Working adults with access to employee wellness programs had higher odds of receiving influenza vaccination (OR=1.57, 95% CI=1.43, 1.72, pemployee wellness programs and the use of Pap smear test and colon cancer screening services. Using a nationally representative sample of individuals, this study found a positive association between access to employee wellness programs and the use of preventive care services. The results support favorable policies to encourage implementing wellness programs in all worksites, especially those with employees. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  9. Going Digital in Rural America.

    Science.gov (United States)

    Malecki, Edward J.

    This paper examines the extent to which rural America is digital--has access to the Internet and to newer technologies such as wireless broadband--and discusses rural supply and demand for "going digital." Supply aspects include issues of both infrastructure and public policy. Demand aspects include entrepreneurs (business users) and…

  10. 19 CFR 201.149 - Program accessibility: Discrimination prohibited.

    Science.gov (United States)

    2010-04-01

    .... 201.149 Section 201.149 Customs Duties UNITED STATES INTERNATIONAL TRADE COMMISSION GENERAL RULES OF... Conducted by the U.S. International Trade Commission § 201.149 Program accessibility: Discrimination... agency's facilities are inaccessible to or unusable by handicapped persons, be denied the benefits of, be...

  11. Evaluation of the content and accessibility of microsurgery fellowship program websites.

    Science.gov (United States)

    Silvestre, Jason; Vargas, Christina R; Ho, Olivia; Lee, Bernard T

    2015-10-01

    Microsurgery fellowship applicants utilize Internet-based resources such as the San Francisco Match (SF Match) to manage their applications. In deciding where to apply, applicants rely on advice from mentors and online resources including microsurgery fellowship websites (MFWs). The purpose of this study was to evaluate the content and accessibility of MFWs. While microsurgery is practiced by many surgical specialties, this study focused on MFWs for programs available in the 2014 Microsurgery Fellowship Match. Program lists from the American Society for Reconstructive Microsurgery (ASRM) and the San Francisco Match (SF Match) were analyzed for the accessibility of MFW links. MFWs were evaluated for education and recruitment content, and MFW comprehensiveness was compared on the basis of program characteristics using chi square tests. Of the 25 fellowships available, only 18 had websites (72%). SF Match and ASRM listed similar programs (96% overlap) and provided website links (89%, 76%), but only a minority connected directly to the MFW (38%, 23%). A minority of programs were responsive via email inquiry (36%). MFWs maintained minimal education and recruitment content. MFW comprehensiveness was not associated with program characteristics. MFWs are often not readily accessible and contain limited information for fellowship applicants. Given the relative low-cost of website development, MFWs may be improved to facilitate fellow recruitment. © 2015 Wiley Periodicals, Inc.

  12. Urban-rural differences in a population-based breast cancer screening program in Croatia

    Science.gov (United States)

    Stamenić, Valerija; Strnad, Marija

    2011-01-01

    Aim To investigate urban-rural differences in the distribution of risk factors for breast cancer. Methods We analyzed the data from the first round of the “Mamma” population based-screening program conducted in Croatia between 2007 and 2009 and self-reported questionnaire results for 924 patients with histologically verified breast cancer. Reproductive and anthropometric characteristics, family history of breast cancer, history of breast disease, and prior breast screening history were compared between participants from the city of Zagreb (n = 270) and participants from 13 counties with more than 50% of rural inhabitants (n = 654). Results The screen-detected breast cancer rate was 4.5 per 1000 mammographies in rural counties and 4.6 in the city of Zagreb, while the participation rate was 61% in rural counties and 59% in Zagreb. Women from Zagreb had significantly more characteristics associated with an increased risk of breast cancer (P < 0.001 in all cases): no pregnancies (15% vs 7%), late age of first pregnancy (≥30 years) (10% vs 4%), and the most recent mammogram conducted 2-3 years ago (32% vs 14%). Women from rural counties were more often obese (41% vs 28%) and had early age of first live birth (<20 years) (20% vs 7%, P < 0.001 for both). Conclusion Identification of rural-urban differences in mammography use and their causes at the population level can be useful in designing and implementing interventions targeted at the reduction of inequalities and modifiable risk factors. PMID:21328724

  13. Evaluation of a patient navigation program to promote colorectal cancer screening in rural Georgia, USA.

    Science.gov (United States)

    Honeycutt, Sally; Green, Rhonda; Ballard, Denise; Hermstad, April; Brueder, Alex; Haardörfer, Regine; Yam, Jennifer; Arriola, Kimberly J

    2013-08-15

    Colorectal cancer (CRC) is a leading cause of cancer death in the United States. Early detection through recommended screening has been shown to have favorable treatment outcomes, yet screening rates among the medically underserved and uninsured are low, particularly for rural and minority populations. This study evaluated the effectiveness of a patient navigation program that addresses individual and systemic barriers to CRC screening for patients at rural, federally qualified community health centers. This quasi-experimental evaluation compared low-income patients at average risk for CRC (n = 809) from 4 intervention clinics and 9 comparison clinics. We abstracted medical chart data on patient demographics, CRC history and risk factors, and CRC screening referrals and examinations. Outcomes of interest were colonoscopy referral and examination during the study period and being compliant with recommended screening guidelines at the end of the study period. We conducted multilevel logistic analyses to evaluate the program's effectiveness. Patients at intervention clinics were significantly more likely than patients at comparison clinics to undergo colonoscopy screening (35% versus 7%, odds ratio = 7.9, P screening test (43% versus 11%, odds ratio = 5.9, P Screening Program, can be an effective approach to ensure that lifesaving, preventive health screenings are provided to low-income adults in a rural setting. Copyright © 2013 American Cancer Society.

  14. Rural retention of new medical graduates from the Collaborative Project to Increase Production of Rural Doctors (CPIRD): a 12-year retrospective study.

    Science.gov (United States)

    Techakehakij, Win; Arora, Rajin

    2017-07-01

    Physician scarcity in rural areas is a major obstacle to healthcare access, leading to health inequity worldwide. In Thailand, a special recruitment program of medical education [Collaborative Project to Increase Production of Rural Doctors (CPIRD)] was initiated with four different medical training tracks. No previous research has examined the rural retention of new medical graduates across the CPIRD tracks, compared with those receiving conventional medical education (Normal track). This study examines the public retention of rural physicians from different tracks of entry. A retrospective study was conducted in new medical graduates who entered Ministry of Public Health (MoPH) hospitals from January 2003 to October 2014, and followed up until June 2015, using administrative data from the Personnel Administration Division, MoPH. The CPIRD registry database was used to identify physicians' tracks of entry. Survival analyses and multiple logistic regression analyses were applied to compare the annual retention and the probability of 3-year retention of rural physicians. Results clearly demonstrated a high rural retention of CPIRD medical graduates, compared with their Normal track peers, regarding both lower annual resignation (HR 0.456, P rural retention were revealed across the different CPIRD tracks. Evidence from this study can be used as part of the information to reshape the physician production policy to reduce health inequity in rural areas. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  15. 49 CFR 28.151 - Program accessibility: New construction and alterations.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false Program accessibility: New construction and alterations. 28.151 Section 28.151 Transportation Office of the Secretary of Transportation ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE DEPARTMENT OF TRANSPORTATION...

  16. 42 CFR 485.603 - Rural health network.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Rural health network. 485.603 Section 485.603... Participation: Critical Access Hospitals (CAHs) § 485.603 Rural health network. A rural health network is an... quality assurance with at least— (1) One hospital that is a member of the network when applicable; (2) One...

  17. Ground water security and drought in Africa: linking availability, access, and demand.

    Science.gov (United States)

    Calow, Roger C; Macdonald, Alan M; Nicol, Alan L; Robins, Nick S

    2010-01-01

    Drought in Africa has been extensively researched, particularly from meteorological, agricultural, and food security perspectives. However, the impact of drought on water security, particularly ground water dependent rural water supplies, has received much less attention. Policy responses have concentrated on food needs, and it has often been difficult to mobilize resources for water interventions, despite evidence that access to safe water is a serious and interrelated concern. Studies carried out in Ghana, Malawi, South Africa, and Ethiopia highlight how rural livelihoods are affected by seasonal stress and longer-term drought. Declining access to food and water is a common and interrelated problem. Although ground water plays a vital role in buffering the effects of rainfall variability, water shortages and difficulties in accessing water that is available can affect domestic and productive water uses, with knock-on effects on food consumption and production. Total depletion of available ground water resources is rarely the main concern. A more common scenario is a spiral of water insecurity as shallow water sources fail, additional demands are put on remaining sources, and mechanical failures increase. These problems can be planned for within normal development programs. Water security mapping can help identify vulnerable areas, and changes to monitoring systems can ensure early detection of problems. Above all, increasing the coverage of ground water-based rural water supplies, and ensuring that the design and siting of water points is informed by an understanding of hydrogeological conditions and user demand, can significantly increase the resilience of rural communities to climate variability.

  18. Recruitment of rural healthcare professionals for live continuing education

    Directory of Open Access Journals (Sweden)

    Ronnie Scott Holuby

    2015-11-01

    Full Text Available 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.

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

    Science.gov (United States)

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

    2016-10-29

    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. 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. 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

  20. 28 CFR 513.43 - Inmate access to certain Bureau Program Statements.

    Science.gov (United States)

    2010-07-01

    ... Statements. 513.43 Section 513.43 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE GENERAL... simple local access procedures described in this section to review certain Bureau Program Statements... 28 CFR), local access is available through the institution law library. (b) For a current Bureau...

  1. Building capacity in the rural physiotherapy workforce: a paediatric training partnership.

    Science.gov (United States)

    Williams, E N; McMeeken, J M

    2014-01-01

    Building capacity in the rural physiotherapy workforce: a paediatric training partnership' provided 6 months postgraduate paediatric clinical and academic training for two physiotherapists in rural Australia. It is described as a model for improving services and workforce retention. The need for 'an appropriate, skilled and well-supported health workforce' is the third goal in Australia's National Strategic Framework for Rural and Remote Health 2011. The World Health Organization recently published its first global policy for improving the retention of rural and remote health workers. Education is its first recommendation and aims to 'design continuing education and professional development programmes that meet the needs of rural health workers and that are accessible from where they live and work, so as to support their retention …'. Additionally, '… to be successful, continuing education needs to be linked to career paths, as well as with other education interventions'. The problem is a lack of paediatric physiotherapy expertise in rural areas due to an absence of postgraduate clinical training opportunities in the rural workforce. The result is fragmented local services for families who are forced to travel to metropolitan services, costly in terms of both time and money. The aims were to improve local paediatric physiotherapy clinical services, provide physiotherapists additional access to professional development and subsequently provide a career path to retain these health professionals. Evaluation of the project used purpose-built questionnaires as there are no specific indicators to monitor the performance of systems and services that are available to children and families in Australia. The paediatric physiotherapy training program was enabled through initial funding for a 12-month pilot project. Further government funding built on that success for this reported 6-month project. Funding to employ the postgraduate physiotherapists was essential to the

  2. The activities of non-governmental organizations for equal educational opportunities for children from the rural environment

    Directory of Open Access Journals (Sweden)

    KATARZYNA PALKA

    2017-10-01

    Full Text Available We live in a world where the access to knowledge has a decisive influence on our future. A large number of children in Poland have difficulties with this access, because they are raised in impoverished, excluded, poorly educated families of low social status. This phenomenon is mainly related to rural areas. Nonformal education should provide important support for formal education. Nonformal education should be organized with the cooperation of schools, kindergartens, and non-governmental organizations. The educational activities proposed for children and their parents by non-governmental organizations complement formal education. These activities are of crucial importance in the equalization of educational opportunities for children from rural areas. It is essential that these activities be planned, long-term, and a part of the entire educational program

  3. [Social determinants of infant mortality in socioeconomic deprived rural areas in Mexico].

    Science.gov (United States)

    Duarte-Gómez, María Beatriz; Núñez-Urquiza, Rosa María; Restrepo-Restrepo, José Alonso; Richardson-López-Collada, Vesta Louise

    The aim of this study was to identify determinants of infant mortality in rural areas in Mexico and recommend strategies for its decrease. A study was conducted in a sample of 16 municipalities among those with the lowest index of human development. Infant deaths were identified through official data, records and through interviews with civil authorities, health workers and community leaders. Mothers of children who died were also interviewed. In most cases, deaths were related with intermediate social determinants (living conditions and health services converged). The most important critical factors were the prevention programs and delays in receiving healthcare. Deficiencies in intersectorial policies to guarantee effective access to health services were found. To decrease infant mortality in rural areas of Mexico, geographic access has to be improved as well as investment in resources and training health personnel in intercultural competence and primary health care skills. Copyright © 2015. Publicado por Masson Doyma México S.A.

  4. Training child psychiatrists in rural public mental health.

    Science.gov (United States)

    Petti, T A; Benswanger, E G; Fialkov, M J; Sonis, M

    1987-04-01

    Lack of appropriate training in both public mental health service and rural mental health service is a major factor in the critical shortage of child psychiatrists in rural settings. The authors describe a residency training program in rural public mental health designed to help alleviate that shortage. The program familiarizes fourth-year residents in child psychiatry with the clinical, political, and social aspects of rural public mental health services through didactic and supervisory sessions as well as an eight-month practicum experience involving provision of inservice training and administrative and case-related consultation to staff of mental health agencies. An assessment of the program indicated that participants felt it was beneficial, but the program was only partly successful in increasing the number of child psychiatrists entering practice in rural areas. The authors urge that residency programs in child psychiatry give priority to training child psychiatrists for work in rural settings.

  5. A socially excluded space: restrictions on access to health care for older women in rural Bangladesh.

    Science.gov (United States)

    Hossen, Abul; Westhues, Anne

    2010-09-01

    This study was an exploration of the experiences of 17 women, age 60 or more years, from Bangladesh. The women were asked about decision-making processes with respect to their access to health care and whether they perceived that there were differences based on age and sex in the way a household responds to an illness episode. The overall theme that characterized their experiences was "being in a socially excluded space." The themes that explained this perception of social exclusion included gender- and age-based social practices, gender- and class-based economic practices, religious beliefs that restricted the mobility of women, and social constructions of health and illness that led the women to avoid seeking health care. We conclude that the Bangladesh constitutional guarantee that disparities will be eliminated in access to health care between rich and poor, men and women, rural and urban residents, and younger and older citizens has not yet been realized.

  6. Changes in Veterinary Students' Attitudes Toward the Rural Environment and Rural Veterinary Practice: A Longitudinal Cohort Study.

    Science.gov (United States)

    Hashizume, Cary T; Woloschuk, Wayne; Hecker, Kent G

    2015-01-01

    There is a paucity of research regarding veterinary students' attitudes toward the rural environment and rural veterinary practice and how these attitudes might change over the course of a veterinary medicine program that includes rural clinical experience. Using a 23-item questionnaire, attitudes toward rural lifestyle, rural work-life balance, opportunities for career and skill development in rural veterinary practice, and inter-professional teamwork in the rural environment were assessed at the beginning and completion of a four-year veterinary medicine program. Eighty-six students (74.4% female) were included in this Canadian study over a six-year period. Thirty-one participants (36.1%) were rural students. Overall, students' attitudes toward the rural lifestyle, rural work-life balance, and inter-professional teamwork in rural veterinary practice all significantly decreased (pstudents, rural students had significantly higher rural lifestyle scores at both the beginning (pworking in a rural environment could influence students to exclude rural veterinary practice as a career choice. Rural clinical experiences designed to sustain or increase veterinary student interest in rural practice may not be sufficient to support positive rural attitudes. Given the demand for rural veterinary services in developed countries, the implications of this study may extend beyond Canada.

  7. NGO-promoted microcredit programs and women's empowerment in rural Bangladesh: quantitative and qualitative evidence.

    Science.gov (United States)

    Amin, R; Becker, S; Bayes, A

    1998-01-01

    Nongovernmental organizations (NGOs) in rural Bangladesh are reaching out to poor women with collateral-free credit programs aimed at both alleviating poverty and increasing women's status. The present study investigated the hypothesis that participation in credit-related activities by NGO credit members leads to greater empowerment of credit members compared to nonmembers. The sample was comprised of 1164 loanees and 1200 nonloanees from the five NGO areas in Bangladesh and of 1200 nonloanees from non-program areas of rural Bangladesh with no significant NGO presence. NGO credit members had significantly higher scores on all three indices of female empowerment: inter-spouse consultation, autonomy, and authority. Moreover, nonmembers within NGO program areas had higher autonomy and authority scores than nonmembers within the comparison areas. Even after background variables were controlled in the multivariate analysis, NGO credit membership and residence in an NGO program area remained significantly and positively associated with both the autonomy and authority indices. Other variables that exerted a significant positive effect on women's empowerment were concrete or corrugated buildings, area of residence outside the southern or eastern regions, nonagricultural occupation, respondent's education, and age. In focus group discussions, NGO credit loanees reported that the program made them more confident, assertive, intelligent, self-reliant, and aware of their rights. NGO credit programs that target poor women are likely to produce substantial improvements in women's social and economic status, without the long delays associated with education or employment opportunities in the formal sector.

  8. FM POD: an evidence-based blended teaching skills program for rural preceptors.

    Science.gov (United States)

    Delver, Hilary; Jackson, Wesley; Lee, Sonya; Palacios, Mone

    2014-05-01

    The University of Calgary's Rural Integrated Community Clerkship anchors final-year medical student education in 9 months of family medicine. The purpose of this pilot study was to evaluate the Family Medicine Preceptor Online Development (FM POD) program, designed to meet the faculty development needs of rural preceptors facing challenges of geographical distribution and time constraints. The theoretically based program used a blended learning approach, beginning with a face-to-face workshop to strengthen participants' social presence during online interactions to follow. Asynchronous narrated presentations supplied foundational knowledge prior to facilitated synchronous web conferences, where participants shared experiences and co-constructed new knowledge. The program was evaluated using mixed methods, including surveys and focus group discussion. Evaluation tools generated data with high internal consistency reliability; focus group information substantiated and enriched the quantitative survey data. Participants enjoyed collaborating with colleagues and rated their learning experiences highly, reporting meaningful and statistically significant increases in mean comfort with all the precepting skills taught: giving effective feedback, using questions to teach, teaching communications skills, helping learners in difficulty, and making teaching time-efficient. All effect sizes were large. Increased comfort with distance learning technologies was a positive consequence. Results support the applicability of principles of social constructivism, experiential learning, and reflective learning in these participants. The program was highly rated and effectively increased participants' comfort with teaching skills, offering practical off-the-peg modular faculty development in basic teaching skills for distributed faculty. Participants appreciated the flexible delivery format, which course developers found readily adaptable for additional topics.

  9. Professional Access 2013 programming

    CERN Document Server

    Hennig, Teresa; Hepworth, George; Yudovich, Dagi (Doug)

    2013-01-01

    Authoritative and comprehensive coverage for building Access 2013 Solutions Access, the most popular database system in the world, just opened a new frontier in the Cloud. Access 2013 provides significant new features for building robust line-of-business solutions for web, client and integrated environments.  This book was written by a team of Microsoft Access MVPs, with consulting and editing by Access experts, MVPs and members of the Microsoft Access team. It gives you the information and examples to expand your areas of expertise and immediately start to develop and upgrade projects. Exp

  10. 12 CFR 410.151 - Program accessibility: New construction and alterations.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Program accessibility: New construction and alterations. 410.151 Section 410.151 Banks and Banking EXPORT-IMPORT BANK OF THE UNITED STATES ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY EXPORT-IMPORT BANK OF THE UNITED...

  11. Development Strategy for Mobilecommunications Market in Chinese Rural Area

    Science.gov (United States)

    Zhang, Liwei; Zhang, Yanjun; Xu, Liying; Li, Daoliang

    Based on full analysis of rural mobile communication market, in order to explore mobile operators in rural areas of information services for sustainable development model, this paper presents three different aspects, including rural mobile communications market demand, the rural market for mobile communications business model and development strategies for rural mobile communications market research business. It supplies some valuable references for operators to develop rural users rapidly, develop the rural market effectively and to get access to develop a broad space.

  12. Material Implications of Rural Electrification—A Methodological Framework to Assess In-Use Stocks of Off-Grid Solar Products and EEE in Rural Households in Bangladesh

    Directory of Open Access Journals (Sweden)

    Alexander Batteiger

    2018-02-01

    Full Text Available “Universal access to electricity” is proclaimed as the seventh sustainable development goal (SDG 7 of the United Nations (UN Sustainable Development Goals list. The achievement of this goal will result in a rapid diffusion of energy technologies that would in turn increase materials stocks, subsequently increase the raw material demand as well as the arising waste flows. This study describes a methodological framework to assess in-use stocks of off-grid solar products and electrical and electronic equipment (EEE for rural communities in developing countries. The methodology is based on energy-access data. Furthermore, the specifics of the characteristics of off-grid solar products are discussed. The methodology is applied to rural Bangladesh and its solar home system (SHS program. By the end of 2016, around 4.1 million SHSs were installed. This type of access to electricity has a significant impact on the in-use stocks, as households add the comparatively heavy SHSs to their in-use stocks. In-use stocks of EEE, in general, are low. Off-grid solar products are lighter than standard EEE, and fewer products types are available. These findings will help to better understand material stocks and future waste flows in the given context and will support the adaption of recycling infrastructures.

  13. Knowledge Access in Rural Inter-connected Areas Network ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    ... de Capacitación en Desarrollo Rural. Pays d' institution. Chile. Site internet ... Woman conquering male business in Yemen : Waleya's micro-enterprise ... des données probantes sur l'autonomisation des femmes sur le marché du travail.

  14. Spanish-Language Community-Based Mental Health Treatment Programs, Policy-Required Language-Assistance Programming, and Mental Health Treatment Access Among Spanish-Speaking Clients

    Science.gov (United States)

    McClellan, Sean R.

    2013-01-01

    Objectives. We investigated the extent to which implementing language assistance programming through contracting with community-based organizations improved the accessibility of mental health care under Medi-Cal (California’s Medicaid program) for Spanish-speaking persons with limited English proficiency, and whether it reduced language-based treatment access disparities. Methods. Using a time series nonequivalent control group design, we studied county-level penetration of language assistance programming over 10 years (1997–2006) for Spanish-speaking persons with limited English proficiency covered under Medi-Cal. We used linear regression with county fixed effects to control for ongoing trends and other influences. Results. When county mental health plans contracted with community-based organizations, those implementing language assistance programming increased penetration rates of Spanish-language mental health services under Medi-Cal more than other plans (0.28 percentage points, a 25% increase on average; P language-related disparities. Conclusions. Mental health treatment programs operated by community-based organizations may have moderately improved access after implementing required language assistance programming, but the programming did not reduce entrenched disparities in the accessibility of mental health services. PMID:23865663

  15. Spanish-language community-based mental health treatment programs, policy-required language-assistance programming, and mental health treatment access among Spanish-speaking clients.

    Science.gov (United States)

    Snowden, Lonnie R; McClellan, Sean R

    2013-09-01

    We investigated the extent to which implementing language assistance programming through contracting with community-based organizations improved the accessibility of mental health care under Medi-Cal (California's Medicaid program) for Spanish-speaking persons with limited English proficiency, and whether it reduced language-based treatment access disparities. Using a time series nonequivalent control group design, we studied county-level penetration of language assistance programming over 10 years (1997-2006) for Spanish-speaking persons with limited English proficiency covered under Medi-Cal. We used linear regression with county fixed effects to control for ongoing trends and other influences. When county mental health plans contracted with community-based organizations, those implementing language assistance programming increased penetration rates of Spanish-language mental health services under Medi-Cal more than other plans (0.28 percentage points, a 25% increase on average; P language-related disparities. Mental health treatment programs operated by community-based organizations may have moderately improved access after implementing required language assistance programming, but the programming did not reduce entrenched disparities in the accessibility of mental health services.

  16. Implementation and Outcomes of a Comprehensive Type 2 Diabetes Program in Rural Guatemala.

    Directory of Open Access Journals (Sweden)

    David Flood

    Full Text Available The burden of chronic, non-communicable diseases such as diabetes is growing rapidly in low- and middle-income countries. Implementing management programs for diabetes and other chronic diseases for underserved populations is thus a critical global health priority. However, there is a notable dearth of shared programmatic and outcomes data from diabetes treatment programs in these settings.We describe our experiences as a non-governmental organization designing and implementing a type 2 diabetes program serving Maya indigenous people in rural Guatemala. We detail the practical challenges and solutions we have developed to build and sustain diabetes programming in this setting.We conduct a retrospective chart review from our electronic medical record to evaluate our program's performance. We generate a cohort profile, assess cross-sectional indicators using a framework adapted from the literature, and report on clinical longitudinal outcomes.A total of 142 patients were identified for the chart review. The cohort showed a decrease in hemoglobin A1C from a mean of 9.2% to 8.1% over an average of 2.1 years of follow-up (p <0.001. The proportions of patients meeting glycemic targets were 53% for hemoglobin A1C < 8% and 32% for the stricter target of hemoglobin A1C < 7%.We first offer programmatic experiences to address a gap in resources relating to the practical issues of designing and implementing global diabetes management interventions. We then present clinical data suggesting that favorable diabetes outcomes can be attained in poor areas of rural Guatemala.

  17. MEDNET: Telemedicine via Satellite Combining Improved Access to Health-Care Services with Enhanced Social Cohesion in Rural Peru

    Science.gov (United States)

    Panopoulos, Dimitrios; Sachpazidis, Ilias; Rizou, Despoina; Menary, Wayne; Cardenas, Jose; Psarras, John

    Peru, officially classified as a middle-income country, has benefited from sustained economic growth in recent years. However, the benefits have not been seen by the vast majority of the population, particularly Peru's rural population. Virtually all of the nation's rural health-care centres are cut off from the rest of the country, so access to care for most people is not only difficult but also costly. MEDNET attempts to redress this issue by developing a medical health network with the help of the collaboration medical application based on TeleConsult & @HOME medical database for vital signs. The expected benefits include improved support for medics in the field, reduction of patient referrals, reduction in number of emergency interventions and improved times for medical diagnosis. An important caveat is the emphasis on exploiting the proposed infrastructure for education and social enterprise initiatives. The project has the full support of regional political and health authorities and, importantly, full local community support.

  18. Marketing mix for rural development in Romania

    Directory of Open Access Journals (Sweden)

    POLGÁR (DESZKE Klára-Dalma

    2017-01-01

    Full Text Available The sustainable development supposes a uniformly increasing of living level for the entire population of a nation. The reducing of disparities between the urban and rural regions is a purpose of the rural development policy, as a part of Community Agriculture Policy and also subject of European financing programs. A marketing approach of rural development could ensure an integrated implementation of LEADER program in Romania. This paper defines the components of marketing mix for rural development and their content for Romanian rural development marketing.

  19. 78 FR 66885 - Subsistence Management Program for Public Lands in Alaska; Rural Determination Process

    Science.gov (United States)

    2013-11-07

    ..., Federal Subsistence Board, c/o U.S. Fish and Wildlife Service, Attention: Gene Peltola, Office of... harvest seasons and limits. In administering the program, the Secretaries divided Alaska into 10... public on the rural determination process and regulations, and ways to improve them for the benefit of...

  20. Monetary Value of a Prescription Assistance Program Service in a Rural Family Medicine Clinic

    Science.gov (United States)

    Whitley, Heather P.

    2011-01-01

    Purpose: To quantify the monetary value of medications provided to rural Alabamians through provision of pharmaceutical manufacturer-sponsored prescription assistance programs (PAPs) provided by a clinical pharmacist in a private Black Belt family medicine clinic during 2007 and 2008. Methods: Patients struggling to afford prescription medications…

  1. Rural women's health

    National Research Council Canada - National Science Library

    Thurston, Wilfreda E; Leach, Belinda; Leipert, Beverly

    2012-01-01

    ... about reduction of government funding and access to health care, and about the shortage of new volunteers to replace them when they burn out. These are a few of the stories told in the chapters of this book. This ground-breaking collection of essays identifies priority issues that must be addressed to ensure rural women's well-being, and offers innovative ideas for improvement and further research. Rural women play a critical role within their families and communities, and the health of these wome...

  2. Rural energetic troubles in Ecuador; Problemas de la Energizacion rural en Ecuador

    Energy Technology Data Exchange (ETDEWEB)

    Barriga, A [Facultad de Ingenieria Mecanica, Escuela superior politecnica del Litoral, ESPOL, Guayaquil (Ecuador)

    1994-07-01

    The present work presents a general situation of Ecuador, its demand of Energy, programs of electrification rural, energy requirements in the hydroelectric rural sector, central sector built in Ecuador and the priorities of energy use.

  3. Institutional options for rural energy access: Exploring the concept of the multifunctional platform in West Africa

    DEFF Research Database (Denmark)

    Nygaard, Ivan

    2010-01-01

    The concept of the multifunctional platform for rural energy access has increasingly been supported by donors in five West African countries since 1994. While it is often referred to as a highly successful concept, recent reviews and interviews with local stakeholders in Mali and Burkina Faso...... in the dominant discourse of development, and how including concerns, such as poverty alleviation, gender equity, local democracy, decentralisation and the environment, have attracted donors outside the energy sector. The paper thus argues that, while the integration of multiple technical functions, preconceived...... practical programmes provides an argument for building development aid on existing structures instead of inventing new complicated concepts and approaches....

  4. Developing a strategic marketing plan for physical and occupational therapy services: a collaborative project between a critical access hospital and a graduate program in health care management.

    Science.gov (United States)

    Kash, Bita A; Deshmukh, A A

    2013-01-01

    The purpose of this study was to develop a marketing plan for the Physical and Occupational Therapy (PT/OT) department at a Critical Access Hospital (CAH). We took the approach of understanding and analyzing the rural community and health care environment, problems faced by the PT/OT department, and developing a strategic marketing plan to resolve those problems. We used hospital admissions data, public and physician surveys, a SWOT analysis, and tools to evaluate alternative strategies. Lack of awareness and negative perception were key issues. Recommended strategies included building relationships with physicians, partnering with the school district, and enhancing the wellness program.

  5. Rural Depopulation Pattern at Yogyakarta Special Province (DIY

    Directory of Open Access Journals (Sweden)

    M Baiquni

    2004-01-01

    This paper is based on a secondary data research i.e. statistical data at rural levels in Yogyakarta, thematics maps and other documents. Statistical methodes and map pattern analysis are employed to analysis data. The result of this research are as follows: a the rural depopulation in DIY can be found in 189 rural areas of 393 rural areas (48.09%; b the spatial distribution of the rural depopulation are in Gunung Kidul District (80 rural areas, Kulon Progo District (59 rural areas Sleman District (33 rural areas, and Bantul District (17 rural areas; c the rural depopulation in Yogyakarta at least related to six factors whih have been identified as out – migration, local resources, carrying capacity, geographycal location or accessibility, rural infrastructure, and service availability.

  6. US Health Care Reform and Rural America: Results From the ACA's Medicaid Expansions.

    Science.gov (United States)

    Benitez, Joseph A; Seiber, Eric E

    2018-03-01

    Medicaid expansions, prompted by the Affordable Care Act, generated generally positive effects on coverage and alleviated much of the financial burden associated with seeking health care. We do not know if these shifts also extend to the nation's rural populations. Using 2011-2015 Behavioral Risk Factor Surveillance System data, this study compares trend changes for coverage, access to care, and health care utilization in response to Medicaid expansion among urban and rural residents using a difference-in-differences regression approach. Following Medicaid expansion, low-income rural and urban residents both experienced reductions in uninsurance; however, the coverage uptake in rural settings (8.5 percentage points [pp], P .10). In spite of larger uptakes in coverage among rural residents, reductions in cost-related barriers to medical care were slightly larger among urban residents, and access to a regular source of medical care (5.2 pp, P rural residents than urban residents; however, it appears there remain opportunities to improve access to care among potentially vulnerable rural residents. © 2017 National Rural Health Association.

  7. Access to special education for exceptional students in French immersion programs: An equity issue

    Directory of Open Access Journals (Sweden)

    Nancy Wise

    2011-06-01

    Full Text Available Abstract Exceptional pupils enrolled in Canadian French immersion programs rarely have access to the same range of special education programs and services that are available to students in the regular English program. More often than not, students with special needs are encouraged to transfer to English programs to access necessary support services. This counselling-out process perpetuates the elitist status commonly attributed to French immersion programs. From a critical pedagogy perspective, this inquiry examines the lack of incentive on the part of multiple French immersion stakeholders to accommodate students with special needs. It further attempts to unveil the myths created by these stakeholders to better understand this discriminatory educational practice. The impact of federal and provincial funding models on access to special education programs and services is discussed, and the application of funding allocations by English-language district school boards is explored. The inquiry concludes with recommendations to promote more inclusionary practices.

  8. How primary health care staff working in rural and remote areas access skill development and expertise to support health promotion practice.

    Science.gov (United States)

    McFarlane, Kathryn A; Judd, Jenni; Wapau, Hylda; Nichols, Nina; Watt, Kerrianne; Devine, Sue

    2018-05-01

    Health promotion is a key component of comprehensive primary health care. Health promotion approaches complement healthcare management by enabling individuals to increase control over their health. Many primary healthcare staff have a role to play in health promotion practice, but their ability to integrate health promotion into practice is influenced by their previous training and experience. For primary healthcare staff working in rural and remote locations, access to professional development can be limited by what is locally available and prohibitive in terms of cost for travel and accommodation. This study provides insight into how staff at a large north Queensland Aboriginal community controlled health service access skill development and health promotion expertise to support their work. A qualitative exploratory study was conducted. Small group and individual semi-structured interviews were conducted with staff at Apunipima Cape York Health Council (n=9). A purposive sampling method was used to recruit participants from a number of primary healthcare teams that were more likely to be involved in health promotion work. Both on-the-ground staff and managers were interviewed. All participants were asked how they access skill development and expertise in health promotion practice and what approaches they prefer for ongoing health promotion support. The interviews were transcribed verbatim and analysed thematically. All participants valued access to skill development, advice and support that would assist their health promotion practice. Skill development and expertise in health promotion was accessed from a variety of sources: conferences, workshops, mentoring or shared learning from internal and external colleagues, and access to online information and resources. With limited funds and limited access to professional development locally, participants fostered external and internal organisational relationships to seek in-kind advice and support. Irrespective of

  9. Validity of Medical Student Questionnaire Data in Prediction of Rural Practice Choice and Its Association With Service Orientation.

    Science.gov (United States)

    Shannon, C Ken; Jackson, Jodie

    2015-01-01

    The validity of medical student projection of, and predictors for, rural practice and the association of a measure of service orientation, projected practice accessibility to the indigent, were investigated. West Virginia (WV) medical student online pre- and postrural rotation questionnaire data were collected during the time period 2001-2009. Of the 1,517 respondent students, submissions by 1,271 met the time interval criterion for inclusion in analyses. Subsequent WV licensing data were available for 461 in 2013. These 2 databases were used to assess for validity of projection of rural practice, for predictors of rural practice, and for student projected accessibility of the future practice to indigent patients. There were statistically significant associations between both pre- and postrotation projections of rural practice and subsequent rural practice. The most significant independent predictors of rural practice were student rural background, reported primary care intent, prediction of rural practice and projection of greater accessibility of the future practice to indigent patients. For scoring of practice access, there were trends for higher scoring by rural students and rural practitioners, with greater pre-post increases for those with urban hometowns. This study demonstrates the utility of medical student questionnaires for projections of numbers of future rural physicians. It suggests that students with a rural background, rural practice intent, or greater service orientation are more likely to enter rural practice. It also suggests that students, particularly those with urban hometowns, are influenced by rural rotation experiences in forecasting greater practice accessibility and in entering rural practice. © 2015 National Rural Health Association.

  10. Evaluation as a tool for planning: a case study on rural electrification; Avaliacao como instrumento de planejamento: estudo de caso em eletrificacao rural

    Energy Technology Data Exchange (ETDEWEB)

    Pereira, Marcio Giannini; Rodrigues, Alexia de Freitas; Paz, Luciana Rocha Leal da [Centro de Pesquisas de Energia Eletrica (CEPEL), Rio de Janeiro, RJ (Brazil); Camacho, Cristiane Farias [Fundacao Padre Leonel Franca, Rio de Janeiro, RJ (Brazil)

    2008-07-01

    The universalization of access of the electric energy is one of the goals established by the Brazilian government so as to attend the rural and urban population. The arrival of electric energy in remote and low income areas allows these populations to reach one of the basic conditions to improve the quality of life and citizenship. In order to achieve this goal efficiently, it is necessary to build tools that make possible the impact and process evaluation, searching the continuous improvement of the planning and decision making, either in the direction of the attendance of the proposed goals, or in the poverty mitigation. The knowledge originated from evaluation impact studies provides an important contribution to the improvement of social programs, and a return to society as how the public fund is being managed, promoting transparency and focus. In this context, tolls are developed so as to support the impact and process evaluation in terms of rural electrification publics policies, using a study case that includes about 23.000 questionnaires in 21 states, considering the moment before the access (ex-ante) and after (ex-post), during the years of 2000 and 2004. (author)

  11. Views of young people in rural Australia on SPARX, a fantasy world developed for New Zealand youth with depression

    DEFF Research Database (Denmark)

    Cheek, Colleen; Bridgman, Heather; Fleming, Theresa

    2014-01-01

    Background: A randomized control trial demonstrated that a computerized cognitive behavioral therapy (cCBT) program (Smart, Positive, Active, Realistic, X-factor thoughts [SPARX]) was an appealing and efficacious treatment for depression for adolescents in New Zealand. Little is known about...... the acceptability of computerized therapy programs for rural Australians and the suitability of computerized programs developed in one cultural context when used in another country. Issues such as accents and local differences in health care access might mean adjustments to programs are required. Objective...

  12. Evaluation of criteria for sustainability of community-based rural homestay programs via a modified pairwise comparison method

    Science.gov (United States)

    Ramli, Rohaini; Kasim, Maznah Mat; Ramli, Razamin; Kayat, Kalsom; Razak, Rafidah Abd

    2014-12-01

    Ministry of Tourism and Culture Malaysia has long introduced homestay programs across the country to enhance the quality of life of people, especially those living in rural areas. This type of program is classified as a community-based tourism (CBT) as it is expected to economically improve livelihood through cultural and community associated activities. It is the aspiration of the ministry to see that the income imbalance between people in the rural and urban areas is reduced, thus would contribute towards creating more developed states of Malaysia. Since 1970s, there are 154 homestay programs registered with the ministry. However, the performance and sustainability of the programs are still not satisfying. There are only a number of homestay programs that perform well and able to sustain. Thus, the aim of this paper is to identify relevant criteria contributing to the sustainability of a homestay program. The criteria are evaluated for their levels of importance via the use of a modified pairwise method and analyzed for other potentials. The findings will help the homestay operators to focus on the necessary criteria and thus, effectively perform as the CBT business initiative.

  13. Pregnancy and Village Outreach Tibet: a descriptive report of a community- and home-based maternal-newborn outreach program in rural Tibet.

    Science.gov (United States)

    Dickerson, Ty; Crookston, Benjamin; Simonsen, Sara E; Sheng, Xiaoming; Samen, Arlene; Nkoy, Flory

    2010-01-01

    The Pregnancy and Village Outreach Tibet (PAVOT) program, a model for community- and home-based maternal-newborn outreach in rural Tibet, is presented. This article describes PAVOT, including the history, structure, content, and activities of the program, as well as selected program outcome measures and demographic characteristics, health behaviors, and pregnancy outcomes of women who recently participated in the program. The PAVOT program was developed to provide health-related services to pregnant rural Tibetan women at risk of having an unattended home birth. The program involves training local healthcare workers and laypersons to outreach pregnant women and family members. Outreach includes basic maternal-newborn health education and simple obstetric and neonatal life-saving skills training. In addition, the program distributes safe and clean birth kits, newborn hats, blankets, and maternal micronutrient supplements (eg, prenatal vitamins and minerals). More than 980 pregnant women received outreach during the study period. More than 92% of outreach recipients reported receiving safe pregnancy and birth education, clean birthing and uterine massage skills instruction, and clean umbilical cord care training. Nearly 80% reported basic newborn resuscitation skills training. Finally, nearly 100% of outreach recipients received maternal micronutrient supplements and safe and clean birth kits. The PAVOT program is a model program that has been proven to successfully provide outreach to rural-living Tibetans by delivering maternal-newborn health education, skills training, and resources to the home.

  14. A qualitative study of medical students in a rural track: views on eventual rural practice.

    Science.gov (United States)

    Roseamelia, Carrie; Greenwald, James L; Bush, Tiffany; Pratte, Morgan; Wilcox, Jessica; Morley, Christopher P

    2014-04-01

    Rural tracks (RTs) exist within medical schools across the United States. These programs often target those students from rural areas and those with primary care career interests, given that these factors are robust predictors of eventual rural practice. However, only 26% to 64% of graduates from RTs enter eventual rural practice. We conducted a qualitative, exploratory study of medical students enrolled in one school's RT, examining their interests in rural training, specialization, and eventual rural practice, via open coding of transcripts from focus groups and in-depth individual interviews, leading to identification of emerging themes. A total of 16 out of 54 eligible first- and second-year preclinical medical students participated in focus group sessions, and a total of seven out of 17 eligible third- and fourth-year medical students participated in individual interviews. Analyses revealed the recognition of a "Rural Identity," typical characteristics, and the importance of "Program Fit" and "Intentions for Practice" that trended toward family medicine specialization and rural practice. However, nuances within the comments reveal incomplete commitment to rural practice. In many cases, student preference for rural practice was driven largely by a disinterest in urban practice. Students with rural and primary care practice interests are often not perfectly committed to rural practice. However, RTs may provide a haven for such students within medical school.

  15. Information needs of rural health professionals: a review of the literature.

    Science.gov (United States)

    Dorsch, J L

    2000-10-01

    This review analyzes the existing research on the information needs of rural health professionals and relates it to the broader information-needs literature to establish whether the information needs of rural health professionals differ from those of other health professionals. The analysis of these studies indicates that rural health practitioners appear to have the same basic needs for patient-care information as their urban counterparts, and that both groups rely on colleagues and personal libraries as their main sources of information. Rural practitioners, however, tend to make less use of journals and online databases and ask fewer clinical questions; a difference that correlates with geographic and demographic factors. Rural practitioners experience pronounced barriers to information access including lack of time, isolation, inadequate library access, lack of equipment, lack of skills, costs, and inadequate Internet infrastructure. Outreach efforts to this group of underserved health professionals must be sustained to achieve equity in information access and to change information-seeking behaviors.

  16. INVESTMENTS AND SERVICES ON THE RURAL DEVELOPMENT IN ROMANIA

    Directory of Open Access Journals (Sweden)

    Popa Ana

    2013-04-01

    Full Text Available The article started with the modern connection observed between sectors in EU -primary, secondary and tertiary- on rural areas, where agriculture becomes essential. First, this connection is manifested in Romania under the impact of the main directions of the Common Agricultural Policy (CAP during 2014-2020, namely: a more market-oriented production, but also related to the public, promoting food security, while considering environmental issues and, in addition, achieve cooperation and alignment to the European Economic Area, including equality in European funding. Secondly, there is a dedicated rural development policy, which is supported by a series of investments, but imposed a number of directions that will lead to the expansion of tertiary sector measures, marketing, tourism, ecology, and promoting social inclusion, poverty reduction and economic development in rural areas. Other influences are generated by foreign direct investments-FDI in rural areas. The conclusion is based on the fragility of the rural sector in Romania, compared to other European countries and highlights specific areas of interest of stakeholders for the following issues: improving policies and decisions, access to markets, infrastructure development, access to financial services, access to knowledge, services innovation and risk reduction.

  17. Association of mandated language access programming and quality of care provided by mental health agencies.

    Science.gov (United States)

    McClellan, Sean R; Snowden, Lonnie

    2015-01-01

    This study examined the association between language access programming and quality of psychiatric care received by persons with limited English proficiency (LEP). In 1999, the California Department of Mental Health required county Medicaid agencies to implement a "threshold language access policy" to meet the state's Title VI obligations. This policy required Medi-Cal agencies to provide language access programming, including access to interpreters and translated written material, to speakers of languages other than English if the language was spoken by at least 3,000, or 5%, of the county's Medicaid population. Using a longitudinal study design with a nonequivalent control group, this study examined the quality of care provided to Spanish speakers with LEP and a severe mental illness before and after implementation of mandatory language access programming. Quality was measured by receipt of at least two follow-up medication visits within 90 days or three visits within 180 days of an initial medication visit over a period of 38 quarter-years. On average, only 40% of Spanish-speaking clients received at least three medication follow-up visits within 180 days. In multivariate analyses, language access programming was not associated with receipt of at least two medication follow-up visits within 90 days or at least three visits within 180 days. This study found no evidence that language access programming led to increased rates of follow-up medication visits for clients with LEP.

  18. Randomized Trial of Supported Employment Integrated With Assertive Community Treatment for Rural Adults With Severe Mental Illness

    Science.gov (United States)

    Gold, Paul B; Meisler, Neil; Santos, Alberto B; Carnemolla, Mark A; Williams, Olivia H; Keleher, Jennie

    2006-01-01

    Urban-based randomized clinical trials of integrated supported employment (SE) and mental health services in the United States on average have doubled the employment rates of adults with severe mental illness (SMI) compared to traditional vocational rehabilitation. However, studies have not yet explored if the service integrative functions of SE will be effective in coordinating rural-based services that are limited, loosely linked, and geographically dispersed. In addition, SE's ability to replicate the work outcomes of urban programs in rural economies with scarce and less diverse job opportunities remains unknown. In a rural South Carolina county, we designed and implemented a program blending Assertive Community Treatment (ACT) with an SE model, Individual Placement and Support (IPS). The ACT-IPS program operated with ACT and IPS subteams that tightly integrated vocational with mental health services within each self-contained team. In a 24-month randomized clinical trial, we compared ACT-IPS to a traditional program providing parallel vocational and mental health services on competitive work outcomes for adults with SMI (N = 143; 69% schizophrenia, 77% African American). More ACT-IPS participants held competitive jobs (64 versus 26%; p < .001, effect size [ES] = 0.38) and earned more income (median [Mdn] = $549, interquartile range [IQR] = $0–$5,145, versus Mdn = $0, IQR = $0–$40; p < .001, ES = 0.70) than comparison participants. The competitive work outcomes of this rural ACT-IPS program closely resemble those of urban SE programs. However, achieving economic self-sufficiently and developing careers probably require increasing access to higher education and jobs imparting marketable technical skills. PMID:16177278

  19. A mobile phone-based, community health worker program for referral, follow-up, and service outreach in rural Zambia: outcomes and overview.

    Science.gov (United States)

    Schuttner, Linnaea; Sindano, Ntazana; Theis, Mathew; Zue, Cory; Joseph, Jessica; Chilengi, Roma; Chi, Benjamin H; Stringer, Jeffrey S A; Chintu, Namwinga

    2014-08-01

    Mobile health (m-health) utilizes widespread access to mobile phone technologies to expand health services. Community health workers (CHWs) provide first-level contact with health facilities; combining CHW efforts with m-health may be an avenue for improving primary care services. As part of a primary care improvement project, a pilot CHW program was developed using a mobile phone-based application for outreach, referral, and follow-up between the clinic and community in rural Zambia. The program was implemented at six primary care sites. Computers were installed at clinics for data entry, and data were transmitted to central servers. In the field, using a mobile phone to send data and receive follow-up requests, CHWs conducted household health surveillance visits, referred individuals to clinic, and followed up clinic patients. From January to April 2011, 24 CHWs surveyed 6,197 households with 33,304 inhabitants. Of 15,539 clinic visits, 1,173 (8%) had a follow-up visit indicated and transmitted via a mobile phone to designated CHWs. CHWs performed one or more follow-ups on 74% (n=871) of active requests and obtained outcomes on 63% (n=741). From all community visits combined, CHWs referred 840 individuals to a clinic. CHWs completed all planned aspects of surveillance and outreach, demonstrating feasibility. Components of this pilot project may aid clinical care in rural settings and have potential for epidemiologic and health system applications. Thus, m-health has the potential to improve service outreach, guide activities, and facilitate data collection in Zambia.

  20. Feasibility and quality of cardiovascular disease prevention within a community-based health insurance program in rural Nigeria: an operational cohort study

    NARCIS (Netherlands)

    Hendriks, Marleen E.; Bolarinwa, Oladimeji A.; Wit, Ferdinand W. N. W.; Brewster, Lizzy M.; Odusola, Aina O.; Rosendaal, Nicole T. A.; Bindraban, Navin R.; Adenusi, Peju; Agbede, Kayode; Lange, Joep M. A.; Akande, Tanimola M.; Schultsz, Constance

    2015-01-01

    To assess the feasibility of providing guideline-based cardiovascular disease (CVD) prevention care within the context of a community-based health insurance program (CBHI) in rural Nigeria. A prospective operational cohort study was conducted in a primary healthcare clinic in rural Nigeria,

  1. 78 FR 53423 - Section 538 Guaranteed Rural Rental Housing Program for Fiscal Year 2013

    Science.gov (United States)

    2013-08-29

    ... 3560.406) of existing direct Section 515 and Section 514/516 Farm Labor Housing (FLH) (transfer costs... is taken to extend the eligible properties to include Rural Development financed Farm Labor Housing...) program. Equity payment, as stipulated in 7 CFR 3560.406, in the transfer of existing direct Section 515...

  2. Women's experiences accessing a women-centered cardiac rehabilitation program: a qualitative study.

    Science.gov (United States)

    Rolfe, Danielle E; Sutton, Erica J; Landry, Mireille; Sternberg, Len; Price, Jennifer A D

    2010-01-01

    The health benefits of cardiac rehabilitation (CR) for women living with heart disease are well documented, yet women remain underrepresented in traditionally structured CR programs. This health service delivery gap has been attributed to a number of sex-related factors experienced by women, including lower rates of physician referral, travel-related barriers, competing work and caregiving responsibilities, greater cardiovascular disease severity, and number of comorbid health conditions. Whether a program specifically designed for women is able to address these barriers and facilitate women's participation is a question that has seldom been explored in the CR literature. As part of a larger study exploring whether 6 predefined principles of women's health (empowerment of women, accessible programs, broad definition of health care, high-quality of care, collaborative planning, and innovative and creative approaches) are reflected in the practices of the Women's Cardiovascular Health Initiative (WCHI) (a comprehensive CR and primary prevention program designed for women), the objective of this analysis was to explore how the principle of "accessible programs" is experienced by women participating in the WCHI. Fourteen women previously enrolled in the WCHI program participated in a single, in-person qualitative interview. Transcripts were analyzed using a constant-comparative approach to identify relevant themes related to program accessibility. Key themes identified included participants' experiences with acquiring physician referral, negotiating transportation issues, and navigating program schedules. Women discussed how peer support and staff members' willingness to address their health-related concerns facilitated their participation. While a women-centered CR/primary prevention program may facilitate and encourage women's participation by providing flexible program schedules as well as peer and professional support, efforts are still required to address

  3. Accessing diabetes care in rural Uganda

    DEFF Research Database (Denmark)

    Nielsen, Jannie; Bahendeka, Silver K.; Bygbjerg, Ib C.

    2017-01-01

    Non-communicable diseases including type 2 diabetes (T2D) are increasing rapidly in most Sub-Saharan African (SSA) countries like Uganda. Little attention has been given to how patients with T2D try to achieve treatment when the availability of public health care for their disease is limited......, as is the case in most SSA countries. In this paper we focus on the landscape of availability of care and the therapeutic journeys of patients within that landscape. Based on fieldwork in south-western Uganda including 10 case studies, we explore the diabetes treatment options in the area and what it takes...... to access the available treatment. We analyse the resources patients need to use the available treatment options, and demonstrate that the patients’ journeys to access and maintain treatment are facilitated by the knowledge and support of their therapy management groups. Patients access treatment more...

  4. Access to Money and Relation to Women's Use of Family Planning Methods Among Young Married Women in Rural India.

    Science.gov (United States)

    Reed, Elizabeth; Donta, Balaiah; Dasgupta, Anindita; Ghule, Mohan; Battala, Madhusudana; Nair, Saritha; Silverman, Jay; Jadhav, Arun; Palaye, Prajakta; Saggurti, Niranjan; Raj, Anita

    2016-06-01

    Objectives The social positioning (i.e. social status and autonomy) of women in the household facilitates women's access to and decision-making power related to family planning (FP). Women's access to spending money, which may be an indicator of greater social positioning in the household, may also be greater among women who engage in income generating activities for their families, regardless of women's status in the household. However, in both scenarios, access to money may independently afford greater opportunity to obtain family planning services among women. This study seeks to assess whether access to money is associated with FP outcomes independently of women's social positioning in their households. Methods Using survey data from married couples in rural Maharashtra, India (n = 855), crude and adjusted regression was used to assess women's access to their own spending money in relation to past 3 month use of condoms and other forms of contraceptives (pills, injectables, intrauterine device). Results Access to money (59 %) was associated with condom and other contraceptive use (AORs ranged 1.5-1.8). These findings remained significant after adjusting for women's FP decision-making power in the household and mobility to seek FP services. Conclusion While preliminary, findings suggest that access to money may increase women's ability to obtain FP methods, even in contexts where social norms to support women's power in FP decision-making may not be readily adopted.

  5. 25 CFR 170.128 - Are housing access roads and housing streets eligible for IRR Program funding?

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Are housing access roads and housing streets eligible for... INTERIOR LAND AND WATER INDIAN RESERVATION ROADS PROGRAM Indian Reservation Roads Program Policy and Eligibility Irr Housing Access Roads § 170.128 Are housing access roads and housing streets eligible for IRR...

  6. Enhancing rural connectivity through an extended internet cafés business models

    DEFF Research Database (Denmark)

    Williams, Idongesit; Gyaase, Patrick Ohemeng Kwadwo; Falch, Morten

    2013-01-01

    This paper discusses the potentials of an adaptation of the Internet café business model adopted for Internet access in African cities to improve rural Internet access through a partnership between the public and private sectors. The rural areas in most developing countries e lack of Internet...... are replicated in the rural areas. . A study is carried out in Ghana, where the market players in the Internet café operations to ascertain the potential viability of public –private partnership in the provisioning of internet access in the rural areas in Ghana. A new business model in the form of Public Private...... connectivity due to commercial unviability of such investment by the private sector alone.. The modernization theory is used to support the concept that the availability of Internet services in rural can be catalyzed if an Adaptation of the Internet cafés business model incorporating the public participation...

  7. From aquaculture goals to real social and ecological impacts: carp introduction in rural Central Mexico.

    Science.gov (United States)

    Tapia, Mónica; Zambrano, Luis

    2003-06-01

    Aquaculture has been seen as a solution to food/protein availability in rural populations of poor countries. It is mainly based on exotic species, that produce changes in host system dynamics once introduced. Aquaculture not only changes the ecology of freshwater systems, but can also lead to modification of social relations. Until now, aquaculture programs have not been adequately analyzed no questioned enough. We evaluate both ecological effects and local social benefits of common carp aquaculture programs in shallow ponds of rural areas, using a municipality in Central Mexico as a case study. Using an "environmental entitlements" approach, our findings suggest that: i) carp aquaculture increases water turbidity and depletes native species reducing the poor people's access to them; ii) aquaculture mainly benefits pond owners rather than poor peasants. This mainly results from changes in fishing rights. We conclude that aquaculture policy goals and assumptions of benefits should be reviewed, if the negative ecological effects are to be decreased and conditions for people in rural areas are to be improved.

  8. Persistent problems of access to appropriate, affordable TB services in rural China: experiences of different socio-economic groups.

    Science.gov (United States)

    Zhang, Tuohong; Tang, Shenglan; Jun, Gao; Whitehead, Margaret

    2007-02-08

    Large-scale Tuberculosis (TB) control programmes in China have been hailed a success. Concerns remain, however, about whether the programme is reaching all sections of the population, particularly poorer groups within rural communities, and whether there are hidden costs. This study takes a household perspective to investigate receipt of appropriate care and affordability of services for different socio-economic groups with TB symptoms in rural China. Secondary analysis of Chinese National Household Health Survey for 2003: 40,000 rural households containing 143,991 individuals, 2,308 identified as TB suspects. use of services and expenditure of TB suspects, by gender and socio-economic position, indicated by household income, education, material assets, and insurance status. 37% of TB suspects did not seek any professional care, with low-income groups less likely to seek care than more affluent counterparts. Of those seeking care, only 35% received any of the recommended diagnostic tests. Of the 182 patients with a confirmed TB diagnosis, 104 (57%) received treatment at the recommended level, less likely if lacking health insurance or material assets. The burden of payment for services amounted to 45% of annual household income for the low-income group, 16% for the high-income group. Access to appropriate, affordable TB services is still problematic in some rural areas of China, and receipt of care and affordability declines with declining socio-economic position. These findings highlight the current shortcomings of the national TB control programme in China and the formidable challenge it faces if it is to reach all sections of the population, including the poor with the highest burden of disease.

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

    Science.gov (United States)

    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.

  10. Misoprostol for the prevention of postpartum hemorrhage during home births in rural Lao PDR: establishing a pilot program for community distribution.

    Science.gov (United States)

    Durham, Jo; Phengsavanh, Alongkone; Sychareun, Vanphanom; Hose, Isaac; Vongxay, Viengnakhone; Xaysomphou, Douangphachanh; Rickart, Keith

    2018-01-01

    The purpose of this study was to gather the necessary data to support the design and implementation of a pilot program for women who are unable to deliver in a healthcare facility in the Lao People's Democratic Republic (PDR), by using community distribution of misoprostol to prevent postpartum hemorrhage (PPH). The study builds on an earlier research that demonstrated both support and need for community-based distribution of misoprostol in Lao PDR. This qualitative study identified acceptability of misoprostol and healthcare system needs at varying levels to effectively distribute misoprostol to women with limited access to facility-based birthing. Interviews (n=25) were undertaken with stakeholders at the central, provincial, and district levels and with community members in five rural communities in Oudomxay, a province with high rates of maternal mortality. Focus group discussions (n=5) were undertaken in each community. Respondents agreed that PPH was the major cause of preventable maternal mortality with community distribution of misoprostol an acceptable and feasible interim preventative solution. Strong leadership, training, and community mobilization were identified as critical success factors. While several participants preferred midwives to distribute misoprostol, given the limited availability of midwives, there was a general agreement that village health workers or other lower level workers could safely administer misoprostol. Many key stakeholders, including women themselves, considered that these community-level staff may be able to provide misoprostol to women for self-administration, as long as appropriate education on its use was included. The collected data also helped identify appropriate educational messages and key indicators for monitoring and evaluation for a pilot program. The findings strengthen the case for a pilot program of community distribution of misoprostol to prevent PPH in remote communities where women have limited access to a

  11. Sustaining the rural primary healthcare workforce: survey of healthcare professionals in the Scottish Highlands.

    Science.gov (United States)

    Richards, Helen M; Farmer, Jane; Selvaraj, Sivasubramaniam

    2005-01-01

    Many westernised countries face ongoing difficulties in the recruitment and retention of health professionals in remote and rural communities. Predictors of rural working have been identified by the international literature, and include: the individual having been born or educated in a rural location; exposure to rural healthcare during training; access to continuing professional education; good relationships with peers; spousal contentedness; adoption of a rural 'lifestyle'; successful integration into local communities; and educational opportunities for children. However, those themes remain unverified in the UK. The present study aimed to ascertain whether the internationally identified determinants of recruitment and retention of the rural health workforce apply in the Highlands of Scotland, which includes the most sparsely populated area of the UK mainland, as well as an urban area. In 2003, a questionnaire was sent to all 2070 primary healthcare professionals working in the Highlands (which makes up one-third of Scotland's land area (9800 square miles) and has just 4% of the country's population (209,000)). Approximately one-quarter of the Highland's population live in Inverness. The area is ideal for investigating the rural workforce due to its population sparsity and the inclusion of small towns and Inverness, allowing urban/rural comparisons. The questionnaire asked about places of birth and education; intentions to stay/leave current location; professional isolation; access to amenities; and perceptions of belonging to the local community. The response rate was 53%. Compared with respondents working in urban areas, those working in rural areas were more likely to have been born in rural areas. Professionals living in rural areas were more likely to have been born outside Scotland and to have completed their secondary education and professional training outside Scotland, compared with those living in urban areas. Approximately one-third (34%) had lived in

  12. Rural energy finance in Tanzania: Thinking outside the box

    International Nuclear Information System (INIS)

    Persson, Therese Hindman; Anderson, Ryan

    2006-01-01

    Conventional financing approaches have proven inadequate in the drive to provide rural communities with modern energy. A recent study by ECON found a critical need for initiatives aimed at improving consumer's access to financing. In addition, demonstration projects are needed to prove the financial viability of investments in rural energy. ECON's recommendations are focused on strengthening the demand side of the financial supply chain and, in particular, consumers' access to credit

  13. Validating competencies for an undergraduate training program in rural medicine using the Delphi technique.

    Science.gov (United States)

    Gouveia, Eneline Ah; Braga, Taciana D; Heráclio, Sandra A; Pessoa, Bruno Henrique S

    2016-01-01

    Worldwide, half the population lives in rural or remote areas; however, less than 25% of doctors work in such regions. Despite the continental dimensions of Brazil and its enormous cultural diversity, only some medical schools in this country offer students the opportunity to acquire work experience focused on medicine in rural or remote areas. The objective of the present study was to develop a framework of competencies for a longitudinal medical training program in rural medicine as an integrated part of medical training in Brazil. Two rounds of a modified version of the Delphi technique were conducted. Initially, a structured questionnaire was elaborated, based on a literature review. This questionnaire was submitted to the opinion of 20 panelists affiliated with the Rural Medicine Working Party of the Brazilian Society of Family and Community Medicine. The panelists were asked to evaluate the relevance of the competencies using a five-point Likert-type scale. In this study, the consensus criterion for a competency to be included in the framework was it being deemed 'very important' or 'indispensable' by a simple majority of the participants, while the criterion for excluding a competency was that a simple majority of the panel members considered that it 'should not be included' or was 'of little importance'. When a consensus was not reached regarding a given competency, it was submitted to a second round to enable the panelists to re-evaluate the now dichotomized questions. Compliance in responding to the questionnaire was better among the panelists predominantly involved in teaching activities (85%; n=12) compared to those working principally in patient care (45%; n=8). The questionnaire consisted of 26 core competencies and 165 secondary competencies. After evaluation by the specialists, all the 26 core competencies were classified as relevant, with none being excluded and only eight secondary competencies failing to achieve a consensus. No new competencies

  14. Renewable Energy for Rural Health Clinics

    International Nuclear Information System (INIS)

    Jimenez, T.; Olson, K.

    1999-01-01

    This is first of a series of application guides that the Program of 'Energia of Villas' of NREL has commissioned to connect renewable commercial systems with rural applications, including water, rural schools and micro companies. The guide is complemented by the development activities of the Program of 'Energia of Villas' of NREL, international pilot projects and programs of professional visits [es

  15. The Health and Social Impacts of Easy Access to Alcohol and Exposure to Alcohol Advertisements Among Women of Childbearing Age in Urban and Rural South Africa.

    Science.gov (United States)

    Amanuel, Hanna; Morojele, Neo; London, Leslie

    2017-03-07

    The purpose of this study was to analyze the impact of easy access to alcohol and exposure to alcohol advertisements on women's alcohol consumption, reproductive history, and health and social outcomes in an urban and rural site in South Africa. Trained fieldworkers conducted face-to-face interviews with 1,018 women of childbearing age in the Moot, Mamelodi, and Eesterus areas of the City of Tshwane (Gauteng province) and in the rural Cederberg, Bergrivier, and Swartland municipalities (Western Cape province), recruited through random sampling and stratified cluster random sampling, respectively. Multivariate logistic regression analyses were conducted, stratified according to the urban and rural sites and controlled for four demographic factors. In Tshwane, complications in the last pregnancy (odds ratio [OR] = 7.84, 95% CI [1.77, 34.80]), interpartner binge drinking (OR = 6.50, 95% CI [3.85, 10.94]), and community drinking (OR = 7.92, 95% CI [4.59, 13.65]) were positively associated with alcohol accessibility. Interpartner violence (OR = 4.16, 95% CI [1.99, 8.70]) and community drinking (OR = 3.39, 95% CI [2.07, 5.53]) were positively associated with exposure to alcohol advertisements. In Western Cape, community drinking (OR = 10.26, 95% CI [4.02, 26.20]) was positively associated with alcohol accessibility, whereas ability to pay for health care (OR = 0.48, 95% CI [0.24, 0.96]) was inversely associated. Hazardous drinking on the Alcohol Use Disorders Identification Test (AUDIT; OR = 2.26, 95% CI [1.03, 4.95]) and CAGE (OR = 4.51, 95% CI [1.30, 15.61]), interpartner violence (OR = 1.69, 95% CI [1.04, 2.76]), and community drinking (OR = 3.39, 95% CI [2.07, 5.53]) were positively associated with exposure to alcohol advertisements. Easy access to alcohol and exposure to alcohol advertisements are positively associated with adverse health and social outcomes. Although further studies are needed, these findings lend support to emphasizing upstream policy

  16. Local management of rural power supply. A new approach in Tanzania

    Energy Technology Data Exchange (ETDEWEB)

    Gullberg, Monica; Katyega, Maneno; Kjellstroem, Bjoern

    1999-07-01

    The rural electrification program in Tanzania has been on going since independence in 1961, with the national utility, Tanzania Electric Supply Company Ltd. (TANESCO) being responsible for its implementation. By 1992, 14 townships and 37 villages had been electrified as a result of this program. This covers only a small fraction of rural Tanzania. It is estimated that in 1998, less than 1% of the rural households in Tanzania had access to electricity. Electricity constitutes only 1% of Tanzania's final energy consumption. Except for the few latest years, electricity generation and distribution in Tanzania has been the full responsibility of TANESCO. The national electricity grid is mainly supplied by large-scale hydro power plants (391 MW), and thermal power plants (148 MW). Rural areas are supplied either by a transmission line from the national grid or by diesel generator sets. The isolated branches run by TANESCO have an installed capacity amounting to a total of 23 MW. Electric lighting is the dominating use of electricity in rural areas. Industrial use in these areas is marginal. Very few rural households use electricity for cooking. Cooking is made with fuelwood and to some extent charcoal and kerosene. Where electricity is not available, kerosene in simple wick lamps is used for lighting. As part of the research co-operation between TANESCO and the Stockholm Environment Institute, SEI, an extensive evaluation of the experiences from the rural electrification program in Tanzania was carried out in 1989 - 1991. The four main conclusions from this evaluation were in summary: The rural people appreciate electrification. Rural electrification is a large financial burden on TANESCO. The quality of the service, in particular the supply reliability, is low in rural areas. Many of the perceived benefits of rural electrification, like the creation of small scale industries or reduced use of fuel wood for cooking, have not materialised to a significant degree. As

  17. Perceptions of water access in the context of climate change by rural households in the Seke and Murewa districts, Zimbabwe

    OpenAIRE

    Mudombi, Shakespear; Muchie, Mammo

    2013-01-01

    The objective of the study was to assess perceptions of rural household heads with regard to various aspects of water access and climate change, and to evaluate whether there were significant differences in perceptions of respondents from female-headed and male-headed households. The study is based on a cross-sectional survey of 300 respondents conducted in the Seke and Murewa districts of Zimbabwe in 2011. The analysis included mainly descriptive statistics. The majority of both female-heade...

  18. Improving Sanitation and Health in Rural Alaska

    Science.gov (United States)

    Bubenheim, David L.

    2013-01-01

    In rural Alaskan communities personal health is threatened by energy costs and limited access to clean water, wastewater management, and adequate nutrition. Fuel-­-based energy systems are significant factors in determining local accessibility to clean water, sanitation and food. Increasing fuel costs induce a scarcity of access and impact residents' health. The University of Alaska Fairbanks (UAF) School of Natural Resources and Agricultural Sciences (SNRAS), NASA's Ames Research Center, and USDA Agricultural Research Service (ARS) have joined forces to develop high-efficiency, low­-energy consuming techniques for water treatment and food production in rural circumpolar communities. Methods intended for exploration of space and establishment of settlements on the Moon or Mars will ultimately benefit Earth's communities in the circumpolar north. The initial phase of collaboration is completed. Researchers from NASA Ames Research Center and SNRAS, funded by the USDA­-ARS, tested a simple, reliable, low-energy sewage treatment system to recycle wastewater for use in food production and other reuse options in communities. The system extracted up to 70% of the water from sewage and rejected up to 92% of ions in the sewage with no carryover of toxic effects. Biological testing showed that plant growth using recovered water in the nutrient solution was equivalent to that using high-purity distilled water. With successful demonstration that the low energy consuming wastewater treatment system can provide safe water for communities and food production, the team is ready to move forward to a full-scale production testbed. The SNRAS/NASA team (including Alaska students) will design a prototype to match water processing rates and food production to meet rural community sanitation needs and nutritional preferences. This system would be operated in Fairbanks at the University of Alaska through SNRAS. Long­-term performance will be validated and operational needs of the

  19. Admission Factors Predicting Family Medicine Specialty Choice: A Literature Review and Exploratory Study among Students in the Rural Medical Scholars Program

    Science.gov (United States)

    Avery, Daniel M., Jr.; Wheat, John R.; Leeper, James D.; McKnight, Jerry T.; Ballard, Brent G.; Chen, Jia

    2012-01-01

    Purpose: The Rural Medical Scholars Program (RMSP) was created to increase production of rural family physicians in Alabama. Literature review reveals reasons medical students choose careers in family medicine, and these reasons can be categorized into domains that medical schools can address through admission, curriculum, and structural…

  20. [Medical Service Information Seeking Behaviors in Rural and Urban Patients in Sichuan Province].

    Science.gov (United States)

    Zhang, Wen-Jie; Xue, Li; Chen, Rao; Duan, Zhan-Qi; Liu, Dan-Ping

    2018-03-01

    To understand how rural and urban patients seek medical service information in Sichuan province. A self-designed questionnaire was distributed randomly to patients who visited primary,secondary and tertiary health facilities in Chengdu,Yibin and Suining,collecting data in relation to their sources of medical service information,as well as the contents and credibility of the information. The major sources of medical service information came from friends,past experiences and television programs,which were consistent with the most desirable access channels. The urban patients were more likely to trust (5.3%) and use (10.6%) the Internet to obtain medical service information compared with their rural counterparts (3.4% and 5.5%,respectively, P marketing strategies for urban and rural patients should be developed to channel patients to appropriate health facilities. Copyright© by Editorial Board of Journal of Sichuan University (Medical Science Edition).

  1. Operational performance of the Bangladesh rural electrification program and its determinants with a focus on political interference

    International Nuclear Information System (INIS)

    Taniguchi, Mariko; Kaneko, Shinji

    2009-01-01

    This article tries to quantitatively capture the effect of political intervention on the operational performance of the Bangladesh Rural Electrification Program (REP). Firstly, efficiency changes over the last 15 years of rural electric cooperatives in the REP are examined using data envelopment analysis (DEA). Then, the critical determinants of the efficiency changes including political indicator are identified with an application of the Tobit model. Results from the DEA analysis show the overall efficiency score, on a scale of zero to one, changes in the 0.856-0.929 range in 15 years, with two turnaround points in 1996 and 2001. These are the years that the national elections were held. The results also find a gap between the efficient rural electric cooperatives and the inefficient rural electric cooperatives. The results of the Tobit model imply that political power has a negative impact on efficiency.

  2. Assessing the active living environment in three rural towns with a high proportion of Native Hawaiians and other Pacific Islanders.

    Science.gov (United States)

    Hafoka, Siosaia F

    2017-01-01

    Background: Existing literature on the built environment and physical activity in rural areas is very limited. Studies have shown that residents in rural areas are less likely to meet physical activity requirements than their counterparts living in urban and suburban areas. They are also less likely to have access to amenities and programs that promote physical activity. This study seeks to fill gaps in the literature by assessing the built environment in three rural towns in Hawai'i that have a high proportion of Native Hawaiians and other Pacific Islanders. Methods: The Rural Active Living Assessment (RALA) tools will be used to assess the built environment. The RALA has three components - Policy and Program Assessment (PPA), Town Wide Assessment (TWA), and Street Segment Assessment (SSA) which will be used to provide a comprehensive assessment of the active living environment. Assessments were completed in September and October 2016. Results: One assessment was completed in each town for the TWA and PPA. The SSA was completed with 60 segments (20 from each town). Conclusion: The RALA tools identified supports in these three rural towns. The assessment also identified barriers and gaps - especially with the town and school polices of each town.

  3. Surgical referral coordination from a first-level hospital: a prospective case study from rural Nepal.

    Science.gov (United States)

    Fleming, Matthew; King, Caroline; Rajeev, Sindhya; Baruwal, Ashma; Schwarz, Dan; Schwarz, Ryan; Khadka, Nirajan; Pande, Sami; Khanal, Sumesh; Acharya, Bibhav; Benton, Adia; Rogers, Selwyn O; Panizales, Maria; Gyorki, David; McGee, Heather; Shaye, David; Maru, Duncan

    2017-09-25

    Patients in isolated rural communities typically lack access to surgical care. It is not feasible for most rural first-level hospitals to provide a full suite of surgical specialty services. Comprehensive surgical care thus depends on referral systems. There is minimal literature, however, on the functioning of such systems. We undertook a prospective case study of the referral and care coordination process for cardiac, orthopedic, plastic, gynecologic, and general surgical conditions at a district hospital in rural Nepal from 2012 to 2014. We assessed the referral process using the World Health Organization's Health Systems Framework. We followed the initial 292 patients referred for surgical services in the program. 152 patients (52%) received surgery and four (1%) suffered a complication (three deaths and one patient reported complication). The three most common types of surgery performed were: orthopedics (43%), general (32%), and plastics (10%). The average direct and indirect cost per patient referred, including food, transportation, lodging, medications, diagnostic examinations, treatments, and human resources was US$840, which was over 1.5 times the local district's per capita income. We identified and mapped challenges according to the World Health Organization's Health Systems Framework. Given the requirement of intensive human capital, poor quality control of surgical services, and the overall costs of the program, hospital leadership decided to terminate the referral coordination program and continue to build local surgical capacity. The results of our case study provide some context into the challenges of rural surgical referral systems. The high relative costs to the system and challenges in accountability rendered the program untenable for the implementing organization.

  4. 78 FR 19183 - Notice of Funding Availability for the Rural Energy for America Program

    Science.gov (United States)

    2013-03-29

    ... solar panels on the five stores. However, if this same owner wishes to install solar panels on three of... for either the solar panels or for the wind turbines in the same fiscal year. V. Program Provisions... facilities. For example, a rural small business owner owns five retail stores and wishes to install solar...

  5. Internet Accessibility: Challenges before the African Nations

    African Journals Online (AJOL)

    Internet Accessibility: Challenges Before The African Nations. 207. Information ... increasing internet access in Africa (Jensen, ... bite, particularly in the area of policy ... especially the urban and rural poor. ... supply, but electricity power supply.

  6. 41 CFR 51-10.149 - Program accessibility: Discrimination prohibited.

    Science.gov (United States)

    2010-07-01

    ...: Discrimination prohibited. 51-10.149 Section 51-10.149 Public Contracts and Property Management Other Provisions Relating to Public Contracts COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED 10... FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED § 51-10.149 Program accessibility...

  7. Policies and programs to facilitate access to targeted cancer therapies in Thailand.

    Directory of Open Access Journals (Sweden)

    Rosarin Sruamsiri

    Full Text Available Increasing access to clinically beneficial targeted cancer medicines is a challenge in every country due to their high cost. We describe the interplay of innovative policies and programs involving multiple stakeholders to facilitate access to these medicines in Thailand, as well as the utilization of selected targeted therapies over time.We selected two medicines on the 2013 Thai national list of essential medicines (NLEM [letrozole and imatinib] and three unlisted medicines for the same indications [trastuzumab, nilotinib and dasatinib]. We created timelines of access policies and programs for these products based on scientific and grey literature. Using IMS Health sales data, we described the trajectories of sales volumes of the study medicines between January 2001 and December 2012. We compared estimated average numbers of patients treated before and after the implementation of policies and programs for each product.Different stakeholders implemented multiple interventions to increase access to the study medicines for different patient populations. During 2007-2009, the Thai Government created a special NLEM category with different coverage requirements for payers and issued compulsory licenses; payers negotiated prices with manufacturers and engaged in pooled procurement; pharmaceutical companies expanded patient assistance programs and lowered prices in different ways. Compared to before the interventions, estimated numbers of patients treated with each medicine increased significantly afterwards: for letrozole from 645 (95% CI 366-923 to 3683 (95% CI 2,748-4,618; for imatinib from 103 (95% CI 72-174 to 350 (95% CI 307-398; and for trastuzumab from 68 (95% CI 45-118 to 412 (95% CI 344-563.Government, payers, and manufacturers implemented multi-pronged approaches to facilitate access to targeted cancer therapies for the Thai population, which differed by medicine. Routine monitoring is needed to assess clinical and economic impacts of these

  8. Rural versus urban academic hospital mortality following stroke in Canada.

    Science.gov (United States)

    Fleet, Richard; Bussières, Sylvain; Tounkara, Fatoumata Korika; Turcotte, Stéphane; Légaré, France; Plant, Jeff; Poitras, Julien; Archambault, Patrick M; Dupuis, Gilles

    2018-01-01

    Stroke is one of the leading causes of death in Canada. While stroke care has improved dramatically over the last decade, outcomes following stroke among patients treated in rural hospitals have not yet been reported in Canada. To describe variation in 30-day post-stroke in-hospital mortality rates between rural and urban academic hospitals in Canada. We also examined 24/7 in-hospital access to CT scanners and selected services in rural hospitals. We included Canadian Institute for Health Information (CIHI) data on adjusted 30-day in-hospital mortality following stroke from 2007 to 2011 for all acute care hospitals in Canada excluding Quebec and the Territories. We categorized rural hospitals as those located in rural small towns providing 24/7 emergency physician coverage with inpatient beds. Urban hospitals were academic centres designated as Level 1 or 2 trauma centres. We computed descriptive data on local access to a CT scanner and other services and compared mean 30-day adjusted post-stroke mortality rates for rural and urban hospitals to the overall Canadian rate. A total of 286 rural hospitals (3.4 million emergency department (ED) visits/year) and 24 urban hospitals (1.5 million ED visits/year) met inclusion criteria. From 2007 to 2011, 30-day in-hospital mortality rates following stroke were significantly higher in rural than in urban hospitals and higher than the Canadian average for every year except 2008 (rural average range = 18.26 to 21.04 and urban average range = 14.11 to 16.78). Only 11% of rural hospitals had a CT-scanner, 1% had MRI, 21% had in-hospital ICU, 94% had laboratory and 92% had basic x-ray facilities. Rural hospitals in Canada had higher 30-day in-hospital mortality rates following stroke than urban academic hospitals and the Canadian average. Rural hospitals also have very limited local access to CT scanners and ICUs. These rural/urban discrepancies are cause for concern in the context of Canada's universal health care system.

  9. Libyan intuitive for rural electrification

    International Nuclear Information System (INIS)

    Ibrahim, I. M. Saleh; Kreama, N. M.; Khalat, M. A.

    2006-01-01

    One of the obstacles in rural electrification is choosing the type of the electric source which best fits rural areas technically, socially, and economically. Renewable sources can be used to electrify rural areas. Rural electrification in Libya by photovoltaic systems in a national program which is devoted to electrify isolated villages, as part of this program the installation of 300 systems was started at the beginning of the year 2003 with a total power of 400 K Wp, the sizes of stand alone systems are 1.8 K Wp, 1.2 K Wp, 0.75 K Wp, and 0.15 K Wp, beside a hybrid system of diesel and PV. The systems was designed to supply different family needs a total of 5000 inhabitants will benefit from this project. In this paper we will introduce the rural photovoltaic electrification in Libya program, company the performance of three different PV sizes through the first two years of working. The systems performing well and with performance ratio much more than the deigned, very little power failure was reported, and there are social and technical issues to be addressed before, and after the installation of the PV system.(Author)

  10. RURAL TOURISM AS AN IMPORTANT SOURCE OF INCOME FOR RURAL PLACES

    Directory of Open Access Journals (Sweden)

    Mariana IATAGAN

    2009-06-01

    Full Text Available Tourism is the most important economic branch, worldwide, owning 12% of all areas of activity and revenue of approximately 530 billion dollars per year. In the past 10 years we could see an increasing demand for rural tourism and ecotourism, many of the international travel agencies offering ecotourism packages. Our country is attractive from the perspective of international travel agencies, because of unpolluted nature, the authenticity of traditions, the Danube Delta, old forests and not least, because the Romanian hospitality.Rural tourism had been practiced for a long time in Romania but for the past 15-20 years, it was casual and without any form of organization. Tourism activities in rural areas are carried out when agricultural activities takeplace and contribute to the welfare of rural communities that practice it.The development of tourism activities requires attention to the quality of the environment by preserving and developing the quality in the areas that have entered the tourist circuit, controlling the activity quality for a rational use of tourism resources.Our country benefits from EU funding through several programs including SAPARD, taking one of the measures, Measure 3.4, which is called the development and diversification of economic activities that generate multiple activities and alternative incomes.A deciding role in the development of rural tourism is held by the general infrastructure, requiring subsidies from the budget for tourism attraction areas for sustaining, by public administrations, programs to support tourism in rural areas.Rural tourism contributes to the sustainable development of the Romanian rural environment by proper use of local resources, establishing youth in rural areas, reducing the number of unemployed, women's involvement in economic and social life of rural settlements, raising living standards, growth in household rural areas, increasing the industry's contribution to the formation of gross

  11. The price of 'free'. Quantifying the costs incurred by rural residents attending publically funded outpatient clinics in rural and base hospitals.

    Science.gov (United States)

    Fearnley, David; Kerse, Ngaire; Nixon, Garry

    2016-09-01

    INTRODUCTION Rural living is associated with increased costs in many areas, including health care. However, there is very little local data to quantify these costs, and their unknown quantity means that costs are not always taken into account in health service planning and delivery. AIM The aim of this study was to calculate the average time and travel costs of attending rural and base hospital outpatient clinics for rural Central Otago residents. METHODS A survey of 51 people attending rural hospital outpatient clinics. Individual costs in terms of travel and time were quantified and an average cost of both rural and base hospital attendance was calculated. RESULTS The average travel and lost time cost of attending a rural outpatient clinic was NZ$182 and 61% of respondents reported this cost had a significant effect on their weekly budget. The average cost incurred by residents associated with a base hospital attendance in Dunedin was NZ$732. DISCUSSION This study data show that costs are substantial and probably higher than most people might expect for both rural and base hospital attendances. It seems likely that these costs are a potential barrier to service access. However, the full implications of the personal costs incurred by rural residents in accessing health services are largely unstudied and therefore remain unknown in New Zealand.

  12. Retinal photography screening programs to prevent vision loss from diabetic retinopathy in rural and urban Australia: a review.

    Science.gov (United States)

    Tapp, Robyn J; Svoboda, Jean; Fredericks, Bronwyn; Jackson, A Jonathan; Taylor, Hugh R

    2015-02-01

    This review assessed the effectiveness of diabetic retinopathy (DR) screening programs, using retinal photography in Australian urban and rural settings, and considered implications for public health strategy and policy. An electronic search of MEDLINE, PubMed, and Embase for studies published between 1 January 1996 and the 30 June 2013 was undertaken. Key search terms were "diabetic retinopathy," "screening," "retinal photography" and "Australia." Twelve peer-reviewed publications were identified. The 14 DR screening programs identified from the 12 publications were successfully undertaken in urban, rural and remote communities across Australia. Locations included a pathology collection center, and Indigenous primary health care and Aboriginal community controlled organizations. Each intervention using retinal photography was highly effective at increasing the number of people who underwent screening for DR. The review identified that prior to commencement of the screening programs a median of 48% (range 16-85%) of those screened had not undergone a retinal examination within the recommended time frame (every year for Indigenous people and every 2 years for non-Indigenous people in Australia). A median of 16% (range 0-45%) of study participants had evidence of DR. This review has shown there have been many pilot and demonstration projects in rural and urban Australia that confirm the effectiveness of retinal photography-based screening for DR.

  13. Validity and reliability of the Arabic version of the Household Food Insecurity Access Scale in rural Lebanon.

    Science.gov (United States)

    Naja, Farah; Hwalla, Nahla; Fossian, Talar; Zebian, Dina; Nasreddine, Lara

    2015-02-01

    To assess the validity and reliability of the Arabic version of the Household Food Insecurity Access Scale (HFIAS) in rural Lebanon. A cross-sectional study on a sample of households with at least one child aged 0-2 years. In a one-to-one interview, participants completed an adapted Arabic version of the HFIAS. In order to evaluate the validity of the HFIAS, basic sociodemographic information, anthropometric measurements of the mother and child, and dietary intake data of the child were obtained. In order to examine reproducibility, the HFIAS was re-administered after 3 months. Rural Lebanon. Mother and child pairs (n 150). Factor analysis of HFIAS items revealed two factors: 'insufficient food quality' and 'insufficient food quantity'. Using Pearson's correlation, food insecurity was inversely associated with mother's and father's education levels, number of cars and electrical appliances in the household, income, weight-for-age and length-for-age of the child and the child's dietary adequacy. In contrast, mother's BMI and crowding index were positively associated with food insecurity scores (P Lebanon, lending further evidence to the utility of the HFIAS in assessing food insecurity in culturally diverse populations.

  14. Conceptions of Contraceptive Use in Rural KwaZulu-Natal, South Africa: Lessons for Programming

    Science.gov (United States)

    Ndinda, Catherine; Ndhlovu, Tidings; Khalema, Nene Ernest

    2017-01-01

    Community family planning programmes in South Africa arose from the controversial apartheid history of controlling the African population while encouraging the growth of European migrant population. Post-apartheid population policies shifted away from population control to aligning policies to the global agenda that placed emphasis on the link between population and development. The focus on population and development polices in post-apartheid South Africa is on social equality, justice and peace rather than controlling sections of the population. Given the shift, this paper interrogates the conceptions of contraceptive use among rural communities in KwaZulu-Natal. Our primary objective is to understand the dynamics surrounding access to and use of family planning services in peri-urban and rural areas of KwaZulu-Natal. Using focus group data, the findings of the study suggest that different social categories interact with the family planning programmes differently. How teenagers and married women perceive the value of family planning differs. Gender differences regarding the use of condoms are also evident. The paper attempts to grapple with the non-use of condoms despite the knowledge that these prevent pregnancy and provide protection from sexually-transmitted diseases. The contribution of this paper lies in its identification of socio-cultural factors and the political economy underlying the different attitudes towards contraceptive use in rural KwaZulu-Natal. PMID:28350334

  15. Conceptions of Contraceptive Use in Rural KwaZulu-Natal, South Africa: Lessons for Programming.

    Science.gov (United States)

    Ndinda, Catherine; Ndhlovu, Tidings; Khalema, Nene Ernest

    2017-03-28

    Community family planning programmes in South Africa arose from the controversial apartheid history of controlling the African population while encouraging the growth of European migrant population. Post-apartheid population policies shifted away from population control to aligning policies to the global agenda that placed emphasis on the link between population and development. The focus on population and development polices in post-apartheid South Africa is on social equality, justice and peace rather than controlling sections of the population. Given the shift, this paper interrogates the conceptions of contraceptive use among rural communities in KwaZulu-Natal. Our primary objective is to understand the dynamics surrounding access to and use of family planning services in peri-urban and rural areas of KwaZulu-Natal. Using focus group data, the findings of the study suggest that different social categories interact with the family planning programmes differently. How teenagers and married women perceive the value of family planning differs. Gender differences regarding the use of condoms are also evident. The paper attempts to grapple with the non-use of condoms despite the knowledge that these prevent pregnancy and provide protection from sexually-transmitted diseases. The contribution of this paper lies in its identification of socio-cultural factors and the political economy underlying the different attitudes towards contraceptive use in rural KwaZulu-Natal.

  16. Utilization of Adult and Non-Formal Education Programs in Combating Rural Poverty in Nigeria

    Science.gov (United States)

    Ihejirika, John Chinedu

    2012-01-01

    The purpose of this paper was to examine the concept of poverty and its causes in Nigeria and to analyze how adult and non-formal education programs can be utilized to reduce rural poverty in Nigeria. In spite of Nigeria's affluence in human and material resources, it is classified among countries with high level of poverty. Incidentally, the…

  17. Forgotten Places: Uneven Development in Rural America. Rural America Series.

    Science.gov (United States)

    Lyson, Thomas A., Ed.; Falk, William W., Ed.

    This book examines predominantly rural regions of the United States that lag behind the rest of the country in income, employment, access to services, and measures of education and health. Case studies of nine regions examine historical background; current economic and social conditions (including demography, educational attainment, and…

  18. Lighting Rural India : Load Segregation Eexperience in Selected States

    OpenAIRE

    Khanna, Ashish; Mukherjee, Mohua; Banerjee, Sudeshna Ghosh; Saraswat, Kavita; Khurana, Mani

    2014-01-01

    Socioeconomic development of the rural populace is critical to India achieving its stated objective of inclusive growth. It is widely accepted that access to a reliable and sufficient power supply is a key enabler of rural economic growth. Traditionally, India's rural power supply has been restricted by having feeders to villages serve both agriculture and household loads. Because agric...

  19. Household electricity access, availability and human well-being: Evidence from India

    International Nuclear Information System (INIS)

    Ahmad, Sohail; Mathai, Manu V.; Parayil, Govindan

    2014-01-01

    According to the 2011 Census of India, over 31% of India's 1.2 billion people lived in nearly 8000 towns and cities; the remaining 830 million people lived in over 638,000 villages. About 55% of rural households and 93% of urban households had access to electricity. The 2005 Indian Human Development Survey showed that on average, electricity availability (hours of supply per day) in rural and urban households were 14 and 19 h, respectively (Desai et al., 2007). Using nationally representative data from Indian Human Development Survey, this study estimated the impact of electricity access and availability on two attributes of human well-being, viz. education and health attainment. It found a significant positive relationship between electricity availability and well-being in rural and urban households. Electricity accessibility, revealed a significant positive relationship only for rural households. The paper concludes with implications for electricity policy and infrastructure choices. - Graphical abstract: Impact of electricity security on the attributes of human well-being. - Highlights: • Nexus between well-being, and electricity access and availability is quantified. • Electricity access is positively associated with well-being in rural but not urban. • Electricity availability negatively associates with morbidity and absenteeism. • Electricity security as human well-being enabler seeks nuanced policy attention. • Decentralized rapidly deployable modular technologies and microgrids are advocated

  20. A telecommunications journey rural health network.

    Science.gov (United States)

    Moore, Joe

    2012-01-01

    Utilizing a multi-gigabit statewide fiber healthcare network, Radiology Consultants of Iowa (RCI) set out to provide instantaneous service to their rural, critical access, hospital partners. RCIs idea was to assemble a collection of technologies and services that would even out workflow, reduce time on the road, and provide superior service. These technologies included PACS, voice recognition enabled dictation, HL7 interface technology, an imaging system for digitizing paper and prior films, and modern communication networks. The Iowa Rural Health Telecommunication Project was undertaken to form a system that all critical access hospitals would participate in, allowing RCI radiologists the efficiency of "any image, anywhere, anytime".

  1. Assessing Effects of Climate Change on Access to Ecosystem Services in Rural Alaska: Enhancing the Science through Community Engagement

    Science.gov (United States)

    Brinkman, T. J.; Cold, H.; Brown, D. N.; Brown, C.; Hollingsworth, T. N.; Verbyla, D.

    2017-12-01

    In Arctic-Boreal regions, studies quantifying the characteristics and prevalence of environmental disruptions to access to ecosystem services are lacking. Empirical investigations are needed to assess the vulnerability of rural communities to climate change. We integrated community-based local observation (9 Interior Alaska Communities), field-based ground measurements, and remote sensing data to: 1) identify and prioritize the relative importance of different environmental changes affecting access, 2) characterize the biophysical causes and mechanisms related to access, and 3) evaluate long-term (30 year) trends in the environment that are challenging access. Dynamic winter ice and snow conditions (e.g., dangerous ice travel; n =147) were the most commonly reported cause of disturbance to access, followed by changes in summer hydrology (e.g., river navigability; n = 77) and seasonal shifts in freeze/thaw cycles (n = 31). Supporting local observations, our remote-sensing analysis indicated a trend toward environmental conditions that hinder or disrupt traditional uses of ecosystem services. For example, we found that the window of safe travel on ice has narrowed by approximately 2 weeks since the 1980s. Shifts in travel have implications on the effectiveness of subsistence activities, such as winter trapping and spring waterfowl hunting. From a methods perspective, we implemented a study design that generated novel science while also addressing locally relevant issues. Our approach and findings highlight opportunities for connecting biophysical science with societal concerns.

  2. Agroproductive educational programs, such as agritourism model for rural development in the canton Santa Clara, Pastaza-Ecuador

    Directory of Open Access Journals (Sweden)

    Karina Carrera Sánchez

    2014-10-01

    Full Text Available The opportunity to connect agriculture with tourism is a new approach as diversify the rural economy, with the vision, this research offers some conceptualizations of agrotourism and the main results of the present situation that allows learning programs potentiate of Centro de Investigación, Posgrado y Conservación de la Biodiversidad Amazónica CIPCA as possible model tourism and agrotourism activity prospects for the development of Santa Clara canton, province of Pastaza, located at km 44 Puyo-Tena. These results are obtained by surveying the producers of Santa Clara and interviews with program productive teaching coordinators and practitioners of center. Methodology we used chi-square test for verification of hypothesis. Eventually show the conclusions that contribute to farm planning for integrated endogenous rural development in Santa Clara.

  3. Extending access to essential services against constraints: the three-tier health service delivery system in rural China (1949-1980).

    Science.gov (United States)

    Feng, Xing Lin; Martinez-Alvarez, Melisa; Zhong, Jun; Xu, Jin; Yuan, Beibei; Meng, Qingyue; Balabanova, Dina

    2017-05-23

    China has made remarkable progress in scaling up essential services during the last six decades, making health care increasingly available in rural areas. This was partly achieved through the building of a three-tier health system in the 1950s, established as a linked network with health service facilities at county, township and village level, to extend services to the whole population. We developed a Theory of Change to chart the policy context, contents and mechanisms that may have facilitated the establishment of the three-tier health service delivery system in rural China. We systematically synthesized the best available evidence on how China achieved universal access to essential services in resource-scarce rural settings, with a particular emphasis on the experiences learned before the 1980s, when the country suffered a particularly acute lack of resources. The search identified only three peered-reviewed articles that fit our criteria for scientific rigor. We therefore drew extensively on government policy documents, and triangulated them with other publications and key informant interviews. We found that China's three-tier health service delivery system was established in response to acute health challenges, including high fertility and mortality rates. Health system resources were extremely low in view of the needs and insufficient to extend access to even basic care. With strong political commitment to rural health and a "health-for-all" policy vision underlying implementation, a three-tier health service delivery model connecting villages, townships and counties was quickly established. We identified several factors that contributed to the success of the three-tier system in China: a realistic health human resource development strategy, use of mass campaigns as a vehicle to increase demand, an innovative financing mechanisms, public-private partnership models in the early stages of scale up, and an integrated approach to service delivery. An

  4. Scoping the context of programs and services for maintaining wellness of older people in rural areas of Indonesia.

    Science.gov (United States)

    Kadar, K S; McKenna, L; Francis, K

    2014-09-01

    Ageing and problems concerning the aged are an increasing and concerning reality in developing and underdeveloped countries such as Indonesia. Improving service quality is important to promote and maintain wellness of older persons, especially in rural areas. To explore programs and services offered to the elderly in a rural area of Indonesia to support them in promoting and maintaining their wellness. To describe roles and practices of health professionals and teams responsible for delivering services to older people. Action research was used with mixed method data collection (interview and survey). Results demonstrated that activities related to the elderly health programs were limited due to budget and facilities. Practices of health staff for elderly in the community focused on intervention tasks, rather than prevention. Lack of available information on the range of programs and services implemented in Indonesia for the elderly in community settings was a limitation of this study. Programs and services for older people have been implemented in Indonesia. However, these do not yet meet their needs, especially in rural areas. There is a need for greater focus on health promotion and illness prevention. Findings contribute to development of international knowledge in community health nursing, as these issues may not be only relevant to Indonesia. It is timely for governments, including in Indonesia, to evaluate health workforce needs in the community and appropriate educational qualifications for delivering optimal health services for older people. © 2014 International Council of Nurses.

  5. Family planning and fertility decline in rural Iran: the impact of rural health clinics.

    Science.gov (United States)

    Salehi-Isfahani, Djavad; Abbasi-Shavazi, M Jalal; Hosseini-Chavoshi, Meimanat

    2010-09-01

    During the first few years of the Islamic Revolution of 1979, and aided by pro-natal government policies, Iranian fertility was on the rise. In a reversal of its population policy, in 1989, the government launched an ambitious and innovative family planning program aimed at rural families. By 2005, the program had covered more than 90% of the rural population and the average number of births per rural woman had declined to replacement level from about 8 births in the mid 1980s. In this paper, we evaluate the impact of a particular feature of the program - health houses - on rural fertility, taking advantage of the variation in the timing of their construction across the country. We use three different methods to obtain a range of estimates for the impact of health houses on village-level fertility: difference-in-differences (DID), matching DID, and length of exposure. We find estimates of impact ranging from 4 to 20% of the decline in fertility during 1986-1996. (c) 2010 John Wiley & Sons, Ltd.

  6. Evaluating the Navy’s Enlisted Accessions Testing Program Based on Future Talent Needs

    Science.gov (United States)

    2017-03-01

    NAVY’S ENLISTED ACCESSIONS TESTING PROGRAM BASED ON FUTURE TALENT NEEDS by Shereka F. Riley March 2017 Thesis Advisor: Joseph Sullivan Co...REPORT TYPE AND DATES COVERED Master’s thesis 4. TITLE AND SUBTITLE EVALUATING THE NAVY’S ENLISTED ACCESSIONS TESTING PROGRAM BASED ON FUTURE TALENT ...public release. Distribution is unlimited. 12b. DISTRIBUTION CODE 13. ABSTRACT (maximum 200 words) In recent years, non-defense related industries

  7. Preventive palliation in the elderly - Organizing health camps for the rural aged

    Directory of Open Access Journals (Sweden)

    Abhijit Dam

    2010-01-01

    Full Text Available Most of the needs of elders for support and assistance in the later stages of life are fulfilled by informal helpers. The position of a large number of older persons has become vulnerable due to which it cannot be taken for granted that their children will be able to look after them when they need care in old age, specially in view of the longer life span implying an extended period of dependency and higher costs to meet health and other needs. The condition of the rural elderly is even more pitiable, contrary to our beliefs, as availability, affordability and accessibility to medicare facilities are poor. We undertook the task of organizing a health camp in a rural set-up with the idea of implementing our concept of "preventive palliation" in which excellent palliative care was coupled with a pinch of prevention, like routine checks of blood pressure, routine physical check-ups, etc, so that any aberration can be detected early and necessary rectification measures can be implemented. These periods of routine check-ups can also be used to assess the psycho-social, cultural and emotional problems, if any. Such an approach, say every monthly, gives the elderly something to look forward to and ensures a high degree of customer satisfaction and greatly reduces the burden on the current health system. The challenges faced and the data obtained from this study were shocking. The elderly living in rural areas of the tribal state of Jharkhand suffer from poor physical and mental health, a factor which was rather unexpected in the Indian cultural system in the rural setting. Simple strategies like implementing routine health check ups with provision of "nutritious meal program" can go a long way in mitigating these problems in a cost-effective and simple manner. To make the government-based programs accessible and available to the end-users, participation of local bodies like NGOs is mandatory. Preventive palliation, a concept introduced by Kosish, is

  8. A Survey of Professional Training and Certification of Rural Administrators and Rural Teachers in New Mexico.

    Science.gov (United States)

    Tingley, Wayne

    Teachers and administrators in rural New Mexico schools and preservice teachers at New Mexico State University were surveyed to determine components that could be included in teacher education programs to augment prospective rural teachers' skills and to ease problems of recruitment/retention of certified personnel in rural schools. Questionnaires…

  9. Oral Health Promotion Intervention In Rural Contexts: Impact assessment. Córdoba, Argentina.

    Directory of Open Access Journals (Sweden)

    Lila Cornejo

    2014-03-01

    Full Text Available Introduction: The study was carried out in Cruz del Eje Department, Cordoba Province, Argentina. It was based on diagnosis of conceptions of health, concentration of fluoride in drinking water and accessibility to dental coverage in 71 rural schools. Additionally, parents and teachers’ conceptions of general and oral health, dental clinical status and sialochemistry of students from eight schools were considered. Objective: To evaluate a community intervention strategy for promoting oral health in rural contexts. Through the participation of the teacher as a mediator of healthy pattern, this strategy was developed. Methods: In order to elaborate oral health promoting strategies, educational workshops, epistolary communication and on site tutorials meetings were implemented. Specific health projects to be added to the Educational Institutional Programs, as a contextualized mediating strategy for promoting oral health were designed by teachers. The strategy was evaluated comparing dental caries increase (CI detected the previous year and the one following the implementation of the educational plans. Mac Nemar's test was applied, and p<0.05 was set to indicate statistical differences between both periods. Results: A 30.43% CI (p<0.0001 was observed the year before implementing the educational programs as well as a CI reduction to 17.39% (p=0.0002 a year after their application. Conclusion: The drop off in 57.14% of the CI in rural areas, confirms the intervention strategy of designed for this particular context.Keywords: community intervention, oral health promotion, rural communities.

  10. Changing patterns in electrical burn injuries in a developing country: should prevention programs focus on the rural population?

    Science.gov (United States)

    Patil, Surendra B; Khare, Nishant Anil; Jaiswal, Sumeet; Jain, Arvind; Chitranshi, Anurag; Math, Mahantesh

    2010-01-01

    In the developing world, the incidence of electrical injuries has increased in the past few years. This study attempts to identify the causative and demographic risk factors that can help in formulating a targeted prevention program. The study was conducted prospectively and retrospectively from 2004 to 2009. Eighty-four consecutive patients with electrical burn injuries were analyzed for their demographic profile, age, sex, occupation, rural-urban distribution, mode of injury, and place of injury. The patients were asked to fill out a questionnaire regarding their awareness about electrical burn injuries, and the results were tabulated. The age of presentation ranged from 3 to 61 years. The most frequently affected age group was the second decade of life (33.3%). Of 84 patients studied, 71 were male and 13 female. Fifty-nine patients were from the urban area, while 25 were from the surrounding rural area. Students including children and adolescents were the most common affected single group (22.5%). Contact with live wire or contact with an object that was in contact with a live wire (secondary contact) accounted for 43 of 84 cases (51%). Home was the most common location where injury occurred (51.2%). Twenty-one of 59 cases (35.6%) reported from the urban area and 3 of 25 cases (12%) from the rural area had specific knowledge about prevention of electrical burn injury. Forty-one patients (69.4%) from the urban area and 22 (88%) from the rural area believed that adequate information regarding electrical burn injury was not available. Thirty-six patients (61%) from the urban area and 24 (96%) from the rural area believed that they would have behaved differently if the information had been available. The authors recommend that prevention programs should be modified to cater to the specific needs of the younger age groups and the rural population.

  11. Access to Money and Relation to Women’s Use of Family Planning Methods among Young Married Women in Rural India

    Science.gov (United States)

    Reed, Elizabeth; Donta, Balaiah; Dasgupta, Anindita; Ghule, Mohan; Battala, Madhusudana; Nair, Saritha; Silverman, Jay; Jadhav, Arun; Palaye, Prajakta; Saggurti, Niranjan; Raj, Anita

    2016-01-01

    Objectives The social positioning (i.e. social status and autonomy) of women in the household facilitates women’s access to and decision-making power related to family planning (FP). Women’s access to spending money, which may be an indicator of greater social positioning in the household, may also be greater among women who engage in income generating activities for their families, regardless of women’s status in the household. However, in both scenarios, access to money may independently afford greater opportunity to obtain family planning services among women. This study seeks to assess whether access to money is associated with FP outcomes independently of women’s social positioning in their households. Methods Using survey data from married couples in rural Maharashtra, India (n=855), crude and adjusted regression was used to assess women’s access to their own spending money in relation to past 3 month use of condoms and other forms of contraceptives (pills, injectables, intrauterine device). Results Access to money (59%) was associated with condom and other contraceptive use (AORs ranged: 1.5 – 1.8). These findings remained significant after adjusting for women’s FP decision-making power in the household and mobility to seek FP services. Conclusion While preliminary, findings suggest that access to money may increase women’s ability to obtain FP methods, even in contexts where social norms to support women’s power in FP decision-making may not be readily adopted. PMID:26971270

  12. Access to Educational Opportunity in Rural Communities: Alternative Patterns of Delivering Vocational Education in Sparsely Populated Areas. Volume 2: The Heartland Vocational Center: A Decentralized Center.

    Science.gov (United States)

    Thomas, Ruth G.; And Others

    One of the four case studies addressing access of rural students to vocational education through inter-school district cooperation, the Heartland case study represents the decentralized variation of the center cooperative school pattern, identifies essential features of this form of cooperation, details factors facilitating/impeding the…

  13. Agrarian Reform and Rural Development.

    Science.gov (United States)

    Biswas, Margaret R.

    1979-01-01

    This paper presents the plight of the world's poor, which was discussed at The World Conference on Agrarian Reform and Rural Development in July, 1979. Urban bias is attributed to the failure of rural development. More participation of rural people is needed. Progress is being made. Examples of literary programs in Iraq and the Sudan are included.…

  14. Smart sustainable energy for rural community development

    CSIR Research Space (South Africa)

    Szewczuk, S

    2014-10-01

    Full Text Available Reliable access to electricity is a basic precondition for improving people’s lives in rural areas, for enhanced healthcare and education, and for growth within local economies. Currently more than 1.5 billion people worldwide do not have access...

  15. Physical and mental health perspectives of first year undergraduate rural university students.

    Science.gov (United States)

    Hussain, Rafat; Guppy, Michelle; Robertson, Suzanne; Temple, Elizabeth

    2013-09-15

    University students are often perceived to have a privileged position in society and considered immune to ill-health and disability. There is growing evidence that a sizeable proportion experience poor physical health, and that the prevalence of psychological disorders is higher in university students than their community peers. This study examined the physical and mental health issues for first year Australian rural university students and their perception of access to available health and support services. Cross-sectional study design using an online survey form based on the Adolescent Screening Questionnaire modeled on the internationally recognised HEADSS survey tool. The target audience was all first-year undergraduate students enrolled in an on-campus degree program. The response rate was 41% comprising 355 students (244 females, 111 males). Data was analysed using standard statistical techniques including descriptive and inferential statistics; and thematic analysis of the open-ended responses. The mean age of the respondents was 20.2 years (SD 4.8). The majority of the students lived in on-campus residential college style accommodation, and a third combined part-time paid work with full-time study. Most students reported being in good physical health. However, on average two health conditions were reported over the past six months, with the most common being fatigue (56%), frequent headaches (26%) and allergies (24%). Mental health problems included anxiety (25%), coping difficulties (19.7%) and diagnosed depression (8%). Most respondents reported adequate access to medical doctors and support services for themselves (82%) and friends (78%). However the qualitative comments highlighted concerns about stigma, privacy and anonymity in seeking counselling. The present study adds to the limited literature of physical and mental health issues as well as barriers to service utilization by rural university students. It provides useful baseline data for the

  16. Factors facilitating and inhibiting implementation of easy accessible sporting programs.

    NARCIS (Netherlands)

    Ooms, L.; Veenhof, C.

    2012-01-01

    Introduction: The organized sport sector has been identified as a potential setting for physical activity promotion. In The Netherlands, ten national sporting organizations were funded to develop and implement easy accessible sporting programs, especially for the least active population groups. A

  17. Unpacking the relationship between rural healthcare, mobility and access

    CSIR Research Space (South Africa)

    Mashiri, M

    2008-07-01

    Full Text Available , from the remoteness and spatial dispersion of rural communities. A variety of qualitative and quantitative instruments were employed to gather data to respond to the study hypotheses and research questions. The findings indicate a symbiotic...

  18. Does improved access to water supply by rural households enhance the concept of safe water at the point of use? A case study from deep rural South Africa.

    Science.gov (United States)

    Jagals, P

    2006-01-01

    The concept of safe water is defined by three principles: the health-related quality must be suitable, the supply/source must be accessible and the water must constantly be available in quantities sufficient for the intended use. If any one (or more) of these three elements is missing from a water services improvement programme, providing safe water is not successfully achieved. A study in a deep rural area in South Africa showed that providing small communities, using untreated river water as their only water source, with good quality water through a piped distribution system and accessible at communal taps did not fall within our parameters of safe water. The parameters for measuring the three principles were: absence of Escherichia coli in drinking water samples; accessibility by improving tap distances to within 200 m from each household; availability by assessing whether households have at least 25 L per person per day. Results show that although E. coli levels were reduced significantly, households were still consuming water with E. coli numbers at non-compliant levels. Access (distance) was improved from an average of 750 m from households to river source to an average of 120 m to new on-tap source points. This did not result in significant increases in household quantities, which on average remained around 18 L per person per day.

  19. Improving Maternal Care through a State-Wide Health Insurance Program: A Cost and Cost-Effectiveness Study in Rural Nigeria.

    Science.gov (United States)

    Gomez, Gabriela B; Foster, Nicola; Brals, Daniella; Nelissen, Heleen E; Bolarinwa, Oladimeji A; Hendriks, Marleen E; Boers, Alexander C; van Eck, Diederik; Rosendaal, Nicole; Adenusi, Peju; Agbede, Kayode; Akande, Tanimola M; Boele van Hensbroek, Michael; Wit, Ferdinand W; Hankins, Catherine A; Schultsz, Constance

    2015-01-01

    .9-152.3), during one-way sensitivity analyses, and when cost, quality, cost and utilization parameters of the base case scenario were changed. The sustainability of this program's scale up by the State is dependent on further investments in healthcare. This study provides evidence that the investment made by the KSHI program in rural Nigeria is likely to have been cost-effective; however, further healthcare investments are needed for this program to be successfully expanded within Kwara State. Policy makers should consider supporting financial initiatives to reduce maternal mortality tackling both supply and demand issues in the access to care.

  20. Improving Maternal Care through a State-Wide Health Insurance Program: A Cost and Cost-Effectiveness Study in Rural Nigeria.

    Directory of Open Access Journals (Sweden)

    Gabriela B Gomez

    interval 21.9-152.3, during one-way sensitivity analyses, and when cost, quality, cost and utilization parameters of the base case scenario were changed. The sustainability of this program's scale up by the State is dependent on further investments in healthcare.This study provides evidence that the investment made by the KSHI program in rural Nigeria is likely to have been cost-effective; however, further healthcare investments are needed for this program to be successfully expanded within Kwara State. Policy makers should consider supporting financial initiatives to reduce maternal mortality tackling both supply and demand issues in the access to care.

  1. Rural energetic troubles in Ecuador

    International Nuclear Information System (INIS)

    Barriga, A

    1994-01-01

    The present work presents a general situation of Ecuador, its demand of Energy, programs of electrification rural, energy requirements in the hydroelectric rural sector, central sector built in Ecuador and the priorities of energy use

  2. Local resource based approach to maintaining and preserving rural local access roads assets: Siyatentela institutional framework and governance case study discourses

    CSIR Research Space (South Africa)

    Chakwizira, J

    2010-10-01

    Full Text Available and other development agencies focusing on the use of appropriate technologies for civil construction be it in the road, transport, water, agriculture or environmental sectors (World Bank 2001; ILO, 2002; Clegg, 2003). The seminal study conducted... and contribution of local resource based approach to rural and community access roads requires a review of the labour based initiatives in the road, transport and infrastructure sub-sector. An apt statement that captures the essence of building local community...

  3. Rural Revitalization through Collaboration.

    Science.gov (United States)

    Norman, Charles

    In recent years, service programs targeted for Georgia's rural communities have decreased proportionately in relation to those intended for the state's rapidly expanding population centers. At the same time, erosion of traditional manufacturing industries and an adverse agricultural economy have decreased the ability of rural communities to…

  4. 77 FR 6479 - Leased Commercial Access; Development of Competition and Diversity in Video Programming...

    Science.gov (United States)

    2012-02-08

    ... Commercial Access; Development of Competition and Diversity in Video Programming Distribution and Carriage... contained in the Second Report and Order, FCC 11-119, pertaining to carriage of video programming vendors by multichannel video programming distributors (program carriage rules). This notice is consistent with the Secord...

  5. 76 FR 60651 - Leased Commercial Access; Development of Competition and Diversity in Video Programming...

    Science.gov (United States)

    2011-09-29

    ... programming services seeking access through their conduit.''); H.R. Rep. No. 102-628 (1992), at 41 (``[T]he... Programming Distribution and Carriage; Revision of the Commission's Program Carriage Rules; Final Rule and... Programming Distribution and Carriage AGENCY: Federal Communications Commission. ACTION: Final rule. SUMMARY...

  6. Leading the rebirth of the rural obstetrician.

    Science.gov (United States)

    Campbell, Alison M; Brown, James; Simon, David R; Young, Sari; Kinsman, Leigh

    2014-12-11

    To understand the factors influencing the decisions of rural general practitioners and GP registrars to practise obstetrics, and to understand the impact on these decisions of an innovative obstetric training and support program in the Gippsland region of Victoria. Qualitative approach using semistructured interviews conducted in July and August 2013 and inductive content analysis. Participants were identified from training records over the previous 5 years for the Gippsland GP obstetric training and support program. Two questions were posed during interviews: What challenges face rural GPs in practising obstetrics? What impact has the Gippsland GP obstetric program had on GP obstetric career decisions? Of 60 people invited to participate, 22 agreed. Interviews ranged in duration from 40 to 90 minutes. The major themes that emerged on the challenges facing rural GPs in practising obstetrics were isolation, work-life balance and safety. The major themes that emerged on the impact of the Gippsland GP obstetric program were professional support, structured training and effective leadership. Rural GP obstetricians are challenged by isolation, the impact of their job on work-life balance, and safety. The support, training and leadership offered by the Gippsland expanded obstetric training program helped doctors to deal with these challenges. The Gippsland model of training offers a template for GP obstetric procedural training programs for other rural settings.

  7. Access to medicines in remote and rural areas: a survey of residents in the Scottish Highlands & Western Isles.

    Science.gov (United States)

    Rushworth, G F; Diack, L; MacRobbie, A; Munoz, S-A; Pfleger, S; Stewart, D

    2015-03-01

    Sparsely populated areas are potentially predisposed to health inequalities due to limited access to services. This study aimed to explore and describe issues of access to medicines and related advice experienced by residents of the Scottish Highlands and Western Isles. Cross-sectional cohort study. Anonymized questionnaires were mailed to a random sample of 6000 residents aged ≥18 years identified from the electoral register. The questionnaire contained items on: access to medicines; interactions with health care services; and perceptions of the services. Results were analysed using descriptive, inferential and spatial statistics. Adjusted response rate was 49.5% (2913/5889). Almost two thirds (63.4%, 1847) were prescribed medicines regularly, 88.5% (1634) of whom considered the source convenient. Pharmacy (73.8%, 1364) or dispensing GP (24.0%, 443) were the most accessed sources. Prescription medicine advice was mainly obtained from the GP (55.7%, 1029). Respondents ≥80 years old were significantly (P 80 years living alone disagreed that they obtained prescribed medicines from a convenient source. The majority of respondents who felt they did not have a convenient medicines source, regardless of urban/rural classification, lived within five miles of a pharmacy or GP practice. Respondents accessed medicines and advice from a variety of sources. While most considered their access to medicines convenient, there were issues for those over 80 years and living alone. Perceived convenience would not appear to be solely based on geographical proximity to supply source. This requires further exploration given that these individuals are likely to have long-term conditions and be prescribed medicines on a chronic basis. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  8. Farmers' Participation in Extension Programs and Technology Adoption in Rural Nepal: A Logistic Regression Analysis

    Science.gov (United States)

    Suvedi, Murari; Ghimire, Raju; Kaplowitz, Michael

    2017-01-01

    Purpose: This paper examines the factors affecting farmers' participation in extension programs and adoption of improved seed varieties in the hills of rural Nepal. Methodology/approach: Cross-sectional farm-level data were collected during July and August 2014. A sample of 198 farm households was selected for interviewing by using a multistage,…

  9. The Arizona Galileoscope Project: A 5th Grade Rural Education Program

    Science.gov (United States)

    Sparks, Robert T.; Pompea, Stephen M.; Walker, Constance E.

    2015-01-01

    The Galileoscope is a low cost, high quality telescope kit developed for the International Year of Astronomy (IYA). Over 200,000 Galileoscopes have been sold and used by the public and education programs around the world.The National Optical Astronomy Observatory has been a leader in Galileoscope education programs. In 2009 we started the Arizona Galileoscope Star Party Program. We have partnered with rural school districts around the state including Flagstaff, Safford, Yuma, Globe and Payson to bring Galilesocope educational program to the students and teachers. The program begins with a professional development workshop where teachers learn about the optics of telescopes and how to assemble the Galileoscope and use it on a tripod. The teachers receive a Teaching With Telescopes (TWT) kit that contains a variety of lenses, lasers and lights to do all the activities in the workshop and a classroom supply of Galileoscopes and tripods to take back to their classroom. Their students learn about telescope optics and how to use a Galileoscope. Several weeks after the professional development workshop, a district wide star party is held for the parents, teachers and students.In the coming years, we are expanding the program in cooperation with Science Foundation Arizona. We are currently in the process of recruiting new cities to join the program in addition to supporting our previous communities. We will describe our past efforts, the evaluation of the program and our future expansion.

  10. Availability of kerosene to rural households: a case study from India

    International Nuclear Information System (INIS)

    Rehman, Ibrahim Hafeezur; Malhotra, Preeti; Pal, Ram Chandra; Singh, Phool Badan

    2005-01-01

    A majority of the rural population in India continues to rely on kerosene for domestic lighting. Measures to promote inter-fuel substitution in domestic lighting by promoting rural electrification have met with partial success. Electrified households in rural areas also use kerosene as a back up fuel because of erratic and poor electricity supply. Kerosene is subsidised, and an extensive network has been put in place for its distribution. Both these measures are meant to facilitate access and affordability by the poor. However, this is not the case at the grass-roots level. Further, use of traditional lighting devices has also had an adverse affect on the quality of life of the people for these devices are inefficient, emit smoke, and give poor-quality light. In this the poorest of the poor, who have limited choices and options are worst affected. This paper, taking the example of a TERI (the Energy and Resources Institute) case study in the state of Rajasthan, analyses the issues of access and availability of kerosene to rural masses, especially the poor. It highlights the existing problems with the kerosene distribution system and examines the subsidy-based, supply driven approach to distribution in terms of facilitating access to the poor. It, accordingly, puts forward specific policy measures for improving access to kerosene and its more efficient use as a lighting fuel in rural India

  11. Health behaviours of young, rural residents: a case study.

    Science.gov (United States)

    Bourke, Lisa; Humphreys, John; Lukaitis, Fiona

    2009-04-01

    To analyse self-reported health behaviours of young people from a rural community and the factors influencing their behaviours. Interviews were conducted with 19 young people, 11 parents and 10 key informants from a small rural Victorian community, asking about teenage health behaviours and the factors influencing these behaviours. Young people ate both healthy and unhealthy foods, most participated in physical activity, few smoked and most drank alcohol. The study found that community level factors, including community norms, peers, access issues and geographic isolation, were particularly powerful in shaping health behaviours, especially alcohol consumption. Smoking was influenced by social participation in the community and national media health campaigns. Diet and exercise behaviour were influenced by access and availability, convenience, family, peers and local and non-local cultural influences. The rural context, including less access to and choice of facilities and services, lower incomes, lack of transport and local social patterns (including community norms and acceptance), impact significantly on young people's health behaviours. Although national health promotion campaigns are useful aspects of behaviour modification, much greater focus on the role and importance of the local contexts in shaping health decisions of young rural people is required.

  12. Coroners' records of rural and non-rural cases of youth suicide in New South Wales.

    Science.gov (United States)

    Dudley, M; Kelk, N; Florio, T; Waters, B; Howard, J; Taylor, D

    1998-04-01

    The aim of this study is to compare the frequency of certain putative risk factors for youth suicide in New South Wales (especially use of alcohol, social class, unemployment, and internal migration) in metropolitan and rural settings. A review of 137 files for 10-19-year-old subjects judged by the Coroner to have committed suicide in 1988-1990 was carried out. One hundred and fifteen males and 21 females were identified (one subjects sex was unavailable). The male-female ratio was higher in rural (13.0) areas than non-rural (4.9 chi 2 = 12.14, p Australia, most migrated in a rural direction, and most to rural shires. Unemployment was somewhat more common among rural (38.5%) than non-rural (28.9%) subjects (chi 2 = 0.75, p = 0.39). Eleven of 50 non-rural parents of the deceased, but none of the 11 rural parents, were ranked as being in social classes 2 or 3. Alcohol consumption appeared more common in rural shires (44%) than metropolitan areas (32.9%), but this was not statistically significant. Medical services were less utilised prior to death in rural (15%) than non-rural (25%) areas (chi 2 = 1.69, p = 0.19), and a psychiatric diagnosis was recorded more commonly in non-rural areas. Incomplete coronial file data and relatively small numbers limit this study's conclusions. Male suicides, principally by firearms, predominated in rural areas. Youth firearm access remains highly relevant to rural communities. Possible trends among rural subjects toward rural migration, higher unemployment, lower social class and lower medical attendance may point to resource deprivation among this group; these matters require further investigation.

  13. Quantification of rural livelihood dynamics

    DEFF Research Database (Denmark)

    Walelign, Solomon Zena

    role in lifting poor out poverty which could be due to restricted access to more remunerative environmental resources, (ii) the developed approach for livelihood clustering (combining household income and asset variables using regression models) outperform both existing income and asset approaches (iii......Improved understanding of rural livelihoods is required to reduce rural poverty faster. To that end, this PhD study quantified rural livelihood dynamics emphasizing (i) the role of environmental resources use in helping rural households to escape poverty, (ii) development of a new approach...... households. Two groups of attrite households were identified: ‘movers’ (households that left their original location) and ‘non-movers’ (households that still resided in the same location but were not interviewed for different reasons). The findings revealed that (i) total environmental income had a limited...

  14. Mujeres Fuertes y Corazones Saludables: adaptation of the StrongWomen -healthy hearts program for rural Latinas using an intervention mapping approach.

    Science.gov (United States)

    Perry, Cynthia K; McCalmont, Jean C; Ward, Judy P; Menelas, Hannah-Dulya K; Jackson, Christie; De Witz, Jazmyne R; Solanki, Emma; Seguin, Rebecca A

    2017-12-28

    To describe our use of intervention mapping as a systematic method to adapt an evidence-based physical activity and nutrition program to reflect the needs of rural Latinas. An intervention mapping process involving six steps guided the adaptation of an evidence based physical activity and nutrition program, using a community-based participatory research approach. We partnered with a community advisory board of rural Latinas throughout the adaptation process. A needs assessment and logic models were used to ascertain which program was the best fit for adaptation. Once identified, we collaborated with one of the developers of the original program (StrongWomen - Healthy Hearts) during the adaptation process. First, essential theoretical methods and program elements were identified, and additional elements were added or adapted. Next, we reviewed and made changes to reflect the community and cultural context of the practical applications, intervention strategies, program curriculum, materials, and participant information. Finally, we planned for the implementation and evaluation of the adapted program, Mujeres Fuertes y Corazones Saludables, within the context of the rural community. A pilot study will be conducted with overweight, sedentary, middle-aged, Spanish-speaking Latinas. Outcome measures will assess change in weight, physical fitness, physical activity, and nutrition behavior. The intervention mapping process was feasible and provided a systematic approach to balance fit and fidelity in the adaptation of an evidence-based program. Collaboration with community members ensured that the components of the curriculum that were adapted were culturally appropriate and relevant within the local community context.

  15. Quality of Vegetables Based on Total Phenolic Concentration Is Lower in More Rural Consumer Food Environments in a Rural American State.

    Science.gov (United States)

    Ahmed, Selena; Byker Shanks, Carmen

    2017-08-17

    While daily consumption of fruits and vegetables (FVs) is widely recognized to be associated with supporting nutrition and health, disparities exist in consumer food environments regarding access to high-quality produce based on location. The purpose of this study was to evaluate FV quality using total phenolic (TP) scores (a phytochemical measure for health-promoting attributes, flavor, appearance, and shelf-life) in consumer food environments along a rural to urban continuum in the rural state of Montana, United States. Significant differences were found in the means of the FV TP scores ( p vegetable TP scores ( p vegetable TP scores were highest for the least rural stores and lowest for the most rural stores. Results indicate an access gap to high-quality vegetables in more rural and more health-disparate consumer food environments of Montana compared to urban food environments. Findings highlight that food and nutrition interventions should aim to increase vegetable quality in rural consumer food environments in the state of Montana towards enhancing dietary quality and food choices. Future studies are called for that examine TP scores of a wide range of FVs in diverse food environments globally. Studies are further needed that examine linkages between FV quality, food choices, diets, and health outcomes towards enhancing food environments for public health.

  16. Out-of-hours service in rural areas. An observational study of accessibility, attitudes and quality standards among general practitioners in Iceland.

    Science.gov (United States)

    Olafsson, G; Sigurdsson, J A

    2000-06-01

    To examine the access, workload, duties, commitments and quality standards of primary care physicians (GPs) resulting from out-of-hours service. All GPs (n = 96) in rural Iceland. Answers to a postal survey. The participation rate was 80%. The GPs estimated that in 97% of the cases they could be contacted within 5 minutes in an emergency. Under usual circumstances (weather conditions) and within a distance of 10 km, 70% of them could reach the patient within 30 minutes of receiving the call. In severe weather conditions, 50% of the GPs in smaller districts (650-6000 inhabitants) estimated that it could take up to 5 hours or more to reach the patient (which could happen once a year). In the least populated districts, 84% of the GPs had to be on call 14 days or more per month. Serious emergencies (involving special training such as cardiac resuscitation or tracheal intubation) were relatively rare, and GPs expressed the necessity for regular refresher courses in such fields. Modern telecommunication networks guarantee good access to out-of-hours service. The workload and on-call duties are great and do not comply with European Union (EU) recommendations regarding minimal rest time. If GPs in rural areas are to be expected to provide frontline health care, including in severe emergency situations, regular training courses are needed.

  17. How to start a minimal access mitral valve program.

    Science.gov (United States)

    Hunter, Steven

    2013-11-01

    The seven pillars of governance established by the National Health Service in the United Kingdom provide a useful framework for the process of introducing new procedures to a hospital. Drawing from local experience, the author present guidance for institutions considering establishing a minimal access mitral valve program. The seven pillars of governance apply to the practice of minimally invasive mitral valve surgery, based on the principle of patient-centred practice. The author delineate the benefits of minimally invasive mitral valve surgery in terms of: "clinical effectiveness", including reduced length of hospital stay, "risk management effectiveness", including conversion to sternotomy and aortic dissection, "patient experience" including improved cosmesis and quicker recovery, and the effectiveness of communication, resources and strategies in the implementation of minimally invasive mitral valve surgery. Finally, the author have identified seven learning curves experienced by surgeons involved in introducing a minimal access mitral valve program. The learning curves are defined as: techniques of mitral valve repair, Transoesophageal Echocardiography-guided cannulation, incisions, instruments, visualization, aortic occlusion and cardiopulmonary bypass strategies. From local experience, the author provide advice on how to reduce the learning curves, such as practising with the specialised instruments and visualization techniques during sternotomy cases. Underpinning the NHS pillars are the principles of systems awareness, teamwork, communication, ownership and leadership, all of which are paramount to performing any surgery but more so with minimal access surgery, as will be highlighted throughout this paper.

  18. An Accessible User Interface for Geoscience and Programming

    Science.gov (United States)

    Sevre, E. O.; Lee, S.

    2012-12-01

    The goal of this research is to develop an interface that will simplify user interaction with software for scientists. The motivating factor of the research is to develop tools that assist scientists with limited motor skills with the efficient generation and use of software tools. Reliance on computers and programming is increasing in the world of geology, and it is increasingly important for geologists and geophysicists to have the computational resources to use advanced software and edit programs for their research. I have developed a prototype of a program to help geophysicists write programs using a simple interface that requires only simple single-mouse-clicks to input code. It is my goal to minimize the amount of typing necessary to create simple programs and scripts to increase accessibility for people with disabilities limiting fine motor skills. This interface can be adapted for various programming and scripting languages. Using this interface will simplify development of code for C/C++, Java, and GMT, and can be expanded to support any other text based programming language. The interface is designed around the concept of maximizing the amount of code that can be written using a minimum number of clicks and typing. The screen is split into two sections: a list of click-commands is on the left hand side, and a text area is on the right hand side. When the user clicks on a command on the left hand side the applicable code is automatically inserted at the insertion point in the text area. Currently in the C/C++ interface, there are commands for common code segments that are often used, such as for loops, comments, print statements, and structured code creation. The primary goal is to provide an interface that will work across many devices for developing code. A simple prototype has been developed for the iPad. Due to the limited number of devices that an iOS application can be used with, the code has been re-written in Java to run on a wider range of devices

  19. Assessing the Impacts of Rural Electrification in Sub-Saharan Africa: The Case of Ethiopia

    Science.gov (United States)

    Aragaw, Mekonnen Lulie

    This study links rural electrification and the transition to modern energy services with poverty reduction and rural development in Ethiopia. Benefits of rural electrification in reducing poverty and accelerating rural development in low-income developing countries have been insufficiently researched. This study analyses available empirical evidence at a local level and examines how electricity access translates into productive use beyond powering radios and lighting. A survey of 336 households was conducted in Northern Ethiopia on impacts of electrification on four rural towns with varying number of years of access to electricity. Evidence at household and community levels shows that access to electricity was followed by an increase in household connectivity rate, and slow transition to modern energy services based on level of household income and number of years of a household's connection to electricity services. The pace of transition to modern energy services was slow, and household energy poverty and dependence on biomass fuels continued in most rural towns, having little impact on improved environmental management practices. Improvement in rural livelihood, poverty reduction, and delivery of public services was highest for those with more years of access to electricity, and higher income households. The fact that impacts of RE depend on number of years of a household's electricity connection implies gradual improvements rather than immediate benefits after connection. In the short-term, households improved their quality of life through better lighting and reduced indoor-air pollution. In the medium and longer-term, households and communities diversified their income and received improved public services such as education, health, and potable water. Further benefits were wider off-farm and non-farm employment, increased rural markets, and improved environment for rural development. Very poor households benefited least, while those better-off utilized

  20. Confronting Challenges at the Intersection of Rurality, Place, and Teacher Preparation: Improving Efforts in Teacher Education to Staff Rural Schools

    Directory of Open Access Journals (Sweden)

    Amy Price Azano

    2016-02-01

    Full Text Available Recruiting and retaining highly qualified teachers in rural schools is a persistent struggle in many countries, including the U.S. Salient challenges related to poverty, geographic isolation, low teacher salaries, and a lack of community amenities seem to trump perks of living in rural communities. Recognizing this issue as a complex and hard to solve fixture in the composition of rural communities, we sought to understand how teacher preparation programs might better prepare preservice teachers for successful student teaching placements and, ideally, eventual careers in rural schools. In this study, we explore teacher candidates’ perceptions of rurality while examining how specific theory, pedagogy, and practice influence their feelings of preparedness for working in a rural school. Using pre- and post- questionnaire data, classroom observations, and reflections, we assess the effectiveness of deliberate efforts in our teacher preparation program to increase readiness for rural teaching. In our analysis and discussion, we draw on critical and sociocultural theories to understand the experiences of a cohort of teacher candidates as they explore personal histories, the importance of place, expectations, and teaching strategies for rural contexts. While rural education researchers have long lamented the struggle to recruit and retain teachers, there is relatively little known about intentional efforts to prepare teachers specifically for rural classrooms. We conclude our article with recommendations for enhancing teacher preparation programs in ways that might result in significant progress toward the goal of staffing rural schools with the highly skilled teachers all students deserve.