Sample records for rural hospitals face

  1. Unique factors rural Veterans' Affairs hospitals face when implementing health care-associated infection prevention initiatives. (United States)

    Harrod, Molly; Manojlovich, Milisa; Kowalski, Christine P; Saint, Sanjay; Krein, Sarah L


    Health care-associated infection (HAI) is costly to hospitals and potentially life-threatening to patients. Numerous infection prevention programs have been implemented in hospitals across the United States. Yet, little is known about infection prevention practices and implementation in rural hospitals. The purpose of this study was to understand the infection prevention practices used by rural Veterans' Affairs (VA) hospitals and the unique factors they face in implementing these practices. This study used a sequential, mixed methods approach. Survey data to identify the HAI prevention practices used by rural VA hospitals were collected, analyzed, and used to inform the development of a semistructured interview guide. Phone interviews were conducted followed by site visits to rural VA hospitals. We found that most rural VA hospitals were using key recommended infection prevention practices. Nonetheless, a number of challenges with practice implementation were identified. The 3 most prominent themes were: (1) lack of human capital including staff with HAI expertise; (2) having to cultivate needed resources; and (3) operating as a system within a system. Rural VA hospitals are providing key infection prevention services to ensure a safe environment for the veterans they serve. However, certain factors, such as staff expertise, limited resources, and local context impacted how and when these practices were used. The creative use of more accessible alternative resources as well as greater flexibility in implementing HAI-related initiatives may be important strategies to further improve delivery of these important services by rural VA hospitals. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

  2. Marketing strategy determinants in rural hospitals. (United States)

    Smith, H L; Haley, D; Piland, N F


    Rural hospitals confront an inauspicious environment due to changes in patient reimbursement and medical practice. Facing a situation of declining revenues, marketing presents an option for rural hospitals to adapt to the growing constraints. This paper analyzes the determinants of marketing strategy emphasis in rural hospitals. The conceptual model adopted in this study predicts that prior performance and contextual variables explain marketing strategy emphasis. The relationships are examined in a case study of rural New Mexico hospitals. Results suggest that prior performance and several contextual variables explain variations in marketing strategy emphasis. In particular, higher gross patient revenues are associated with more emphasis on television and radio advertising. Furthermore, rural New Mexico hospitals with high numbers of licensed beds and medical staff members, or that are affiliated with a chain organization, place greater emphasis on market research and market planning. The implications for marketing practice in rural hospitals are discussed.

  3. Approach to malaria in rural hospitals

    Directory of Open Access Journals (Sweden)

    Jency Maria Koshy


    Full Text Available Malaria is one of the most common parasitic infections in the developing countries. In Rural India, most patients would be treated by primary and secondary care physicians. This article is aimed at providing a feasible approach to the cases of malaria in mission hospitals and other rural hospitals taking into account all the resource limitations. A study done over one year on patients detected to have malaria at Jiwan Jyoti Christian Hospital in Sonbhadra district has helped the authors to identify the various challenges faced by doctors working in the rural hospitals. The article has looked at the various complications associated with malaria and their management. It has also stressed upon the increasing incidence of chloroquine resistance.

  4. Barriers facing junior doctors in rural practice. (United States)

    Smith, Deborah M


    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

  5. Estimating Uncompensated Care Charges at Rural Hospital Emergency Departments (United States)

    Bennett, Kevin J.; Moore, Charity G.; Probst, Janice C.


    Context: Rural hospitals face multiple financial burdens. Due to federal law, emergency departments (ED) provide a gateway for uninsured and self-pay patients to gain access to treatment. It is unknown how much uncompensated care in rural hospitals is due to ED visits. Purpose: To develop a national estimate of uncompensated care from patients…

  6. Developing IT Infrastructure for Rural Hospitals: A Case Study of Benefits and Challenges of Hospital-to-Hospital Partnerships. (United States)

    Reddy, Madhu C; Purao, Sandeep; Kelly, Mary


    This article presents a study identifying benefits and challenges of a novel hospital-to-hospital information technology (IT) outsourcing partnership (HHP). The partnership is an innovative response to the problem that many smaller, rural hospitals face: to modernize their IT infrastructure in spite of a severe shortage of resources. The investigators studied three rural hospitals that outsourced their IT infrastructure, through an HHP, to a larger, more technologically advanced hospital in the region. The study design was based on purposive sampling and interviews of senior managers from the four hospitals. The results highlight the HHP's benefits and challenges from both the rural hospitals' and vendor hospital's perspectives. The HHP was considered a success: a key outcome was that it has improved the rural hospitals' IT infrastructure at an affordable cost. The investigators discuss key elements for creating a successful HHP and offer preliminary answers to the question of what it takes for an HHP to be successful.

  7. Challenges faced in rural hospitals: the experiences of nurse managers in Uganda. (United States)

    Kakyo, T A; Xiao, L D


    The aim of this study was to understand nurse ward managers perceived challenges in the rural healthcare setting in Uganda. The health workforce, essential medicines and equipment and political unrest are the main factors affecting the international community in addressing the hefty disease burden in World Health Organization African regions. Nurse ward managers have an important role to play to mitigate these factors in health facilities in these regions through leadership, supervision and support for staff. This study utilized interpretive phenomenology based on Gadamer's hermeneutical principles. Eleven nurse managers from two rural public hospitals in Uganda were interviewed. Those with more than a 2-year experience in their management role were invited to participate in the study. Nurse managers pointed out four major challenges with staffing, while they worked in the rural healthcare settings. These are summarized into themes: 'Numbers do matter'; 'I cannot access them when I need them at work'; 'Challenges in dealing with negative attitudes'; and 'Questioning own ability to manage health services'. Health facilities in rural areas face extremely low staff-to-patient ratio, a high level of workload, lack of essential medicines and equipment, low salaries and delayed payment for staff. Nurse managers demonstrated situation-based performance to minimize the impact of these challenges on the quality and safety of patient care, but they had less influence on policy and resource development. It is imperative to mobilize education for nurse ward managers to enable them to improve leadership, management skills and to have a greater impact on policy and resource development. © 2018 International Council of Nurses.

  8. Rural model dedicated education unit: partnership between college and hospital. (United States)

    Harmon, Lisa M


    This article describes the pilot project development of a rural model Dedicated Education Unit (DEU) by a rural college nursing program and a rural hospital to increase student nurses' confidence and proficiency and improve recruitment of prepared rural staff nurses. Traditionally, for economies of scale, most student clinical rotations occurred in urban settings with the number of students per clinical instructor allowed by the state board of nursing. College budget constraints negated the placement of fewer than this mandated maximum number of students in a rural hospital with a clinical instructor; moreover, rural hospitals could not accommodate 10 students at one time. Rural nursing students were anxious in the urban settings, and this anxiety precluded learning in many instances. Rural hospitals face higher registered nurse vacancies than urban centers. Of the nurses applying for open positions, many were not prepared for the demands of rural nursing, resulting in increased turnover and high orientation costs. The rural model DEU addressed issues of both the nursing program and the hospital. The design and development of the rural model DEU and the advantages of the partnership for the college nursing program and the hospital are discussed. Initial outcomes and serendipitous findings from the pilot project are also discussed. Copyright 2013, SLACK Incorporated.

  9. The Successful Implementation of Electronic Health Records at Small Rural Hospitals (United States)

    Richardson, Daniel


    Electronic health records (EHRs) have been in use since the 1960s. U.S. rural hospital leaders and administrators face significant pressure to implement health information technology because of the American Recovery and Reinvestment Act of 2009. However, some leaders and managers of small rural hospital lack strategies to develop and implement…

  10. Infection prevention needs assessment in Colorado hospitals: rural and urban settings. (United States)

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


    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.

  11. Rural-Urban Differences in Preventable Hospitalizations among Community-Dwelling Veterans with Dementia (United States)

    Thorpe, Joshua M.; Van Houtven, Courtney H.; Sleath, Betsy L.; Thorpe, Carolyn T.


    Context: Alzheimer's patients living in rural communities may face significant barriers to effective outpatient medical care. Purpose: We sought to examine rural-urban differences in risk for ambulatory care sensitive hospitalizations (ACSH), an indicator of access to outpatient care, in community-dwelling veterans with dementia. Methods: Medicare…

  12. The Rural Obstetric Workforce in US Hospitals: Challenges and Opportunities (United States)

    Kozhimannil, Katy B.; Casey, Michelle M.; Hung, Peiyin; Han, Xinxin; Prasad, Shailendra; Moscovice, Ira S.


    Purpose The purpose of this study was to describe the types and combinations of clinicians who are delivering babies in rural hospitals, their employment status, the relationship between hospital birth volume and staffing models, and the staffing challenges faced by rural hospitals. Methods We conducted a telephone survey of 306 rural hospitals in 9 states: Colorado, Iowa, Kentucky, New York, North Carolina, Oregon, Vermont, Washington, and Wisconsin, from November 2013-March 2014 to assess their obstetric workforce. Bivariate associations between hospitals’ annual birth volume and obstetric workforce characteristics were examined, as well as qualitative analysis of workforce changes and staffing challenges. Findings Hospitals with lower birth volume (< 240 births per year) are more likely to have family physicians and general surgeons attending deliveries, while those with a higher birth volume more frequently have obstetricians and midwives attending deliveries. Reported staffing challenges include scheduling, training, census fluctuation, recruitment and retention, and intra-hospital relationships. Conclusions Individual hospitals working in isolation may struggle to address staffing challenges. Federal and state policy makers, regional collaboratives, and health care delivery systems can facilitate solutions through programs such as telehealth, simulation training, and interprofessional education. PMID:25808202

  13. The hub-and-spoke organization design revisited: a lifeline for rural hospitals. (United States)

    Elrod, James K; Fortenberry, John L


    Characterized by declining populations, high poverty, reduced employment opportunities, and high numbers of uninsured residents, rural communities pose significant challenges for healthcare providers desirous of addressing these medically underserved areas. Such difficult environments, in fact, have forced the closure of many rural hospitals across America, with scores facing the same threat, compelling intensive efforts to identify pathways which will yield an improved future. Collaborations with stronger urban or suburban healthcare institutions offer a prudent avenue for rural hospitals to continue serving their patients. Such relationships can be structured in many different ways, but Willis-Knighton Health System found that its use of the hub-and-spoke organization design set the stage for the institution to cast a vital lifeline to neighboring rural hospitals, affording the relatively seamless integration and assimilation of partner facilities into its network, ensuring continuity of services in remote regions. This article supplies an overview of the hub-and-spoke network and discusses Willis-Knighton Health System's use of it to facilitate the establishment of productive partnerships with rural hospitals. The delivery of healthcare services in rural environments is essential, but with small community hospitals increasingly being under threat, the outlook is not particularly attractive. Partnerships with better positioned healthcare entities offer significant hope, but care must be taken to structure these arrangements optimally. Willis-Knighton Health System found utility and value in its hub-and-spoke organization design, with the insights presented in this account potentially offering a pathway for others to follow as they go about addressing the healthcare needs of rural populations.

  14. Problems Facing Rural Schools. (United States)

    Stewart, C. E.; And Others

    Problems facing rural Scottish schools range from short term consideration of daily operation to long term consideration of organizational alternatives. Addressed specifically, such problems include consideration of: (1) liaison between a secondary school and its feeder primary schools; (2) preservice teacher training for work in small, isolated…

  15. The Rising Rate of Rural Hospital Closures. (United States)

    Kaufman, Brystana G; Thomas, Sharita R; Randolph, Randy K; Perry, Julie R; Thompson, Kristie W; Holmes, George M; Pink, George H


    Since 2010, the rate of rural hospital closures has increased significantly. This study is a preliminary look at recent closures and a formative step in research to understand the causes and the impact on rural communities. The 2009 financial performance and market characteristics of rural hospitals that closed from 2010 through 2014 were compared to rural hospitals that remained open during the same period, stratified by critical access hospitals (CAHs) and other rural hospitals (ORHs). Differences were tested using Pearson's chi-square (categorical variables) and Wilcoxon rank test of medians. The relationships between negative operating margin and (1) market factors and (2) utilization/staffing factors were explored using logistic regression. In 2009, CAHs that subsequently closed from 2010 through 2014 had, in general, lower levels of profitability, liquidity, equity, patient volume, and staffing. In addition, ORHs that closed had smaller market shares and operated in markets with smaller populations compared to ORHs that remained open. Odds of unprofitability were associated with both market and utilization factors. Although half of the closed hospitals ceased providing health services altogether, the remainder have since converted to an alternative health care delivery model. Financial and market characteristics appear to be associated with closure of rural hospitals from 2010 through 2014, suggesting that it is possible to identify hospitals at risk of closure. As closure rates show no sign of abating, it is important to study the drivers of distress in rural hospitals, as well as the potential for alternative health care delivery models. © 2015 National Rural Health Association.

  16. The Practice of Midwifery in Rural US Hospitals. (United States)

    Kozhimannil, Katy B; Henning-Smith, Carrie; Hung, Peiyin


    Workforce shortages limit access to care for pregnant women in rural and remote areas. The goal of this analysis was to describe the role of certified nurse-midwives (CNMs) in providing maternity care in rural US hospitals and to examine state-level variation in rural CNM practice. We identified 306 rural hospitals with at least 10 births in 2010 using discharge data from the Statewide Inpatient Databases for 9 US states. We conducted a telephone survey of hospital maternity unit managers (N = 244) from November 2013 to March 2014 to understand their maternity care workforce and practice models. We describe the presence of CNMs attending births by hospital and state characteristics. Using logistic multivariate regression, we examined whether CNMs attend births, adjusting for hospital characteristics, practice regulations, and state. We also analyzed the content of open-ended responses about staffing plans, challenges, and opportunities that unit managers identified, with a focus on midwifery practice. CNMs attend births at one-third of rural maternity hospitals in 9 US states. Significant variability across states appears to be partially related to autonomous practice regulations: states allowing autonomous midwifery practice have a greater proportion of rural hospitals with midwives attending births (34% vs 28% without autonomous midwifery practice). In rural maternity hospitals, CNMs practice alongside obstetricians in 86%, and with family physicians in 44%, of hospitals. Fourteen percent of all respondents planned recruitment to increase the number of midwives at their hospital, although many, especially in smaller hospitals, noted challenges in doing so. CNMs play a crucial role in the maternity care workforce in rural US hospitals. The participation of CNMs in birth attendance varies by hospital birth volume and across state settings. Interprofessional practice is common for CNMs attending births in rural hospitals, and administrators hope to increase the

  17. Occupational Therapy and Physiotherapy in Acute Stroke: Do Rural Patients Receive Less Therapy?

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    Josie Merchant


    Full Text Available Objective. To assess whether acute stroke patients in rural hospitals receive less occupational therapy and physiotherapy than those in metropolitan hospitals. Design. Retrospective case-control study of health data in patients ≤10 days after stroke. Setting. Occupational therapy and physiotherapy services in four rural hospitals and one metropolitan hospital. Participants. Acute stroke patients admitted in one health district. Main Outcome Measures. Frequency and duration of face-to-face and indirect therapy sessions. Results. Rural hospitals admitted 363 patients and metropolitan hospital admitted 378 patients. Mean age was 73 years. Those in rural hospitals received more face-to-face (p>0.0014 and indirect (p=0.001 occupational therapy when compared to those in the metropolitan hospital. Face-to-face sessions lasted longer (p=0.001. Patients admitted to the metropolitan hospital received more face-to-face (p>0.000 and indirect (p>0.000 physiotherapy when compared to those admitted to rural hospitals. Face-to-face sessions were shorter (p>0.000. Almost all were seen within 24 hours of referral. Conclusions. Acute stroke patients in Australian rural hospital may receive more occupational therapy and less physiotherapy than those in metropolitan hospitals. The dose of therapy was lower than recommended, and the referral process may unnecessarily delay the time from admission to a patient’s first therapy session.

  18. Rural versus urban academic hospital mortality following stroke in Canada. (United States)

    Fleet, Richard; Bussières, Sylvain; Tounkara, Fatoumata Korika; Turcotte, Stéphane; Légaré, France; Plant, Jeff; Poitras, Julien; Archambault, Patrick M; Dupuis, Gilles


    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.

  19. Predicting Financial Distress and Closure in Rural Hospitals. (United States)

    Holmes, George M; Kaufman, Brystana G; Pink, George H


    Annual rates of rural hospital closure have been increasing since 2010, and hospitals that close have poor financial performance relative to those that remain open. This study develops and validates a latent index of financial distress to forecast the probability of financial distress and closure within 2 years for rural hospitals. Hospital and community characteristics are used to predict the risk of financial distress 2 years in the future. Financial and community data were drawn for 2,466 rural hospitals from 2000 through 2013. We tested and validated a model predicting a latent index of financial distress (FDI), measured by unprofitability, equity decline, insolvency, and closure. Using the predicted FDI score, hospitals are assigned to high, medium-high, medium-low, and low risk of financial distress for use by practitioners. The FDI forecasts 8.01% of rural hospitals to be at high risk of financial distress in 2015, 16.3% as mid-high, 46.8% as mid-low, and 28.9% as low risk. The rate of closure for hospitals in the high-risk category is 4 times the rate in the mid-high category and 28 times that in the mid-low category. The ability of the FDI to discriminate hospitals experiencing financial distress is supported by a c-statistic of .74 in a validation sample. This methodology offers improved specificity and predictive power relative to existing measures of financial distress applied to rural hospitals. This risk assessment tool may inform programs at the federal, state, and local levels that provide funding or support to rural hospitals. © 2016 National Rural Health Association.

  20. Metrics help rural hospitals achieve world-class performance. (United States)

    Goodspeed, Scott W


    This article describes the emerging trend of using metrics in rural hospitals to achieve world-class performance. This trend is a response to the fact that rural hospitals have small patient volumes yet must maintain a profit margin in order to fulfill their mission to the community. The conceptual idea for this article is based largely on Robert Kaplan and David Norton's Balanced Scorecard articles in the Harvard Business Review. The ideas also come from the experiences of the 60-plus rural hospitals that are using the Balanced Scorecard and their implementation of metrics to influence performance and behavior. It is indeed possible for rural hospitals to meet and exceed the unique needs of patients and physicians (customers), to achieve healthy profit margins, and to be the rural hospital of choice that employees are proud to work for.

  1. Extent of telehealth use in rural and urban hospitals. (United States)

    Ward, Marcia M; Ullrich, Fred; Mueller, Keith


    Key Findings. Data from 4,727 hospitals in the 2013 HIMSS Analytics database yielded these findings: (1) Two-thirds (66.0% of rural defined as nonmetropolitan and 68.0% of urban) had no telehealth services or were only in the process of implementing a telehealth application. One-third (34.0%rural and 32.0% urban) had at least one telehealth application currently in use. (2) Among hospitals with "live and operational" telehealth services, 61.4% indicated only a single department/program with an operational telehealth service, and 38.6% indicated two or more departments/programs with operational telehealth services. Rural hospitals were significantly less likely to have multiple services (35.2%) than were urban hospitals (42.1%) (3) Hospitals that were more likely to have implemented at least one telehealth service were academic medical centers, not-for-profit institutions, hospitals belonging to integrated delivery systems, and larger institutions (in terms of FTEs but not licensed beds). Rural and urban hospitals did not differ significantly in overall telehealth implementation rates. (4) Urban and rural hospitals did differ in the department where telehealth was implemented. Urban hospitals were more likely than rural hospitals to have operational telehealth implementations in cardiology/stroke/heart attack programs (7.4% vs. 6.2%), neurology (4.4% vs. 2.1%), and obstetrics/gynecology/NICU/pediatrics (3.8% vs. 2.5%). In contrast, rural hospitals were more likely than urban hospital to have operational telehealth implementations in radiology departments (17.7% vs. 13.9%) and in emergency/trauma care (8.8% vs. 6.3%).

  2. Implementing Patient Safety Initiatives in Rural Hospitals (United States)

    Klingner, Jill; Moscovice, Ira; Tupper, Judith; Coburn, Andrew; Wakefield, Mary


    Implementation of patient safety initiatives can be costly in time and energy. Because of small volumes and limited resources, rural hospitals often are not included in nationally driven patient safety initiatives. This article describes the Tennessee Rural Hospital Patient Safety Demonstration project, whose goal was to strengthen capacity for…

  3. The financial performance of rural hospitals and implications for elimination of the Critical Access Hospital program. (United States)

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


    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.

  4. Rural hospitals: an asset in the continuum of care. (United States)

    Arduino, Kelly


    When embarking on a partnership or acquisition, a rural hospital and a larger health system can accomplish a smooth transition, as long as they both keep in mind: > The fundamental (and financial) differences between urban and rural hospitals > The areas where the rural hospital in the partnership or acquisition is profitable > The importance of a clinic strategy in a partnership.

  5. Rural vs urban hospital performance in a 'competitive' public health service. (United States)

    Garcia-Lacalle, Javier; Martin, Emilio


    In some western countries, market-driven reforms to improve efficiency and quality have harmed the performance of some hospitals, occasionally leading to their closure, mostly in rural areas. This paper seeks to explore whether these reforms affect urban and rural hospitals differently in a European health service. Rural and urban hospital performance is compared taking into account their efficiency and perceived quality. The study is focused on the Andalusian Health Service (SAS) in Spain, which has implemented a freedom of hospital choice policy and a reimbursement system based on hospital performance. Data Envelopment Analysis, the Mann-Whitney U test and Multidimensional Scaling techniques are conducted for two years, 2003 and 2006. The results show that rural and urban hospitals perform similarly in the efficiency dimension, whereas rural hospitals perform significantly better than urban hospitals in the patient satisfaction dimension. When the two dimensions are considered jointly, some rural hospitals are found to be the best performers. As such, market-driven reforms do not necessary result in a difference in the performance of rural and urban hospitals. Copyright 2010 Elsevier Ltd. All rights reserved.

  6. The Rural Inpatient Mortality Study: Does Urban-Rural County Classification Predict Hospital Mortality in California? (United States)

    Linnen, Daniel T; Kornak, John; Stephens, Caroline


    Evidence suggests an association between rurality and decreased life expectancy. To determine whether rural hospitals have higher hospital mortality, given that very sick patients may be transferred to regional hospitals. In this ecologic study, we combined Medicare hospital mortality ratings (N = 1267) with US census data, critical access hospital classification, and National Center for Health Statistics urban-rural county classifications. Ratings included mortality for coronary artery bypass grafting, stroke, chronic obstructive pulmonary disease, heart attack, heart failure, and pneumonia across 277 California hospitals between July 2011 and June 2014. We used generalized estimating equations to evaluate the association of urban-rural county classifications on mortality ratings. Unfavorable Medicare hospital mortality rating "worse than the national rate" compared with "better" or "same." Compared with large central "metro" (metropolitan) counties, hospitals in medium-sized metro counties had 6.4 times the odds of rating "worse than the national rate" for hospital mortality (95% confidence interval = 2.8-14.8, p centers may contribute to these results, a potential factor that future research should examine.

  7. The potential migration effect of rural hospital closures

    DEFF Research Database (Denmark)

    Sørensen, Jens Fyhn Lykke


    to out-migration, although the hypothetical way of questioning leaves uncertainty about the actual scale of out-migration. Child families appear to be the most likely out-migrants. Elderly people may be hardest hit by a hospital closure, being most reliant on health care and least inclined to move away.......Rural hospital closures are high on the current health care agenda in Denmark. One raised concern is that rural hospital closures may further decrease population numbers in rural areas, as closures may induce some residents to move away from affected areas, i.e. closer to health care services...

  8. Meaningful Use of Health Information Technology by Rural Hospitals (United States)

    McCullough, Jeffrey; Casey, Michelle; Moscovice, Ira; Burlew, Michele


    Purpose: This study examines the current status of meaningful use of health information technology (IT) in Critical Access Hospitals (CAHs), other rural, and urban US hospitals, and it discusses the potential role of Medicare payment incentives and disincentives in encouraging CAHs and other rural hospitals to achieve meaningful use. Methods: Data…

  9. Rural hospital wages (United States)

    Hendricks, Ann M.


    Average fiscal year 1982 wages from 2,302 rural American hospitals were used to test for a gradient descending from hospitals in counties adjacent to metropolitan areas to those not adjacent. Considerable variation in the ratios of adjacent to nonadjacent averages existed. No statistically significant difference was found, however. Of greater importance in explaining relative wages within States were occupational mix, mix of part-time and full-time workers, case mix, presence of medical residencies, and location in a high-rent county within the State. Medicare already adjusts payments for only two of these variables. PMID:10313454

  10. The Maternity Care Nurse Workforce in Rural U.S. Hospitals. (United States)

    Henning-Smith, Carrie; Almanza, Jennifer; Kozhimannil, Katy B

    To describe the maternity care nurse staffing in rural U.S. hospitals and identify key challenges and opportunities in maintaining an adequate nursing workforce. Cross-sectional survey study. Maternity care units within rural hospitals in nine U.S. states. Maternity care unit managers. We calculated descriptive statistics to characterize the rural maternity care nursing workforce by hospital birth volume and nursing staff model. We used simple content analysis to analyze responses to open-ended questions and identified themes related to challenges and opportunities for maternity care nursing in rural hospitals. Of the 263 hospitals, 51% were low volume (maternity care nurses. They did, however, identify significant challenges related to recruiting nurses, maintaining adequate staffing during times of census variability, orienting and training nurses, and retaining experienced nurses. Rural maternity care unit managers recognize the importance of nursing and have varied staffing needs. Policy implementation and programmatic support to ameliorate challenges may help ensure that an adequate nursing staff can be maintained, even in small-volume rural hospitals. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  11. Willingness to pay for municipality hospital services in rural Japan: a contingent valuation study

    Directory of Open Access Journals (Sweden)

    Nakamura Toshihito


    Full Text Available Abstract Background The Japanese healthcare system has undergone reforms to address the struggles that municipality hospitals face. Reform guidelines clearly define criteria for administrative improvement. However, criteria to evaluate the demand for healthcare provisions in rural Japan, including the needs of rural residents for municipality hospitals in particular have not been specified. The purpose of this paper is to measure residents' willingness to pay (WTP for municipality hospital services using the contingent valuation method, and to evaluate municipality hospital valuation on the basis of WTP. K town, located in the Hokkaido prefecture of Japan, was selected as the location for this study. Participants were recruited by a town hall healthcare administrator, hospital and clinic staff, and a local dentist. Participants were asked what amount they would be willing to pay as taxes to continue accessing the services of the municipality hospital for one year by using open-ended questions in face-to-face interviews. Findings Forty-eight residents were initially recruited, and 40 participants were selected for the study (response rate 83%. As compared to K town's population, this data slanted toward the elderly, although there was no significant difference in frequency among the characteristics. The median WTP was estimated at 39,484 yen ($438.71, with a 95% confidence interval 27,806-55,437 yen ($308.95-615.96. Logistic regression revealed no significant factors affecting WTP. Conclusions If the total amount of residents' WTP for the municipality hospital were to be estimated by this result, it would calculate with 129,586,000 yen ($1,439,844. This is approximately equal to the amount of money to be transferred from the general account of the government of K town, more than one-half of the town tax of K town, and about two-fold in comparison to Japan as a whole. This showed that K town's residents placed a high valuation on the municipality

  12. Rural Hospital Wages and the Area Wage Index (United States)

    Dalton, Kathleen; Slifkin, Rebecca T.; Howard, Hilda A.


    We examined data on hospital hourly wages and the prospective payment system (PPS) wage index from 1990 to 1997, to determine if incremental changes to the index have improved its precision and equity as a regional cost adjuster. The differential between average rural and urban PPS hourly wages has declined by almost one-fourth over the 8-year study period. Nearly one-half of the decrease is attributable to regulatory and reporting changes in the annual hospital wage survey. Patterns of within-market wage variation across rural-urban continuum codes identify three separate sub-markets within the State-level aggregates defining rural labor markets. Geographic reclassification decisions appear to eliminate one of the three. Remaining systematic within-market rural wage differences work to the reimbursement advantage of hospitals in the smaller and more isolated communities. PMID:12545604

  13. 42 CFR 440.20 - Outpatient hospital services and rural health clinic services. (United States)


    ... Definitions § 440.20 Outpatient hospital services and rural health clinic services. (a) Outpatient hospital... services that are not generally furnished by most hospitals in the State. (b) Rural health clinic services... 42 Public Health 4 2010-10-01 2010-10-01 false Outpatient hospital services and rural health...

  14. Rural hospital ownership: medical service provision, market mix, and spillover effects. (United States)

    Horwitz, Jill R; Nichols, Austin


    To test whether nonprofit, for-profit, or government hospital ownership affects medical service provision in rural hospital markets, either directly or through the spillover effects of ownership mix. Data are from the American Hospital Association, U.S. Census, CMS Healthcare Cost Report Information System and Prospective Payment System Minimum Data File, and primary data collection for geographic coordinates. The sample includes all nonfederal, general medical, and surgical hospitals located outside of metropolitan statistical areas and within the continental United States from 1988 to 2005. We estimate multivariate regression models to examine the effects of (1) hospital ownership and (2) hospital ownership mix within rural hospital markets on profitable versus unprofitable medical service offerings. Rural nonprofit hospitals are more likely than for-profit hospitals to offer unprofitable services, many of which are underprovided services. Nonprofits respond less than for-profits to changes in service profitability. Nonprofits with more for-profit competitors offer more profitable services and fewer unprofitable services than those with fewer for-profit competitors. Rural hospital ownership affects medical service provision at the hospital and market levels. Nonprofit hospital regulation should reflect both the direct and spillover effects of ownership. © Health Research and Educational Trust.

  15. The adoption of provider-based rural health clinics by rural hospitals: a study of market and institutional forces. (United States)

    Krein, S L


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

  16. Financially fragile rural hospitals: mergers and closures. (United States)

    Holmes, Mark


    Rural hospitals serve as major sources of health care and employment for their communities, but recently they have been under increased financial stress. What are the causes of this stress, and how have hospitals and their communities responded?

  17. Effects of Rural Medical Insurance on Chronically Ill Patients' Choice of the Same Hospital Again in Rural Northern China. (United States)

    Jiang, Ke; You, Daming; Li, Zhendong; Wei, Wei; Mainstone, Mitchell


    The emergence of rural health insurance plays a crucial role in alleviating the pressure on rural medical expenditure. Under the current medical system in northern China, rural medical insurance may reduce the free referral of patients with chronic diseases among hospitals. This study was carried out based on the results of an investigation of rural chronically-ill patients in eight county hospitals in northern China, as well as through the comparison and analysis of patients with chronic diseases, considering whether they were with or without rural health insurance. The main results showed that both age ( χ 2 = 22.9, p rural peoples' willingness to buy health insurance. Meanwhile, both the quality of the hospital's treatment ( B = 0.555, p rural health insurance had weakened the three relationships upon which the aforementioned correlations were based.

  18. Rural Hospital Employment of Physicians and Use of Cesareans and Nonindicated Labor Induction. (United States)

    Prasad, Shailendra; Hung, Peiyin; Henning-Smith, Carrie; Casey, Michelle; Kozhimannil, Katy


    Workforce issues constrain obstetric care services in rural US hospitals, and one strategy hospitals use is to employ physicians to provide obstetric care. However, little is known about the relationship between hospital employment of maternity care physicians and use of obstetric care procedures in rural hospitals. We examined the association between obstetric physician employment and use of cesareans and nonindicated labor induction. We conducted a cross-sectional analysis of a telephone survey of all 306 rural hospitals providing obstetric care in 9 states from November 2013 to March 2014 and linked the survey data (N = 263, 86% response rate) to all-payer childbirth data on maternity care utilization from 2013 Statewide Inpatient Database (SID) hospital discharge data. Using logistic regression models, we assessed the proportion of a hospital's maternity care physicians employed by the hospital and estimated its association with utilization of low-risk and nonindicated cesareans, and nonindicated labor induction. Rural hospitals that employed family physicians but not obstetricians had lower cesarean rates among low-risk pregnancies. Rural hospitals that employed only obstetricians did not show a relationship between employment and procedure utilization. Across hospitals with both obstetricians and family physicians, a 10% higher proportion of obstetricians employed was associated with 4.6% higher low-risk cesarean rates (4.6% [0.7%-8.4%]), while no significant relationship was found for the proportion of family physicians employed by a hospital. In rural US hospitals, associations between physician employment and obstetric procedure use differed by physician mix and the types of physicians employed. © 2017 National Rural Health Association.

  19. Rural Hospital Mergers and Acquisitions: Which Hospitals Are Being Acquired and How Are They Performing Afterward?. (United States)

    Noles, Marissa J; Reiter, Kristin L; Boortz-Marx, Jonathan; Pink, George


    The number of stand-alone rural hospitals has been shrinking as larger health systems target these hospitals for mergers and acquisitions (M and As). However, little research has focused specifically on rural hospital M and A transactions. Using data from Irving Levin Associates' Healthcare M and A Report and Medicare Cost Reports from 2005 to 2012, we examined two research questions: (1) What were the characteristics of rural hospitals that merged or were acquired, and (2) were there changes in rural hospital financial performance, staffing, or services after an M and A transaction? We used logistic regression to identify factors predictive of merger, and we used multiple regression to examine various hospital measures after an M or A. Study results showed that hospitals with weaker financial performance but lower staffing levels and staffing costs were more likely to merge or be acquired. Statistically weak evidence suggested that operating margins declined after the merger; stronger evidence suggested reductions in salary expense. There was no statistically significant evidence of changes to the number of full-time equivalent (FTE) employees, the service lines that were included in the study, capital expenditures, or the amount of debt financing among the hospitals that merged or were acquired. M and A may not result in a rapid influx of capital, a relief of debt burden, or an improvement in bottom-line profitability. However, M and A may be a viable option for maintaining the hospital and the access to care it provides.

  20. Maternity Care Services Provided by Family Physicians in Rural Hospitals. (United States)

    Young, Richard A

    The purpose of this study was to describe how many rural family physicians (FPs) and other types of providers currently provide maternity care services, and the requirements to obtain privileges. Chief executive officers of rural hospitals were purposively sampled in 15 geographically diverse states with significant rural areas in 2013 to 2014. Questions were asked about the provision of maternity care services, the physicians who perform them, and qualifications required to obtain maternity care privileges. Analysis used descriptive statistics, with comparisons between the states, community rurality, and hospital size. The overall response rate was 51.2% (437/854). Among all identified hospitals, 44.9% provided maternity care services, which varied considerably by state (range, 17-83%; P maternity care, a mean of 271 babies were delivered per year, 27% by cesarean delivery. A mean of 7.0 FPs had privileges in these hospitals, of which 2.8 provided maternity care and 1.8 performed cesarean deliveries. The percentage of FPs who provide maternity care (mean, 48%; range, 10-69%; P maternity care who are FPs (mean, 63%; range, 10-88%; P maternity care services in US rural hospitals, including cesarean deliveries. Some family medicine residencies should continue to train their residents to provide these services to keep replenishing this valuable workforce. © Copyright 2017 by the American Board of Family Medicine.

  1. Rural teachers' views: What are gender-based challenges facing ...

    African Journals Online (AJOL)

    This paper gives prominence to rural teachers' accounts of gender-based challenges facing Free Primary Education in Lesotho. It draws on feminist interpretations of social constructionism to discuss factors within the Basotho communities that affect gender equality in the schools. The inductive analysis offered makes use ...

  2. The WAMI Rural Hospital Project. Part 3: Building health care leadership in rural communities. (United States)

    Elder, W G; Amundson, B A


    The WAMI Rural Hospital Project (RHP) intervention combined aspects of community development, strategic planning and organizational development to address the leadership issues in six Northwest rural hospitals. Hospitals and physicians, other community health care providers and local townspeople were involved in this intervention, which was accomplished in three phases. In the first phase, extensive information about organizational effectiveness was collected at each site. Phase two consisted of 30 hours of education for the physician, board, and hospital administrator community representatives covering management, hospital board governance, and scope of service planning. In the third phase, each community worked with a facilitator to complete a strategic plan and to resolve conflicts addressed in the management analyses. The results of the evaluation demonstrated that the greatest change noted among RHP hospitals was improvement in the effectiveness of their governing boards. All boards adopted some or all of the project's model governance plan and had successfully completed considerable portions of their strategic plans by 1989. Teamwork among the management triad (hospital, board, and medical staff) was also substantially improved. Other improvements included the development of marketing plans for the three hospitals that did not initially have them and more effective use of outside consultants. The project had less impact on improving the functioning of the medical chief of staff, although this was not a primary target of the intervention. There was also relatively less community interest in joining regional health care associations. The authors conclude that an intervention program tailored to address specific community needs and clearly identified leadership deficiencies can have a positive effect on rural health care systems.

  3. The price of 'free'. Quantifying the costs incurred by rural residents attending publically funded outpatient clinics in rural and base hospitals. (United States)

    Fearnley, David; Kerse, Ngaire; Nixon, Garry


    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.

  4. Identifying maternity services in public hospitals in rural and remote Australia. (United States)

    Longman, Jo; Pilcher, Jennifer M; Donoghue, Deborah A; Rolfe, Margaret; Kildea, Sue V; Kruske, Sue; Oats, Jeremy J N; Morgan, Geoffrey G; Barclay, Lesley M


    This paper articulates the importance of accurately identifying maternity services. It describes the process and challenges of identifying the number, level and networks of rural and remote maternity services in public hospitals serving communities of between 1000 and 25000 people across Australia, and presents the findings of this process. Health departments and the national government's websites, along with lists of public hospitals, were used to identify all rural and remote Australian public hospitals offering maternity services in small towns. State perinatal reports were reviewed to establish numbers of births by hospital. The level of maternity services and networks of hospitals within which services functioned were determined via discussion with senior jurisdictional representatives. In all, 198 rural and remote public hospitals offering maternity services were identified. There were challenges in sourcing information on maternity services to generate an accurate national picture. The nature of information about maternity services held centrally by jurisdictions varied, and different frameworks were used to describe minimum requirements for service levels. Service networks appeared to be based on a combination of individual links, geography and transport infrastructure. The lack of readily available centralised and comparable information on rural and remote maternity services has implications for policy review and development, equity, safety and quality, network development and planning. Accountability for services and capacity to identify problems is also compromised.

  5. Comparing Costs of Telephone versus Face-to-Face Extended Care Programs for the Management of Obesity in Rural Settings (United States)

    Radcliff, Tiffany A.; Bobroff, Linda B.; Lutes, Lesley D.; Durning, Patricia E.; Daniels, Michael J.; Limacher, Marian C.; Janicke, David M.; Martin, A. Daniel; Perri, Michael G.


    Background A major challenge following successful weight loss is continuing the behaviors required for long-term weight maintenance. This challenge may be exacerbated in rural areas with limited local support resources. Objective This study describes and compares program costs and cost-effectiveness for 12-month extended care lifestyle maintenance programs following an initial 6-month weight loss program. Design A 1-year prospective controlled randomized clinical trial. Participants/Setting The study included 215 female participants age 50 or older from rural areas who completed an initial 6-month lifestyle program for weight loss. The study was conducted from June 1, 2003, to May 31, 2007. Intervention The intervention was delivered through local Cooperative Extension Service offices in rural Florida. Participants were randomly-assigned to a 12-month extended care program using either individual telephone counseling (n=67), group face-to-face counseling (n=74), or a mail/control group (n=74). Main Outcome Measures Program delivery costs, weight loss, and self-reported health status were directly assessed through questionnaires and program activity logs. Costs were estimated across a range of enrollment sizes to allow inferences beyond the study sample. Statistical Analyses Performed Non-parametric and parametric tests of differences across groups for program outcomes were combined with direct program cost estimates and expected value calculations to determine which scales of operation favored alternative formats for lifestyle maintenance. Results Median weight regain during the intervention year was 1.7 kg for participants in the face-to-face format, 2.1 kg for the telephone format, and 3.1 kg for the mail/control format. For a typical group size of 13 participants, the face-to-face format had higher fixed costs, which translated into higher overall program costs ($420 per participant) when compared to individual telephone counseling ($268 per participant) and

  6. A survey of rural hospitals' perspectives on health information technology outsourcing. (United States)

    Johnson, Nicholas; Murphy, Alison; McNeese, Nathan; Reddy, Madhu; Purao, Sandeep


    A survey of rural hospitals was conducted in the spring of 2012 to better understand their perspectives on health information technology (HIT) outsourcing and the role that hospital-to-hospital HIT partnerships (HHPs) can play as an outsourcing mechanism. The survey sought to understand how HHPs might be leveraged for HIT implementation, as well as the challenges with forming them. The results suggest that HHPs have the potential to address rural hospitals' slow rate of HIT adoption, but there are also challenges to creating these partnerships. These issues, as well as avenues for further research, are then discussed.

  7. A national study of nurse leadership and supports for quality improvement in rural hospitals. (United States)

    Paez, Kathryn; Schur, Claudia; Zhao, Lan; Lucado, Jennifer


    This study assessed the perceptions and actions of rural hospital nurse executives with regard to patient safety and quality improvement (QI). A national sample of rural hospital nurse executives (n = 300) completed a survey measuring 4 domains related to patient safety and QI: (a) patient "Safety Culture," (b) adequacy of QI "Resources," (c) "Barriers" related to QI, and (d) "Nurse Leader Engagement" in activities supporting QI. Perceptions of Safety Culture were strong but 47% of the Resources needed to carry out QI were inadequate, 29% of Barriers were moderate to major, and 25% of Nurse Leader Engagement activities were performed infrequently. Nurse Leader Engagement in quality-related activities was less frequent among nurses in isolated and small rural town hospitals compared with large rural city hospitals. To further QI, rural nurse executives may need to use their communications and actions to raise the visibility of QI.

  8. Patient Safety Outcomes in Small Urban and Small Rural Hospitals (United States)

    Vartak, Smruti; Ward, Marcia M.; Vaughn, Thomas E.


    Purpose: To assess patient safety outcomes in small urban and small rural hospitals and to examine the relationship of hospital and patient factors to patient safety outcomes. Methods: The Nationwide Inpatient Sample and American Hospital Association annual survey data were used for analyses. To increase comparability, the study sample was…

  9. Development of a nurse case management service: a proposed business plan for rural hospitals. (United States)

    Adams, Marsha Howell; Crow, Carolyn S


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

  10. Nile Crossings: Hospitality and Revenge in Egyptian Rural Narratives


    Granara, William E.


    This essay looks at acts of hospitality and revenge as constituent elements of a broad social code in rural Egyptian narratives. By looking at five stories in particular, I argue that hospitality and revenge work in complementarity, and that they often trespass and blur each other’s social and literary borders, creating ambiguity and complexity in the stories. The traditional rules that govern hospitality are at times challenged or inverted by hostile intentions, and revenge may be exacted fo...

  11. Strategic activity and financial performance of U.S. rural hospitals: a national study, 1983 to 1988. (United States)

    Mick, S S; Morlock, L L; Salkever, D; de Lissovoy, G; Malitz, F; Wise, C G; Jones, A


    This study examines the effect of 13 strategic management activities on the financial performance of a national sample of 797 U.S. rural hospitals during the period of 1983-1988. Controlled for environment-market, geographic-region, and hospital-related variables, the results show almost no measurable effect of strategic adoption on rural hospital profitability and liquidity. Where statistically significant relationships existed, they were more often negative than positive. These findings were not expected; it was hypothesized that positive effects across a broad range of strategies would emerge, other things being equal. Discussed are possible explanations for these findings as well as their implication for a rural health policy relying on individual rural hospital strategic adaptation to environmental change.

  12. Introduction of Tele-ICU in rural hospitals: Changing organisational culture to harness benefits. (United States)

    Goedken, Cassie Cunningham; Moeckli, Jane; Cram, Peter M; Reisinger, Heather Schacht


    This study evaluates rural hospital staff perceptions of a telemedicine ICU (Tele-ICU) before and after implementation. We conducted a longitudinal qualitative study utilising semistructured group or individual interviews with staff from three rural ICU facilities in the upper Midwest of the United States that received Tele-ICU support. Interviews occurred pre-implementation and at two time points post-implementation. Interviews were conducted with: ICU administrators (n=6), physicians (n=3), nurses (n=9), respiratory therapists (n=5) and other (n=1) from July 2011 to May 2013. Transcripts were analysed for thematic content. Overall, rural ICU staff viewed Tele-ICU as a welcome benefit for their facility. Major themes included: (1) beneficial where recruitment and retention of staff can be challenging; (2) extra support for day shifts and evening, night and weekend shifts; (3) reduction in the number of transfers larger tertiary hospitals in the community; (4) improvement in standardisation of care; and (5) organisational culture of rural ICUs may lead to under-utilisation. ICU staff at rural facilities view Tele-ICU as a positive, useful tool to provide extra support and assistance. However, more research is needed regarding organisational culture to maximise the potential benefits of Tele-ICU in rural hospitals. Published by Elsevier Ltd.

  13. Small rural hospitals: an example of market segmentation analysis. (United States)

    Mainous, A G; Shelby, R L


    In recent years, market segmentation analysis has shown increased popularity among health care marketers, although marketers tend to focus upon hospitals as sellers. The present analysis suggests that there is merit to viewing hospitals as a market of consumers. Employing a random sample of 741 small rural hospitals, the present investigation sought to determine, through the use of segmentation analysis, the variables associated with hospital success (occupancy). The results of a discriminant analysis yielded a model which classifies hospitals with a high degree of predictive accuracy. Successful hospitals have more beds and employees, and are generally larger and have more resources. However, there was no significant relationship between organizational success and number of services offered by the institution.

  14. The changing nature of nursing work in rural and small community hospitals. (United States)

    Montour, Amy; Baumann, Andrea; Blythe, Jennifer; Hunsberger, Mabel


    The nursing literature includes descriptions of rural nursing workforces in Canada, the United States of America and Australia. However, inconsistent definitions of rural demography, diverse employment conditions and health care system reorganization make comparisons of these data difficult. In 2007, the Ministry of Health and Long-term Care in Ontario, Canada, transferred responsibility for decision-making and funding to 14 regional governing bodies known as Local Health Integration Networks (LHINs). Little is known about rural-urban variations in the nursing workforces in the LHINs because existing data repositories do not describe them. This study investigated the influence of demographic characteristics, provincial policies, organizational changes and emerging practice challenges on nursing work in a geographically unique rural region. The purpose was to describe the nature of nursing work from the perspective of rural nurse executives and frontline nurses. The study was conducted in 7 small rural and community hospitals in the Hamilton Niagara Haldimand Brant LHIN. Data collection occurred between August and November 2007. A qualitative descriptive study design was chosen to facilitate exploration of nursing in the rural setting. Study participants were identified through purposive snowball sampling. All nurses, nurse managers and nurse executives currently employed in the 7 study hospitals were eligible to participate. Data collection included the use of questionnaires and semi-structured interviews. Memos were also created to describe the relevance and applicability of concepts, categories and properties emerging from the data. Themes were compared across interviews to determine relevance and value. Twenty-one nurses from 7 different hospitals participated. The nurses reflect the aging trend in the provincial and regional workforces of Ontario. All study participants anticipate a substantial increase in retirements during the next decade, which will alter

  15. [The nurse mobilised in the face of precarity in the rural environment]. (United States)

    Francès, Pierre


    In the rural environment, faced with people in situations of precarity, the nurse is an ideal partner for health professionals, as a general practitioner working in a centre for emergency housing and social reintegration explains. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  16. Rural Bypass of Critical Access Hospitals in Iowa: Do Visiting Surgical Specialists Make a Difference? (United States)

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


    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.

  17. Rural emergency medical technician pre-hospital electrocardiogram transmission. (United States)

    Powell, A M; Halon, J M; Nelson, J


    Emergent care of the acute heart attack patient continues to be at the forefront of quality and cost reduction strategies throughout the healthcare industry. Although the average cardiac door-to-balloon (D2B) times have decreased substantially over the past few years, there are still vast disparities found in D2B times in populations that reside in rural areas. Such disparities are mostly related to prolonged travel time and subsequent delays in cardiac catherization lab team activation. Urban ambulance companies that are routinely staffed with paramedic level providers have been successful in the implementation of pre-hospital 12-lead electrocardiogram (ECG) protocols as a strategy to reduce D2B times. The authors sought to evaluate the evidence related to the risk and benefits associated with the replication of an ECG transmission protocol in a small rural emergency medical service. The latter is staffed with emergency medical technician-basics (EMT-B), emergency medical technician-advanced (EMT-A), and emergency medical technician-intermediate (EMT-I) level. The evidence reviewed was limited to studies with relevant data regarding the challenges and complexities of the ECG transmission process, the difficulties associated with ECG transmission in rural settings, and ECG transmission outcomes by provider level. The evidence supports additional research to further evaluate the feasibility of ECG transmission at the non-paramedic level. Multiple variables must be investigated including equipment cost, utilization, and rural transmission capabilities. Clearly, pre-hospital ECG transmission and early activation of the cardiac catheterization laboratory are critical components to successfully decreasing D2B times.

  18. Surgical skills deficiencies and needs of rural general practitioners ...

    African Journals Online (AJOL)

    This open-access article is distributed under. Creative ... procedures performed in rural hospitals in Africa; and Framework for CPD ..... quality surgical care in rural areas is a challenge faced by the present .... Mullan F. The metrics of the physician brain drain. N Engl J Med ... Dare AJ, NgKamstra JS, Patra J, et al. Deaths ...

  19. A hospital-randomized controlled trial of a formal quality improvement educational program in rural and small community Texas hospitals: one year results. (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


    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.

  20. Problems facing Korean hospitals and possible countermeasures. (United States)

    Kim, Kwang-Tae


    Korea has a unique health care system, of which the private sector comprises most of the country's health resources: 88% of the beds and 91% of specialists in Korea, but are funded by public financing, such as national health insurance and the national aid program. However, the public financing pays only 50% of actual costs and the patient's co-payment is still high. Healthcare organizations in Korea are categorized into four types; tertiary care hospitals, general hospitals, hospitals and clinics by scale of operator: number of beds. General hospitals must have 100 beds and over, and compulsorily specialties in internal medicine, surgery, obstetrics-gynecology, pediatrics, dental service, other ancillary service units and an emergency care unit. General hospitals with 300 beds and more must operate an intensive care unit. There are many challenges facing the Korean healthcare system, such as reformation of primary healthcare system, enhancing hospitals' competitiveness, and permission of for-profit hospital, introduction of private health insurance, enhancement of geriatric care. These challenges can be resolved with long-term vision, willingness and strategies of the Korean government to ensure equitable financing and access to healthcare, combined with the active participation and utilization of the private sector.

  1. Exploring example models of cross-sector, sessional employment of pharmacists to improve medication management and pharmacy support in rural hospitals. (United States)

    Tan, Amy Cw; Emmerton, Lynne M; Hattingh, Laetitia; La Caze, Adam


    Many rural hospitals in Australia are not large enough to sustain employment of a full-time pharmacist, or are unable to recruit or retain a full-time pharmacist. The absence of a pharmacist may result in hospital nurses undertaking medication-related roles outside their scope of practice. A potential solution to address rural hospitals' medication management needs is contracted part-time ('sessional') employment of a local pharmacist external to the hospital ('cross-sector'). The aim of this study was to explore the roles and experiences of pharmacists in their provision of sessional services to rural hospitals with no on-site pharmacist and explore how these roles could potentially address shortfalls in medication management in rural hospitals. A qualitative study was conducted to explore models with pharmacists who had provided sessional services to a rural hospital. A semi-structured interview guide was informed by a literature review, preliminary research and stakeholder consultation. Participants were recruited via advertisement and personal contacts. Consenting pharmacists were interviewed between August 2012 and January 2013 via telephone or Skype for 40-55 minutes. Thirteen pharmacists with previous or ongoing hospital sessional contracts in rural communities across Australia and New Zealand participated. Most commonly, the pharmacists provided weekly services to rural hospitals. All believed the sessional model was a practical solution to increase hospital access to pharmacist-mediated support and to address medication management gaps. Roles perceived to promote quality use of medicines were inpatient consultation services, medicines information/education to hospital staff, assistance with accreditation matters and system reviews, and input into pharmaceutical distribution activities. This study is the first to explore the concept of sessional rural hospital employment undertaken by pharmacists in Australia and New Zealand. Insights from participants

  2. Injuries treated in hospital among urban and rural inhabitants of eastern Poland. (United States)

    Kos, Marek; Drop, Bartłomiej; Dziewa, Agnieszka; Jędrych, Marian


    Injuries are a serious medical and social problem, especially when accompanied by distant or deferred effects, often causing serious dysfunctions and permanent disability for life. The study aimed at presenting the incidence of injuries of urban and rural population treated in a district hospital in eastern Poland. The study was carried out in the Independent Public Health Care Institution in Kraśnik in 2011 among patients hospitalized in the Department of Trauma Surgery and Orthopedic Unit who sustained injuries. Medical records of 795 patients - 326 women and 469 men, aged 10-99 years, were analyzed. During the period considered among those hospitalized due to injuries, men (59%), those aged 50-59 years (19.0%), and living in rural areas (72.7%) predominated. Injuries most commonly affected the head (18.87%), elbow and forearm (16.86%), knee and lower leg (16.60%), and the hip and thigh (13.96%). Average hospital stay was 5.65 days and was the longest for hip and thigh injuries (11.86 days). Injuries occurred most frequently in the population of patients living in rural areas, often among men, usually on weekdays and in the morning.

  3. Critical access hospital informatics: how two rural Iowa hospitals overcame challenges to achieve IT excellence. (United States)

    Bahensky, James A; Moreau, Brian; Frieden, Rob; Ward, Marcia M


    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.

  4. Concurrent alcohol and medication poisoning hospital admissions among older rural and urban residents. (United States)

    Zanjani, Faika; Smith, Rachel; Slavova, Svetla; Charnigo, Richard; Schoenberg, Nancy; Martin, Catherine; Clayton, Richard


    Alcohol and medication interactions are projected to increase due to the growth of older adults that are unsafely consuming alcohol and medications. Plus, aging adults who reside in rural areas are at the highest risk of experiencing medication interactions. Estimate concurrent alcohol and medication (alcohol/medication) hospitalizations in adults 50+ years, comparing age groups and rural/urban regions. Kentucky nonfederal, acute care inpatient hospital discharge electronic records for individuals aged 50+ years from 2001 to 2012 were examined. Rate differences were estimated across age and regional strata. Differences in the underlying principal diagnosis, intent, and medications were also examined. There were 2168 concurrent alcohol/medication hospitalizations among 50+ year olds identified. There was a 187% increase in alcohol/medication hospitalizations from 2001 (n = 104) to 2012 (n = 299). The per capita alcohol/medication hospitalization rate increased from 8.91 (per 100,000) in 2001 to 19.98 (per 100,000) in 2012, a 124% increase. The characteristics of the hospitalizations included 75% principal diagnosis as medication poisoning, self-harm as the primary intent (55%) in 50-64-year olds, and unintentional intent (41%) in 65+ adults. Benzodiazepines were most often involved in the poisonings (36.5%). Concurrent alcohol/medication hospitalizations in Kentucky are increasing among aging adults. Greater increases in rural areas and the 65+ aged adults were seen, although there were also higher alcohol/medication hospitalizations in urban and 50-64 aged adults. These findings indicate the need for public-health prevention and clinical intervention to better educate and manage alcohol consuming older adults on safe medication and alcohol practices.

  5. Common geriatric emergencies in a rural hospital in South‑Eastern ...

    African Journals Online (AJOL)

    Common geriatric emergencies in a rural hospital in South‑Eastern Nigeria. ... by emergency health conditions that predispose them to higher risk of disability and ... The geriatric patients seen within the study period who met the selection ...

  6. The maintenance of competence of rural district hospital medical ...

    African Journals Online (AJOL)

    District hospital doctors are likely to have educational needs covering surgery, emergency and trauma, in-patient as well as out-patient care at primary service level, an understanding of the rural context and role of other health workers, public-health skills, and teamwork. Given such a broad curriculum, some prioritisation ...

  7. Management of snakebites at a rural South African hospital ...

    African Journals Online (AJOL)

    ... snakebites at this rural hospital where they were treated frequently. It is crucial for primary care physicians to be familiar with the most common venomous snakes in South Africa and the management of their bites in humans. Elevation of the affected limb, administration of intravenous fluids and administration of analgesia, ...

  8. Rural district hospitals - essential cogs in the district health system - and primary healthcare re-engineering. (United States)

    le Roux, K W D P; Couper, I


    The re-engineering of primary healthcare (PHC) is regarded as an essential precursor to the implementation of National Health Insurance in South Africa, but improvements in the provision of PHC services have been patchy. The authors contend that the role of well- functioning rural district hospitals as a hub from which PHC services can be most efficiently managed has been underestimated, and that the management of district hospitals and PHC clinics need to be co-located at the level of the rural district hospital, to allow for proper integration of care and effective healthcare provision.

  9. A double whammy! New baccalaureate registered nurses' transitions into rural acute care. (United States)

    Smith, Jean; Vandall-Walker, Virginia


    Transitioning into the Canadian rural acute care environment can be challenging for new RNs, and so retention is of concern. Currently, few seasoned registered nurses (RNs) are available to support new RNs during transition because (a) the Canadian RN workforce countrywide is aging and significant numbers are retiring, and (b) the number of Canadian RNs working rurally has plummeted in the past 10 years. Investigations into the phenomenon of new RNs\\' transitions into the workforce have been conducted, but little is known about this phenomenon as it relates to Canadian rural acute care hospitals. Most findings have been based on data from urban or mixed rural–urban samples. An interpretive description research approach was used to understand new RNs\\' transition experiences into the Alberta, Canada, rural acute care environment including supports and challenges specific to recruitment and retention. Face-to-face interviews were conducted with a convenience sample of 12 new RNs who had been employed in one or more Alberta rural acute care hospitals from 1 month to less than 2 years. In this study, participants experienced a double whammy consisting of learning I\\'m a generalist! and managing the responsibility of I\\'m it! Participants experienced contradictory emotions of exhilaration and shock that set them on an emotional roller coaster, a finding that differs from previously reported findings, wherein transition was frequently identified as only shocking. The few participants who were well supported by their colleagues and employersreportedexperiencing minor emotional fluctuations and described transition as exciting, good, and manageable. Thosewho were not experienced major fluctuations from exhilaration to shock. They described transition as exhilarating, but overwhelming, and unsafe. Notably, 9 of the 12 participants changed jobs within their first 2 years of practice. Other significant findings included problems with the outdated definitions of rural

  10. Trend of urban-rural disparities in hospital admissions and medical expenditure in China from 2003 to 2011. (United States)

    Fu, Rong; Wang, Yupeng; Bao, Han; Wang, Zhiqiang; Li, Yongquan; Su, Shaofei; Liu, Meina


    To assess the trend of urban-rural disparities in hospital admissions and medical expenditure between 2003 and 2011 in the context of Chinese health-care system reform. The data were from three different national surveys: the Third National Health Services Survey in 2003, the Fourth National Health Services Survey in 2008 and the national health-care reform phased assessment survey in 2011. There were 151421, 143380 and 48356 respondents aged 15 years or older in 2003, 2008 and 2011, respectively. The health insurance coverage expanded considerably from 27.7% in 2003 to 96.4% in 2011 among respondents aged 15 years or older. Hospitalization rate increased rapidly from 4.1% in 2003 to 9.6% in 2011. Urban respondents had higher hospital admissions than rural respondents, and the RR (95% CI) of hospitalization was 1.23 (1.17-1.30), 1.06 (1.02-1.10) and 1.16 (1.10-1.23) in 2003, 2008 and 2011, respectively. The urban-rural disparity in hospital admissions significantly narrowed over time. Urban respondents had a higher admission rate if insured and a lower admission if not insured than their rural counterparts. Of the six medical expenditure measures, the disparities in reimbursement rate and the proportion of hospitalization direct cost to the total consumer spending significantly narrowed. The health insurance coverage has been continually expanding and health service utilization has been substantially improved. Urban-rural disparities have been narrowed but still exist. Therefore, policy-makers should focus on increasing investment and reimbursement levels, developing a uniform standard health insurance system for urban and rural residents and improving the medical assistance system.

  11. Effects of modifiable prehospital factors on survival after out-of-hospital cardiac arrest in rural versus urban areas. (United States)

    Mathiesen, Wenche Torunn; Bjørshol, Conrad Arnfinn; Kvaløy, Jan Terje; Søreide, Eldar


    The modifiable prehospital system factors, bystander cardiopulmonary resuscitation (CPR), emergency medical services (EMS), response time, and EMS physician attendance, may affect short- and long-term survival for both rural and urban out-of-hospital cardiac arrest (OHCA) patients. We studied how such factors influenced OHCA survival in a mixed urban/rural region with a high survival rate after OHCA. We analyzed the association between modifiable prehospital factors and survival to different stages of care in 1138 medical OHCA patients from an Utstein template-based cardiac arrest registry, using Kaplan-Meier type survival curves, univariable and multivariable logistic regression and mortality hazard plots. We found a significantly higher probability for survival to hospital admission (OR: 1.84, 95% CI 1.43-2.36, p rural group. In patients receiving bystander CPR before EMS arrival, the odds of survival to hospital discharge increased more than threefold (OR: 3.05, 95% CI 2.00-4.65, p rural areas, patients with EMS physician attendance had an overall better survival to hospital discharge (survival probability 0.17 with EMS physician vs. 0.05 without EMS physician, p = 0.019). Adjusted for modifiable factors, the survival differences remained. Overall, OHCA survival was higher in urban compared to rural areas, and the effect of bystander CPR, EMS response time and EMS physician attendance on survival differ between urban and rural areas. The effect of modifiable factors on survival was highest in the prehospital stage of care. In patients surviving to hospital admission, there was no significant difference in in-hospital mortality or in 1 year mortality between OHCA in rural versus urban areas.

  12. In-Hospital Mortality among Rural Medicare Patients with Acute Myocardial Infarction: The Influence of Demographics, Transfer, and Health Factors (United States)

    Muus, Kyle J.; Knudson, Alana D.; Klug, Marilyn G.; Wynne, Joshua


    Context/Purpose: Most rural hospitals can provide medical care to acute myocardial infarction (AMI) patients, but a need for advanced cardiac care requires timely transfer to a tertiary hospital. There is little information on AMI in-hospital mortality predictors among rural transfer patients. Methods: Cross-sectional retrospective analyses on…

  13. Obstetric referrals from a rural clinic to a community hospital in Honduras. (United States)

    Josyula, Srirama; Taylor, Kathryn K; Murphy, Blair M; Rodas, Dairamise; Kamath-Rayne, Beena D


    referrals between health care facilities are important in low-resource settings, particularly in maternal and child health, to transfer pregnant patients to the appropriate level of obstetric care. Our aim was to characterise the obstetrical referrals from a rural clinic to a community referral hospital in Honduras, to identify barriers in effective transport/referral, and to describe subsequent patient outcomes. we performed a descriptive retrospective study of patients referred during a 9-month period. We reviewed patient charts to review diagnosis, referral, and treatment times at both sites to understand the continuity of care. ninety-two pregnant patients were referred from the rural clinic to the community hospital. Twenty six pregnant patients (28%) did not have complete and accurate medical records and were excluded from the study. The remaining 66 patients were our study population. Of the 66 patients, 54 (82%) received antenatal care with an average of 5.5±2.4 visits. The most common diagnoses requiring referral were non-reassuring fetal status, hypertensive disorders of pregnancy, and preterm labour. The time spent in the rural clinic until transfer was 7.35±8.60 hours, and transport times were 4.42±1.07 hours. Of the 66 women transferred, 24 (36%) had different primary diagnoses and 16 (24%) had additional diagnoses after evaluation in the community hospital, whereas the remaining 26 (40%) had diagnoses that remained the same. No system was in place to give feedback to the referring clinic doctors regarding their primary diagnoses. our results demonstrate challenges seen in obstetric transport from a rural clinic to a community hospital in Honduras. Further research is needed for reform of emergency obstetric care management, targeting both healthcare personnel and medical referral infrastructure. The example of Honduras can be taken to motivate change in other resource-limited areas. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Jubin Varghese


    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.

  15. A review of stroke admissions at a tertiary hospital in rural ...

    African Journals Online (AJOL)


    Jun 15, 2011 ... The disease is expected to increase in low- and middle-income countries like Nigeria. ... and examine the rural-urban variation of stroke hospitalization in Nigeria. ..... Strasser T. Cerebrovascular disease in the community:.

  16. Traumatic brain injury in a rural and an urban Tanzanian hospital--a comparative, retrospective analysis based on computed tomography. (United States)

    Maier, Daniel; Njoku, Innocent; Schmutzhard, Erich; Dharsee, Jaffer; Doppler, Magdalena; Härtl, Roger; Winkler, Andrea Sylvia


    In a resource-poor environment such as rural East Africa, expensive medical devices such as computed tomographic (CT) scanners are rare. The CT scanner at the rural Haydom Lutheran Hospital (HLH) in Tanzania therefore offers a unique chance to observe possible differences with urban medical centers in the disease pattern of trauma-related cranial pathologies. The purpose of this study was to compare traumatic brain injuries (TBIs) between a rural and an urban area of Tanzania. HLH has 350 beds and one CT scanner. The urban Aga Khan Hospital is a private hospital with 80 beds and one CT scanner. This was a retrospective study. Data of 248 patients at HLH and of 432 patients at Aga Khan Hospital with TBI could be collected. The prevalence of TBI was significantly higher in the rural area compared to the urban area (34.2% vs. 21.9%, P workplace is primarily urban or rural. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Prevention of Clostridium difficile infection in rural hospitals. (United States)

    Haun, Nicholas; Hofer, Adam; Greene, M Todd; Borlaug, Gwen; Pritchett, Jenny; Scallon, Tina; Safdar, Nasia


    Prevention of Clostridium difficile infection (CDI) remains challenging across the spectrum of health care. There are limited data on prevention practices for CDI in the rural health care setting. An electronic survey was administered to 21 rural facilities in Wisconsin, part of the Rural Wisconsin Health Cooperative. Data were collected on hospital characteristics and practices to prevent endemic CDI. Fifteen facilities responded (71%). Nearly all respondent facilities reported regular use of dedicated patient care items, use of gown and gloves, private patient rooms, hand hygiene, and room cleaning. Facilities in which the infection preventionist thought the support of his/her leadership to be "Very good" or "Excellent" employed significantly more CDI practices (13.3 ± 2.4 [standard deviation]) compared with infection preventionists who thought there was less support from leadership (9.8 ± 3.0, P = .033). Surveillance for CDI was highly variable. The most frequent barriers to implementation of CDI prevention practices included lack of adequate resources, lack of a physician champion, and difficulty keeping up with new recommendations. Although most rural facilities in our survey reported using evidence-based practices for prevention of CDI, surveillance practices were highly variable, and data regarding the impact of these practices on CDI rates were limited. Future efforts that correlate CDI prevention initiatives and CDI incidence will help develop evidence-based practices in these resource-limited settings. Published by Mosby, Inc.

  18. Rural Teachers' Views: What Are Gender-Based Challenges Facing Free Primary Education in Lesotho? (United States)

    Morojele, Pholoho


    This paper gives prominence to rural teachers' accounts of gender-based challenges facing Free Primary Education in Lesotho. It draws on feminist interpretations of social constructionism to discuss factors within the Basotho communities that affect gender equality in the schools. The inductive analysis offered makes use of the data generated from…

  19. Anaesthesia for Surgical Outreach in a Rural Nigerian Hospital | Ilori ...

    African Journals Online (AJOL)

    Background: Surgical outreach to rural areas is aimed at improving access to surgical treatment to a deprived community. The study reports the experience of a team consisting of specialist surgical and anaesthetic manpower during a five day surgical outreach at Ogoja General Hospital, Nigeria in 2010. This was on the ...


    Carey, Hollis L.; Andrews, Carroll B.


    Medical care for rural populations is an important problem facing the medical profession nationally and locally. The mechanism for solution lies in the existing American Medical Association and California Medical Association committees on rural medical service and further development of “local health councils.” Additional emphasis on training of physicians for general practice is essential through medical school graduate and postgraduate periods. The problem of providing additional adequately equipped and staffed hospitals must receive much consideration. Recognizing that passiveness invites aggressive non-medical agencies to foster bureaucratic dictation inimical to the practice of medicine, the rural physician must act through medical and community organizations to correct weaknesses in the structure of medical practice. PMID:18116230

  1. How have hospitals faced the pricing issues of the 1990's? (United States)

    Kleimenhagen, A; Naidu, G M; Pillari, G D


    National health care expenditures are rising rapidly, bringing on a health care financing crisis. For this reason, it is useful to see how hospitals are facing the price issues of the 1990's. This study examines the price strategies hospitals follow and analyzes their observations on price sensitivity and payer mix. The results clearly show that hospitals have not given much attention to the pricing variable. The study suggests that marketing and finance will have to work closely together in developing future pricing strategies.

  2. Uncanny valley: A preliminary study on the acceptance of Malaysian urban and rural population toward different types of robotic faces (United States)

    Tay, T. T.; Low, Raymond; Loke, H. J.; Chua, Y. L.; Goh, Y. H.


    The proliferation of robotic technologies in recent years brings robots closer to humanities. There are many researches on going at various stages of development to bring robots into our homes, schools, nurseries, elderly care centres, offices, hospitals and factories. With recently developed robots having tendency to have appearance which increasingly displaying similarities to household animals and humans, there is a need to study the existence of uncanny valley phenomenon. Generally, the acceptance of people toward robots increases as the robots acquire increasing similarities to human features until a stage where people feel very uncomfortable, eerie, fear and disgust when the robot appearance become almost human like but not yet human. This phenomenon called uncanny valley was first reported by Masahiro Mori. There are numerous researches conducted to measure the existence of uncanny valley in Japan and European countries. However, there is limited research reported on uncanny valley phenomenon in Malaysia so far. In view of the different cultural background and exposure of Malaysian population to robotics technology compared to European or East Asian populations, it is worth to study this phenomenon in Malaysian context. The main aim of this work is to conduct a preliminary study to determine the existence of uncanny valley phenomenon in Malaysian urban and rural populations. It is interesting to find if there are any differences in the acceptance of the two set of populations despite of their differences. Among others the urban and rural populations differ in term of the rate of urbanization and exposure to latest technologies. A set of four interactive robotic faces and an ideal human model representing the fifth robot are used in this study. The robots have features resembling a cute animal, cartoon character, typical robot and human-like. Questionnaire surveys are conducted on respondents from urban and rural populations. Survey data collected are

  3. Health worker attrition at a rural district hospital in Rwanda: a need ...

    African Journals Online (AJOL)

    Health worker attrition at a rural district hospital in Rwanda: a need for improved placement and retention strategies. Jackline Odhiambo, Felix Cyamatare Rwabukwisi, Christian Rusangwa, Vincent Rusanganwa, Lisa Ruth Hirschhorn, Evrard Nahimana, Patient Ngamije, Bethany Lynn Hedt-Gauthier ...

  4. An increase in the burden of neonatal admissions to a rural district hospital in Kenya over 19 years

    Directory of Open Access Journals (Sweden)

    Marsh Kevin


    Full Text Available Abstract Background Most of the global neonatal deaths occur in developing nations, mostly in rural homes. Many of the newborns who receive formal medical care are treated in rural district hospitals and other peripheral health centres. However there are no published studies demonstrating trends in neonatal admissions and outcome in rural health care facilities in resource poor regions. Such information is critical in planning public health interventions. In this study we therefore aimed at describing the pattern of neonatal admissions to a Kenyan rural district hospital and their outcome over a 19 year period, examining clinical indicators of inpatient neonatal mortality and also trends in utilization of a rural hospital for deliveries. Methods Prospectively collected data on neonates is compared to non-neonatal paediatric (≤ 5 years old admissions and deliveries' in the maternity unit at Kilifi District Hospital from January 1st 1990 up to December 31st 2008, to document the pattern of neonatal admissions, deliveries and changes in inpatient deaths. Trends were examined using time series models with likelihood ratios utilised to identify indicators of inpatient neonatal death. Results The proportion of neonatal admissions of the total paediatric ≤ 5 years admissions significantly increased from 11% in 1990 to 20% by 2008 (trend 0.83 (95% confidence interval 0.45 -1.21. Most of the increase in burden was from neonates born in hospital and very young neonates aged 7 mmol/l predicted inpatient neonatal death with a sensitivity of 81% and a specificity of 68%. Conclusions There is clear evidence of increasing burden in neonatal admissions at a rural district hospital in contrast to reducing numbers of non-neonatal paediatrics' admissions aged ≤ 5years. Though the inpatient case fatality for all admissions aged ≤ 5 years declined significantly, neonates now comprise close to 60% of all inpatient deaths. Simple indicators may identify

  5. Job Satisfaction Analysis in Rural China: A Qualitative Study of Doctors in a Township Hospital


    Chen, Qiwei; Yang, Lan; Feng, Qiming; Tighe, Scott S.


    Background. Township hospitals in China provide rural communities with basic but much needed critical health care services. The doctors working in these hospitals often feel unsatisfied when considering their work schedules and financial rewards. Method. To explore job satisfaction of health workers in a township hospital, a qualitative study was conducted of 39 doctors from five township hospitals in Guangxi Zhuang Autonomous Region. The goal was to understand the level of job satisfaction o...

  6. Tobacco cessation Clinical Practice Guideline use by rural and urban hospital nurses: a pre-implementation needs assessment

    Directory of Open Access Journals (Sweden)

    Smith Patricia M


    Full Text Available Abstract Background This study was a pre-program evaluation of hospital-based nurses' tobacco intervention beliefs, confidence, training, practice, and perceived intervention barriers and facilitators. It was designed to identify relevant information prior to implementing tobacco cessation guidelines across a large northern rural region, home to 1 urban and 12 rural hospitals. Methods This cross-sectional survey was distributed by nurse managers to nurses in the 13 hospitals and returned by nurses (N = 269 via mail to the researchers. Results Nurses were somewhat confident providing cessation interventions, agreed they should educate patients about tobacco, and 94% perceived tobacco counselling as part of their role. Although only 11% had received cessation training, the majority reported intervening, even if seldom--91% asked about tobacco-use, 96% advised quitting, 89% assessed readiness to quit, 88% assisted with quitting, and 61% arranged post-discharge follow-up. Few performed any of these steps frequently, and among those who intervened, the majority spent Conclusions The findings showed nurses' willingness to engage in tobacco interventions. What the majority were doing maps onto the recommended minimum of 1-3 minutes but intervention frequency and follow-up were suboptimal. The rural-urban differences suggest a need for more research to explore the strengths of rural practice which could potentially inform approaches to smoking cessation in urban hospitals.

  7. Endocrinology Telehealth Consultation Improved Glycemic Control Similar to Face-to-Face Visits in Veterans. (United States)

    Liu, Winnie; Saxon, David R; McNair, Bryan; Sanagorski, Rebecca; Rasouli, Neda


    Rates of diabetes for veterans who receive health care through the Veterans Health Administration are higher than rates in the general population. Furthermore, many veterans live in rural locations, far from Veterans Affairs (VA) hospitals, thus limiting their ability to readily seek face-to-face endocrinology care for diabetes. Telehealth (TH) technologies present an opportunity to improve access to specialty diabetes care for such patients; however, there is a lack of evidence regarding the ability of TH to improve glycemic control in comparison to traditional face-to-face consultations. This was a retrospective cohort study of all new endocrinology diabetes consultations at the Denver VA Medical Center over a 1-year period. A total of 189 patients were included in the analysis. In all, 85 patients had received face-to-face (FTF) endocrinology consultation for diabetes and 104 patients had received TH consultation. Subjects were mostly males (94.7%) and the mean age was 62.8 ± 10.1 years old. HbA1c improved from 9.76% (9.40% to 10.11%) to 8.55% (8.20% to 8.91%) (P Endocrinology TH consultations improved short-term glycemic control as effectively as traditional FTF visits in a veteran population with diabetes. © 2016 Diabetes Technology Society.

  8. Wheelchair Seating Assessment and Intervention: A Comparison Between Telerehabilitation and Face-to-Face Service (United States)

    Barlow, Ingrid G; Liu, Lili; Sekulic, Angela


    This study compared outcomes of wheelchair seating and positioning interventions provided by telerehabilitation (n=10) and face-to-face (n=20; 10 in each of two comparison groups, one urban and one rural). Comparison clients were matched to the telerehabilitation clients in age, diagnosis, and type of seating components received. Clients and referring therapists rated their satisfaction and identified if seating intervention goals were met. Clients recorded travel expenses incurred or saved, and all therapists recorded time spent providing service. Wait times and completion times were tracked. Clients seen by telerehabilitation had similar satisfaction ratings and were as likely to have their goals met as clients seen face-to-face; telerehabilitation clients saved travel costs. Rural referring therapists who used telerehabilitation spent more time in preparation and follow-up than the other groups. Clients assessed by telerehabilitation had shorter wait times for assessment than rural face-to-face clients, but their interventions took as long to complete. PMID:25945159

  9. Disease patterns in the medical wards of a rural South African hospital

    African Journals Online (AJOL)

    Hypertension dominated the disease pattern followed by pulmonary tuberculosis, gastro-enteritis, pneumonia, diabetes, and asthma. The findings of this study suggest that diseases prominent in the affluent urban population affect patients seen at this rural hospital. The focus of primary care physicians should be to manage ...

  10. Racial Disparities in Diabetes Hospitalization of Rural Medicare Beneficiaries in 8 Southeastern States. (United States)

    Wan, Thomas T H; Lin, Yi-Ling; Ortiz, Judith


    This study examined racial variability in diabetes hospitalizations attributable to contextual, organizational, and ecological factors controlling for patient variabilities treated at rural health clinics (RHCs). The pooled cross-sectional data for 2007 through 2013 for RHCs were aggregated from Medicare claim files of patients served by RHCs. Descriptive statistics were presented to illustrate the general characteristics of the RHCs in 8 southeastern states. Regression of the dependent variable on selected predictors was conducted using a generalized estimating equation method. The risk-adjusted diabetes mellitus (DM) hospitalization rates slightly declined in 7 years from 3.55% to 2.40%. The gap between the crude and adjusted rates became wider in the African American patient group but not in the non-Hispanic white patient group. The average DM disparity ratio increased 17.7% from the pre-Affordable Care Act (ACA; 1.47) to the post-ACA period (1.73) for the African American patient group. The results showed that DM disparity ratios did not vary significantly by contextual, organizational, and individual factors for African Americans. Non-Hispanic white patients residing in large and small rural areas had higher DM disparity ratios than other rural areas. The results of this study confirm racial disparities in DM hospitalizations. Future research is needed to identify the underlying reasons for such racial disparities to guide the formulation of effective and efficient changes in DM care management practices coupled with the emphasis of culturally competent, primary and preventive care.

  11. Racial Disparities in Diabetes Hospitalization of Rural Medicare Beneficiaries in 8 Southeastern States

    Directory of Open Access Journals (Sweden)

    Thomas T. H. Wan


    Full Text Available This study examined racial variability in diabetes hospitalizations attributable to contextual, organizational, and ecological factors controlling for patient variabilities treated at rural health clinics (RHCs. The pooled cross-sectional data for 2007 through 2013 for RHCs were aggregated from Medicare claim files of patients served by RHCs. Descriptive statistics were presented to illustrate the general characteristics of the RHCs in 8 southeastern states. Regression of the dependent variable on selected predictors was conducted using a generalized estimating equation method. The risk-adjusted diabetes mellitus (DM hospitalization rates slightly declined in 7 years from 3.55% to 2.40%. The gap between the crude and adjusted rates became wider in the African American patient group but not in the non-Hispanic white patient group. The average DM disparity ratio increased 17.7% from the pre-Affordable Care Act (ACA; 1.47 to the post-ACA period (1.73 for the African American patient group. The results showed that DM disparity ratios did not vary significantly by contextual, organizational, and individual factors for African Americans. Non-Hispanic white patients residing in large and small rural areas had higher DM disparity ratios than other rural areas. The results of this study confirm racial disparities in DM hospitalizations. Future research is needed to identify the underlying reasons for such racial disparities to guide the formulation of effective and efficient changes in DM care management practices coupled with the emphasis of culturally competent, primary and preventive care.

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

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    Louis S. Jenkins


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

  13. Blood transfusion practice in a rural hospital in Northern Ghana, Damongo, West Gonja District. (United States)

    Kubio, Chrysantus; Tierney, Geraldine; Quaye, Theophilus; Nabilisi, James Wewoli; Ziemah, Callistus; Zagbeeb, Sr Mary; Shaw, Sandra; Murphy, William G


    Blood transfusion in rural sub-Saharan Africa presents special challenges. Transfusions are primarily given for emergencies--life-threatening blood loss or anemia; blood is usually collected from family or replacement donors; and facilities to store an adequate reserve in a hospital bank are constrained. We report the everyday and organizational practices in a medium-sized district hospital in Northern Ghana. Information and data on blood transfusion practices at West Gonja Hospital, Damongo, were available from the laboratory reports, from day books and workbooks, and from direct observation in the following four areas: blood collection and blood donors; blood donation testing; blood storage and logistics; and clinical transfusion practice, adverse events, and follow-up. The hospital serves a rural community of 86,000. In 2009, a total of 719 units of whole blood were collected, a rate of 8.36 units per 1000 population. All donors were family or replacement donors. Positivity rates for infectious disease markers were 7.5% (64/853) for hepatitis B surface antigen, 6.1% (50/819) for hepatitis C virus, 3.9% (33/846) for human immunodeficiency virus, and 4.7% (22/468) for syphilis. Supply of laboratory materials was sometimes problematic, especially for temperature-critical materials. Difficulties in sample labeling, storage of blood and laboratory supplies, and disposal of waste were also incurred by operational, material, and financial constraints. Follow-up for outcomes of transfusion is not currently feasible. The operational, demographic, and financial environment pertaining in a rural hospital in Northern Ghana differs substantially from that in which much of current blood transfusion practice and technology evolved. Considerable effort and innovation will be needed to address successfully the challenges posed. © 2012 American Association of Blood Banks.

  14. Making secondary care a primary concern: the rural hospital in Ecuador Hacer de la atención secundaria una preocupación primaria: los hospitales rurales en Ecuador

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    David Gaus


    Full Text Available En Ecuador, el acceso de la población rural a servicios adecuados de atención secundaria de salud se ha hecho cada vez más difícil. A pesar de que los sectores público y privado han acertado en dedicar esfuerzos a la atención primaria y a la salud pública, la mayoría de las poblaciones rurales no tienen acceso a una adecuada atención secundaria. Por lo general, los modelos tradicionales de atención médica secundaria en zonas rurales no se han adaptado a las nuevas situaciones, como la tendencia general a la descentralización, el énfasis en el desarrollo de capacidades locales, el antagonismo entre el acceso universal y la autonomía financiera, las alternativas financieras innovadoras y los recién llegados médicos de familia. En 2001, la organización no gubernamental con sede en los Estados Unidos de América Andean Health & Development (Saludesa en Ecuador inauguró un hospital rural de 17 camas, construido conjuntamente con el municipio local y el Ministerio de Salud de Ecuador. El hospital atiende a una comunidad rural de 50000 personas que antes no tenían acceso local a servicios secundarios de salud. Los esfuerzos de AHD/Saludesa para desarrollar una red autosostenible pública/privada de atención primaria/secundaria de salud y de alta calidad han generado una considerable experiencia en la administración de un hospital rural. El proyecto piloto de AHD se concentró en un hospital rural y logró su autosostenibilidad total en 2007. Esto se logró mediante una combinación de mecanismos financieros, entre ellos la venta de paquetes prepagados de atención sanitaria, un contrato con el Instituto Ecuatoriano de Seguridad Social, contribuciones municipales y el pago tradicional por los servicios.

  15. How a hospital must face a massive emergency: the case of Martini Hospital, Turin

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    Antonio Morra


    Full Text Available The terms “disaster” or “surge capability”, referred to hospitals, are often used to define a massive casualty admission. This may be a misleading concept, because emergency may as well arise from inside hospitals, and the last years high figures related to fires in the about 2,000 italian hospitals should suggest a different point of view. In this article the authors describe their experience in hospital preparedness at Ospedale Martini in Turin. Hospital operators regularly attend basic (GOM and advanced (HDM© courses about disaster response and organization, and a specific course is dedicated to operators involved in internal safety (fire emergency. In this courses, computer simulations are widely used, associated with conventional didactic. If education is one of the two cornerstones of disaster preparedness at Ospedale Martini, well designed emergency plans and an effective disaster management are the other one. The Internal Emergency Plan (Fire and Evacuation is aimed to give a proper response to fires and other events arising from inside the hospital and potentially requiring its partial or total evacuation. The Massive Casualties Admission Emergency Plan increases the surge capability of the hospital allowing to take care of a great number of injured people, and at the same time avoiding a dramatic fall in the treatment quality. The “Hospital Disaster Management©” system, created by the authors, is an organizational scheme based on team work. Its aim is to “put order in chaos” when hospitals are facing a disaster. Properly trained physicians and nurses, assigned to key positions, act in this system as Hospital Disaster Managers: their tasks are to coordinate the teams, to manage critical resources and to use the emergency plans as powerful instruments.

  16. [Subjective Workload, Job Satisfaction, and Work-Life-Balance of Physicians and Nurses in a Municipal Hospital in a Rural Area Compared to an Urban University Hospital]. (United States)

    Körber, Michael; Schmid, Klaus; Drexler, Hans; Kiesel, Johannes


    Medical and nursing shortages in rural areas represent a current serious public health problem. The healthcare of the rural population is at risk. This study compares perceived workload, job satisfaction and work-life balance of physicians and nurses at a clinic in a rural area with two clinics of a University hospital. Physicians and nurses were interviewed anonymously with a standardized questionnaire (paper and pencil), including questions on job satisfaction, subjective workload and work-life balance. The response rate was almost 50% in the University hospital as well as in the municipal hospital. 32 physicians and 54 nurses from the University hospital and 18 physicians and 137 nurses from the municipal hospital participated in the survey. Nurses at the University hospital assessed the organization of the daily routine with 94.1% as better than those at the municipal hospital (82.4%, p=0.03). Physicians at the University hospital were able to better implement acquired knowledge at a University clinic with 87.5% than their counterparts at the municipal hospital (55.5%, p=0.02). In contrast to their colleagues at the municipal hospital, only 50% of the physicians at the University hospital subjectively considered their workload as just right (83.3% municipal, p=0.02). 96.9% of the physicians at the University hospital were "daily" or "several times a week" under time pressure (municipal 50%, pwork and family life (62.9% University hospital, 72.8% Municipal hospital). In contrast, only 20% of the physicians at the University Hospital but 42.9% of the physicians of the municipal hospital had sufficient opportunities to balance workload and family (p=0.13). The return rate of almost 50% can be described as good. Due to the small number of physicians, especially from the municipal hospital, it can be assumed that some interesting differences could not be detected. There were only slight differences between the nurses from the two hospitals. In contrast, subjective

  17. Wheelchair Seating Assessment and Intervention: A Comparison between Telerehabilitation and Face-to-Face Service

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    Ingrid G Barlow


    Full Text Available This study compared outcomes of wheelchair seating and positioning interventions provided by telerehabilitation (n=10 and face-to-face (n=20; 10 in each of two comparison groups, one urban and one rural. Comparison clients were matched to the telerehabilitation clients in age, diagnosis, and type of seating components received. Clients and referring therapists rated their satisfaction and identified if seating intervention goals were met. Clients recorded travel expenses incurred or saved, and all therapists recorded time spent providing service. Wait times and completion times were tracked. Clients seen by telerehabilitation had similar satisfaction ratings and were as likely to have their goals met as clients seen face-to-face; telerehabilitation clients saved travel costs. Rural referring therapists who used telerehabilitation spent more time in preparation and follow-up than the other groups. Clients assessed by telerehabilitation had shorter wait times for assessment than rural face-to-face clients, but their interventions took as long to complete. Keywords: Telerehabilitation, Telehealth, Videoconferencing, Wheelchair Seating, Outcomes, Rehabilitation

  18. Surgical referral coordination from a first-level hospital: a prospective case study from rural Nepal. (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


    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.

  19. The Hidden Face of Hospital Economy. The Hospital of Sant’Andrea of Vercelli in 14th and 15th century

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    Antonio Olivieri


    Full Text Available The study of four fourteenth- and fifteenth-century registers of hospital of San Andrea of Vercelli allows to shine a light on some aspects of property management and hospital economy. On one hand, it is possible to see a technical evolution of the recordings of rents payment; on the other hand one can understand the nature of economic connection between the hospital and his tenants. It changed depending on the location of property together with the origin of the tenants, urban (above all craftsmen or rural. The careful accounting of the actual payment of rents ‒ with accounts of delays, of debts accumulation charging on tenants, of replacements of kind or money rents with manufactured goods or (in the case of peasants labour services ‒ enlightens the specific features of the hospital economy, aimed to product wealth in view of the nurture of the hospital life in its whole.

  20. Job Satisfaction Analysis in Rural China: A Qualitative Study of Doctors in a Township Hospital. (United States)

    Chen, Qiwei; Yang, Lan; Feng, Qiming; Tighe, Scott S


    Background . Township hospitals in China provide rural communities with basic but much needed critical health care services. The doctors working in these hospitals often feel unsatisfied when considering their work schedules and financial rewards. Method . To explore job satisfaction of health workers in a township hospital, a qualitative study was conducted of 39 doctors from five township hospitals in Guangxi Zhuang Autonomous Region. The goal was to understand the level of job satisfaction of doctors and to make recommendations for improvements. Results . About 75% (28/39) of the doctors expressed negative attitudes related to their work conditions. Slightly more than half (22/39) mentioned they should receive greater compensation for their work and more than one were seriously considering other options. Many participants (35/39) showed their satisfaction about the achievement of serving as a doctor. Conclusion . Their main concerns related to job satisfaction included working conditions, financial rewards, and the doctor's relationships with patients. Increasing the incomes and fringe benefits of healthcare workers, improving their work conditions, and providing training and continuing education opportunities would help rural clinics retain doctors and eliminate the current unsatisfactory conditions. The findings also highlight the need for the government to increase financial support of township hospitals.

  1. Job Satisfaction Analysis in Rural China: A Qualitative Study of Doctors in a Township Hospital

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    Qiwei Chen


    Full Text Available Background. Township hospitals in China provide rural communities with basic but much needed critical health care services. The doctors working in these hospitals often feel unsatisfied when considering their work schedules and financial rewards. Method. To explore job satisfaction of health workers in a township hospital, a qualitative study was conducted of 39 doctors from five township hospitals in Guangxi Zhuang Autonomous Region. The goal was to understand the level of job satisfaction of doctors and to make recommendations for improvements. Results. About 75% (28/39 of the doctors expressed negative attitudes related to their work conditions. Slightly more than half (22/39 mentioned they should receive greater compensation for their work and more than one were seriously considering other options. Many participants (35/39 showed their satisfaction about the achievement of serving as a doctor. Conclusion. Their main concerns related to job satisfaction included working conditions, financial rewards, and the doctor’s relationships with patients. Increasing the incomes and fringe benefits of healthcare workers, improving their work conditions, and providing training and continuing education opportunities would help rural clinics retain doctors and eliminate the current unsatisfactory conditions. The findings also highlight the need for the government to increase financial support of township hospitals.

  2. Outcomes of antiretroviral treatment programmes in rural Lesotho: health centres and hospitals compared. (United States)

    Labhardt, Niklaus Daniel; Keiser, Olivia; Sello, Motlalepula; Lejone, Thabo Ishmael; Pfeiffer, Karolin; Davies, Mary-Ann; Egger, Matthias; Ehmer, Jochen; Wandeler, Gilles


    Lesotho was among the first countries to adopt decentralization of care from hospitals to nurse-led health centres (HCs) to scale up the provision of antiretroviral therapy (ART). We compared outcomes between patients who started ART at HCs and hospitals in two rural catchment areas in Lesotho. The two catchment areas comprise two hospitals and 12 HCs. Patients ≥16 years starting ART at a hospital or HC between 2008 and 2011 were included. Loss to follow-up (LTFU) was defined as not returning to the facility for ≥180 days after the last visit, no follow-up (no FUP) as not returning after starting ART, and retention in care as alive and on ART at the facility. The data were analysed using logistic regression, competing risk regression and Kaplan-Meier methods. Multivariable analyses were adjusted for sex, age, CD4 cell count, World Health Organization stage, catchment area and type of ART. All analyses were stratified by gender. Of 3747 patients, 2042 (54.5%) started ART at HCs. Both women and men at hospitals had more advanced clinical and immunological stages of disease than those at HCs. Over 5445 patient-years, 420 died and 475 were LTFU. Kaplan-Meier estimates for three-year retention were 68.7 and 69.7% at HCs and hospitals, respectively, among women (p=0.81) and 68.8% at HCs versus 54.7% at hospitals among men (phospitals among women (odds ratio (OR): 0.89, 95% confidence interval (CI): 0.73-1.09) and higher retention at HCs among men (OR: 1.53, 95% CI: 1.20-1.96). The latter result was mainly driven by a lower proportion of patients LTFU at HCs (OR: 0.68, 95% CI: 0.51-0.93). In rural Lesotho, overall retention in care did not differ significantly between nurse-led HCs and hospitals. However, men seemed to benefit most from starting ART at HCs, as they were more likely to remain in care in these facilities compared to hospitals.

  3. Effect of the new rural cooperative medical system on farmers' medical service needs and utilization in Ningbo, China. (United States)

    Chen, Jianhua; Yu, Hai; Dong, Hengjin


    Many countries are developing health mechanisms to pursue the goal of universal coverage. In China, a rural health insurance system entitled New Cooperative Medical System (NCMS) has being developed since 2003. This paper aims to explore the changes in the health service needs and utilization among rural residents in Ningbo, China after the implementation of the new rural cooperative medical system (NCMS), and provide evidence to further improve the strategies of NCMS in China. Stratified multistage cluster sampling was used to randomly select 10 villages from 5 townships in Yuyao and Fenghua counties of Ningbo Municipality. Eighty families were selected from each village, and face-to-face interviews were conducted by trained investigators to collect data using questionnaires. The two-week visiting rate and prevalence of chronic diseases among the farmers included in the study was 25.40 and 22.50 %, respectively, which were higher than the levels in 2003 and 2008. The rate of not visiting the healthcare facility amongst those with illness, and the rate of non- hospitalization amongst those who required it were 32.36 and 0.60 %, respectively, which was lower than the levels in 2003 and 2008. Most of the outpatient visits were to the village clinics, while the hospitalizations were mainly to county hospitals. NCMS greatly affected the utilization of healthcare services from outpatient clinics and improved the hospitalization rate in county hospitals. Financial difficulties are not the major causes of non-hospitalization and non-visiting any longer. These findings suggest that the NCMS policies alleviated the medical burdens of farmers in a certain degree.

  4. Telehealth-based model of care redesign to facilitate local fitting and management of patients with a spinal fracture requiring a thoracic lumbar sacral orthosis in rural hospitals in New South Wales. (United States)

    Gallagher, Ryan; Giles, Michelle; Morison, Jane; Henderson, Judith


    To develop and implement a telehealth-based model of care for spinal fractures requiring management with thoracic lumbar sacral orthoses that eliminates the need for transfer to a metropolitan tertiary referral hospital. Pre-post design observational study evaluating model of care implementation. Rural referral hospitals in a large NSW region covering metropolitan, rural and remote hospitals. Patients presenting with a thoracic or lumbar spine fracture requiring thoracic lumbar sacral orthoses management and rural clinicians caring for them. Number of patients managed in rural hospitals without transfer to a metropolitan tertiary referral hospital; length of stay and related cost efficiencies; clinicians' perceived skills, knowledge and confidence levels. Model of care was implemented with clinical and system governance processes; and educational workshops across eight rural hospitals. A total of 81 patients managed in rural hospitals under this model between July 2013 and June 2016 without transfer were included in this study. Mean length of stay reduced from nine to four days. Hospital transfers were eliminated from the patient journey, totalling 24 324 km. Workshops were attended by 71 clinicians from nine rural hospitals and survey findings indicated a significant increase in staff knowledge, skill and confidence post education. Cost efficiencies were gained by eliminating 162 inter-hospital transfers and 405 patient bed days. This model has streamlined patient journeys and reduced transfers and travel, enabling rural clinicians to provide specialised services in local communities and facilitating timely evidence-based care in local communities without any adverse events. © 2018 National Rural Health Alliance Ltd.

  5. Expecting excellence is key to receivable success in small and rural hospitals. (United States)

    Boucher, D


    Although small and rural hospitals may have trouble hiring experienced billing and collection personnel, they can succeed in keeping down receivable levels and receivable days by adopting two principles for the business office: expect excellence and inspect for excellence. These principles include setting goals for business office staff as well as listening to and implementing their ideas for more effective operations.

  6. Locum tenens consultant doctors in a rural general hospital - an essential part of the medical workforce or an expensive stopgap? (United States)

    Sim, Andrew Jw


    Maintaining hospital consultant staffing levels often requires the employment of locum tenens to meet service needs. This is particularly so in hospitals where core clinical services are run by a small number of permanently appointed consultants. The problems associated with locum employment are underestimated and little attention has been directed towards addressing the issue in the rural general hospitals of Scotland. This study looked at the permanent and short- and long-term locum consultant usage over an 8 year period in one Scottish rural general hospital, the Western Isles Hospital in Stornoway. Data were extracted from the Human Resources Department of NHS Western Isles' list of locum consultants for most weeks from the beginning of January 2002 to the end of December 2009. The Western Isles Hospital in Stornoway has an establishment of 17 permanent consultants. During the 8 year study period 239 different consultants were employed, 20 held substantive permanent positions, 31 were long-term locums (employed >3 months) and 188 were short-term locums. The short-term locums worked for 535 different locum episodes. The pattern of usage varied according to service configuration. Study data revealed the alarming scope of the locum tenens issue, which will increase unless action is taken. For sustainable medical services to continue in the rural general hospitals of Scotland, staffing models must minimise the need to employ locum consultants.

  7. Beliefs and expectations of rural hospital practitioners towards a developing trauma system: A qualitative case study. (United States)

    Adams, Ryan D F; Cole, Elaine; Brundage, Susan I; Morrison, Zoe; Jansen, Jan O


    An understanding of stakeholders' views is key to the successful development and operation of a rural trauma system. Scotland, which has large remote and rural areas, is currently implementing a national trauma system. The aim of this study was to identify key barriers and enablers to the development of an effective trauma system from the perspective of rural healthcare professionals. This is a qualitative study, which was conducted in rural general hospitals (RGH) in Scotland, from April to June 2017. We used an opportunistic sampling strategy to include hospital providers of rural trauma care across the region. Semi-structured interviews were conducted, recorded, and transcribed. Thematic analysis was used to identify and group participant perspectives on key barriers and enablers to the development of the new trauma system. We conducted 15 interviews with 18 participants in six RGHs. Study participants described barriers and enablers across three themes: 1) quality of care, 2) interfaces within the system and 3) interfaces with the wider healthcare system. For quality of care, enablers included confidence in basic trauma management, whilst a perceived lack of change from current management was seen as a barrier. The theme of interfaces within the system identified good interaction with other services and a single point of contact for referral as enablers. Perceived barriers included challenges in referring to tertiary care. The final theme of interfaces with the wider healthcare system included an improved transport system, increased audit resource and coordinated clinical training as enablers. Perceived barriers included a rural staffing crisis and problematic patient transfer to further care. This study provides insight into rural professionals' perceptions regarding the implementation of a trauma system in rural Scotland. Barriers included practical issues, such as retrieval, transfer and referral processes. Importantly, there is a degree of uncertainty

  8. Remote eye care screening for rural veterans with Technology-based Eye Care Services: a quality improvement project. (United States)

    Maa, April Y; Wojciechowski, Barbara; Hunt, Kelly; Dismuke, Clara; Janjua, Rabeea; Lynch, Mary G


    Veterans are at high risk for eye disease because of age and comorbid conditions. Access to eye care is challenging within the entire Veterans Hospital Administration's network of hospitals and clinics in the USA because it is the third busiest outpatient clinical service and growing at a rate of 9% per year. Rural and highly rural veterans face many more barriers to accessing eye care because of distance, cost to travel, and difficulty finding care in the community as many live in medically underserved areas. Also, rural veterans may be diagnosed in later stages of eye disease than their non-rural counterparts due to lack of access to specialty care. In March 2015, Technology-based Eye Care Services (TECS) was launched from the Atlanta Veterans Affairs (VA) as a quality improvement project to provide eye screening services for rural veterans. By tracking multiple measures including demographic and access to care metrics, data shows that TECS significantly improved access to care, with 33% of veterans receiving same-day access and >98% of veterans receiving an appointment within 30 days of request. TECS also provided care to a significant percentage of homeless veterans, 10.6% of the patients screened. Finally, TECS reduced healthcare costs, saving the VA up to US$148 per visit and approximately US$52 per patient in round trip travel reimbursements when compared to completing a face-to-face exam at the medical center. Overall savings to the VA system in this early phase of TECS totaled US$288,400, about US$41,200 per month. Other healthcare facilities may be able to use a similar protocol to extend care to at-risk patients.

  9. Clinical decision-making of rural novice nurses. (United States)

    Seright, T J


    Nurses in rural settings are often the first to assess and interpret the patient's clinical presentations. Therefore, an understanding of how nurses experience decision-making is important in terms of educational preparation, resource allocation to rural areas, institutional cultures, and patient outcomes. Theory development was based on the in-depth investigation of 12 novice nurses practicing in rural critical access hospitals in a north central state. This grounded theory study consisted of face-to-face interviews with 12 registered nurses, nine of whom were observed during their work day. The participants were interviewed a second time, as a method of member checking, and during this interview they reviewed their transcripts, the emerging themes and categories. Directors of nursing from both the research sites and rural hospitals not involved in the study, experienced researchers, and nurse educators facilitated triangulation of the findings. 'Sociocentric rationalizing' emerged as the central phenomenon and referred to the sense of belonging and agency which impacted the decision-making in this small group of novice nurses in rural critical access hospitals. The observed consequences, which were conceptualized during the axial coding process and were derived from observations and interviews of the 12 novice nurses in this study include: (1) gathering information before making a decision included assessment of: the credibility of co-workers, patients' subjective and objective data, and one's own past and current experiences; (2) conferring with co-workers as a direct method of confirming/denying decisions being made was considered more realistic and expedient than policy books and decision trees; (3) rural practicum clinical experiences, along with support after orientation, provide for transition to the rural nurse role; (4) involved directors of nursing served as both models and protectors of novice nurses placed in high accountability positions early in

  10. Transfers to metropolitan hospitals and coronary angiography for rural Aboriginal and non-Aboriginal patients with acute ischaemic heart disease in Western Australia. (United States)

    Lopez, Derrick; Katzenellenbogen, Judith M; Sanfilippo, Frank M; Woods, John A; Hobbs, Michael S T; Knuiman, Matthew W; Briffa, Tom G; Thompson, Peter L; Thompson, Sandra C


    Aboriginal people have a disproportionately higher incidence rate of ischaemic heart disease (IHD) than non-Aboriginal people. The findings on Aboriginal disparity in receiving coronary artery procedures are inconclusive. We describe the profile and transfers of IHD patients admitted to rural hospitals as emergency admissions and investigate determinants of transfers and coronary angiography. Person-linked hospital and mortality records were used to identify 28-day survivors of IHD events commencing at rural hospitals in Western Australia. Outcome measures were receipt of coronary angiography, transfer to a metropolitan hospital, and coronary angiography if transferred to a metropolitan hospital. Compared to non-Aboriginal patients, Aboriginal patients with IHD were more likely to be younger, have more co-morbidities, reside remotely, but less likely to have private insurance. After adjusting for demographic characteristics, Aboriginal people with MI were less likely to be transferred to a metropolitan hospital, and if transferred were less likely to receive coronary angiography. These disparities were not significant after adjusting for comorbidities and private insurance. In the full multivariate model age, comorbidities and private insurance were adversely associated with transfer to a metropolitan hospital and coronary angiography. Disparity in receiving coronary angiography following emergency admission for IHD to rural hospitals is mediated through the lower likelihood of being transferred to metropolitan hospitals where this procedure is performed. The likelihood of a transfer is increased if the patient has private insurance, however, rural Aboriginal people have a lower rate of private insurance than their non-Aboriginal counterparts. Health practitioners and policy makers can continue to claim that they treat Aboriginal and non-Aboriginal people alike based upon clinical indications, as private insurance is acting as a filter to reduce rural residents

  11. Funding issues and options for pharmacists providing sessional services to rural hospitals in Australia. (United States)

    Tan, Amy Cw; Emmerton, Lynne M; Hattingh, H Laetitia; La Caze, Adam


    Many of Australia' s rural hospitals operate without an on-site pharmacist. In some, community pharmacists have sessional contracts to provide medication management services to inpatients. This paper discusses the funding arrangements of identified sessional employment models to raise awareness of options for other rural hospitals. Semistructured one-on-one interviews were conducted with rural pharmacists with experience in a sessional employment role (n =8) or who were seeking sessional arrangements (n = 4). Participants were identified via publicity and referrals. Interviews were conducted via telephone or Skype for ~40-55 min each, recorded and analysed descriptively. A shortage of state funding and reliance on federal funding was reported. Pharmacists accredited to provide medication reviews claimed remuneration via these federal schemes; however, restrictive criteria limited their scope of services. Funds pooling to subsidise remuneration for the pharmacists was evident and arrangements with local community pharmacies provided business frameworks to support sessional services. Participants were unaware of each other's models of practice, highlighting the need to share information and these findings. Several similarities existed, namely, pooling funds and use of federal medication review remuneration. Findings highlighted the need for a stable remuneration pathway and business model to enable wider implementation of sessional pharmacist models.

  12. The Relationship between Place of Residence and Hospitalization Rate in the Biggest Referral Hospital of the Northwest according to Hospitalization Wards

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    Amin Talebpour


    Full Text Available ​ Background and objectives: In accordance with the global pattern, the urban population in Iran is higher than the rural population. But, are the statistics of using hospitalization services in public hospitals in these two categories similar to this pattern? This study seeks to determine the effect of place of residence on hospitalization rate by examining annual hospitalization statistics of the country’s biggest referral hospital in the northwest. Material and Methods: The method used in this study is cross-sectional and all cases of hospitalization in Imam Reza Hospital as the northwest’s biggest referral hospital were picked by available sampling method. The cases of 30260 hospitalized patients were examined through direct observation and items extracted from their files were recorded in the checklist. In order to determine the relations between the variables, K2 test was applied and the P-value was considered less than 0.05 The obtained data were analyzed by SPSS.16 software. Results: Results indicated that the frequency distribution of patients in terms of their urban or rural residence did not yield any significant difference (P>0/05. Results also showed that the highest hospitalization rate for urban patients was 16.1% (3305 individuals in surgery ward while it was 14.2% (1384 individuals for rural patients in orthopedic ward. The least significant statistical difference between urban and rural hospitalization rates was observed in renal ward with 72.9% (1162 individual urban patients and 27.1% (432 individuals rural patients of total patients hospitalized in this ward. The most significant statistical difference between urban and rural hospitalization rates was observed in ICU with 44.9% (297 individuals urban patients and 55.1% (365 individuals rural patients of the total patients hospitalized in this ward. Conclusion: A relative comparison among illnesses in urban and rural populations, aside from illnesses caused by trauma

  13. Knowledge, attitude and practice about animal bite and rabies among victims attending a rural hospital in eastern India

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    Sirshendu Chaudhuri


    Full Text Available Rabies is highly prevalent in India. It is almost always fatal but preventable by timely administration of vaccine and proper wound care. Rural population have high disease burden. This may be partly due to lack of knowledge regarding the disease. Objectives- To identify the knowledge, attitude & practice of rural people attending in a rural hospital for animal bite management. Materials and Methods- Cross sectional observational study with 119 patients (period prevalence in February 2013. Results- Dogs were the main biting animal (87.4%. Children were the main victim(47.9%. 21% (25 of the respondent said that animal bite may lead to rabies. Neighbors were the main source of knowledge (38.7%. Mean duration of delay in presenting to hospital was 5.02 days. Roughly one third applied soap water to clean the wound. Attitude and practice was significantly associated with knowledge and attitude respectively (p<0.05. Conclusion- Rural population lack enough knowledge on rabies. Targeted group approach like educating mother and children may help improving health care utilization correctly.

  14. What Impact Does Behavior of Doctors and Patients on Service Integration of Multi-institutional Readmission cross Township—county Hospitals in Rural China


    Zhang, Yan; Tang, Wenxi; Zhang, Liang


    Background: With the change of rural residents’ disease spectrum and patients with chronic diseases boom, multi-institutional health service utilization of rural residents and the continuous service demands are growing sharply in rural China.Objective: Evaluate the service integration of multi-institutional readmission cross township—county hospitals (MRCTCH) in rural China, and figure out determines of service integration.Methods: This study featured 7 sample counties in rural China. Based o...

  15. The application of a biometric identification technique for linking community and hospital data in rural Ghana. (United States)

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


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

  16. The application of a biometric identification technique for linking community and hospital data in rural Ghana (United States)

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


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

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

    Directory of Open Access Journals (Sweden)

    Eliezer Ofori Odei-Lartey


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

  18. Innovative financing for rural surgical patients: Experience in mission hospitals

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    Gnanaraj Jesudian


    Full Text Available In rural India most of the surgical patients become impoverished due to surgical treatment pushing several families below poverty line. We describe the various methods that we tried to help these patients pay for the surgical procedures without becoming impoverished. Some of them were successful and many of them were not so successful. The large turnover and innovative methods helped the mission hospitals to serve the poor and the marginalized. Some of these methods might not be relevant in areas other than Northeast India while many could be used in other areas.

  19. High prescription of antimicrobials in a rural district hospital in India

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    Alvarez-Uria G


    Full Text Available Background: The World Health Organization (WHO recommends surveillance of antibiotic use as part of the strategy to fight against antimicrobial resistance. However, there is little information about the antibiotic consumption in developing countries, especially in rural areas. Objective: The objective of this study was to describe the antimicrobial consumption in a rural hospital in India Methods: The study was performed in a district hospital situated in Anantapur, Andhra Pradesh. In accordance with WHO recommendations, we used the defined daily dose (DDD methodology to measure the antibiotic use during one year (from 1st August 2011 to 1st August 2012. The antibiotic use was measured using DDDs/100 admissions and DDDs/100 patient-days for inpatients, and DDDs/100 visits for outpatients. Results: During the study period, there were 15,735 admissions and 250,611 outpatient visits. Antibiotics were prescribed for 86% of inpatients and 12.5% of outpatients. Outpatient prescriptions accounted for 2/3 of the overall antibiotic consumption. For inpatients, the total antibiotic use was 222 DDDs/ 100 patient-days, 693 DDDs/ 100 admissions and the mean number of antibiotics prescribed was 1.8. For outpatients, the total antibiotic use was 86 DDDs/ 100 outpatient visits and the mean number of antibiotics prescribed was 1.2. The most common antibiotics prescribed were aminopenicillins and 3rd generation cephalosporins for inpatients, and tetracyclines and quinolones for outpatients. In a sample of patients with diarrhoea or upper respiratory tract infections (URTI, the proportion of patients who received antibiotics was 84% (95% confidence interval [CI], 67-93 and 52% (95% CI, 43-62, respectively. Conclusion: In this rural setting, the use of antimicrobials was extremely high, even in conditions with a predominantly viral aetiology such as diarrhoea or URTI.

  20. Effect of the new rural cooperative medical system on farmers’ medical service needs and utilization in Ningbo, China

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    Jianhua Chen


    Full Text Available Abstract Background Many countries are developing health mechanisms to pursue the goal of universal coverage. In China, a rural health insurance system entitled New Cooperative Medical System (NCMS has being developed since 2003. This paper aims to explore the changes in the health service needs and utilization among rural residents in Ningbo, China after the implementation of the new rural cooperative medical system (NCMS, and provide evidence to further improve the strategies of NCMS in China. Methods Stratified multistage cluster sampling was used to randomly select 10 villages from 5 townships in Yuyao and Fenghua counties of Ningbo Municipality. Eighty families were selected from each village, and face-to-face interviews were conducted by trained investigators to collect data using questionnaires. Results The two-week visiting rate and prevalence of chronic diseases among the farmers included in the study was 25.40 and 22.50 %, respectively, which were higher than the levels in 2003 and 2008. The rate of not visiting the healthcare facility amongst those with illness, and the rate of non- hospitalization amongst those who required it were 32.36 and 0.60 %, respectively, which was lower than the levels in 2003 and 2008. Most of the outpatient visits were to the village clinics, while the hospitalizations were mainly to county hospitals. Conclusion NCMS greatly affected the utilization of healthcare services from outpatient clinics and improved the hospitalization rate in county hospitals. Financial difficulties are not the major causes of non-hospitalization and non-visiting any longer. These findings suggest that the NCMS policies alleviated the medical burdens of farmers in a certain degree.

  1. Follow-up analysis of federal process of care data reported from three acute care hospitals in rural Appalachia

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    Sills ES


    Full Text Available E Scott Sills,1,2 Liubomir Chiriac,3 Denis Vaughan,4 Christopher A Jones,5 Shala A Salem11Division of Reproductive Endocrinology, Pacific Reproductive Center, Irvine, CA, USA; 2Graduate School of Life Sciences, University of Westminster, London, UK; 3Department of Mathematics, California Institute of Technology, Pasadena, CA, USA; 4Department of Obstetrics and Gynaecology, School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; 5Global Health Economics Unit and Department of Surgery, Center for Clinical and Translational Science, University of Vermont College of Medicine, Burlington, VT, USABackground: This investigation evaluated standardized process of care data collected on selected hospitals serving a remote rural section of westernmost North Carolina.Methods: Centers for Medicare and Medicaid Services data were analyzed retrospectively for multiple clinical parameters at Fannin Regional Hospital, Murphy Medical Center, and Union General Hospital. Data were analyzed by paired t-test for individual comparisons among the three study hospitals to compare the three facilities with each other, as well as with state and national average for each parameter.Results: Centers for Medicare and Medicaid Services “Hospital Compare” data from 2011 showed Fannin Regional Hospital to have significantly higher composite scores on standardized clinical process of care measures relative to the national average, compared with Murphy Medical Center (P = 0.01 and Union General Hospital (P = 0.01. This difference was noted to persist when Fannin Regional Hospital was compared with Union General Hospital using common state reference data (P = 0.02. When compared with national averages, mean process of care scores reported from Murphy Medical Center and Union General Hospital were both lower but not significantly different (−3.44 versus −6.07, respectively, P = 0.54.Conclusion: The range of process of care scores submitted by acute care

  2. Antibiotics in Wastewater of a Rural and an Urban Hospital before and after Wastewater Treatment, and the Relationship with Antibiotic Use—A One Year Study from Vietnam

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    La Thi Quynh Lien


    Full Text Available Hospital effluents represent an important source for the release of antibiotics and antibiotic resistant bacteria into the environment. This study aims to determine concentrations of various antibiotics in wastewater before and after wastewater treatment in a rural hospital (60 km from the center of Hanoi and in an urban hospital (in the center of Hanoi in Vietnam, and it aims to explore the relationship between antibiotic concentrations in wastewater before wastewater treatment and quantities of antibiotics used in the rural hospital, over a period of one year in 2013. Water samples were collected using continuous sampling for 24 h in the last week of every month. The data on quantities of antibiotics delivered to all inpatient wards were collected from the Pharmacy department in the rural hospital. Solid-phase extraction and high performance liquid chromatography-tandem mass spectrometry were used for chemical analysis. Significant concentrations of antibiotics were present in the wastewater both before and after wastewater treatment of both the rural and the urban hospital. Ciprofloxacin was detected at the highest concentrations in the rural hospital’s wastewater (before treatment: mean = 42.8 µg/L; after treatment: mean = 21.5 µg/L. Metronidazole was detected at the highest concentrations in the urban hospital’s wastewater (before treatment: mean = 36.5 µg/L; after treatment: mean = 14.8 µg/L. A significant correlation between antibiotic concentrations in wastewater before treatment and quantities of antibiotics used in the rural hospital was found for ciprofloxacin (r = 0.78; p = 0.01 and metronidazole (r = 0.99; p < 0.001.

  3. Antibiotics in Wastewater of a Rural and an Urban Hospital before and after Wastewater Treatment, and the Relationship with Antibiotic Use—A One Year Study from Vietnam (United States)

    Lien, La Thi Quynh; Hoa, Nguyen Quynh; Chuc, Nguyen Thi Kim; Thoa, Nguyen Thi Minh; Phuc, Ho Dang; Diwan, Vishal; Dat, Nguyen Thanh; Tamhankar, Ashok J.; Lundborg, Cecilia Stålsby


    Hospital effluents represent an important source for the release of antibiotics and antibiotic resistant bacteria into the environment. This study aims to determine concentrations of various antibiotics in wastewater before and after wastewater treatment in a rural hospital (60 km from the center of Hanoi) and in an urban hospital (in the center of Hanoi) in Vietnam, and it aims to explore the relationship between antibiotic concentrations in wastewater before wastewater treatment and quantities of antibiotics used in the rural hospital, over a period of one year in 2013. Water samples were collected using continuous sampling for 24 h in the last week of every month. The data on quantities of antibiotics delivered to all inpatient wards were collected from the Pharmacy department in the rural hospital. Solid-phase extraction and high performance liquid chromatography-tandem mass spectrometry were used for chemical analysis. Significant concentrations of antibiotics were present in the wastewater both before and after wastewater treatment of both the rural and the urban hospital. Ciprofloxacin was detected at the highest concentrations in the rural hospital’s wastewater (before treatment: mean = 42.8 µg/L; after treatment: mean = 21.5 µg/L). Metronidazole was detected at the highest concentrations in the urban hospital’s wastewater (before treatment: mean = 36.5 µg/L; after treatment: mean = 14.8 µg/L). A significant correlation between antibiotic concentrations in wastewater before treatment and quantities of antibiotics used in the rural hospital was found for ciprofloxacin (r = 0.78; p = 0.01) and metronidazole (r = 0.99; p < 0.001). PMID:27314366

  4. Barriers to quality patient care in rural district hospitals

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    Johanna E. Eygelaar


    Reliability of the instrument was verified using the Cronbach alpha coefficient and a pilot study. The validity, specifically construct and content validity, were assured by means of an extensive literature review, pilot study and use of experts. Ethics approval was obtained from the relevant stakeholders. Results showed that 272 participants (97% disagreed that provision of staff was adequate, with staff above 40 years of age more likely to disagree (p = <0.01. A statistically significant association was shown between availability of doctors and staff not being able to cope with emergencies (p = <0.01. Most participants (n =212; 76% indicated that they were not receiving continuing education, with the registered nurses more likely to disagree (χ² test, p = 0.02. Participants in both hospital types A (n = 131; 82% and B (n = 108; 91% also disagreed that provision of equipment and consumables was adequate. The research showed that inadequacies relating to human resources, professional development, consumables and equipment influenced the quality of patient care. Urgent attention should be given to the problems identified to ensure quality of patient care in rural hospitals.

  5. Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Short Inpatient Hospital Stays; Transition for Certain Medicare-Dependent, Small Rural Hospitals Under the Hospital Inpatient Prospective Payment System; Provider Administrative Appeals and Judicial Review. Final rule with comment period; final rule. (United States)


    This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2016 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. Further, this document includes certain finalized policies relating to the hospital inpatient prospective payment system: Changes to the 2-midnight rule under the short inpatient hospital stay policy; and a payment transition for hospitals that lost their status as a Medicare-dependent, small rural hospital (MDH) because they are no longer in a rural area due to the implementation of the new Office of Management and Budget delineations in FY 2015 and have not reclassified from urban to rural before January 1, 2016. In addition, this document contains a final rule that finalizes certain 2015 proposals, and addresses public comments received, relating to the changes in the Medicare regulations governing provider administrative appeals and judicial review relating to appropriate claims in provider cost reports.

  6. Trauma on rural roads: the role of a peripheral hospital.

    LENUS (Irish Health Repository)

    Street, J T


    Road accident trauma is a leading cause of death and serious morbidity among healthy young adults in the developed world. The Irish Republic has the third worst road safety record in the EU. In studying the unique demographics of rural road accidents, our aim was to provide information essential to the future development of trauma care in Ireland. Our figures highlight the inadequacies of data received by the National Roads Authority, illustrate the resource impact of road trauma on a peripheral hospital, and demonstrate the need for similar studies in the rationalisation of trauma care as we approach the next millennium.

  7. Rural women caregivers in Canada. (United States)

    Crosato, Kay E; Leipert, Beverly


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

  8. Do Older Rural and Urban Veterans Experience Different Rates of Unplanned Readmission to VA and Non-VA Hospitals? (United States)

    Weeks, William B.; Lee, Richard E.; Wallace, Amy E.; West, Alan N.; Bagian, James P.


    Context: Unplanned readmission within 30 days of discharge is an indicator of hospital quality. Purpose: We wanted to determine whether older rural veterans who were enrolled in the VA had different rates of unplanned readmission to VA or non-VA hospitals than their urban counterparts. Methods: We used the combined VA/Medicare dataset to examine…

  9. Achieving timely percutaneous reperfusion for rural ST-elevation myocardial infarction patients by direct transport to an urban PCI-hospital. (United States)

    Bennin, Charles-Lwanga K; Ibrahim, Saif; Al-Saffar, Farah; Box, Lyndon C; Strom, Joel A


    ST-elevation myocardial infarction (STEMI) guidelines recommend reperfusion by primary percutaneous coronary intervention (PCI) ≤ 90 min from time of first medical contact (FMC). This strategy is challenging in rural areas lacking a nearby PCI-capable hospital. Recommended reperfusion times can be achieved for STEMI patients presenting in rural areas without a nearby PCI-capable hospital by ground transportation to a central PCI-capable hospital by use of protocol-driven emergency medical service (EMS) STEMI field triage protocol. Sixty STEMI patients directly transported by EMS from three rural counties (Nassau, Camden and Charlton Counties) within a 50-mile radius of University of Florida Health-Jacksonville (UFHJ) from 01/01/2009 to 12/31/2013 were identified from its PCI registry. The STEMI field triage protocol incorporated three elements: (1) a cooperative agreement between each of the rural emergency medical service (EMS) agency and UFHJ; (2) performance of a pre-hospital ECG to facilitate STEMI identification and laboratory activation; and (3) direct transfer by ground transportation to the UFHJ cardiac catheterization laboratory. FMC-to-device (FMC2D), door-to-device (D2D), and transit times, the day of week, time of day, and EMS shift times were recorded, and odds ratio (OR) of achieving FMC2D times was calculated. FMC2D times were shorter for in-state STEMIs (81 ± 17 vs . 87 ± 19 min), but D2D times were similar (37 ± 18 vs . 39 ± 21 min). FMC2D ≤ 90 min were achieved in 82.7% in-state STEMIs compared to 52.2% for out-of-state STEMIs (OR = 4.4, 95% CI: 1.24-15.57; P = 0.018). FMC2D times were homogenous after adjusting for weekday vs . weekend, EMS shift times. Nine patients did not meet FMC2D ≤ 90 min. Six were within 10 min of target; all patient achieved FMC2D ≤ 120 min. Guideline-compliant FMC2D ≤ 90 min is achievable for rural STEMI patients within a 50 mile radius of a PCI-capable hospital by use of protocol-driven EMS ground

  10. Urban versus rural populations' views of health care in Scotland. (United States)

    Farmer, Jane; Hinds, Kerstin; Richards, Helen; Godden, David


    To compare satisfaction with, and expectations of, health care of people in rural and urban areas of Scotland. Questions were included in the 2002 Scottish Social Attitudes Survey (SSAS). The Scottish House-hold Survey urban-rural classification was used to categorize locations. A random sample of 2707 people was contacted to participate in a face-to-face interview and a self-completion questionnaire survey. SPSS (v.10) was used to analyse the data. Relationships between location category and responses were explored using logistic regression analysis. In all, 1665 (61.5%) interviews were conducted and 1507 (56.0%) respondents returned self-completion questionnaires. Satisfaction with local doctors and hospital services was higher in rural locations. While around 40% of those living in remote areas thought A&E services too distant, this did not rank as a top priority for health service improvement. This could be due to expectations that general practitioners would assist in out-of-hours emergencies. Most Scots thought services should be good in rural areas even if this was costly, and that older people should not be discouraged from moving to rural areas because of their likely health care needs. In all, 79% of respondents thought that care should be as good in rural as urban areas. Responses to many questions were independently significantly affected by rural/urban location. Most Scots want rural health care to continue to be good, but the new UK National Health Service (NHS) general practitioner contract and service redesign will impact on provision. Current high satisfaction, likely to be due to access and expectations about local help, could be affected. This study provides baseline data on attitudes and expectations before potential service redesign, which should be monitored at intervals in future.

  11. Hospital Medicine and Fellowship Program in Rural North Dakota - A Multifaceted Success Story. (United States)

    Hyder, S S; Amundson, Mary


    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.

  12. Rural Health Concerns (United States)

    People in rural areas face some different health issues than people who live in towns and cities. Getting health care can ... long distances to get routine checkups and screenings. Rural areas often have fewer doctors and dentists, and ...

  13. Duration and setting of rural immersion during the medical degree relates to rural work outcomes. (United States)

    O'Sullivan, Belinda; McGrail, Matthew; Russell, Deborah; Walker, Judi; Chambers, Helen; Major, Laura; Langham, Robyn


    Providing year-long rural immersion as part of the medical degree is commonly used to increase the number of doctors with an interest in rural practice. However, the optimal duration and setting of immersion has not been fully established. This paper explores associations between various durations and settings of rural immersion during the medical degree and whether doctors work in rural areas after graduation. Eligible participants were medical graduates of Monash University between 2008 and 2016 in postgraduate years 1-9, whose characteristics, rural immersion information and work location had been prospectively collected. Separate multiple logistic regression and multinomial logit regression models tested associations between the duration and setting of any rural immersion they did during the medical degree and (i) working in a rural area and (ii) working in large or smaller rural towns, in 2017. The adjusted odds of working in a rural area were significantly increased if students were immersed for one full year (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.15-2.79), for between 1 and 2 years (OR, 2.26; 95% CI, 1.54-3.32) and for 2 or more years (OR, 4.43; 95% CI, 3.03-6.47) relative to no rural immersion. The strongest association was for immersion in a mix of both regional hospitals and rural general practice (OR, 3.26; 95% CI, 2.31-4.61), followed by immersion in regional hospitals only (OR, 1.94; 95% CI, 1.39-2.70) and rural general practice only (OR, 1.91; 95% CI, 1.06-3.45). More than 1 year's immersion in a mix of regional hospitals and rural general practices was associated with working in smaller regional or rural towns (immersion programmes. Longer rural immersion and immersion in both regional hospitals and rural general practices are likely to increase rural work and rural distribution of early career doctors. © 2018 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

  14. Application of smart phone and supporting set for fundus imaging in primary hospital of rural area

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    Yong-Feng Jing


    Full Text Available AIM: To describe the application of smart phone and supporting set for acquiring fundus images with slitlamp examination and non-contact lens in primary hospital of the rural area. METHODS: The supporting set for smart phone was purchased from taobao and securely connected to the ocular lens of slitlamp microscopy. The fundus photos were imaged with assistance of non-contact slitlamp lens from Volk. RESULTS: High quality images of various retinal diseases could be successfully taken with smart phone and supporting set by slitlamp examination. The fundus images were send to patients with Wechat as medical records or used for telconsultant. CONCLUSION: High resolution smart phones are wildly used nowadays and supporting sets are very accessible; thus high quality of images could be obtained with minimal cost in rural hospitals. The digital fundus images will be beneficial for medical record and rapid diagnosis with telconsultant.

  15. Connecting College Learners with Rural Entrepreneurship Opportunities: The Rural Entrepreneurship Teaching Unit (United States)

    Frazier, Barbara J.; Niehm, Linda S.; Stoel, Leslie


    The Rural Entrepreneurship Teaching Unit (RETU) is designed to acquaint university retailing and hospitality majors with rural entrepreneurship opportunities. The unit is an outcome of a federal grant focused on the contribution of the local retail sector to rural community resilience. The RETU integrates knowledge regarding rural development,…

  16. Return-on-Investment (ROI) Analyses of an Inpatient Lay Health Worker Model on 30-Day Readmission Rates in a Rural Community Hospital. (United States)

    Cardarelli, Roberto; Bausch, Gregory; Murdock, Joan; Chyatte, Michelle Renee


    The purpose of the study was to assess the return-on-investment (ROI) of an inpatient lay health worker (LHW) model in a rural Appalachian community hospital impacting 30-day readmission rates. The Bridges to Home (BTH) study completed an evaluation in 2015 of an inpatient LHW model in a rural Kentucky hospital that demonstrated a reduction in 30-day readmission rates by 47.7% compared to a baseline period. Using the hospital's utilization and financial data, a validated ROI calculator specific to care transition programs was used to assess the ROI of the BTH model comparing 3 types of payment models including Diagnosis Related Group (DRG)-only payments, pay-for-performance (P4P) contracts, and accountable care organizations (ACOs). The BTH program had a -$0.67 ROI if the hospital had only a DRG-based payment model. If the hospital had P4P contracts with payers and 0.1% of its annual operating revenue was at risk, the ROI increased to $7.03 for every $1 spent on the BTH program. However, if the hospital was an ACO as was the case for this study's community hospital, the ROI significantly increased to $38.48 for every $1 spent on the BTH program. The BTH model showed a viable ROI to be considered by community hospitals that are part of an ACO or P4P program. A LHW care transition model may be a cost-effective alternative for impacting excess 30-day readmissions and avoiding associated penalties for hospital systems with a value-based payment model. © 2017 National Rural Health Association.

  17. Rural older people had lower mortality after accidental falls than non-rural older people

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    Huang JW


    Full Text Available Jen-Wu Huang,1,2 Yi-Ying Lin,2,3 Nai-Yuan Wu,4 Yu-Chun Chen5–7 1Department of Surgery, National Yang-Ming University Hospital, National Yang-Ming University, Yilan, Taiwan; 2Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 3Department of Pediatrics, Heping Fuyou Branch, Taipei City Hospital, Taipei, Taiwan; 4Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan; 5Department of Medical Research and Education, National Yang-Ming University Hospital, Yilan, Taiwan; 6Faculty of Medicine and School of Medicine, National Yang-Ming University, Taipei, Taiwan; 7Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan Objective: This study aimed to investigate the mortality rate after falls of rural and non-rural older people and to explore the risk factors of mortality after falls among older people. Patients and methods: This population-based case–control study identified two groups from a nationwide claim database (National Health Insurance Research Database in Taiwan: a rural group and a non-rural group, which included 3,897 and 5,541 older people, respectively, who were hospitalized for accidental falls (The International Classification of Diseases, Ninth Revision, Clinical Modification: E880–E888 during 2006–2009. Both groups were followed up for 4 years after falls. Four-year cumulative all-cause mortality rate after falls was calculated, and the demographic factor, comorbidity, and medications were considered as the potential risk factors of mortality after falls. Results: The rural group had a significantly higher frequency of fall-related hospitalizations (7.4% vs 4.3%, P<0.001, but a lower 4-year cumulative all-cause mortality rate after falls than the non-rural group (8.8% vs 23.4%, P<0.001. After adjusting for age, gender, comorbidity, and medication use, the rural group had

  18. Correspondence: risk factors of acute respiratory infection in under-fives in a rural hospital of Central India – Authors’ reply

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    Amar Taksande


    Full Text Available Dear Editor,We thank the authors for their interest and comments on our paper. They have raised some very valid points. This corrispondence refers to the following article:Taksande AM, Yeole M. Risk factors of Acute Respiratory Infection (ARI in under-fives in a rural hospital of Central India. J Pediatr Neonat Individual Med. 2016;5(1:e050105. doi: 10.7363/050105 br />Comments can be found in the following article:Mandal A, Sahi PK. Correspondence: risk factors of acute respiratory infection in under-fives in a rural hospital of Central India. J Pediatr Neonat Individual Med. 2016;5(2:e050207. doi: 10.7363/050207

  19. Clinical indications and determinants of the rise of cesarean section in three hospitals in rural China. (United States)

    Qin, Cheng; Zhou, Min; Callaghan, William M; Posner, Samuel F; Zhang, Jun; Berg, Cynthia J; Zhao, Gengli


    This study investigated changes in cesarean delivery rate and cesarean indications in 3 county-level hospitals in rural China. Hospital delivery records in 1997 and 2003 were used to examine the reasons behind the changes. In Chengde County Hospital, the cesarean delivery rate increased from 28% in 1997 to 54% in 2003. The rate increased from 43% in 1997 to 65% in 2003 in Anxian County Hospital and Anxian Maternal and Child Health Hospital. The dramatic increase in cesarean delivery in the study hospitals was associated with a shift from more severe to mild or no clinical indications. The ratio of mild to moderate to severe hypertension increased substantially. More than half of the cephalopelvic disproportion cases were diagnosed prior to labor. The majority of nuchal cord cases were diagnosed without fetal distress. Maternal/family request was the number one cesarean indication in Anxian County Hospital and Anxian MCH Hospital in 2003. Ultrasound evidence of nuchal cord moved from the ninth ranked indication in 1997 to the second in 2003 in Chengde County Hospital.

  20. Promoting self-management through adherence among heart failure patients discharged from rural hospitals: a study protocol [v2; ref status: indexed,

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    Lufei Young


    Full Text Available Background Heart failure is one of the most prevalent chronic conditions in adults, leading to prolonged morbidity, repeated hospitalizations, and placing tremendous economic burden on the healthcare system. Heart failure patients discharged from rural hospitals, or primarily critical access hospitals, have higher 30-day readmission and mortality rates compared to patients discharged from urban hospitals. Self-management improves heart failure patients’ health outcomes and reduces re-hospitalizations, but adherence to self-management guidelines is low. We propose a home based post-acute care service managed by advanced practice nurses to enhance patient activation and lead to the improvement of self-management adherence in heart failure patients discharged from rural hospitals. Objective This article describes the study design and research methods used to implement and evaluate the intervention. Method Our intervention is a 12-week patient activation (Patient AcTivated Care at Home [PATCH] to improve self-management adherence. Patients were randomized into two parallel groups (12-week PATCH intervention + usual care vs. usual care only to evaluate the effectiveness of this intervention. Outcomes were measured at baseline, 3 and 6 months. Discussion This study aimed to examine the effectiveness of a rural theory based, advance practice nurse led, activation enhancing intervention on the self-management adherence in heart failure patients residing in rural areas. Our expectation is to facilitate adherence to self-management behaviors in heart failure patients following discharge from rural hospitals and decrease complications and hospital readmissions, leading to the reduction of economic burden.  Clinical Trial Registration Information:; NCT01964053

  1. Promoting self-management through adherence among heart failure patients discharged from rural hospitals: a study protocol [v1; ref status: indexed,

    Directory of Open Access Journals (Sweden)

    Lufei Young


    Full Text Available Background Heart failure is one of the most prevalent chronic conditions in adults, leading to prolonged morbidity, repeated hospitalizations, and placing tremendous economic burden on the healthcare system. Heart failure patients discharged from rural hospitals, or primarily critical access hospitals, have higher 30-day readmission and mortality rates compared to patients discharged from urban hospitals. Self-management improves heart failure patients’ health outcomes and reduces re-hospitalizations, but adherence to self-management guidelines is low. We propose a home based post-acute care service managed by advanced practice nurses to enhance patient activation and lead to the improvement of self-management adherence in heart failure patients discharged from rural hospitals. Objective This article describes the study design and research methods used to implement and evaluate the intervention. Method Our intervention is a 12-week patient activation (Patient AcTivated Care at Home [PATCH] to improve self-management adherence. Patients were randomized into two parallel groups (12-week PATCH intervention + usual care vs. usual care only to evaluate the effectiveness of this intervention. Outcomes were measured at baseline, 3 and 6 months. Discussion This study aimed to examine the effectiveness of a rural theory based, advance practice nurse led, activation enhancing intervention on the self-management adherence in heart failure patients residing in rural areas. Our expectation is to facilitate adherence to self-management behaviors in heart failure patients following discharge from rural hospitals and decrease complications and hospital readmissions, leading to the reduction of economic burden.  Clinical Trial Registration Information:; NCT01964053

  2. The Journey to Meet Emerging Community Benefit Requirements in a Rural Hospital: A Case Study (United States)

    Sabin, Allison V; Levin, Pamela F


    The Affordable Care Act requires nonprofit hospitals to collaborate with public health agencies and community stakeholders to identify and address community health needs. As a rural organization, Wabash County (Indiana) Hospital pursued new approaches to achieve these revised requirements of the community benefit mandate. Using a case study approach, the authors provide a historical review of governmental relationships with nonprofit community hospitals, offer a case study application for implementing legislative mandates and community benefit requirements, share the insights they garnered on their journey to meet the mandates, and conclude that drawing upon the existing resources in the community and using current community assets in novel ways can help conserve time, and also financial, material, and human resources in meeting legislative mandates.

  3. Methicillin-resistant Staphylococcus aureus prevention practices in hospitals throughout a rural state. (United States)

    McDanel, Jennifer S; Ward, Melissa A; Leder, Laurie; Schweizer, Marin L; Dawson, Jeffrey D; Diekema, Daniel J; Smith, Tara C; Chrischilles, Elizabeth A; Perencevich, Eli N; Herwaldt, Loreen A


    The Institute for Healthcare Improvement (IHI) created an evidence-based bundle to help reduce methicillin-resistant Staphylococcus aureus (MRSA) health care-associated infections. The study aim was to identify which components of the IHI's MRSA bundle that rural hospitals have implemented and to identify barriers that hindered implementation of bundle components. Four surveys about the IHI's MRSA bundle were administered at the Iowa Statewide Infection Prevention Seminar between 2007 and 2011. Surveys were mailed to infection preventionists (IPs) who did not attend the meetings. The percentage of IPs reporting that their hospital implemented a hand hygiene program (range by year, 87%-94%) and used contact precautions for patients infected (range by year, 97%-100%) or colonized (range by year, 77%-92%) with MRSA did not change significantly. The number of hospitals that monitored the effectiveness of environmental cleaning significantly increased from 23%-71% (P hospitals assessed daily if central lines were necessary (range by year, 22%-26%). IPs perceived lack of support to be a major barrier to implementing bundle components. Most IPs reported that their hospitals had implemented most components of the MRSA bundle. Support within the health care system is essential for implementing each component of an evidence-based bundle. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  4. Depression in chronic respiratory disorders in a tertiary rural hospital of Central India

    Institute of Scientific and Technical Information of China (English)

    Sameer singhal; Pankaj Banode; Nitish Baisakhiya


    Objective: To determine prevalence of depression in chronic respiratory disorders in a tertiary rural hospital of Central India. Various studies done in past have shown that prevalence of depression in diabetes and hypertension is around 40%-57%. Few studies have been done to screen depression in chronic respiratory disorders. This study was conducted in a tertiary rural hospital of Central India to find out prevalence of depression in indoor patients suffering from chronic respiratory disorders. Methods: Total 68 patients were evaluated for depression. Patients suffering from chronic respiratory disorders (total duration of illness >3 months) were evaluated using Prime MD Questionnaire. Patients suffering from diabetes, heart diseases, stroke, having past history of psychiatric illness, drug abusers, having lack of social support and suffering from chronic upper respiratory tract infections were excluded from this study. Questionnaire was asked when treatment for acute phase of illness is over. Results: Out of 68 patients evaluated, 36 (53%) were found out to be suffering from depression. Female gender (80%) was more prone to depression, inspite of the fact that all alcoholics were male. 39% of all chronic obstructive pulmonary disease (COPD) patients were suffering from depression in comparison to 65% for pulmonary tuberculosis and 44% for other chronic respiratory illness. 54% of patients suffering from depression are 60 yrs of age, suggesting that age has no relation with depression. No association was seen between alcoholism and depression. Conclusion: Prevalence of depression in patients of chronic respiratory illness is very high, like in cases of diabetes and hypertension. Further community and hospital based studies are needed to find out exact prevalence of depression in chronic respiratory illnesses.

  5. Analysis of birth weights of a rural hospital

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    Ashtekar Shyam


    Full Text Available Background: Low birth weight remains a major reason behind childhood malnutrition. The NFHS findings show no dent in this problem. Objective: This study was undertaken to explore change in birth weights in a period from 1989 to 2007 and any associations thereof. Materials and Methods: All birth records of a private rural hospital spanning two decades (1989-2007 were analyzed for birth weight, age of mother, gender, birth order of the baby, proportion of pre-term babies and low birth weight babies. Results: No change was observed in the average birth weights (average 2.71 kg over the period. Although the birth weight shows some expected variance with the age of mother, it was found to have no relation with the baby′s birth order and gender. The low birth weight proportion is about 24% and shows little difference before and after the series midpoint of year 1998. Conclusion: The birth weights have hardly changed in this population in the two decades.

  6. Analysis of Birth Weights of a Rural Hospital (United States)

    Ashtekar, Shyam V; Kulkarni, Madhav B; Sadavarte, Vaishali S; Ashtekar, Ratna S


    Background: Low birth weight remains a major reason behind childhood malnutrition. The NFHS findings show no dent in this problem. Objective: This study was undertaken to explore change in birth weights in a period from 1989 to 2007 and any associations thereof. Materials and Methods: All birth records of a private rural hospital spanning two decades (1989-2007) were analyzed for birth weight, age of mother, gender, birth order of the baby, proportion of pre-term babies and low birth weight babies. Results: No change was observed in the average birth weights (average 2.71 kg) over the period. Although the birth weight shows some expected variance with the age of mother, it was found to have no relation with the baby’s birth order and gender. The low birth weight proportion is about 24% and shows little difference before and after the series midpoint of year 1998. Conclusion: The birth weights have hardly changed in this population in the two decades. PMID:20922101

  7. The incidence, aetiology and outcome of acute seizures in children admitted to a rural Kenyan district hospital

    NARCIS (Netherlands)

    Idro, Richard; Gwer, Samson; Kahindi, Michael; Gatakaa, Hellen; Kazungu, Tony; Ndiritu, Moses; Maitland, Kathryn; Neville, Brian G. R.; Kager, Piet A.; Newton, Charles R. J. C.


    BACKGROUND: Acute seizures are a common cause of paediatric admissions to hospitals in resource poor countries and a risk factor for neurological and cognitive impairment and epilepsy. We determined the incidence, aetiological factors and the immediate outcome of seizures in a rural malaria endemic

  8. 42 CFR 485.603 - Rural health network. (United States)


    ... 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...

  9. Non-adherence to standard treatment guidelines in a rural paediatric hospital in Sierra Leone. (United States)

    De Bruycker, M; Van den Bergh, R; Dahmane, A; Khogali, M; Schiavetti, B; Nzomukunda, Y; Alders, P; Allaouna, M; Cloquet, C; Enarson, D A; Satyarayanan, S; Magbity, E; Zachariah, R


    A rural paediatric hospital in Bo, Sierra Leone. To assess the level of adherence to standard treatment guidelines among clinicians prescribing treatment for children admitted with a diagnosis of malaria and/or lower respiratory tract infection (LRTI), and determine the association between (non) adherence and hospital outcomes, given that non-rational use of medicines is a serious global problem. Secondary analysis of routine programme data. Data were collected for 865 children admitted with an entry diagnosis of malaria and 690 children with LRTI during the period January to April 2011; some patients were classified in both categories. Non-adherence to guidelines comprised use of non-standard drug regimens, dosage variations, non-standard frequency of administration and treatment duration. Cumulative non-adherence to guidelines for LRTI cases was 86%. For malaria, this involved 12% of patients. Potentially harmful non-adherence was significantly associated with an unfavourable hospital outcome, both for malaria and for LRTI cases. Overall non-adherence to standard treatment guidelines by clinicians in a routine hospital setting is very high and influences hospital outcomes. This study advocates for the implementation of routine measures to monitor and improve rational drug use and the quality of clinical care in such hospitals.

  10. Cost-effectiveness of the "helping babies breathe" program in a missionary hospital in rural Tanzania. (United States)

    Vossius, Corinna; Lotto, Editha; Lyanga, Sara; Mduma, Estomih; Msemo, Georgina; Perlman, Jeffrey; Ersdal, Hege L


    The Helping Babies Breathe" (HBB) program is an evidence-based curriculum in basic neonatal care and resuscitation, utilizing simulation-based training to educate large numbers of birth attendants in low-resource countries. We analyzed its cost-effectiveness at a faith-based Haydom Lutheran Hospital (HLH) in rural Tanzania. Data about early neonatal mortality and fresh stillbirth rates were drawn from a linked observational study during one year before and one year after full implementation of the HBB program. Cost data were provided by the Tanzanian Ministry of Health and Social Welfare (MOHSW), the research department at HLH, and the manufacturer of the training material Lærdal Global Health. Costs per life saved were USD 233, while they were USD 4.21 per life year gained. Costs for maintaining the program were USD 80 per life saved and USD 1.44 per life year gained. Costs per disease adjusted life year (DALY) averted ranged from International Dollars (ID; a virtual valuta corrected for purchasing power world-wide) 12 to 23, according to how DALYs were calculated. The HBB program is a low-cost intervention. Implementation in a very rural faith-based hospital like HLH has been highly cost-effective. To facilitate further global implementation of HBB a cost-effectiveness analysis including government owned institutions, urban hospitals and district facilities is desirable for a more diverse analysis to explore cost-driving factors and predictors of enhanced cost-effectiveness.

  11. Cost-effectiveness of the "helping babies breathe" program in a missionary hospital in rural Tanzania.

    Directory of Open Access Journals (Sweden)

    Corinna Vossius

    Full Text Available The Helping Babies Breathe" (HBB program is an evidence-based curriculum in basic neonatal care and resuscitation, utilizing simulation-based training to educate large numbers of birth attendants in low-resource countries. We analyzed its cost-effectiveness at a faith-based Haydom Lutheran Hospital (HLH in rural Tanzania.Data about early neonatal mortality and fresh stillbirth rates were drawn from a linked observational study during one year before and one year after full implementation of the HBB program. Cost data were provided by the Tanzanian Ministry of Health and Social Welfare (MOHSW, the research department at HLH, and the manufacturer of the training material Lærdal Global Health.Costs per life saved were USD 233, while they were USD 4.21 per life year gained. Costs for maintaining the program were USD 80 per life saved and USD 1.44 per life year gained. Costs per disease adjusted life year (DALY averted ranged from International Dollars (ID; a virtual valuta corrected for purchasing power world-wide 12 to 23, according to how DALYs were calculated.The HBB program is a low-cost intervention. Implementation in a very rural faith-based hospital like HLH has been highly cost-effective. To facilitate further global implementation of HBB a cost-effectiveness analysis including government owned institutions, urban hospitals and district facilities is desirable for a more diverse analysis to explore cost-driving factors and predictors of enhanced cost-effectiveness.

  12. Diabetes mellitus, hypertension and albuminuria in rural Zambia: a hospital-based survey. (United States)

    Rasmussen, Jon B; Thomsen, Jakúp A; Rossing, Peter; Parkinson, Shelagh; Christensen, Dirk L; Bygbjerg, Ib C


    To assess albuminuria in rural Zambia among patients with diabetes mellitus only (DM group), hypertension only (HTN group) and patients with combined DM and HTN (DM/HTN group). A cross-sectional survey was conducted at St. Francis Hospital in the Eastern province of Zambia. Albumin-creatinine ratio in one urine sample was used to assess albuminuria. Other information obtained included age, sex, body mass index (BMI), waist circumference (WC), blood pressure (BP), glycosylated haemoglobin (HbA1c ), random capillary glucose, time since diagnosis, medication and family history of DM or HTN. A total of 193 participants were included (DM group: n = 33; HTN group: n = 92; DM/HTN group: n = 68). The participants in the DM group used insulin more frequently as diabetes medication than the DM/HTN group (P < 0.05). Furthermore, the DM group was younger and had lower BMI, WC and BP than the two other groups. In the DM group, HTN group and DM/HTN group, microalbuminuria was found in 12.1%, 19.6% and 29.4% (P = 0.11), and macroalbuminuria was found in 0.0%, 3.3% and 13.2% (P = 0.014), respectively. The urine albumin (P = 0.014) and albumin-creatinine ratio (P = 0.0006) differed between the three groups. This hospital-based survey in rural Zambia found a lower frequency of albuminuria among the participants than in previous studies of patients with DM or HTN in urban sub-Saharan Africa. © 2013 John Wiley & Sons Ltd.

  13. 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.

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    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.

  14. The value of the WIRHE Scholarship Programme in training health professionals for rural areas: Views of participants. (United States)

    Mapukata, Nontsikelelo O; Couper, Ian; Smith, Jocelyn


    Rural hospitals in South Africa, as elsewhere, face enduring shortages of, and challenges in attracting and retaining, suitably qualified staff. The Wits Initiative for Rural Health Education (WIRHE), based at the University of the Witwatersrand but covering three universities, is a rural scholarship programme established to find local solutions to these challenges in the North West and Mpumalanga provinces. The purpose of this evaluation was to ascertain whether the WIRHE project was achieving its objectives. This article draws from an evaluation commissioned by the Swiss-South African Cooperative Initiative, a major funder of the programme when WIRHE was launched in 2003. Qualitative interviews were conducted either as face-to-face meetings or telephonically with 21 WIRHE students and graduates. Content analysis was undertaken to identify common themes. There was a consistency in the findings as the students and graduates reported similar experiences. Many of the participants were overwhelmed by their initial challenges of having to adapt to a different language, an institutional culture and resources that they previously did not have access to. The participants acknowledged the role of WIRHE staff in facilitating the transition from home to university and, in particular, the value of the financial and academic support. The geographic distance to Wits presented a challenge for the Pretoria- and Sefako Makgatho-based students. The holiday work affirmed clinical advantages for WIRHE students and heightened students' interest in becoming healthcare workers. WIRHE's key success factors are the financial, academic and emotional support offered to students. WIRHE achieved its objectives based on a principled strategic approach and an understanding that students from rural backgrounds are more likely to return to rural areas. The study supports the value of structured support programmes for students of rural origin as they pursue their studies.

  15. Comparing antiretroviral treatment outcomes between a prospective community-based and hospital-based cohort of HIV patients in rural Uganda

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    Alibhai Arif


    Full Text Available Abstract Background Improved availability of antiretroviral therapy in sub-Saharan Africa is intended to benefit all eligible HIV-infected patients; however in reality antiretroviral services are mainly offered in urban hospitals. Poor rural patients have difficulty accessing the drugs, making the provision of antiretroviral therapy inequitable. Initial tests of community-based treatment programs in Uganda suggest that home-based treatment of HIV/AIDS may equal hospital-based treatment; however the literature reveals limited experiences with such programs. The research This intervention study aimed to; 1 assess the effectiveness of a rural community-based ART program in a subcounty (Rwimi of Uganda; and 2 compare treatment outcomes and mortality in a rural community-based antiretroviral therapy program with a well-established hospital-based program. Ethics approvals were obtained in Canada and Uganda. Results and outcomes Successful treatment outcomes after two years in both the community and hospital cohorts were high. All-cause mortality was similar in both cohorts. However, community-based patients were more likely to achieve viral suppression and had good adherence to treatment. The community-based program was slightly more cost-effective. Per capita costs in both settings were unsustainable, representing more than Uganda’s Primary Health Care Services current expenditures per person per year for all health services. The unpaid community volunteers showed high participation and low attrition rates for the two years that this program was evaluated. Challenges and successes Key successes of this study include the demonstration that antiretroviral therapy can be provided in a rural setting, the creation of a research infrastructure and culture within Kabarole’s health system, and the establishment of a research collaboration capable of enriching the global health graduate program at the University of Alberta. Challenging questions about the

  16. Challenges faced by professional nurses when implementing the Expanded Programme on Immunisation at rural clinics in Capricorn District, Limpopo

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    Tebogo M. Mothiba


    Full Text Available Background: Immunisation is the cornerstone of primary healthcare. Apart from the provision of safe water, immunisation remains the most cost-effective public health intervention currently available. Immunisation prevents infectious conditions that are debilitating, fatal and have the potential to cause huge public health burdens, both financially and socially, in South Africa. Aim: To determine the challenges faced by professional nurses when implementing the Expanded Programme on Immunisation (EPI at rural clinics in Capricorn District, Limpopo Province, South Africa. Setting: The study was conducted in selected primary healthcare clinics of Capricorn District, Limpopo Province. Methods: A qualitative explorative descriptive contextual research design was used to gather data related to the challenges faced by professional nurses when implementing EPI at rural clinics in Capricorn District. Results: The findings revealed that professional nurses had knowledge of the programme, but that they experienced several challenges during implementation of EPI that included staff shortages and problems related to maintenance of the vaccines’ potency. Conclusions: The Department of Health as well as the nursing administration should monitor policies and guidelines, and especially maintenance of a cold chain for vaccines, to ensure that they are practised throughout Limpopo Province. The problem of staff shortages also needs to be addressed so that the EPI can achieve its targeted objectives. Keywords: Professional nurse, knowledge, EPI-SA, immunisation

  17. Moral dilemmas faced by hospitals in time of war: the Rambam Medical Center during the second Lebanon war. (United States)

    Bar-El, Yaron; Reisner, Shimon; Beyar, Rafael


    Rambam Medical Center, the only tertiary care center and largest hospital in northern Israel, was subjected to continuous rocket attacks in 2006. This extreme situation posed serious and unprecedented ethical dilemmas to the hospital management. An ambiguous situation arose that required routine patient care in a tertiary modern hospital together with implementation of emergency measures while under direct fire. The physicians responsible for hospital management at that time share some of the moral dilemmas faced, the policy they chose to follow, and offer a retrospective critical reflection in this paper. The hospital's first priority was defined as delivery of emergency surgical and medical services to the wounded from the battlefields and home front, while concomitantly providing the civilian population with all elective medical and surgical services. The need for acute medical service was even more apparent as the situation of conflict led to closure of many ambulatory clinics, while urgent or planned medical care such as open heart surgery and chemotherapy continued. The hospital management took actions to minimize risks to patients, staff, and visitors during the ongoing attacks. Wards were relocated to unused underground spaces and corridors. However due to the shortage of shielded spaces, not all wards and patients could be relocated to safer areas. Modern warfare will most likely continue to involve civilian populations and institutes, blurring the division between peaceful high-tech medicine and the rough battlefront. Hospitals in high war-risk areas must be prepared to function and deliver treatment while under fire or facing similar threats.

  18. CT scanning in stroke patients: meeting the challenge in the remote and rural district general hospital. (United States)

    Todd, A W; Anderson, E M


    National audit data allow crude comparison between centres and indicate that most Scottish hospitals fail to meet current guidelines for CT scanning of the brain in stroke patients. This study identifies some of the reasons for delay in performing CT scans in a largely rural population. This audit study assesses the delays from onset of symptoms, time of admission and request received to CT scan in stroke patients for three different in-patient groups as well as those managed in the community. The reasons for delay in CT scanning varied between different patient groups but for one group of in-patients, changes in booking procedure and introduction of a second CT scanner increased the proportion scanned within 48 hours of request from 65% to 96%. Further developments including the introduction of Saturday and Sunday routine CT scanning, radiologist reporting from home and additional CT scanners placed in remote hospitals may be expected to improve these figures further. Target times of three hours from onset of symptoms to scan to allow thrombolysis may however be impossible to meet for all stroke patients in rural areas.

  19. Retrospective study of antibiotic resistance among uropathogens from rural teaching hospital, Tamilnadu, India

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    Kasi Murugan


    Full Text Available Objective: To determine the community associated urinary tract infection (UTI causing uropathogen's prevalence, antibiotic resistance pattern and the risk factors predisposing infection in Indian rural settings. Methods: A pilot study was conducted between January and December 201 0 among out patients attending rural teaching medical college hospital at Tamilnadu, India. The demographic details, culture, common antibiotic Kirby-Bauer disc diffusion assay susceptibility profiles of the isolates and the resistance analysis by WHONET 5.6 software were performed. Results: During this surveillance study, a total number of 1 359 urinary samples were collected, among which 309 (22.78% gave positive culture. The common uropathogens encountered were Escherichia coli (66.02%, Staphylococcus sp. (12.62%, Klebsiella sp. (5.83%, Streptococcus sp. (5.1 8%, Enterococcus sp. (2.59% and Proteus sp., (2.26%. Antibiotic resistance analysis revealed the multiple drug resistance nature of the isolates to the commonly used antibiotics. It is also found that both genders at the specific age group of 40-50 were more prone to infection and seasonal variations also play an important role in their establishment. Conclusions: The obtained results suggest that antibiotic selection for empirical treatment should be based on individual drug-sensitive test results. There is also an urgent need to develop a new combination of chemotherapeutic agents and awareness on antibiotic use for the effective UTI management in rural settings.

  20. What are gender-based challenges facing Free Primary Education ...

    African Journals Online (AJOL)

    Rural teachers' views: What are gender-based challenges facing. Free Primary Education in Lesotho .... resulted in high levels of poverty amongst women, particularly in rural areas. Women ...... Lesotho demographics profile 2010. Available at ...

  1. [The Internet:an alternative to face-to-face training for teachers in remote locations?]. (United States)

    Gagnon, Suzanne; Minguet, Cassian


    For some family medicine supervisors working in rural and remote areas, access to face-to-face training is problematic. They need distance training programs designed specifically for them. To study the advantages, disadvantages, and feasibility of a training program for these supervisors that is delivered over the Internet. This was a pilot project for international on-line training consisting of a platform of courses and a collaborative type of Web conferencing that ran for 2 hours each week for 5 weeks. The training focused on the acquisition of teaching skills and the use of information and communications technology, and included discussions on topics related to practising and teaching in rural areas. Such a program is feasible and economical. The main difficulties are recruiting participants, keeping them in the program, and the amount of time spent on development and supervision. Participants who persevered reported high levels of satisfaction. The content of this type of training, barriers to participation, and the role of distance education in rural supervisor training programs remain to be explored.

  2. Shortcomings in snake bite management in rural Cameroon: a case report. (United States)

    Tianyi, Frank-Leonel; Dimala, Christian Akem; Feteh, Vitalis Fambombi


    Snake bites are an important public health problem in developing countries with most bites occurring in rural areas. Severe envenomation often occurs in children and following bites to the face. Prompt administration of potent anti-venom remains the mainstay of management. However in Cameroon, the use of anti-venoms is limited by non-availability, high cost (where available) and poor mastery of treatment guidelines. We present a 10-year-old muslim Cameroonian child from an enclaved rural area, brought to the hospital 12 h after a snake bite to the face, with signs of severe envenomation. Despite the suboptimal anti-venom dose administered to this patient due to a stock out of this medication, supportive therapy was beneficial in ensuring a positive outcome and satisfactory recovery. This highlights snake bites as a public health problem due to the lack of snake anti-venoms in peripheral health facilities, rendering them unable to appropriately manage these cases. National health policies should encourage constant peripheral availability of anti-venoms and the institution of an intervention package for snake bite management, comprising: treatment protocol, staff training, monitoring of compliance and community education to help reduce the mortality and morbidity from snake bites.

  3. Evidence to service gap: cardiac rehabilitation and secondary prevention in rural and remote Western Australia. (United States)

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


    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

  4. Deepening the quality of clinical reasoning and decision-making in rural hospital nursing practice. (United States)

    Sedgwick, M G; Grigg, L; Dersch, S


    Rural acute care nursing requires an extensive breadth and depth of knowledge as well as the ability to quickly reason through problems in order to make sound clinical decisions. This reasoning often occurs within an environment that has minimal medical or ancillary support. Registered nurses (RN) new to rural nursing, and employers, have raised concerns about patient safety while new nurses make the transition into rural practice. In addition, feeling unprepared for the rigors of rural hospital nursing practice is a central issue influencing RN recruitment and retention. Understanding how rural RNs reason is a key element for identifying professional development needs and may support recruitment and retention of skilled rural nurses. The purpose of this study was to explore how rural RNs reason through clinical problems as well as to assess the quality of such reasoning. This study used a non-traditional approach for data collection. Fifteen rural acute care nurses with varying years of experience working in southern Alberta, Canada, were observed while they provided care to patients of varying acuity within a simulated rural setting. Following the simulation, semi-structured interviews were conducted using a substantive approach to critical thinking. Findings revealed that the ability to engage in deep clinical reasoning varied considerably among participants despite being given the same information under the same circumstances. Furthermore, the number of years of experience did not seem to be directly linked to the ability to engage in sound clinical reasoning. Novice nurses, however, did rely heavily on others in their decision making in order to ensure they were making the right decision. Hence, their relationships with other staff members influenced their ability to engage in clinical reasoning and decision making. In situations where the patient's condition was deteriorating quickly, regardless of years of experience, all of the participants depended on

  5. The Issues Facing the Sustainable Development of Rural Tourism and the Path Selection


    ZHANG, Jianhong


    There is a long way to go for sustainable development of rural tourism. It is necessary to strengthen the planning for training rural tourism talents, and establish sustainable reserve tourism service personnel; innovate upon the promotion mode of rural tourism and open the tourist source market; strengthen the building of characteristic brand of rural tourism, and create sustainable development core of tourism; give play to the role of government in guiding rural tourism, strengthen the opti...

  6. Networking the rural community. (United States)

    Tiongson, K H; Arneson, S I


    A branch network of affiliate hospitals has been providing home care services to rural North Dakota residents successfully for a decade. Here's how this effective system meets the special challenges that a rural environment poses for hiring, training, scheduling, and supporting home care aides.

  7. Out-of-hospital cardiac arrest (OHCA) survival in rural Northwest Ireland: 17 years' experience.

    LENUS (Irish Health Repository)

    Masterson, Siobhán


    SAVES, the name used to describe a register of survivors of out-of-hospital cardiac arrest (OHCA), was established in rural Northwest Ireland in 1992. From 1992 to 2008, 80 survivors were identified (population 239,000 (2006)). Most incidents were witnessed (69\\/70) and all were in shockable rhythm at the time of first rhythm analysis (66\\/66). Of 66 patients who could be traced, 46 were alive in December 2008. Average survival rates appeared to increase over the lifetime of the database. SAVES has also contributed to the development of a national OHCA register.

  8. Risk factors for type 2 diabetes mellitus among patients attending a rural Kenyan hospital

    Directory of Open Access Journals (Sweden)

    Masemiano P. Chege


    Objectives: To describe the risk factors for type 2 diabetes mellitus among patients attending the outpatient clinics in a rural mission hospital in Kenya. Method: Forty-five diabetics and forty-five non-diabetics, resident in this rural hospital’s catchment area for at least 10 years, were randomly selected from patients attending outpatient clinics. Diabetics in a stable condition (not requiring hospitalisation, whose fasting blood sugars were below 6.1 mmol/L, were matched for age and gender with the non-diabetics who came to the hospital for outpatient services. A pilot-tested questionnaire on demography, current and past dietary habits, social habits, and family history was used to collect data. Waist circumference, height and weight were measured and BMI calculated. Data was analysed using SPSS for Windows. The Kruskal–Wallis test was used to compare the medians for the continuous variables, while the chi-squared test was used for the categorical variables. The z-test was used to calculate the relative risk. Results: Ninety participants (26 males, 64 females. The mean age was 61.8 for diabetics and 61.4 for non-diabetics. Childhood starvation (relative risk 2.08, p = 0.0090 and use of cassava for sustenance during childhood starvation (relative risk 3.12, p = 0.0090 were identified as risk factors. Diabetes in close relatives, another risk factor for this population (relative risk 2.2, p = 0.0131. Abdominal obesity was a risk factor for this population (in females relative risk 2.0, p = 0.0010. Conclusion: The risk factors for type 2 diabetes mellitus described in this rural population include advancing age, diabetes in a first-degree relative and abdominal obesity. This is similar to what has been cited in other studies. At variance, we found that more than 50% of the diabetics reported having suffered malnutrition/starvation in childhood, with more than half of them reporting their dependence on cassava as the only food source during starvation.

  9. Medical Device-Associated Candida Infections in a Rural Tertiary Care Teaching Hospital of India

    Directory of Open Access Journals (Sweden)

    Sachin C. Deorukhkar


    Full Text Available Health care associated infections (HCAIs add incrementally to the morbidity, mortality, and cost expected of the patient’s underlying diseases alone. Approximately, about half all cases of HCAIs are associated with medical devices. As Candida medical device-associated infection is highly drug resistant and can lead to serious life-threatening complications, there is a need of continuous surveillance of these infections to initiate preventive and corrective measures. The present study was conducted at a rural tertiary care hospital of India with an aim to evaluate the rate of medical device-associated Candida infections. Three commonly encountered medical device-associated infections (MDAI, catheter-associated urinary tract infection (CA-UTI, intravascular catheter-related blood stream infections (CR-BSI, and ventilator-associated pneumonia (VAP, were targeted. The overall rate of MDAI in our hospital was 2.1 per 1000 device days. The rate of Candida related CA-UTI and CR-BSI was noted as 1.0 and 0.3, respectively. Untiring efforts taken by team members of Hospital Acquired Infection Control Committee along with maintenance of meticulous hygiene of the hospital and wards may explain the low MDAI rates in our institute. The present surveillance helped us for systematic generation of institutional data regarding MDAI with special reference to role of Candida spp.

  10. Use of a "secure room" and a security guard in the management of the violent, aggressive or suicidal patient in a rural hospital: a 3-year audit. (United States)

    Brock, Gordon; Gurekas, Vydas; Gelinas, Anne-Fredrique; Rollin, Karina


    Little has been published on the management of psychiatric crises in rural areas, and little is known of the security needs or use of "secure rooms" in rural hospitals. We conducted a 3-year retrospective chart audit on the use of our secure room/security guard system at a rural hospital in a town of 3500, located 220 km from our psychiatric referral centre. Use of our secure room/security guard system occurred at the rate of 1.1 uses/1000 emergency department visits, with the most common indication being physician perception of risk of patient suicide or self-harm. Concern for staff safety was a factor in 10% of uses. Eighty percent of patients were treated locally, with most being released from the secure room after 2 days or less. Fourteen percent of patients required ultimate transfer to our psychiatric referral centre and 6% to a detoxification centre. The average annual cost of security was $16 259.61. A secure room can provide the opportunity for close observation of a potentially self-harming patient, additional security for staff and early warning if a patient flees the hospital. Most admissions were handled locally, obviating the need for transfer to distant psychiatric referral centres. Most patients who were admitted were already known as having a psychiatric illness and 80% of the patients required the use of the secure room/security guard system for less than a 2-night stay, suggesting that most rural mental health crises pass quickly. Most patients admitted to a rural hospital with a mental health crisis can be managed locally if an adequate secure room/security guard system is available.

  11. [Influence of malnutrition on childhood mortality in a rural hospital in Rwanda]. (United States)

    Ngirabega, J-d-D; Munyanshongore, C; Donnen, P; Dramaix, M


    Recent estimates of the role of malnutrition on childhood mortality have led to a call for action by decision makers in the fight against child malnutrition. Further evaluation is needed to assess the burden of malnutrition in terms of morbidity and mortality, as well as to assess the impact of various interventions. The objective of this study is to determine the effect of malnutrition on mortality in a pediatric service of a rural hospital in Rwanda. A prospective cohort study included children aged 6-59 months coming from the catchment area of the hospital and admitted to the pediatric ward between January 2008 and June 2009. Anthropometric, clinical and biological data were gathered at the time of admission. The effect of malnutrition at the time of admission on mortality during hospitalization was analyzed by using logistic regression. At the time of admission, the prevalences of wasting, underweight and stunting among children was 14.2%, 37.5% and 57.3% respectively. Fifty-six children died during hospitalization. The period mortality rate was 6.9%. After adjustment for age, sex, malaria thick smear and breathing with chest retractions, death was associated with underweight and stunting with adjusted odds rations of 4.6 (IC95% 2.5-8.4) and 4.0 (IC95% 2.0-8.2) respectively. The study confirmed the influence of malnutrition on child mortality in pediatrics wards. These results can be of great help for improving the awareness of the community decision-makers in the fight to prevent malnutrition. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  12. Effect of medicare payment on rural health care systems. (United States)

    McBride, Timothy D; Mueller, Keith J


    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.

  13. Indications for Caesarean sections in a rural hospital in the Highlands of Papua New Guinea. (United States)

    Mark, Terence B; Radcliffe, Jim; Laman, Moses


    We retrospectively documented indications for Caesarean sections in a rural district level hospital in the highlands of Papua New Guinea. Over a 53-month study period, 745 Caesarean sections were performed. Prolonged labour, previous history of Caesarean section, cephalopelvic disproportion, malpresentation and fetal distress accounted for over 88% of Caesarean sections performed. In older mothers (aged >30 years), antepartum haemorrhage (Fisher exact test, P = 0.05) and multiple indications (P = 0.001) were leading reasons for Caesarean sections while cephalopelvic disproportion (P = 0.005) was the leading indication in younger mothers. Further prospective studies incorporating perinatal and maternal mortality rates are required to optimise the value of Caesarean sections at district level hospitals in Papua New Guinea. © The Author(s) 2014 Reprints and permissions:

  14. Experts speak: advice from key informants to small, rural hospitals on implementing the electronic health record system. (United States)

    Craven, Catherine K; Sievert, MaryEllen C; Hicks, Lanis L; Alexander, Gregory L; Hearne, Leonard B; Holmes, John H


    The US government has allocated $30 billion dollars to implement Electronic Health Records (EHRs) in hospitals and provider practices through a policy called Meaningful Use. Small, rural hospitals, particularly those designated as Critical Access Hospitals (CAHs), comprising nearly a quarter of US hospitals, had not implemented EHRs before. Little is known on implementation in this setting. We interviewed a spectrum of 31 experts in the domain. The interviews were then analyzed qualitatively to ascertain the expert recommendations. Nineteen themes emerged. The pool of experts included staff from CAHs that had recently implemented EHRs. We were able to compare their answers with those of other experts and make recommendations for stakeholders. CAH peer experts focused less on issues such as physician buy-in, communication, and the EHR team. None of them indicated concern or focus on clinical decision support systems, leadership, or governance. They were especially concerned with system selection, technology, preparatory work and a need to know more about workflow and optimization. These differences were explained by the size and nature of these small hospitals.

  15. Portrait of Rural Virtual Schooling (United States)

    Barbour, Michael K.


    Over the past two decades, distance education has become a reality of rural schooling in Newfoundland and Labrador. In this article, I provide historical background into the challenges facing rural schools in the province and how distance education was introduced to address that challenge. I also describe how that system of distance education…

  16. Rural-to-Urban Migrants' Experiences with Primary Care under Different Types of Medical Institutions in Guangzhou, China.

    Directory of Open Access Journals (Sweden)

    Jiazhi Zeng

    Full Text Available China is facing the unprecedented challenge of rapidly increasing rural-to-urban migration. Migrants are in a vulnerable state when they attempt to access to primary care services. This study was designed to explore rural-to-urban migrants' experiences in primary care, comparing their quality of primary care experiences under different types of medical institutions in Guangzhou, China.The study employed a cross-sectional survey of 736 rural-to-urban migrants in Guangzhou, China in 2014. A validated Chinese version of Primary Care Assessment Tool--Adult Short Version (PCAT-AS, representing 10 primary care domains was used to collect information on migrants' quality of primary care experiences. These domains include first contact (utilization, first contact (accessibility, ongoing care, coordination (referrals, coordination (information systems, comprehensiveness (services available, comprehensiveness (services provided, family-centeredness, community orientation and culturally competent. These measures were used to assess the quality of primary care performance as reported from patients' perspective. Analysis of covariance was conducted for comparison on PCAT scores among migrants accessing primary care in tertiary hospitals, municipal hospitals, community health centers/community health stations, and township health centers/rural health stations. Multiple linear regression models were used to explore factors associated with PCAT total scores.After adjustments were made, migrants accessing primary care in tertiary hospitals (25.49 reported the highest PCAT total scores, followed by municipal hospitals (25.02, community health centers/community health stations (24.24, and township health centers/rural health stations (24.18. Tertiary hospital users reported significantly better performance in first contact (utilization, first contact (accessibility, coordination (information system, comprehensiveness (service available, and cultural competence

  17. Relationships between dental personnel and non-dental primary health care providers in rural and remote Queensland, Australia: dental perspectives. (United States)

    Stuart, Jackie; Hoang, Ha; Crocombe, Len; Barnett, Tony


    Collaboration between dental practitioners and non-dental primary care providers has the potential to improve oral health care for people in rural and remote communities, where access to oral health services is limited. However, there is limited research on collaboration between these professional disciplines. The purpose of this paper was to explore the relationships between dental practitioners and non-dental primary care providers from rural and remote areas of Queensland and to identify strategies that could improve collaboration between these disciplines from the perspective of dental participants. Semi-structured interviews were conducted between 2013 and 2015 with visiting, local and regional dental practitioners (n = 12) who had provided dental services to patients from eight rural and remote Queensland communities that did not have a resident dentist. Participants were purposely recruited through a snow ball sampling technique. Interview data were analysed using thematic analysis with the assistance of QSR Nvivo v.10. Four major themes emerged from the data: (1) Communication between dental practitioners and rural primary care providers; (2) Relationships between dental and primary care providers; (3) Maintenance of professional dualism; (4) Strategies to improve interprofessional relationships (with subthemes: face to face meetings; utilisation of technology; oral health training for primary care providers; and having a community based oral health contact person). Participants observed that there was a lack of communication between the dental providers who saw patients from these rural communities and the primary care providers who worked in each community. This was attributed to poor communication, the high turnover of staff and the siloed behaviours of some practitioners. Visiting dental practitioners were likely to have stronger professional relationships with hospital nursing, administrative and allied health care staff who were often long term

  18. Sustainable Community Sanitation for a Rural Hospital in Haiti

    Directory of Open Access Journals (Sweden)

    Jason Jawidzik


    Full Text Available A fully sustainable sanitation system was developed for a rural hospital in Haiti. The system operates by converting human waste into biogas and fertilizer without using external energy. It is a hybrid anaerobic/aerobic system that maximizes methane production while producing quality compost. The system first separates liquid and solid human waste at the source to control carbon to nitrogen ratio and moisture content to facilitate enhanced biodegradation. It will then degrade human waste through anaerobic digestion and capture the methane gas for on-site use as a heating fuel. For anaerobic decomposition and methane harvesting a bioreactor with two-stage batch process was designed. Finally, partially degraded human waste is extracted from the bioreactor with two-stage batch process and applied to land farming type aerobic composter to produce fertilizer. The proposed system is optimized in design by considering local conditions such as waste composition, waste generation, reaction temperature, residence time, construction materials, and current practice. It is above ground with low maintenance requirements.

  19. Adaptation of intensive mental health intensive case management to rural communities in the Veterans Health Administration. (United States)

    Mohamed, Somaia


    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.

  20. Teenagers in Rural Areas Faced With Organ Donation and Transplantation. (United States)

    Febrero, B; Almela, J; Ríos, A; Ros, I; Pérez-Sánchez, B; Martínez-Alarcón, L; Ruiz-Carreño, P; Ferreras, D; Ramírez, P; Parrilla, P


    In rural areas it is common to find unfavorable attitudes toward organ donation, and therefore it is important to find out the attitude and profile of new generations for improving predisposition to organ donation in these areas. Our objective was to analyze the attitude toward organ donation and the related variables of teenagers in a rural area. Students in the final year of compulsory education (mostly 15-16 years of age) were selected from secondary schools in a rural area in southeastern Spain (n = 319; population density donating their organs, 30% (n = 90) were undecided, and 5% (n = 16) were against. Attitude toward the donation of one's own organs was related with sex (P = .015), previous experience of organ donation or transplantation (P = .046), comment on the topic of organ donation within the family (P = .003; odds ratio 2.155), knowing one's mother's opinion about the matter (P = .021), knowing the correct concept of brain death (P = .012; odds ratio 2.076), and religion (P = .014). A favorable attitude of teenagers in rural areas toward organ donation is slightly higher than in the adult population and is determined by many psychosocial variables, above all family discussion about organ donation and transplantation and correct knowledge of the brain death concept. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. "Human Immunodeficiency Virus serostatus disclosure-Rate, reactions, and discrimination": a cross-sectional study at a rural tertiary care hospital. (United States)

    Joge, Umesh S; Deo, Deepali S; Choudhari, Sonali G; Malkar, Vilas R; Ughade, Harshada M


    From the moment scientists identified Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS), social responses of fear, denial, stigma, and discrimination have accompanied the epidemic. To assess the rate of disclosure of HIV serostatus, reactions by the HIV/AIDS patients and their spouse, and discrimination faced by the patients. The present cross-sectional study was conducted at Antiretroviral Therapy (ART) center of a rural tertiary care hospital, situated in Marathawada region of Maharashtra state from November 2008 to October 2010. Totally, 801 HIV-positive patients coming to ART center for treatment were included after ensuring confidentiality and taking informed consent. A preformed questionnaire was used to enquire about reaction after diagnosis, disclosure, and discrimination faced by the patients. The data analyzed using descriptive statistics and Chi-square test. The most common immediate reaction by the HIV patients after getting diagnosed as seropositive was fear (593, 74.03%) followed by depression (385, 48.06%) and suicidal thoughts (98, 12.25%). Out of 801 patients, 769 (96%) had spouse and of these maximum number of patients (653, 84.92%) had disclosed HIV status to their spouses. Most common immediate reaction by spouse after disclosure was crime (324, 42.13%) followed by horror (294, 38.23%) and anger (237, 36.29%). Maximum number of patients were discriminated by friends (120, 71.01%) followed by discrimination at workplace (49, 67.12%), by neighbors (32, 56.14%), and by relatives (53, 43.80%). Male positives were granted greater acceptance, care, and support by their spouses. More percentage of females discriminated by neighbors, relatives, and friends and at workplace which might be due to factors like customs, morals, and taboos.

  2. Learning maternity: the experiences of rural nurses. (United States)

    MacKinnon, Karen


    Two research studies explored rural nurses' experience with the provision of maternity care in rural British Columbia, Canada. Frontline nurses, managers, and health-care providers were interviewed and their practices observed. One of the main challenges identified by rural nurses was ensuring that a knowledgeable/skilled maternity or perinatal nurse was always available at the local hospital. Learning how to provide safe and supportive maternity care is difficult for nurses working in small rural hospitals today due to declining birth rates, increased workloads, and a decrease in opportunities for mentoring. Decisions about the allocation of time off and resources for rural nurses' continuing professional education (CPE) were structured by discourses of personal responsibility for "continuing competence." These institutional work processes increase the burden on rural nurses, negatively affecting their opportunities for CPE and their experiences of providing maternity care, with implications for both patient safety and nurse retention.

  3. Using disaster exercises to determine staff educational needs and improve disaster outcomes in rural hospitals: the role of the nursing professional development educator. (United States)

    Anderson, Denise A


    Using human potential in rural hospitals is vital to successful outcomes when handling disasters. Nursing professional development educators provide leadership and guiding vision during a time when few educational research studies demonstrate how to do so. This article explains the role of the rural nursing professional development educator as a disaster preparedness educator, facilitator, collaborator, researcher, and leader, using the American Nurses Association's Nursing Professional Development: Scope and Standards of Practice. Copyright 2012, SLACK Incorporated.

  4. Different perspectives on the key challenges facing rural health: The challenges of power and knowledge. (United States)

    Malatzky, Christina; Bourke, Lisa


    To examine the effects of dominant knowledge in rural health, including how they shape issues central to rural health. In particular, this article examines the roles of: (i) deficit knowledge of rural health workforce; (ii) dominant portrayals of generalism; and (iii) perceptions of inferiority about rural communities in maintaining health disparities between rural- and metropolitan-based Australians. A Foucauldian framework is applied to literature, evidence, case studies and key messages in rural health. Three scenarios are used to provide practical examples of specific knowledge that is prioritised or marginalised. The analysis of three areas in rural health identifies how deficit knowledge is privileged despite it undermining the purpose of rural health. First, deficit knowledge highlights the workforce shortage rather than the type of work in rural practice or the oversupply of workforce in metropolitan areas. Second, the construction of generalist practice as less skilled and more monotonous undermines other knowledge that it is diverse and challenging. Third, dominant negative stereotypes of rural communities discourage rural careers and highlight undesirable aspects of rural practice. The privileging of deficit knowledge pertaining to rural health workforce, broader dominant discourses of generalism and the nature of rural Australian communities reproduces many of the key challenges in rural health today, including persisting health disparities between rural- and metropolitan-based Australians. To disrupt the operations of power that highlight deficit knowledge and undermine other knowledge, we need to change the way in which rural health is currently constructed and understood. © 2018 National Rural Health Alliance Ltd.

  5. Electronic health systems: challenges faced by hospital-based providers. (United States)

    Agno, Christina Farala; Guo, Kristina L


    The purpose of this article is to discuss specific challenges faced by hospitals adopting the use of electronic medical records and implementing electronic health record (EHR) systems. Challenges include user and information technology support; ease of technical use and software interface capabilities; compliance; and financial, legal, workforce training, and development issues. Electronic health records are essential to preventing medical errors, increasing consumer trust and use of the health system, and improving quality and overall efficiency. Government efforts are focused on ways to accelerate the adoption and use of EHRs as a means of facilitating data sharing, protecting health information privacy and security, quickly identifying emerging public health threats, and reducing medical errors and health care costs and increasing quality of care. This article will discuss physician and nonphysician staff training before, during, and after implementation; the effective use of EHR systems' technical features; the selection of a capable and secure EHR system; and the development of collaborative system implementation. Strategies that are necessary to help health care providers achieve successful implementation of EHR systems will be addressed.

  6. Computerizing primary schools in rural kenya

    DEFF Research Database (Denmark)

    Ogembo, J.G.; Ngugi, B.; Pelowski, Matthew John


    questions surrounding this endeavour. Specifically: 1.) what problems do rural schools actually want to solve with computerization; 2.) is computerization the most important priority for rural schools; 3.) are schools ready, in terms of infrastructure, for a computer in the classroom; or 4.) might...... and protective roofing -posing severe challenges to the outstanding conception of computerization. We consider these results and make recommendations for better adapting programs for computer introduction, and also suggest the use of new innovative devices, such as cell phones, which might already have overcome......This paper investigates the outstanding challenges facing primary schools' computerization in rural Kenya. Computerization of schools is often envisaged as a 'magic', or at least a particularly efficient, solution to many of the problems that developing countries face in improving primary school...

  7. Women's access needs in maternity care in rural Tasmania, Australia: a mixed methods study. (United States)

    Hoang, Ha; Le, Quynh; Terry, Daniel


    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.

  8. Critical Access Hospitals (CAH) (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, ...

  9. We cannot staff for 'what ifs': the social organization of rural nurses' safeguarding work. (United States)

    MacKinnon, Karen


    Rural nurses play an important role in the provision of maternity care for Canadian women. This care is an important part of how rural nurses safeguard the patients who receive care in small rural hospitals. This study utilized institutional ethnography as an approach for describing rural nursing work and for exploring how nurses' work experiences are socially organized. Rural nurses advocated for safe healthcare environments by ensuring that skilled nurses were available for every shift, day and night, at their local hospital. Rural nurses noted that this work was particularly difficult for the provision of maternity care. This article explores two threads or cues to institutional organization that were identified in our interviews and observations; namely staffing and safety standards, and the need for flexibility in staffing in small rural hospitals. Rural nurses' concerns about ensuring that skilled nurses are available in small rural hospitals do not enter into current management discourses that focus on efficiency and cost savings or find a home within current discourses of patient safety 'competencies'. © 2011 Blackwell Publishing Ltd.

  10. The status of rural garbage disposal (United States)

    Qin, Ruqiong; Chen, Hong


    With the development of rural construction and the improvement of the living standard of residents, the production of rural living waste is increasing day by day. These wastes not only pollute the environment, destroy the rural landscape, but also spread disease, threaten the life safety of human beings, and become one of the public hazards. The problem of rural living waste is a major environmental problem facing China and the world. This paper make a summary analysis about the present situation of municipal waste in China, this paper expounds the problems in rural garbage treatment, and in view of status quo of municipal waste in China put forward comprehensive countermeasures.

  11. Differences in Readiness between Rural Hospitals and Primary Care Providers for Telemedicine Adoption and Implementation: Findings from a Statewide Telemedicine Survey (United States)

    Martin, Amy Brock; Probst, Janice C.; Shah, Kyle; Chen, Zhimin; Garr, David


    Purpose: Published advantages of and challenges with telemedicine led us to examine the scope of telemedicine adoption, implementation readiness, and barriers in a southern state where adoption has been historically low. We hypothesized that rural hospitals and primary care providers (RPCPs) differ on adoption, readiness, and implementation…

  12. Doctors' and nurses' perceptions of a ward-based pharmacist in rural northern Sweden. (United States)

    Sjölander, Maria; Gustafsson, Maria; Gallego, Gisselle


    Background This project is part of the prospective quasi experimental proof-of-concept investigation of clinical pharmacist intervention study to reduce drug-related problems among people admitted to a ward in a rural hospital in northern Sweden. Objective To explore doctors' and nurses' perceptions and expectations of having a ward-based pharmacist providing clinical pharmacy services. Setting Medical ward in a rural hospital in northern Sweden. Method Eighteen face-to-face semi-structured interviews were conducted with a purposive sample of doctors and nurses working on the ward where the clinical pharmacy service was due to be implemented. Semi-structured interviews were digitally recorded, transcribed and analysed using thematic analysis. Main outcome measure Perceptions and expectations of nurses and doctors. Results Doctors and nurses had limited experience of working with pharmacists. Most had a vague idea of what pharmacists can contribute within a ward setting. Participants, mainly nurses, suggested inventory and drug distribution roles, but few were aware of the pharmacists' skills and clinical competence. Different views were expressed on whether the new clinical pharmacy service would have an impact on workload. However, most participants took a positive view of having a ward-based pharmacist. Conclusion This study provided an opportunity to explore doctors' and nurses' expectations of the role of clinical pharmacists before a clinical pharmacy service was implemented. To successfully implement a clinical pharmacy service, roles, clinical competence and responsibilities should be clearly described. Furthermore, it is important to focus on collaborative working relationships between doctors, nurses and pharmacists.

  13. Rural Districts Left Behind? Rural Districts and the Challenges of Administering the Elementary and Secondary Education Act (United States)

    Yettick, Holly; Baker, Robin; Wickersham, Mary; Hupfeld, Kelly


    The purpose of this study was to inform the upcoming and overdue reauthorization of the Elementary and Secondary Education Act (ESEA) by exploring whether rural school districts face disadvantages as they attempt to follow the law's provisions and, if so, if the law's rural-specific section ameliorates these disadvantages. The research drew upon…

  14. A scoping review identifying contemporary issues in rural nursing leadership. (United States)

    Bish, Melanie; Kenny, Amanda; Nay, Rhonda


    Rural nurse leaders on a global scale are being challenged to create structures and processes to enable excellence in nursing care. The purpose of this scoping review is to offer an indication of the available literature relating to contemporary issues in rural nursing leadership. A review of contemporary issues facing rural nurse leaders is timely to assist strategy development that will achieve the goal of excellence in nursing. An interpretative scoping literature review methodological framework has been used with an emphasis on thematic construction. Literature published between 2008 and 2012 was reviewed from five electronic databases using the key words rural, nursing, and leadership. Four themes have been identified: expectations of rural nursing leadership, a highly educated workforce, competing interests, and partnering within rural healthcare systems. The content may resonate with rural nurse leaders and encourage a greater awareness of their relevance to leadership practices. The findings provide a greater awareness and understanding of contemporary issues facing rural nurse leaders and may assist with the development of context-sensitive leadership strategies to facilitate excellence in nursing care. © 2012 Sigma Theta Tau International.

  15. Burden, causes, and outcomes of people with epilepsy admitted to a rural hospital in Kenya. (United States)

    Kariuki, Symon M; Chengo, Eddie; Ibinda, Fredrick; Odhiambo, Rachael; Etyang, Anthony; Ngugi, Anthony K; Newton, Charles R J C


    People with epilepsy (PWE) develop complications and comorbidities often requiring admission to hospital, which adds to the burden on the health system, particularly in low-income countries. We determined the incidence, disability-adjusted life years (DALYs), risk factors, and causes of admissions in PWE. We also examined the predictors of prolonged hospital stay and death using data from linked clinical and demographic surveillance system. We studied children and adults admitted to a Kenyan rural hospital, between January 2003 and December 2011, with a diagnosis of epilepsy. Poisson regression was used to compute incidence and rate ratios, logistic regression to determine associated factors, and the DALY package of the R-statistical software to calculate years lived with disability (YLD) and years of life lost (YLL). The overall incidence of admissions was 45.6/100,000 person-years of observation (PYO) (95% confidence interval [95% CI] 43.0-48.7) and decreased with age (p causes of admission were epilepsy-related complications: convulsive status epilepticus (CSE) (38%), and postictal coma (12%). Age was independently associated with prolonged hospital stay (OR 1.02, 95% CI 1.00-1.04) and mortality (OR, 1.07, 95% CI 1.04-1.10). Epilepsy is associated with significant number of admissions to hospital, considerable duration of admission, and mortality. Improved supply of AEDs in the community, early initiation of treatment, and adherence would reduce hospitalization of PWE and thus the burden of epilepsy on the health system. © 2015 The Authors. Epilepsia published by Wiley Periodicals, Inc. on behalf of International League Against Epilepsy.

  16. [General surgery in a rural hospital in the State of Quintana Roo, Mexico]. (United States)

    Padrón-Arredondo, Guillermo


    The general surgeon maintains extraordinary validity worldwide, especially in countries like the United States, Canada, India, and continents such as Australia and Africa. In addition to their role as a general surgeon, they assist with surgical pathologies in rural areas where there is generally a lack of technology to carry out complicated procedures. Therefore, we undertook this study to determine the number and type of surgical procedures carried out in a rural hospital with three general surgeons, as well as to determine morbidity and respective mortality. The study was retrospective and longitudinal, using descriptive statistics during a 5.5-year period. During the period of June 1999 to December 2004, a total of 651 (100%) surgical procedures were carried out. There were 351 males (53%) and 300 females (47%) with average age of 28.5 +/- 16.0 years. There were 408 (63%) minor surgical procedures accomplished in the operating room: 150 (45%) for females with average age of 25.8 +/- 13.8 years old and 258 (55%) for males with average age of 27.7 +/- 15.5 years old. There were 243 major surgical procedures (37%): for females there were 150 (60%) with average age of 28.4 +/- 11.8 years old and for males there were 93 (40%) with average age of 29.5 +/- 16.6 years old [morbidity, six cases (0.9%) and mortality, two cases (0.3%)]. The demand for surgery in rural areas is not different from the surgery carried out in large cities, although there are limitations. It is important in this regard to adequately prepare the general surgeon in Mexico.

  17. Management of severe acute malnutrition in children under 5 years through the lens of health care workers in two rural South African hospitals


    Muzigaba, Moise; van Wyk, Brian; Puoane, Thandi


    Background Despite the widespread implementation of the World Health Organization (WHO) guidelines for the management of severe malnutrition in South Africa, poor treatment outcomes for children under 5 years are still observed in some hospitals, particularly in rural areas. Objective To explore health care workers’ perceptions about upstream and proximal factors contributing to poor treatment outcomes for severe acute malnutrition in two district hospitals in South Africa. Methods An explora...

  18. Management of severe acute malnutrition in children under 5 years through the lens of health care workers in two rural South African hospitals


    Moise Muzigaba; Brian van Wyk; Thandi Puoane


    Background: Despite the widespread implementation of the World Health Organization (WHO) guidelines for the management of severe malnutrition in South Africa, poor treatment outcomes for children under 5 years are still observed in some hospitals, particularly in rural areas.Objective: To explore health care workers’ perceptions about upstream and proximal factors contributing to poor treatment outcomes for severe acute malnutrition in two district hospitals in South Africa.Methods: An explor...

  19. Urban Rural Comparisons of Polycystic Ovary Syndrome Burden among Adolescent Girls in a Hospital Setting in India

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    Swetha Balaji


    Full Text Available Background. Polycystic ovarian syndrome (PCOS is a multifaceted disorder characterized by varying clinical presentations. Objective. The aim of this study was to determine urban and rural differences in the burden of polycystic ovarian syndrome among Indian adolescent females aged 12 to 19 years. Methods. A pilot cross-sectional study was conducted for a period of one month (August-September 2013 at Balaji Hospital, Vellore, Tamil Nadu, India. The final sample included 126 study participants located in various urban (50%, n=63 and rural (50%, n=63 settings. Information was gathered on sociodemographic and anthropometric characteristics, clinical history, occurrence of acne and hirsutism, serum testosterone levels, obstetric history, family history of chronic diseases, menstrual history, physical activity, and dietary intake. Results. Eighteen percent of the participants were confirmed of having PCOS by recent guidelines of Rotterdam Consensus for adolescent diagnosis of PCOS (presence of all three elements. Majority of the individuals with PCOS had an average age of 16 (SD = 2 (P=.02 years with an average age of menarche 12 years (SD = 1. Conclusion. The proportion of participants diagnosed with PCOS was higher among urban participants in comparison to rural participants.

  20. Can a chronic disease management pulmonary rehabilitation program for COPD reduce acute rural hospital utilization? (United States)

    Rasekaba, T M; Williams, E; Hsu-Hage, B


    Chronic obstructive pulmonary disease (COPD) imposes a costly burden on healthcare. Pulmonary rehabilitation (PR) is the best practice to better manage COPD to improve patient outcomes and reduce acute hospital care utilization. To evaluate the impact of a once-weekly, eight-week multidisciplinary PR program as an integral part of the COPD chronic disease management (CDM) Program at Kyabram District Health Services. The study compared two cohorts of COPD patients: CDM-PR Cohort (4-8 weeks) and Opt-out Cohort (0-3 weeks) between February 2006 and March 2007. The CDM-PR Program involved multidisciplinary patient education and group exercise training. Nonparametric statistical tests were used to compare acute hospital care utilization 12 months before and after the introduction of CDM-PR. The number of patients involved in the CDM-PR Cohort was 29 (n = 29), and that in the Opt-out Cohort was 24 (n = 24). The CDM-PR Cohort showed significant reductions in cumulative acute hospital care utilization indicators (95% emergency department presentations, 95% inpatient admissions, 99% length of stay; effect sizes = 0.62-0.66, P 0.05). Total costs associated with the hospital care utilization decreased from $130,000 to $7,500 for the CDM-PR Cohort and increased from $77,700 to $101,200 for the Opt-out Cohort. Participation in the CDM-PR for COPD patients can significantly reduce acute hospital care utilization and associated costs in a small rural health service.

  1. The nurse work environment, job satisfaction and turnover rates in rural and urban nursing units. (United States)

    Baernholdt, Marianne; Mark, Barbara A


    The aim of the present study was to determine whether there are differences in hospital characteristics, nursing unit characteristics, the nurse work environment, job satisfaction and turnover rates in rural and urban nursing units. Research in urban hospitals has found an association between the nurse work environment and job satisfaction and turnover rates, but this association has not been examined in rural hospitals. Rural and urban nursing units were compared in a national random sample of 97 United States hospitals (194 nursing units) with between 99 and 450 beds. Significant differences were found between hospital and nursing unit characteristics and the nurse work environment in rural and urban nursing units. Both nursing unit characteristics and the work environment were found to have a significant influence on nurse job satisfaction and turnover rates. Job satisfaction and turnover rates in rural and urban nursing units are associated with both nursing unit characteristics and the work environment. Both rural and urban hospitals can improve nurse job satisfaction and turnover rates by changing unit characteristics, such as creating better support services and a work environment that supports autonomous nursing practice. Rural hospitals can also improve the work environment by providing nurses with more educational opportunities.

  2. Culture and rural health. (United States)

    Farmer, Jane; Bourke, Lisa; Taylor, Judy; Marley, Julia V; Reid, John; Bracksley, Stacey; Johnson, Nicole


    This paper considers the role of culture in rural health, suggesting that the concept and its impacts are insufficiently understood and studied. It reviews some of the ways that culture has been considered in (rural) health, and states that culture is either used ambiguously and broadly - for example, suggesting that there is a rural culture, or narrowly - indeed perhaps interchangeably with ethnicity, for example Aboriginal culture as a unity. The paper notes that, although culture is a dynamic social concept, it has been adopted into a biomedical research paradigm as though it is fixed. Culture is often treated as though it is something that can be addressed simplistically, for example, through cultural sensitivity education. Authors suggest that culture is an unaddressed 'elephant in the room' in rural health, and that exploring cultural differences and beliefs and facing up to cultural differences are vital in understanding and addressing rural health and health system challenges. © 2012 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.

  3. "Human immunodeficiency virus serostatus disclosure-Rate, reactions, and discrimination": A cross-sectional study at a rural tertiary care hospital

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    Umesh S Joge


    Full Text Available Background: From the moment scientists identified Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS, social responses of fear, denial, stigma, and discrimination have accompanied the epidemic. Aims: To assess the rate of disclosure of HIV serostatus, reactions by the HIV/AIDS patients and their spouse, and discrimination faced by the patients. Methods: The present cross-sectional study was conducted at Antiretroviral Therapy (ART center of a rural tertiary care hospital, situated in Marathawada region of Maharashtra state from November 2008 to October 2010. Totally, 801 HIV-positive patients coming to ART center for treatment were included after ensuring confidentiality and taking informed consent. A preformed questionnaire was used to enquire about reaction after diagnosis, disclosure, and discrimination faced by the patients. The data analyzed using descriptive statistics and Chi-square test. Results: The most common immediate reaction by the HIV patients after getting diagnosed as seropositive was fear (593, 74.03% followed by depression (385, 48.06% and suicidal thoughts (98, 12.25%. Out of 801 patients, 769 (96% had spouse and of these maximum number of patients (653, 84.92% had disclosed HIV status to their spouses. Most common immediate reaction by spouse after disclosure was crime (324, 42.13% followed by horror (294, 38.23% and anger (237, 36.29%. Maximum number of patients were discriminated by friends (120, 71.01% followed by discrimination at workplace (49, 67.12%, by neighbors (32, 56.14%, and by relatives (53, 43.80%. Conclusion: Male positives were granted greater acceptance, care, and support by their spouses. More percentage of females discriminated by neighbors, relatives, and friends and at workplace which might be due to factors like customs, morals, and taboos.

  4. Rural nurse job satisfaction. (United States)

    Molinari, D L; Monserud, M A


    The lack of rural nursing studies makes it impossible to know whether rural and urban nurses perceive personal and organizational factors of job satisfaction similarly. Few reports of rural nurse job satisfaction are available. Since the unprecedented shortage of qualified rural nurses requires a greater understanding of what factors are important to retention, studies are needed. An analysis of the literature indicates job satisfaction is studied as both an independent and dependent variable. In this study, the concept is used to examine the intention to remain employed by measuring individual and organizational characteristics; thus, job satisfaction is used as a dependent variable. One hundred and three rural hospital nurses, from hospitals throughout the Northwest region of the United States were recruited for the study. Only nurses employed for more than one year were accepted. The sample completed surveys online. The McCloskey/Mueller Satisfaction Scale, the Gerber Control Over Practice Scale, and two open-ended job satisfaction questions were completed. The qualitative analysis of the open-ended questions identified themes which were then used to support the quantitative findings. Overall alphas were 0.89 for the McCloskey/Mueller Scale and 0.96 for the Gerber Control Over Practice Scale. Rural nurses indicate a preference for rural lifestyles and the incorporation of rural values in organizational practices. Nurses preferred the generalist role with its job variability, and patient variety. Most participants intended to remain employed. The majority of nurses planning to leave employment were unmarried, without children at home, and stated no preference for a rural lifestyle. The least overall satisfied nurses in the sample were employed from 1 to 3 years. Several new findings inform the literature while others support previous workforce studies. Data suggest some job satisfaction elements can be altered by addressing organizational characteristics and by

  5. Where do the rural poor deliver when high coverage of health facility delivery is achieved? Findings from a community and hospital survey in Tanzania.

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    Manuela Straneo

    Full Text Available As part of maternal mortality reducing strategies, coverage of delivery care among sub-Saharan African rural poor will improve, with a range of facilities providing services. Whether high coverage will benefit all socio-economic groups is unknown. Iringa rural District, Southern Tanzania, with high facility delivery coverage, offers a paradigm to address this question. Delivery services are available in first-line facilities (dispensaries, health centres and one hospital. We assessed whether all socio-economic groups access the only comprehensive emergency obstetric care facility equally, and surveyed existing delivery services.District population characteristics were obtained from a household community survey (n = 463. A Hospital survey collected data on women who delivered in this facility (n = 1072. Principal component analysis on household assets was used to assess socio-economic status. Hospital population socio-demographic characteristics were compared to District population using multivariable logistic regression. Deliveries' distribution in District facilities and staffing were analysed using routine data.Women from the hospital compared to the District population were more likely to be wealthier. Adjusted odds ratio of hospital delivery increased progressively across socio-economic groups, from 1.73 for the poorer (p = 0.0031 to 4.53 (p<0.0001 for the richest. Remarkable dispersion of deliveries and poor staffing were found. In 2012, 5505/7645 (72% institutional deliveries took place in 68 first-line facilities, the remaining in the hospital. 56/68 (67.6% first-line facilities reported ≤100 deliveries/year, attending 33% of deliveries. Insufficient numbers of skilled birth attendants were found in 42.9% of facilities.Poorer women remain disadvantaged in high coverage, as they access lower level facilities and are under-represented where life-saving transfusions and caesarean sections are available. Tackling the challenges

  6. Together with the farmers: social and rural medicine in Japan. (United States)

    Abrams, H K


    Japan emerged from feudalism a century ago. Farmers comprise 20 percent of the population of 110 million. The agricultural cooperative movement sponsors 118 hospitals in rural areas. Of these, the Saku Central Hospital is the largest, and provides leadership to a vigorous rural health movement. Its unique outreach program and its contributions to rural health are described, together with remarks about Japan's health situation generally. There may be lessons here for America.

  7. Reluctant Rural Regionalists (United States)

    Hall, Peter V.; Stern, Pamela


    Recently, scholars have begun to explore questions of regionalism and regionalization in rural contexts. Regionalism is often understood and presented as a pragmatic solution to intractable problems of fragmentation, inefficiency, accountability, spillover and neglect in the face of economic restructuring and other external threats. These…

  8. A telemedicine network to support paediatric care in small hospitals in rural Tanzania. (United States)

    Krüger, Carsten; Niemi, Mauri


    We reviewed our experience with the Tanzanian Telemedicine Network in supporting paediatric care at 40 small, rural hospitals in the country. The network began operating in 2008. Store and forward telemedicine was provided via the open source software iPath. The 33 volunteer consultants were based in several countries, although most of them had practical experience in Tanzania. During the first three years of network operation there were 533 referrals. There were 159 paediatric cases (median age five years). Three paediatric specialists provided most consultations (64%), but other specialists provided recommendations when required. The response time was usually less than two days (median 6 h; inter-quartile range 2-24 h). A precise recommendation was not always provided, but since all consultants had an intimate knowledge of the state of health services in Tanzania, their advice was usually well adapted to the local circumstances of the hospitals. Referral to a higher level of care was recommended in 26 cases (16%). A simple web-based telemedicine system combined with email alerts is feasible in remote locations in Tanzania, even where fast Internet connections are not available. Copyright © 2012 by the Royal Society of Medicine Press Ltd

  9. The experience of rural families in the face of cancer. (United States)

    Girardon-Perlini, Nara Marilene Oliveira; Ângelo, Margareth


    To understand the meanings of cancer within the experience of rural families and how such meanings influence family dynamics. Qualitative study guided by Symbolic Interactionism as a theoretical framework and Grounded Theory as a methodological framework. Six rural families (18 participants) undergoing the experience of having a relative with cancer participated in the interview. Constant comparative analysis of data allowed the elaboration of an explanatory substantive theory, defined by the main category Caregiving to support the family world, which represents the family's symbolic actions and strategies to reconcile care for the patient and care for family life. Throughout the experience, rural families seek to preserve the interconnected symbolic elements that provide support for the family world: family unit, land, work and care. Compreender os significados do câncer presentes na experiência de famílias rurais e como esses significados influenciam a dinâmica familiar. Estudo qualitativo orientado pelo Interacionismo Simbólico como referencial teórico e pela Teoria Fundamentada nos Dados como referencial metodológico. Participaram, por meio de entrevista, seis famílias rurais (18 participantes) que estavam vivendo a experiência de ter um familiar com câncer. A análise comparativa constante dos dados permitiu a elaboração de uma teoria substantiva explicativa da experiência, definida pela categoria central Cuidando para manter o mundo da família amparado, que representa as ações e estratégias simbólicas da família visando a conciliar o cuidado do familiar doente e o cuidado da vida familiar. Ao longo da experiência, a família rural procura preservar os elementos simbólicos que, conectados, constituem o amparo do mundo da família: a unidade familiar, a terra, o trabalho e o cuidado.

  10. rural medicine as a sub-specialty

    African Journals Online (AJOL)

    hospital for a year can be regarded as a rural medical specialist. Most often they realise ... of them, that they leave the public service for ever, for a situation that is ... So for rural medicine, it is an extremely wide set of skills that best describes ...

  11. Fostering resilience: Empowering rural communities in the face of hardship

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    Darryl Maybery


    Full Text Available Australian rural communities are experiencing some of the worst climactic and economic conditions in decades. Unfortunately, the multiple government and non-government agency responses have reportedly been uncoordinated, sometimes losing sight of their consumers. This article describes a program designed to strengthen and empower resilience in small rural communities and summarises the outcomes, including needs and action planning undertaken. The 97 participants were from eight outer regional or remote towns and communities in the northern Riverina region of New South Wales, Australia. As groups representing their communities, they attended meetings and responded to a series of questions regarding issues arising from the drought, community needs, and actions their community could take to address these issues and needs. The study findings highlight the stress and strain of the climatic conditions and the insecurity of rural incomes, as well as problems with the high cost of transport. The communities recognised a degree of social disintegration but also expressed considerable hope that, by working together and better utilising social agencies, they could develop a social connectedness that would make their communities more resilient. Approaches that empower and facilitate community resilience are suggested as an effective model that governments and non-government agencies can use to encourage social groups that are struggling to build resilience.

  12. outreach programme: consultant visits to rural hospitals

    African Journals Online (AJOL)


    Feb 2, 2011 ... Director: Centre for Rural Health, University of KwaZulu-Natal. Bernhard ... governance and health systems as well as the relationship between social circumstances and child wellbeing. .... mental health services in Limpopo.

  13. Educational strategies for rural new graduate registered nurses. (United States)

    Dowdle-Simmons, Sara


    Rural health care facilities are geographically remote, tend to be small, and often possess limited resources. Although newly graduated registered nurses are important to the work force of many rural communities, maintaining a formal preceptorship/mentorship program within a rural hospital may prove difficult as a result of limited resources. Unfortunately, the new graduate may become overwhelmed by the many expectations for clinical practice and the facility can experience high turnover rates of new graduate hires. This article explores the unique traits of the rural hospital and the new graduate nurse as well as the pros and cons of a formal preceptorship program within a rural setting. Constructivist learning theory is used to develop practical teaching strategies that can be used by the preceptor and the new graduate. These strategies are inexpensive, yet effective, and are feasible for even the smallest of facilities. Copyright 2013, SLACK Incorporated.

  14. Rural community birth: Maternal and neonatal outcomes for planned community births among rural women in the United States, 2004-2009. (United States)

    Nethery, Elizabeth; Gordon, Wendy; Bovbjerg, Marit L; Cheyney, Melissa


    Approximately 22% of women in the United States live in rural areas with limited access to obstetric care. Despite declines in hospital-based obstetric services in many rural communities, midwifery care at home and in free standing birth centers is available in many rural communities. This study examines maternal and neonatal outcomes among planned home and birth center births attended by midwives, comparing outcomes for rural and nonrural women. Using the Midwives Alliance of North America Statistics Project 2.0 dataset of 18 723 low-risk, planned home, and birth center births, rural women (n = 3737) were compared to nonrural women. Maternal outcomes included mode of delivery (cesarean and instrumental delivery), blood transfusions, severe events, perineal lacerations, or transfer to hospital and a composite (any of the above). The primary neonatal outcome was a composite of early neonatal intensive care unit or hospital admissions (longer than 1 day), and intrapartum or neonatal deaths. Analysis involved multivariable logistic regression, controlling for sociodemographics, antepartum, and intrapartum risk factors. Rural women had different risk profiles relative to nonrural women and reduced risk of adverse maternal and neonatal outcomes in bivariable analyses. However, after adjusting for risk factors and confounders, there were no significant differences for a composite of maternal (adjusted odds ratio [aOR] 1.05 [95% confidence interval {CI} 0.93-1.19]) or neonatal (aOR 1.13 [95% CI 0.87-1.46]) outcomes between rural and nonrural pregnancies. Among this sample of low-risk women who planned midwife-led community births, no increased risk was detected by rural vs nonrural status. © 2017 Wiley Periodicals, Inc.

  15. Molecular and phenotypic characteristics of healthcare- and community-associated methicillin-resistant Staphylococcus aureus at a rural hospital.

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    Amy E Peterson

    Full Text Available BACKGROUND: While methicillin-resistant Staphylococcus aureus (MRSA originally was associated with healthcare, distinct strains later emerged in patients with no prior hospital contact. The epidemiology of MRSA continues to evolve. METHODS: To characterize the current epidemiology of MRSA-colonized patients entering a hospital serving both rural and urban communities, we interviewed patients with MRSA-positive admission nasal swabs between August 2009 and March 2010. We applied hospitalization risk factor, antimicrobial resistance phenotype, and multi-locus sequence genotype (MLST classification schemes to 94 case-patients. RESULTS: By MLST analysis, we identified 15 strains with two dominant clonal complexes (CCs-CC5 (51 isolates, historically associated with hospitals, and CC8 (27 isolates, historically of community origin. Among patients with CC5 isolates, 43% reported no history of hospitalization within the past six months; for CC8, 67% reported the same. Classification by hospitalization risk factor did not correlate strongly with genotypic classification. Sensitivity of isolates to ciprofloxacin, clindamycin, or amikacin was associated with the CC8 genotype; however, among CC8 strains, 59% were resistant to ciprofloxacin, 15% to clindamycin, and 15% to amikacin. CONCLUSIONS: Hospitalization history was not a strong surrogate for the CC5 genotype. Conversely, patients with a history of hospitalization were identified with the CC8 genotype. Although ciprofloxacin, clindamycin, and amikacin susceptibility distinguished CC8 strains, the high prevalence of ciprofloxacin resistance limited its predictive value. As CC8 strains become established in healthcare settings and CC5 strains disseminate into the community, community-associated MRSA definitions based on case-patient hospitalization history may prove less valuable in tracking community MRSA strains.

  16. Evaluation of sustainable rural tourism development in Serbia

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    Full Text Available Serbian rural tourism face a growing number of challenges. A competitive Serbian rural economy requires a balance between agricultural production, other economic activities, environmental protection and social development. Rural development has focuset on improving agricultural competitiveness consolidating land, improvingmarket orientation, and developing economic infrastructure. Rural tourism is seen as one of the aspects of sustainable economic growth of the four rural areas in Serbia. The paper gives an evaluation of rural tourism development in Serbia through rural tourism product and rural tourism clusters prioritizing. Rural tourism is highlighted as one possible solution for the poor rural areas development. It is seen as an instrument for revitalization of the rural space and for the increasing of their attractiveness.Leisure, recreation and tourism in rural areas are perspectives of a new approach in which society is changing from the concern of production to concern of consumption.

  17. Repeat HIV testing during pregnancy and delivery: missed opportunities in a rural district hospital in Zambia. (United States)

    Heemelaar, Steffie; Habets, Nicole; Makukula, Ziche; van Roosmalen, Jos; van den Akker, Thomas


    To assess coverage of repeat HIV testing among women who delivered in a Zambian hospital. HIV testing of pregnant women and repeat testing every 3 months during pregnancy and breastfeeding is the recommended policy in areas of high HIV prevalence. A prospective implementation study in a second-level hospital in rural Zambia. Included were all pregnant women who delivered in hospital during May and June 2012. Data regarding antenatal visits and HIV testing were collected by two investigators using a standardised form. Of 401 women who delivered in hospital, sufficient antenatal data could be retrieved for 322 (80.3%) women. Of these 322 women, 301 (93.5%) had attended antenatal care (ANC) at least once. At the time of discharge after delivery in hospital, 171 (53.1%) had an unclear HIV status because their negative test result was more than 3 months ago or of an unknown date, or because they had not been tested at all during pregnancy or delivery. An updated HIV status was present for 151 (46.9%) women: 25 (7.8%) were HIV positive and 126 (39.1%) had tested negative within the last 3 months. In this last group, 79 (24.5%) had been tested twice or more during pregnancy. During the study period, none of the women was tested during admission for delivery. Despite high ANC coverage, opportunities for repeat HIV testing were missed in almost half of all women who delivered in this hospital in a high-prevalence HIV setting. © 2014 John Wiley & Sons Ltd.

  18. Surgical specialty procedures in rural surgery practices: implications for rural surgery training. (United States)

    Sticca, Robert P; Mullin, Brady C; Harris, Joel D; Hosford, Clint C


    Specialty procedures constitute one eighth of rural surgery practice. Currently, general surgeons intending to practice in rural hospitals may not get adequate training for specialty procedures, which they will be expected to perform. Better definition of these procedures will help guide rural surgery training. Current Procedural Terminology codes for all surgical procedures for 81% of North Dakota and South Dakota rural surgeons were entered into the Dakota Database for Rural Surgery. Specialty procedures were analyzed and compared with the Surgical Council on Resident Education curriculum to determine whether general surgery training is adequate preparation for rural surgery practice. The Dakota Database for Rural Surgery included 46,052 procedures, of which 5,666 (12.3%) were specialty procedures. Highest volume specialty categories included vascular, obstetrics and gynecology, orthopedics, cardiothoracic, urology, and otolaryngology. Common procedures in cardiothoracic and vascular surgery are taught in general surgical residency, while common procedures in obstetrics and gynecology, orthopedics, urology, and otolaryngology are usually not taught in general surgery training. Optimal training for rural surgery practice should include experience in specialty procedures in obstetrics and gynecology, orthopedics, urology, and otolaryngology. Copyright © 2012 Elsevier Inc. All rights reserved.

  19. Barriers to Rural Induced Abortion Services in Canada: Findings of the British Columbia Abortion Providers Survey (BCAPS) (United States)

    Norman, Wendy V.; Soon, Judith A.; Maughn, Nanamma; Dressler, Jennifer


    Background Rural induced abortion service has declined in Canada. Factors influencing abortion provision by rural physicians are unknown. This study assessed distribution, practice, and experiences among rural compared to urban abortion providers in the Canadian province of British Columbia (BC). Methods We used mixed methods to assess physicians on the BC registry of abortion providers. In 2011 we distributed a previously-published questionnaire and conducted semi-structured interviews. Results Surveys were returned by 39/46 (85%) of BC abortion providers. Half were family physicians, within both rural and urban cohorts. One-quarter (17/67) of rural hospitals offer abortion service. Medical abortions comprised 14.7% of total reported abortions. The three largest urban areas reported 90% of all abortions, although only 57% of reproductive age women reside in the associated health authority regions. Each rural physician provided on average 76 (SD 52) abortions annually, including 35 (SD 30) medical abortions. Rural physicians provided surgical abortions in operating rooms, often using general anaesthesia, while urban physicians provided the same services primarily in ambulatory settings using local anaesthesia. Rural providers reported health system barriers, particularly relating to operating room logistics. Urban providers reported occasional anonymous harassment and violence. Conclusions Medical abortions represented 15% of all BC abortions, a larger proportion than previously reported (under 4%) for Canada. Rural physicians describe addressable barriers to service provision that may explain the declining accessibility of rural abortion services. Moving rural surgical abortions out of operating rooms and into local ambulatory care settings has the potential to improve care and costs, while reducing logistical challenges facing rural physicians. PMID:23840578

  20. Initiation of breastfeeding and prevalence of exclusive breastfeeding at hospital discharge in urban, suburban and rural areas of Zhejiang China

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    Binns Colin W


    Full Text Available Abstract Background Rates of exclusive breastfeeding in China are relatively low and below national targets. The aim of this study was to document the factors that influence exclusive breastfeeding initiation in Zhejiang, PR China. Methods A cohort study of infant feeding practices was undertaken in Zhejiang Province, an eastern coastal region of China. A total of 1520 mothers who delivered in four hospitals located in city, suburb and rural areas during late 2004 to 2005 were enrolled in the study. Multivariate logistic regression analysis was used to explore factors related to exclusive breastfeeding initiation. Results On discharge from hospital, 50.3% of the mothers were exclusively breastfeeding their infants out of 96.9% of the mothers who had earlier initiated breastfeeding. Exclusive breastfeeding was positively related to vaginal birth, baby's first feed being breast milk, mother living in the suburbs or rural areas, younger age of mother, lower maternal education level and family income. Conclusion The exclusive breastfeeding rate in Zhejiang is only 50.3% on discharge and does not reach Chinese or international targets. A number of behaviours have been identified in the study that could be potentially incorporated into health promotion activities.

  1. Critical reflections on the New Rurality and the rural territorial development approaches in Latin America

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    César Ramírez-Miranda


    Full Text Available This paper presents a critical approach to the New Rurality and the Rural Territorial Development (RTD perspectives, which nowadays are hegemonic for governmental organizations and Latin American academies. RTD's core requirements, which are functional for neoliberal policies resulting in the loss of food sovereignty, the globalization of agribusinesses, and migration as a consequence of peasant agricultural weakening, were critically reviewed on the basis of the principal challenges faced by Latin American rural areas. In light of the above consequences, it is thought that changes in such areas are based on neoliberal rurality rather than on the purported New Rurality. By stressing the need for a global historical view that reintroduces the Latin American critical thinking tradition, the urgency for public policies that stop neoliberal prescriptions and seek to strengthen peasant and indigenous agriculture in order to encourage rural development based on food sovereignty, democracy, equity and sustainability were established.

  2. Presentation, management, and outcomes of sepsis in adults and children admitted to a rural Ugandan hospital: A prospective observational cohort study.

    Directory of Open Access Journals (Sweden)

    Kristina E Rudd

    Full Text Available Limited data are available on sepsis in low-resource settings, particularly outside of urban referral centers. We conducted a prospective observational single-center cohort study in May 2013 to assess the presentation, management and outcomes of adult and pediatric patients admitted with sepsis to a community hospital in rural Uganda.We consecutively screened all patients admitted to medical wards who met sepsis criteria. We evaluated eligible patients within 24 hours of presentation and 24-48 hours after admission, and followed them until hospital discharge. In addition to chart review, mental status evaluation, peripheral capillary oxygen saturation, and point-of-care venous whole blood lactate and glucose testing were performed.Of 56 eligible patients, we analyzed data on 51 (20 adults and 31 children. Median age was 8 years (IQR 2-23 years. Sepsis accounted for a quarter of all adult and pediatric medical ward admissions during the study period. HIV prevalence among adults was 30%. On enrollment, over half of patients had elevated point-of-care whole blood lactate, few were hypoglycemic or had altered mental status, and one third were hypoxic. Over 80% of patients received at least one antibiotic, all severely hypoxic patients received supplemental oxygen, and half of patients with elevated lactate received fluid resuscitation. The most common causes of sepsis were malaria and pneumonia. In-hospital mortality was 3.9%.This study highlights the importance of sepsis among adult and pediatric patients admitted to a rural Ugandan hospital and underscores the need for continued research on sepsis in low resource settings.

  3. A case study of the counterpart technical support policy to improve rural health services in Beijing (United States)


    Background There is, globally, an often observed inequality in the health services available in urban and rural areas. One strategy to overcome the inequality is to require urban doctors to spend time in rural hospitals. This approach was adopted by the Beijing Municipality (population of 20.19 million) to improve rural health services, but the approach has never been systematically evaluated. Methods Drawing upon 1.6 million cases from 24 participating hospitals in Beijing (13 urban and 11 rural hospitals) from before and after the implementation of the policy, changes in the rural–urban hospital performance gap were examined. Hospital performance was assessed using changes in six indices over-time: Diagnosis Related Groups quantity, case-mix index (CMI), cost expenditure index (CEI), time expenditure index (TEI), and mortality rates of low- and high-risk diseases. Results Significant reductions in rural–urban gaps were observed in DRGs quantity and mortality rates for both high- and low-risk diseases. These results signify improvements of rural hospitals in terms of medical safety, and capacity to treat emergency cases and more diverse illnesses. No changes in the rural–urban gap in CMI were observed. Post-implementation, cost and time efficiencies worsened for the rural hospitals but improved for urban hospitals, leading to a widening rural–urban gap in hospital efficiency. Conclusions The strategy for reducing urban–rural gaps in health services adopted, by the Beijing Municipality shows some promise. Gains were not consistent, however, across all performance indicators, and further improvements will need to be tried and evaluated. PMID:23272703

  4. Clinical Spectrum, Etiology, and Outcome of Neurological Disorders in the Rural Hospital of Mosango, the Democratic Republic of Congo. (United States)

    Mukendi, Deby; Lilo Kalo, Jean-Roger; Mpanya, Alain; Minikulu, Luigi; Kayembe, Tharcisse; Lutumba, Pascal; Barbé, Barbara; Gillet, Philippe; Jacobs, Jan; Van Loen, Harry; Yansouni, Cédric P; Chappuis, François; Ravinetto, Raffaella; Verdonck, Kristien; Boelaert, Marleen; Winkler, Andrea S; Bottieau, Emmanuel


    There is little published information on the epidemiology of neurological disorders in rural Central Africa, although the burden is considered to be substantial. This study aimed to investigate the pattern, etiology, and outcome of neurological disorders in children > 5 years and adults admitted to the rural hospital of Mosango, province of Kwilu, Democratic Republic of Congo, with a focus on severe and treatable infections of the central nervous system (CNS). From September 2012 to January 2015, 351 consecutive patients hospitalized for recent and/or ongoing neurological disorder were prospectively evaluated by a neurologist, subjected to a set of reference diagnostic tests in blood or cerebrospinal fluid, and followed-up for 3-6 months after discharge. No neuroimaging was available. Severe headache (199, 56.7%), gait/walking disorders (97, 27.6%), epileptic seizure (87, 24.8%), and focal neurological deficit (86, 24.5%) were the predominant presentations, often in combination. Infections of the CNS were documented in 63 (17.9%) patients and mainly included bacterial meningitis and unspecified meningoencephalitis (33, 9.4%), second-stage human African trypanosomiasis (10, 2.8%), and human immunodeficiency virus (HIV)-related neurological disorders (10, 2.8%). Other focal/systemic infections with neurological manifestations were diagnosed in an additional 60 (17.1%) cases. The leading noncommunicable conditions were epilepsy (61, 17.3%), psychiatric disorders (56, 16.0%), and cerebrovascular accident (23, 6.6%). Overall fatality rate was 8.2% (29/351), but up to 23.8% for CNS infections. Sequelae were observed in 76 (21.6%) patients. Clinical presentations and etiologies of neurological disorders were very diverse in this rural Central African setting and caused considerable mortality and morbidity.

  5. Clinical and endoscopic profile of the patients with upper gastrointestinal bleeding in central rural India: A hospital-based cross-sectional study

    Directory of Open Access Journals (Sweden)

    Jyoti Jain


    Full Text Available Introduction: Acute Upper Gastrointestinal bleeding (UGIB is one of the common causes with which the patients present to emergency. The upper gastrointestinal (UGI endoscopy remains a crucial tool in identification of UGIB. The aim of the present study was to determine the endoscopic profile of UGIB in adult population of rural central India admitted with history of UGIB (hemetemesis and/or malena. Methods: This prospective, cross sectional study was conducted in rural hospital in central India and we enrolled all consecutive patients aged 18 years and above who were admitted in the hospital ward with the history of UGIB. After obtaining the demographic data, all patients underwent clinical examination, laboratory investigations and video-endoscopy. We used Student's t test to compare means, Chi-square test to compare proportions and Mann-Whitney test to compare medians. P value <0.05 will be considered significant. Results: The mean age of our study population (N = 118 was 46.2 years. Among 118 patients who underwent endoscopy, 47.4% had esophageal varices, 27.1% had portal hypertensive gastropathy, 14.4% had gastric erosions, 5.9% each had duodenal ulcers and esophagitis, 5% had gastric ulcer disease, 4.2% each had Mallory-Weiss tear and had gastric malignancy, 1.7% had esophageal malignancy and 16.1% had normal endoscopic findings. Conclusion: Esophageal varices were the most common cause of UGIB in the adult population of rural central India presenting with UGIB, when diagnosed by video-endoscopy.

  6. Remote rural women's choice of birthplace and transfer experiences in rural Otago and Southland New Zealand. (United States)

    Patterson, Jean; Foureur, Maralyn; Skinner, Joan


    Birth in primary midwife-led maternity units has been demonstrated to be a safe choice for well women anticipating a normal birth. The incidence of serious perinatal outcomes for these women is comparable to similarly low risk women, who choose to birth in hospital. New Zealand women have a choice of Lead Maternity Carer (LMC) and birthplace; home, primary birthing unit, or a base hospital, though not all women may have all these choices available locally. Women in rural and rural remote areas can also choose to birth in their rural primary maternity unit. A percentage of these women (approx. 15-17%) will require transfer during labour, an event which can cause distress and often loss of midwifery continuity of care. To explore retrospectively the choice of birth place decisions and the labour and birth experiences of a sample of women resident in remotely zoned, rural areas of the lower South Island of New Zealand. A purposive sample of women living in remote rural areas, recruited by advertising in local newspapers and flyers. Individual semi-structured interviews were digitally recorded using a pragmatic interpretive approach. The data (transcripts and field notes) were analysed using thematic and content analysis. Ethical approval was obtained from the Health and Disability Ethics Committee (HEDC) MEC/06/05/045. Thirteen women consented to participate. Each was resident in a remote rural area having given birth in the previous 18 months. The women had been well during their pregnancies and at the onset of labour had anticipated a spontaneous vaginal birth. Rural remote zoned areas in Otago and Southland in the South Island of New Zealand FINDINGS: Five women planned to birth in a regional hospital and eight chose their nearest rural primary maternity unit. All of the women were aware of the possibility of transfer and had made their decision about their birthplace based on their perception of their personal safety, and in consideration of their distance from

  7. Predicting high risk of exacerbations in bronchiectasis: the E-FACED score

    Directory of Open Access Journals (Sweden)

    Martinez-Garcia MA


    Full Text Available Martinez-Garcia MA,1,2 Athanazio RA,3 Girón R,4 Máiz-Carro L,5 de la Rosa D,6 Olveira C,7 de Gracia J,2,8 Vendrell M,9 Prados-Sánchez C,10 Gramblicka G,11 Corso Pereira M,12 Lundgren FL,13 Fernandes De Figueiredo M,14 Arancibia F,15 Rached SZ3 1Pulmonary Service, Polytechnic and University La Fe Hospital, Valencia, Spain; 2CIBERes, CIBER de Enfermedades Respiratorias. Madrid. Spain; 3Pulmonary Division, Heart Institute (Incor, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo; 4Pneumology Service, Hospital La Princesa, 5Pneumology Service, Hospital Ramón y Cajal, Madrid, 6Pneumology Unit, Hospital Plató, Barcelona, 7Pneumology, Málaga Regional University Hospital, Instituto de Biomedicina de Málaga (IBIMA, Málaga University, Spain; 8Pneumology Service, Hospital Vall d’Hebron, Barcelona, 9Bronchiectasis Group IDIBGI, Dr. Trueta University Hospital. UdG. Ciberes CB06/06/0030, 10Unidad de Fibrosis Quística y Bronquiectasias. Hospital Universitario La Paz. Madrid. Spain; 11Pneumology Service, Hospital del Tórax Dr A Cetrángolo, Buenos Aires, Argentina; 12Pneumology Service, Universidade Estadual de Campinas UNICAMP, Sao Paulo, 13Pneumology Service, Hospital Octávio de Freitas, Recife, 14Pneumology Service, Hospital de Messejana, Fortaleza, Brazil; 15Pneumology Service, Instituto Nacional del Tórax, Santiago de Chile, Chile Background: Although the FACED score has demonstrated a great prognostic capacity in bronchiectasis, it does not include the number or severity of exacerbations as a separate variable, which is important in the natural history of these patients.Objective: Construction and external validation of a new index, the E-FACED, to evaluate the predictive capacity of exacerbations and mortality.Methods: The new score was constructed on the basis of the complete cohort for the construction of the original FACED score, while the external validation was undertaken with six cohorts from three

  8. Review of two years of experiences with SPECT among psychiatric patients in a rural hospital setting. (United States)

    Sheehan, William; Thurber, Steven


    We summarize single proton emission computed tomography (SPECT) findings from 63 psychiatric patients in a small rural hospital in western Minnesota. SPECT scans were ordered only for patients in whom documentation of hypoperfusion and functional deficits might be helpful in clarifying diagnoses and treatment planning. The patients referred for SPECT scans had histories of traumatic brain injuries, atypical psychiatric symptom presentations, or conditions that were refractory to standard treatments. In the context of strict referral guidelines and close psychiatrist-radiologist collaboration, a much higher yield of significant findings was obtained compared with those noted in other reports in the literature.

  9. Why do some hospitals achieve better care of severely malnourished children than others? Five-year follow-up of rural hospitals in Eastern Cape, South Africa. (United States)

    Puoane, Thandi; Cuming, Katie; Sanders, David; Ashworth, Ann


    Staff at 11 rural hospitals in an under-resourced region of Eastern Cape Province, South Africa, participated in an intervention to improve the quality of care of severely malnourished children through training and support aimed at implementing the WHO case-management guidelines. Despite similar intervention inputs, some hospitals reduced their case-fatality rates by at least half, whereas others did not. The aim of this study was to investigate reasons for this disparity. Two successful and two poorly performing hospitals were purposively selected based on their case-fatality rates, which were 30% in those performing poorly. Comparative data were collected during June to October 2004 through structured observations of ward procedures, compilation of hospital data on case-loads and resources, and staff interviews and discussions related to attitudes, teamwork, training, supervision, managerial support and leadership. The four study hospitals had broadly similar resources, infrastructure and child:nurse ratios, and all had made changes to their clinical and dietary management following training. Case-management was broadly in line with WHO guidelines but the study revealed clear differences in institutional culture which influenced quality of care. Staff in the successful hospitals were more attentive and assiduous than staff in the poorly performing hospitals, especially in relation to rehydration procedures, feeding and the recording of vital signs. There was a strong emphasis on in-service training and induction of incoming staff in the successful hospitals and better supervision of junior staff and carers. Nurses had more positive attitudes towards malnourished children and their carers, and were less judgmental. Underlying factors were differences in leadership, teamwork, and managerial supervision and support. We conclude that unless there are supportive structures at managerial level, the potential benefits of efficacious interventions and related training

  10. Trauma care in Scotland: effect of rurality on ambulance travel times and level of destination healthcare facility. (United States)

    Yeap, E E; Morrison, J J; Apodaca, A N; Egan, G; Jansen, J O


    The aim of this study was to determine the effect of rurality on the level of destination healthcare facility and ambulance response times for trauma patients in Scotland. We used a retrospective analysis of pre-hospital data routinely collected by the Scottish Ambulance Service from 2009-2010. Incident locations were categorised by rurality, using the Scottish urban/rural classification. The level of destination healthcare facility was coded as either a teaching hospital, large general hospital, general hospital, or other type of facility. A total of 64,377 incidents met the inclusion criteria. The majority of incidents occurred in urban areas, which mostly resulted in admission to teaching hospitals. Incidents from other areas resulted in admission to a lower-level facility. The majority of incidents originating in very remote small towns and very remote rural areas were treated in a general hospital. Median call-out times and travel times increased with the degree of rurality, although with some exceptions. Trauma is relatively rare in rural areas, but patients injured in remote locations are doubly disadvantaged by prolonged pre-hospital times and admission to a hospital that may not be adequately equipped to deal with their injuries. These problems may be overcome by the regionalisation of trauma care, and enhanced retrieval capability.

  11. The influences of Taiwan's National Health Insurance on women's choice of prenatal care facility: Investigation of differences between rural and non-rural areas

    Directory of Open Access Journals (Sweden)

    Chen Chi-Liang


    Full Text Available Abstract Background Taiwan's National Health Insurance (NHI, implemented in 1995, substantially increased the number of health care facilities that can deliver free prenatal care. Because of the increase in such facilities, it is usually assumed that women would have more choices regarding prenatal care facilities and thus experience reduction in travel cost. Nevertheless, there has been no research exploring these issues in the literature. This study compares how Taiwan's NHI program may have influenced choice of prenatal care facility and perception regarding convenience in transportation for obtaining such care for women in rural and non-rural areas in Taiwan. Methods Based on data collected by a national survey conducted by Taiwan's National Health Research Institutes (NHRI in 2000, we tried to compare how women chose prenatal care facility before and after Taiwan's National Health Insurance program was implemented. Basing our analysis on how women answered questionnaire items regarding "the type of major health care facility used and convenience of transportation to and from prenatal care facility," we investigated whether there were disparities in how women in rural and non-rural areas chose prenatal care facilities and felt about the transportation, and whether the NHI had different influences for the two groups of women. Results After NHI, women in rural areas were more likely than before to choose large hospitals for prenatal care services. For women in rural areas, the relative probability of choosing large hospitals to choosing non-hospital settings in 1998–1999 was about 6.54 times of that in 1990–1992. In contrast, no such change was found in women in non-rural areas. For a woman in a non-rural area, she was significantly more likely to perceive the transportation to and from prenatal care facilities to be very convenient between 1998 and 1999 than in the period between 1990 and 1992. No such improvement was found for women in

  12. Surgical face masks worn by patients with multidrug-resistant tuberculosis: impact on infectivity of air on a hospital ward. (United States)

    Dharmadhikari, Ashwin S; Mphahlele, Matsie; Stoltz, Anton; Venter, Kobus; Mathebula, Rirhandzu; Masotla, Thabiso; Lubbe, Willem; Pagano, Marcello; First, Melvin; Jensen, Paul A; van der Walt, Martie; Nardell, Edward A


    Drug-resistant tuberculosis transmission in hospitals threatens staff and patient health. Surgical face masks used by patients with tuberculosis (TB) are believed to reduce transmission but have not been rigorously tested. We sought to quantify the efficacy of surgical face masks when worn by patients with multidrug-resistant TB (MDR-TB). Over 3 months, 17 patients with pulmonary MDR-TB occupied an MDR-TB ward in South Africa and wore face masks on alternate days. Ward air was exhausted to two identical chambers, each housing 90 pathogen-free guinea pigs that breathed ward air either when patients wore surgical face masks (intervention group) or when patients did not wear masks (control group). Efficacy was based on differences in guinea pig infections in each chamber. Sixty-nine of 90 control guinea pigs (76.6%; 95% confidence interval [CI], 68-85%) became infected, compared with 36 of 90 intervention guinea pigs (40%; 95% CI, 31-51%), representing a 56% (95% CI, 33-70.5%) decreased risk of TB transmission when patients used masks. Surgical face masks on patients with MDR-TB significantly reduced transmission and offer an adjunct measure for reducing TB transmission from infectious patients.

  13. Effect of a brief outreach educational intervention on the translation of acute poisoning treatment guidelines to practice in rural Sri Lankan hospitals: a cluster randomized controlled trial. (United States)

    Senarathna, Lalith; Buckley, Nick A; Dibley, Michael J; Kelly, Patrick J; Jayamanna, Shaluka F; Gawarammana, Indika B; Dawson, Andrew H


    In developing countries, including Sri Lanka, a high proportion of acute poisoning and other medical emergencies are initially treated in rural peripheral hospitals. Patients are then usually transferred to referral hospitals for further treatment. Guidelines are often used to promote better patient care in these emergencies. We conducted a cluster randomized controlled trial (ISRCTN73983810) which aimed to assess the effect of a brief educational outreach ('academic detailing') intervention to promote the utilization of treatment guidelines for acute poisoning. This cluster RCT was conducted in the North Central Province of Sri Lanka. All peripheral hospitals in the province were randomized to either intervention or control. All hospitals received a copy of the guidelines. The intervention hospitals received a brief out-reach academic detailing workshop which explained poisoning treatment guidelines and guideline promotional items designed to be used in daily care. Data were collected on all patients admitted due to poisoning for 12 months post-intervention in all study hospitals. Information collected included type of poison exposure, initial investigations, treatments and hospital outcome. Patients transferred from peripheral hospitals to referral hospitals had their clinical outcomes recorded. There were 23 intervention and 23 control hospitals. There were no significant differences in the patient characteristics, such as age, gender and the poisons ingested. The intervention hospitals showed a significant improvement in administration of activated charcoal [OR 2.95 (95% CI 1.28-6.80)]. There was no difference between hospitals in use of other decontamination methods. This study shows that an educational intervention consisting of brief out-reach academic detailing was effective in changing treatment behavior in rural Sri Lankan hospitals. The intervention was only effective for treatments with direct clinician involvement, such as administering activated

  14. Comparison of prescribing and adherence patterns of anti-osteoporotic medications post-admission for fragility type fracture in an urban teaching hospital and a rural teaching hospital in Ireland between 2005 and 2008.

    LENUS (Irish Health Repository)

    McGowan, B


    INTRODUCTION: Poor adherence reduces the potential benefits of osteoporosis therapy, lowering gains in bone mineral density resulting in increased risk of fractures. AIM: To compare prescribing and adherence patterns of anti-osteoporotic medications in patients admitted to an urban teaching hospital in Ireland with a fragility type fracture to patients admitted to a rural hospital in the North Western region. METHODOLOGY: We identified all patients >55 years admitted to Sligo General Hospital between 2005 and 2008 with a fragility fracture (N = 744) using the hospital in-patient enquiry system (HIPE). The medical card number of those patients eligible for the primary care reimbursement services scheme (PCRS) facilitated the linkage of the HSE-PCRS scheme database to the HIPE database which enabled a study to identify persistence rates of patients prescribed osteoporosis therapy after discharge. The results were compared to the findings of a similar study carried out in St. James\\'s Hospital, Dublin. RESULTS: The 12 months post-fracture prescribing increased from 11.0 % (95 % CI 9.6, 12.4) in 2005 to 47 % (95 % CI 43.6, 50.3) in 2008 in the urban setting and from 25 % (95 % CI 21.5, 28.9) to 39 % (95 % CI 34.5, 42.7) in the rural setting. Adherence levels to osteoporosis medications at 12 months post-initiation of therapy was <50 % in both study groups. Patients on less frequent dosing regimes were better adherers. CONCLUSION: The proportion of patients being discharged on anti-osteoporosis medications post-fragility fracture increased between 2005 and 2008 in both patient groups. Sub-optimal adherence levels to osteoporosis medications continue to be a major concern.

  15. Telemental health evaluations enhance access and efficiency in a critical access hospital emergency department. (United States)

    Southard, Erik P; Neufeld, Jonathan D; Laws, Stephanie


    Mentally ill patients in crisis presenting to critical access hospital emergency rooms often face exorbitant wait times to be evaluated by a trained mental health provider. Patients may be discharged from the hospital before receiving an evaluation or boarded in a hospital bed for observation, reducing quality and increasing costs. This study examined the effectiveness of an emergency telemental health evaluation service implemented in a rural hospital emergency room. Retrospective data collection was implemented to consider patients presenting to the emergency room for 212 days prior to telemedicine interventions and for 184 days after. The study compared measures of time to treatment, length of stay (regardless of inpatient or outpatient status), and door-to-consult time. There were 24 patients seen before telemedicine was implemented and 38 seen using telemedicine. All patients had a mental health evaluation ordered by a physician and completed by a mental health specialist. Significant reductions in all three time measures were observed. Mean and median times to consult were reduced from 16.2 h (standard deviation=13.2 h) and 14.2 h, respectively, to 5.4 h (standard deviation =6.4 h) and 2.6 h. Similar reductions in length of stay and door-to-consult times were observed. By t tests, use of telemedicine was associated with a statistically significant reduction in all three outcome measures. Telemedicine appears to be an effective intervention for mentally ill patients by providing more timely access to mental health evaluations in rural hospital emergency departments.

  16. The Attraction of Adjunct Faculty to Rural Community Colleges (United States)

    Charlier, Hara Dracon


    As rural community colleges face mounting fiscal pressure, the ability to attract adjunct faculty members to support the institutional mission becomes increasingly important. Although the professional literature documents differences between rural, suburban, and urban community colleges, the effect of this institutional diversity on the role and…

  17. The effect of health insurance and health facility-upgrades on hospital deliveries in rural Nigeria: a controlled interrupted time-series study. (United States)

    Brals, Daniëlla; Aderibigbe, Sunday A; Wit, Ferdinand W; van Ophem, Johannes C M; van der List, Marijn; Osagbemi, Gordon K; Hendriks, Marleen E; Akande, Tanimola M; Boele van Hensbroek, Michael; Schultsz, Constance


    Access to quality obstetric care is considered essential to reducing maternal and new-born mortality. We evaluated the effect of the introduction of a multifaceted voluntary health insurance programme on hospital deliveries in rural Nigeria. We used an interrupted time-series design, including a control group. The intervention consisted of providing voluntary health insurance covering primary and secondary healthcare, including antenatal and obstetric care, combined with improving the quality of healthcare facilities. We compared changes in hospital deliveries from 1 May 2005 to 30 April 2013 between the programme area and control area in a difference-in-differences analysis with multiple time periods, adjusting for observed confounders. Data were collected through household surveys. Eligible households ( n = 1500) were selected from a stratified probability sample of enumeration areas. All deliveries during the 4-year baseline period ( n = 460) and 4-year follow-up period ( n = 380) were included. Insurance coverage increased from 0% before the insurance was introduced to 70.2% in April 2013 in the programme area. In the control area insurance coverage remained 0% between May 2005 and April 2013. Although hospital deliveries followed a common stable trend over the 4 pre-programme years ( P = 0.89), the increase in hospital deliveries during the 4-year follow-up period in the programme area was 29.3 percentage points (95% CI: 16.1 to 42.6; P health insurance but who could make use of the upgraded care delivered significantly more often in a hospital during the follow-up period than women living in the control area ( P = 0.04). Voluntary health insurance combined with quality healthcare services is highly effective in increasing hospital deliveries in rural Nigeria, by improving access to healthcare for insured and uninsured women in the programme area. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and

  18. Delays in accessing electroconvulsive therapy: a comparison between two urban and two rural populations in Australia. (United States)

    Johnston, Natalie E


    A comparison of the timing, rates and characteristics of electroconvulsive therapy use between urban and rural populations. The medical records of patients who received an acute course of electroconvulsive therapy at two rural and two urban psychiatric hospitals in New South Wales (NSW), Australia, in 2010 were reviewed retrospectively. Main outcome measures were the time from symptom onset, diagnosis and admission to commencing electroconvulsive therapy. Rates of use of electroconvulsive therapy were also compared between rural and urban hospitals using NSW statewide data. There was a significant delay in the time it took for rural patients to receive electroconvulsive therapy compared with urban patients when measured both from the time of symptom onset and from when they received a diagnosis. There were corresponding delays in the time taken for rural patients to be admitted to hospital compared with urban patients. There was no difference in the time it took to commence electroconvulsive therapy once a patient was admitted to hospital. NSW statewide urban-rural comparisons showed rates of electroconvulsive therapy treatment were significantly higher in urban hospitals. Patients in rural areas receive electroconvulsive therapy later in their acute illness due to delays in being admitted to hospital. The rate of use of electroconvulsive therapy also differs geographically. © The Royal Australian and New Zealand College of Psychiatrists 2015.

  19. Immediate Symptom Relief After a First Session of Massage Therapy or Reiki in Hospitalized Patients: A 5-year Clinical Experience from a Rural Academic Medical Center. (United States)

    Vergo, Maxwell T; Pinkson, Briane M; Broglio, Kathleen; Li, Zhongze; Tosteson, Tor D


    There is an increasing demand for and use of alternative and complementary therapies, such as reiki and massage therapy, in hospital-based settings. Most controlled studies and practice-based reports include oncology and surgical patient populations; thus the effect in a more heterogeneous hospitalized patient population is hard to estimate. We examined the immediate symptom relief from a single reiki or massage session in a hospitalized population at a rural academic medical center. Retrospective analysis of prospectively collected data on demographic, clinical, process, and quality of life for hospitalized patients receiving massage therapy or reiki. A 396-bed rural academic and tertiary medical center in the United States. Hospitalized patients requesting or referred to the healing arts team who received either a massage or reiki session and completed both a pre- and post-therapy symptom questionnaire. First session of routine reiki or massage therapy during a hospital stay. Differences between pre- and postsession patient-reported scores in pain, nausea, fatigue, anxiety, depression, and overall well-being using an 11-point Likert scale. Patients reported symptom relief with both reiki and massage therapy. Analysis of the reported data showed reiki improved fatigue (-2.06 vs. -1.55 p massage therapy and did not vary based on age, gender, length of session, and baseline symptoms. Reiki and massage clinically provide similar improvements in pain, nausea, fatigue, anxiety, depression, and overall well-being while reiki improved fatigue and anxiety more than massage therapy in a heterogeneous hospitalized patient population. Controlled trials should be considered to validate the data.

  20. Single-leg squats identify independent stair negotiation ability in older adults referred for a physiotherapy mobility assessment at a rural hospital. (United States)

    Hockings, Rowena L; Schmidt, David D; Cheung, Christopher W


    To determine whether single-leg squats identify ability to negotiate stairs in older adults at a rural hospital. Cross-sectional analytical study. Acute wards and emergency department of a rural hospital in Australia. A systematic sample of 143 older adults (72 men, 71 women, 80.0 ± 6.8 years) from the emergency department or acute wards of Shoalhaven Hospital referred for a physiotherapy mobility assessment. Ability to complete up to three single-leg squats and negotiate up to three steps were measured. Covariates and demographic variables were collected. The squat test had 86% sensitivity, 100% specificity, 100% positive predictive value, and 49% negative predictive value in correctly identifying stair negotiation ability. Participants who could complete single-leg squats were 57 times more likely to be able to independently negotiate stairs than participants who could not complete squats. Multivariate regression analysis indicated that walker use, pain severity and whether participants lived alone were significant and independent predictors of ability to negotiate stairs independently. Single-leg squats may be an accurate identifier of stair negotiation ability in older adults admitted to the hospital for an acute illness or injury. A traditional stairs assessment would be required if older adults were unable to complete the squat test or had moderate to severe pain, used a walker to ambulate, or did not live alone. The squat test is a potentially more-efficient assessment tool than traditional stair assessments in determining an individual's ability to negotiate stairs and suitability for discharge where poor mobility is a problem. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

  1. Accelerating Best Care in Pennsylvania: adapting a large academic system's quality improvement process to rural community hospitals. (United States)

    Haydar, Ziad; Gunderson, Julie; Ballard, David J; Skoufalos, Alexis; Berman, Bettina; Nash, David B


    Industrial quality improvement (QI) methods such as continuous quality improvement (CQI) may help bridge the gap between evidence-based "best care" and the quality of care provided. In 2006, Baylor Health Care System collaborated with Jefferson Medical College of Thomas Jefferson University to conduct a QI demonstration project in select Pennsylvania hospitals using CQI techniques developed by Baylor. The training was provided over a 6-month period and focused on methods for rapid-cycle improvement; data system design; data management; tools to improve patient outcomes, processes of care, and cost-effectiveness; use of clinical guidelines and protocols; leadership skills; and customer service skills. Participants successfully implemented a variety of QI projects. QI education programs developed and pioneered within large health care systems can be adapted and applied successfully to other settings, providing needed tools to smaller rural and community hospitals that lack the necessary resources to establish such programs independently.

  2. Defining the medical imaging requirements for a rural health center

    CERN Document Server


    This book establishes the criteria for the type of medical imaging services that should be made available to rural health centers, providing professional rural hospital managers with information that makes their work more effective and efficient. It also offers valuable insights into government, non-governmental and religious organizations involved in the planning, establishment and operation of medical facilities in rural areas. Rural health centers are established to prevent patients from being forced to travel to distant urban medical facilities. To manage patients properly, rural health centers should be part of regional and more complete systems of medical health care installations in the country on the basis of a referral and counter-referral program, and thus, they should have the infrastructure needed to transport patients to urban hospitals when they need more complex health care. The coordination of all the activities is only possible if rural health centers are led by strong and dedicated managers....

  3. All You Need Is Facebook Friends? Associations between Online and Face-to-Face Friendships and Health. (United States)

    Lima, Maria Luisa; Marques, Sibila; Muiños, Gabriel; Camilo, Cristina


    Positive social relations are known to have a beneficial impact on health, however, little is known about the links of health with online relationships. In this study, we compare face-to-face and virtual friendships in their association with health. By building on previous results of studies conducted on the well-being of college students, we expect to find stronger associations of face-to-face friendships with health than of those established through Facebook. Furthermore, we expect to test the mediating role of social capital variables in this process. Two large-scale studies conducted in community samples (Study 1 = 350 urban residents; Study 2 = 803 urban and rural residents) showed that the number and quality of face-to-face friendships were directly associated with self-reported health status, however, the same did not occur with Facebook friendships. Moreover, the association of face-to-face friendships with health was totally mediated by bonding (mostly) but also bridging social capital. These results, replicated in both studies, were found controlling for confounding variables such as age, gender, education, living alone, self-esteem, and socioeconomic status. This pattern of results emphasizes the gains of face-to-face over online friendships for individuals' health status in community samples.

  4. All You Need Is Facebook Friends? Associations between Online and Face-to-Face Friendships and Health (United States)

    Lima, Maria Luisa; Marques, Sibila; Muiños, Gabriel; Camilo, Cristina


    Positive social relations are known to have a beneficial impact on health, however, little is known about the links of health with online relationships. In this study, we compare face-to-face and virtual friendships in their association with health. By building on previous results of studies conducted on the well-being of college students, we expect to find stronger associations of face-to-face friendships with health than of those established through Facebook. Furthermore, we expect to test the mediating role of social capital variables in this process. Two large-scale studies conducted in community samples (Study 1 = 350 urban residents; Study 2 = 803 urban and rural residents) showed that the number and quality of face-to-face friendships were directly associated with self-reported health status, however, the same did not occur with Facebook friendships. Moreover, the association of face-to-face friendships with health was totally mediated by bonding (mostly) but also bridging social capital. These results, replicated in both studies, were found controlling for confounding variables such as age, gender, education, living alone, self-esteem, and socioeconomic status. This pattern of results emphasizes the gains of face-to-face over online friendships for individuals’ health status in community samples. PMID:28194125

  5. Rural male suicide in Australia. (United States)

    Alston, Margaret


    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.

  6. Health insurance benefit design and healthcare utilization in northern rural China. (United States)

    Wang, Hong; Liu, Yu; Zhu, Yan; Xue, Lei; Dale, Martha; Sipsma, Heather; Bradley, Elizabeth


    Poverty due to illness has become a substantial social problem in rural China since the collapse of the rural Cooperative Medical System in the early 1980s. Although the Chinese government introduced the New Rural Cooperative Medical Schemes (NRCMS) in 2003, the associations between different health insurance benefit package designs and healthcare utilization remain largely unknown. Accordingly, we sought to examine the impact of health insurance benefit design on health care utilization. We conducted a cross-sectional study using data from a household survey of 15,698 members of 4,209 randomly-selected households in 7 provinces, which were representative of the provinces along the north side of the Yellow River. Interviews were conducted face-to-face and in Mandarin. Our analytic sample included 9,762 respondents from 2,642 households. In each household, respondents indicated the type of health insurance benefit that the household had (coverage for inpatient care only or coverage for both inpatient and outpatient care) and the number of outpatient visits in the 30 days preceding the interview and the number of hospitalizations in the 365 days preceding the household interview. People who had both outpatient and inpatient coverage compared with inpatient coverage only had significantly more village-level outpatient visits, township-level outpatient visits, and total outpatient visits. Furthermore, the increased utilization of township and village-level outpatient care was experienced disproportionately by people who were poorer, whereas the increased inpatient utilization overall and at the county level was experienced disproportionately by people who were richer. The evidence from this study indicates that the design of health insurance benefits is an important policy tool that can affect the health services utilization and socioeconomic equity in service use at different levels. Without careful design, health insurance may not benefit those who are most in need

  7. Rural Trends in Diagnosis and Services for Autism Spectrum Disorder

    Directory of Open Access Journals (Sweden)

    Ligia Antezana


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

  8. Severe malnutrition among children under the age of 5 years admitted to a rural district hospital in southern Mozambique. (United States)

    Nhampossa, Tacilta; Sigaúque, Betuel; Machevo, Sónia; Macete, Eusebio; Alonso, Pedro; Bassat, Quique; Menéndez, Clara; Fumadó, Victoria


    To describe the burden, clinical characteristics and prognostic factors of severe malnutrition in children under the age of 5 years. Retrospective study of hospital-based data systematically collected from January 2001 to December 2010. Rural Mozambican district hospital. All children aged malnutrition. During the 10-year long study surveillance, 274 813 children belonging to Manhiça’s Demographic Surveillance System were seen at out-patient clinics, almost half of whom (47 %) presented with some indication of malnutrition and 6% (17 188/274 813) with severe malnutrition. Of these, only 15% (2522/17 188) were eventually admitted. Case fatality rate of severe malnutrition was 7% (162/2274). Bacteraemia, hypoglycaemia, oral candidiasis, prostration, oedema, pallor and acute diarrhoea were independently associated with an increased risk of in-hospital mortality, while malaria parasitaemia and breast-feeding were independently associated with a lower risk of a poor outcome. Overall minimum communitybased incidence rate was 15 cases per 1000 child-years at risk and children aged 12–23 months had the highest incidence. Severe malnutrition among admitted children in this Mozambican setting was common but frequently went undetected, despite being associated with a high risk of death. Measures to improve its recognition by clinicians responsible for the first evaluation of patients at the out-patient level are urgently needed so as to improve their likelihood of survival. Together with this, the rapid management of complications such as hypoglycaemia and concomitant co-infections such as bacteraemia, acute diarrhoea, oral candidiasis and HIV/AIDS may contribute to reverse the intolerable toll that malnutrition poses in the health of children in rural African settings.

  9. Improving access to health care in a rural regional hospital in South Africa: Why do patients miss their appointments? (United States)

    Frost, Lucy; Jenkins, Louis S; Emmink, Benjamin


    Access to health services is one of the Batho Pele ('people first') values and principles of the South African government since 1997. This necessitated some changes around public service systems, procedures, attitudes and behaviour. The challenges of providing health care to rural geographically spread populations include variations in socio-economic status, transport opportunities, access to appointment information and patient perceptions of costs and benefits of seeking health care. George hospital, situated in a rural area, serves 5000 outpatient visits monthly, with non-attendance rates of up to 40%. The aim of this research was to gain a greater understanding of the reasons behind non-attendance of outpatient department clinics to allow locally driven, targeted interventions. This was a descriptive study. We attempted to phone all patients who missed appointments over a 1-month period (n = 574). Only 20% were contactable with one person declining consent. Twenty-nine percent had no telephone number on hospital systems, 7% had incorrect numbers, 2% had died and 42% did not respond to three attempts. The main reasons for non-attendance included unaware of appointment date (16%), out of area (11%), confusion over date (11%), sick or admitted to hospital (10%), family member sick or died (7%), appointment should have been cancelled by clerical staff (6%) and transport (6%). Only 9% chose to miss their appointment. The other 24% had various reasons. Improved patient awareness of appointments, adjustments in referral systems and enabling appointment cancellation if indicated would directly improve over two-thirds of reasons for non-attendance. Understanding the underlying causes will help appointment planning, reduce wasted costs and have a significant impact on patient care.

  10. Degree of value alignment - a grounded theory of rural nurse resignations. (United States)

    Bragg, S M; Bonner, A


    The shortage of nurses willing to work in rural Australian healthcare settings continues to worsen. Australian rural areas have a lower retention rate of nurses than metropolitan counterparts, with more remote communities experiencing an even higher turnover of nursing staff. When retention rates are lower, patient outcomes are known to be poorer. This article reports a study that sought to explore the reasons why registered nurses resign from rural hospitals in the state of New South Wales, Australia. Using grounded theory methods, this study explored the reasons why registered nurses resigned from New South Wales rural hospitals. Data were collected from 12 participants using semi-structured interviews; each participant was a registered nurse who had resigned from a rural hospital. Nurses who had resigned due to retirement, relocation or maternity leave were excluded. Interviews were transcribed verbatim and imported into NVivo software. The constant comparative method of data collection and analysis was followed until a core category emerged. Nurses resigned from rural hospitals when their personal value of how nursing should occur conflicted with the hospital's organisational values driving the practice of nursing. These conflicting values led to a change in the degree of value alignment between the nurse and hospital. The degree of value alignment occurred in three dynamic stages that nurses moved through prior to resigning. The first stage, sharing values, was a time when a nurse and a hospital shared similar values. The second stage was conceding values where, due to perceived changes in a hospital's values, a nurse felt that patient care became compromised and this led to a divergence of values. The final stage was resigning, a stage where a nurse 'gave up' as they felt that their professional integrity was severely compromised. The findings revealed that when a nurse and organisational values were not aligned, conflict was created for a nurse about how

  11. A telecommunications journey rural health network. (United States)

    Moore, Joe


    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".

  12. ‘At the hospital I learnt the truth’: diagnosing male infertility in rural Malawi (United States)

    Parrott, Fiona R.


    This paper examines how men's reproductive bodies are problematised in rural northern Malawi as access to biomedically defined diagnoses of the health of men's sperm contribute to the visibility of male infertility. Ethnographic research with infertile and fertile men explored pathways into the sexual health and fertility services offered in district hospitals, men's clinical engagements and masculine imaginaries. The research suggested that men's willingness to be referred for semen analysis is an extension of intensive and persistent help-seeking for childlessness instigated by couples and encouraged by families. Within the laboratory, acceptable social arrangements for semen sample collection are negotiated between male clients and laboratory staff, which emphasise heterosexual and marital virility. Following diagnosis, counselling by clinical officers, without any significant therapeutic interventions, focuses on compassion in marriage. This paper considers: what is the role of semen analysis within public health facilities and why do men participate? How do men experience an infertility diagnosis and what do they and their partners do with this knowledge? In addition, how do these practices shape gendered relationships in families and communities? The analysis builds on Inhorn's (2012) concept of ‘emergent masculinities’ to better understand the connections between male subjectivities, medical technologies and the globalisation of male reproductive health, as they relate to men's lives in rural Malawi. PMID:25175293

  13. Physical activity of rurally residing children with a disability: A survey of parents and carers. (United States)

    Wakely, Luke; Langham, Jessica; Johnston, Catherine; Rae, Kym


    Children residing in rural areas face unique barriers to physical activity participation. Further, while children with a disability who reside in metropolitan areas face barriers hindering physical activity, rurally residing children with a disability may face the augmented combination of these barriers that could have negative health implications. Parents are often the key advocates for children with disabilities and are likely to have valuable insight into the opportunities and barriers to physical activity for their child. The aim of this study was to investigate parents' perceptions of physical activity opportunities for their child with a disability in a rural area. A mixed method survey examining parent's perceptions of their child's physical activity and possible barriers to participation was mailed to rurally residing parents of children with a disability. Quantitative data were analyzed descriptively using frequencies and proportions. Qualitative data were analyzed using qualitative content analysis. There were 34 completed surveys, a response rate of 37%. Participants' responses indicated 74% of children were not meeting daily recommendations of physical activity. Participation barriers including emotional, physical and environmental issues. Three main themes emerged from qualitative data; segregation, access to facilities and resources and barriers specific to the child. The children in this study were from rural areas and face similar barriers to children in metropolitan areas. However, they are also confronted with the same barriers children without a disability in rural areas face, participating in physical activity. This may have detrimental effects on their health and development. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Leading the rebirth of the rural obstetrician. (United States)

    Campbell, Alison M; Brown, James; Simon, David R; Young, Sari; Kinsman, Leigh


    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.

  15. Exploring resilience in rural GP registrars ? implications for training


    Walters, Lucie; Laurence, Caroline O.; Dollard, Joanne; Elliott, Taryn; Eley, Diann S.


    Background Resilience can be defined as the ability to rebound from adversity and overcome difficult circumstances. General Practice (GP) registrars face many challenges in transitioning into general practice, and additional stressors and pressures apply for those choosing a career in rural practice. At this time of international rural generalist medical workforce shortages, it is important to focus on the needs of rural GP registrars and how to support them to become resilient health care pr...

  16. 78 FR 8353 - Rural Broadband Access Loans and Loan Guarantees (United States)


    ... 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...

  17. Strengthening training in rural practice in Germany: new approach for undergraduate medical curriculum towards sustaining rural health care. (United States)

    Holst, Jens; Normann, Oliver; Herrmann, Markus


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

  18. Pushing personhood into place: situating media in rural knowledge in Africa

    CSIR Research Space (South Africa)

    Bidwell, NJ


    Full Text Available Designing interactions with technologies that are compatible with rural wisdom and skills can help to digitally enfranchise rural people and, thus, contribute to community cohesion in the face of Africa’s urbanization. Oral information has been...



    Katane, Irēna; Laizāne, Anna


    Under conditions of changes and instability in any state rural schools are faced to look for different directions of development in order to manage in the rural areas. Thus the inner structure of rural schools becomes complex and causes formation of new educational environmental models of Latvian rural schools. The aims of the article: 1) to give substantiation of the concept model; 2) to give classification of educational environmental models of rural schools; 3) to emphasize the advantages ...

  20. Neonatal seizures in a rural Iranian district hospital: etiologies, incidence and predicting factors. (United States)

    Sadeghian, Afsaneh; Damghanian, Maryam; Shariati, Mohammad


    Current study determined the overall incidence, common causes as well as main predictors of this final diagnosis among neonates admitted to a rural district hospital in Iran. This study was conducted on 699 neonates who were candidate for admission to the NICU. Study population was categorized in the case group, including patients exposed to final diagnosis of neonatal seizures and the control group without this diagnosis. Neonatal seizure was reported as final diagnosis in 25 (3.6%) of neonates. The most frequent discharge diagnosis in the seizure group was neonatal sepsis and in the non-seizure group was respiratory problems. No significant difference was found in early fatality rate between neonates with and without seizures (8.0% vs. 10.1%). Only gestational age <38 week had a relationship with the appearance of neonatal seizure. Low gestational age has a crucial role for predicting appearance of seizure in Iranian neonates.

  1. Criteria-based audit of caesarean section in a referral hospital in rural Tanzania. (United States)

    Heemelaar, S; Nelissen, E; Mdoe, P; Kidanto, H; van Roosmalen, J; Stekelenburg, J


    WHO uses the Caesarean section (CS) rate to monitor implementation of emergency obstetric care (EmOC). Although CS rates are rising in sub-Saharan Africa, maternal outcome has not improved. We audited indications for CS and related complications among women with severe maternal morbidity and mortality in a referral hospital in rural Tanzania. Cross-sectional study was from November 2009 to November 2011. Women with severe maternal morbidity and mortality were identified and those with CS were included in this audit. Audit criteria were developed based on the literature review and (inter)national guidelines. Tanzanian and Dutch doctors reviewed hospital notes. The main outcome measured was prevalence of substandard quality of care leading to unnecessary CS and delay in performing interventions to prevent CS. A total of 216 maternal near misses and 32 pregnancy-related deaths were identified, of which 82 (33.1%) had a CS. Indication for CS was in accordance with audit criteria for 36 of 82 (44.0%) cases without delay. In 20 of 82 (24.4%) cases, the indication was correct; however, there was significant delay in providing standard obstetric care. In 16 of 82 (19.5%) cases, the indication for CS was not in accordance with audit criteria. During office hours, CS was more often correctly indicated than outside office hours (60.0% vs. 36.0%, P audit. © 2016 John Wiley & Sons Ltd.

  2. Motivation for Math in Rural Schools: Student and Teacher Perspectives (United States)

    Hardre, Patricia L.


    Rural schools, students, teachers, administrators, families and community leaders face unique challenges from those of their urban and suburban counterparts. This paper investigates motivation in rural secondary schools, with a particular focus on mathematics, from teacher and student perspectives. It integrates recent research on math learning…

  3. Increasing Participation of Rural and Regional Students in Higher Education (United States)

    Fleming, Michele J.; Grace, Diana M.


    Regional and rural students in Australia face unique challenges when aspiring to higher education. These challenges reflect systematic disadvantage experienced by rural and regional populations as a whole. In an effort to redress these inequities, and aided by the Australian Government's Higher Education Participation and Partnerships Program…

  4. Complementary and Alternative Medicine in Rural Communities: Current Research and Future Directions (United States)

    Wardle, Jon; Lui, Chi-Wai; Adams, Jon


    Contexts: The consumption of complementary and alternative medicine (CAM) in rural areas is a significant contemporary health care issue. An understanding of CAM use in rural health can provide a new perspective on health beliefs and practice as well as on some of the core service delivery issues facing rural health care generally. Purpose: This…

  5. Using overseas registered nurses to fill employment gaps in rural health services: quick fix or sustainable strategy? (United States)

    Francis, Karen; Chapman, Ysanne; Doolan, Glenn; Sellick, Ken; Barnett, Tony


    This study sought to identify and evaluate approaches used to attract internationally trained nurses from traditional and non-traditional countries and incentives employed to retain them in small rural hospitals in Gippsland, Victoria. An exploratory descriptive design. Small rural hospitals in Gippsland, Victoria. Hospital staff responsible for recruitment of nurses and overseas trained nurses from traditional and non-traditional sources (e.g. England, Scotland, India, Zimbabwe, Holland, Singapore, Malaysia). Recruitment of married overseas trained nurses is more sustainable than that of single registered nurses, however, the process of recruitment for the hospital and potential employees is costly. Rural hospitality diffuses some of these expenses by the employing hospitals providing emergency accommodation and necessary furnishings. Cultural differences and dissonance regarding practice create barriers for some of the overseas trained nurses to move towards a more sanguine position. On the positive side, single overseas registered nurses use the opportunity to work in rural Australian hospitals as an effective working holiday that promotes employment in larger, more specialized hospitals. Overall both the registered nurses and the employees believe the experience to be beneficial rather than detrimental.

  6. The household costs of health care in rural South Africa with free public primary care and hospital exemptions for the poor. (United States)

    Goudge, Jane; Gilson, Lucy; Russell, Steve; Gumede, Tebogo; Mills, Anne


    To measure the direct cost burdens (health care expenditure as a percent of total household expenditure) for households in rural South Africa, and examine the expenditure and use patterns driving those burdens, in a setting with free public primary health care and hospital exemptions for the poor. Data on illness events, treatment patterns and health expenditure in the previous month were assessed from a cross-sectional survey of 280 households conducted in the Agincourt Health and Demographic Surveillance site, South Africa. On average, a household experiencing illness incurred a direct cost burden of 4.5% of total household expenditure. A visit to a public clinic generated a mean burden of 1.3%. Complex sequences of treatments led 20% of households to incur a burden over 10%, with transport costs generating 42% of this burden. An outpatient public hospital visit generated a burden of 8.2%, as only 58% of those eligible obtained an exemption; inpatient stays incurred a burden of 45%. Consultations with private providers incurred a mean burden of 9.5%. About 38% of individuals who reported illness did not take any treatment action, 55% of whom identified financial and perceived supply-side barriers as reasons. The low overall mean cost burden of 4.5% suggests that free primary care and hospital exemptions provided financial protection. However, transport costs, the difficulty of obtaining hospital exemptions, use of private providers, and complex treatment patterns meant state-provided protection had limitations. The significant non-use of care shows the need for other measures such as more outreach services and more exemptions in rural areas. The findings also imply that fee removal anywhere must be accompanied by wider measures to ensure improved access.

  7. Teaching undergraduate students in rural general practice: an evaluation of a new rural campus in England. (United States)

    Bartlett, Maggie; Pritchard, Katie; Lewis, Leo; Hays, Richard B; Mckinley, Robert K


    One approach to facilitating student interactions with patient pathways at Keele University School of Medicine, England, is the placement of medical students for 25% of their clinical placement time in general practices. The largest component is a 15-week 'student attachment' in primary care during the final year, which required the development of a new network of teaching practices in a rural district of England about 90 km (60 mi) from the main campus in North Staffordshire. The new accommodation and education hub was established in 2011-2012 to enable students to become immersed in those communities and learn about medical practice within a rural and remote context. Objectives were to evaluate the rural teaching from the perspectives of four groups: patients, general practice tutors, community hospital staff and students. Learning outcomes (as measured by objective structured clinical examinations) of students learning in rural practices in the final year were compared with those in other practices. Data were gathered from a variety of sources. Students' scores in cohort-wide clinical assessment were compared with those in other locations. Semi-structured interviews were conducted with general practice tutors and community hospital staff. Serial focus groups explored the perceptions of the students, and questionnaires were used to gather the views of patients. Patients reported positive experiences of students in their consultations, with 97% expressing willingness to see students. The majority of patients considered that teaching in general practice was a good thing. They also expressed altruistic ideas about facilitating learning. The tutors were enthusiastic and perceived that teaching had positive impacts on their practices despite negative effects on their workload. The community hospital staff welcomed students and expressed altruistic ideas about helping them learn. There was no significant difference between the rurally placed students' objective

  8. Rural farmers' perspectives on stock theft: police crime statistics ...

    African Journals Online (AJOL)

    Rural farmers are not only facing challenges of severe drought blamed on the El Nino weather pattern, but the stock theft as well. The South African Police's annual crime statistics report and surveys indicates that rural livestock farmers are mostly affected by stock theft in South Africa. The costs paid by these farmers to ...

  9. Amenidades ambientais e desenvolvimento rural


    Dentinho, Tomaz; Rodrigues, Orlando


    Este texto sobre amenidades ambientais e desenvolvimento rural trata, fundamentalmente, da incerteza resultante da reacção das pessoas e das instituições face aos recursos naturais que exploram e quanto ao efeito das políticas que são implementadas.


    Directory of Open Access Journals (Sweden)

    Joel Orlando Marin


    Full Text Available RESUMO O artigo aponta que as práticas sociais dos camponeses frente à Extensão Rural são ambíguas e contraditórias, resultando em conformismo e resistên-cia. Por um lado, a supremacia do conhecimento científico, o caráter impositivo das práticas educacionais extensionistas, o controle através do crédito agrícola e dos pacotes tecnológicos são mecanismos de imposição de novos conhecimentos e tecnologias que, assi-milados pêlos camponeses, conformam-nos à hegemonia da sociedade capitalista. Por outro lado, os camponeses resistem à essa racionalidade tecnológica, fundamentando-se em sua forma própria de organizar a produção agrícola, na sua cultura e saberes adquiridos em suas experiências de vida.

  11. Rural-urban Migration Decisions in China: Evidence from Rural Household Panel Data

    Directory of Open Access Journals (Sweden)

    Kyeongwon Yoo


    Full Text Available This paper analyzes the household's off-farm labor response to risk using the Research Center on the Rural Economy (RCRE panel data in China. This paper aims to find out whether the off-farm labor market, especially the migrant labor market, could be used as a means of coping with risk and shocks to income by poor households in rural China who have only limited access to the credit and insurance markets for managing risk. Instead of using the endogenous transitory income variance under the short time span of the data, we suggest using relatively exogenous measure of risk, such as the coefficient of variation of rainfall in each village, might be more appropriate to find the effect of risk on household's off-farm labor participation decision. Our results support the idea that households facing a riskier or more volatile distribution of precipitation are more likely to participate in the off-farm labor market. Attention to the potential risk-coping benefits from off-farm employment is timely for Chinese policy makers because both local and national policies accommodating the growth of markets for off-farm migrant labor have come under increasing pressure. As cities face growing problems of unemployed workers from state- owned enterprises, both local and national governments have taken measures to reduce competition for jobs between rural laborers and those urban residents left unemployed during the state-owned enterprises reform period. This paper suggests that rural resident would suffer from urban policies restricting the in-flow of migrants in two ways. Households sending temporary migrants to cities will suffer both a loss of income, and a loss of means of coping with risk. In fact, the analysis of this paper suggests that the welfare of Chinese farm households in rural areas can be further improved by eliminating the remaining institutional obstacles to expansion of migrant employment opportunities.

  12. The Rural Institutions in Colombia: Reflections for Analysis and Strengthening

    Directory of Open Access Journals (Sweden)

    Sandro Ropero Beltran


    Full Text Available The rural question is one of the great challenges for institutions in Colombia. The discussion regarding institutional efficiency and effectiveness for the rural sector should be brought forward based on circumstantial aspects that in turn mediate social the social, political, cultural, environmental, economic and productive in the Colombian agriculture, including trade agreements and post-conflict eventually included. The new rurality as an approach to rural development poses a different view about the subject, conceives the rural thing as a multisectorial and multidimensional space, which is the starting point from which arise the elements of analysis that allow advance an institutional debate broad and participatory facing the structural transformation of the rural reality.

  13. School Psychology in Rural Contexts: Ethical, Professional, and Legal Issues (United States)

    Edwards, Lynn M.; Sullivan, Amanda L.


    Delivering psychological services in rural communities presents a number of unique challenges for practitioners relative to their peers in urban and suburban communities. In this article, the authors describe the current context of rural schools and examine the ethical and legal issues school psychologists may face when practicing in rural…

  14. State-level employment, accessibility and rurality

    Directory of Open Access Journals (Sweden)

    Casey Abington


    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.

  15. 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. (United States)

    Kash, Bita A; Deshmukh, A A


    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.

  16. Faces of Change. Five Rural Societies in Transition: Bolivia, Kenya, Afghanistan, Taiwan, China Coast. (United States)

    Miller, Norman N., Ed.; Spitzer, Manon L., Ed.

    The multidisciplinary film project focuses attention on what is happening to rural populations of the world, particularly among developing countries. The roles of women, education, social and economic systems, and the effects of modernization on values are themes explored in each of five rural settings--Bolivian highlands, northern Kenya, northern…

  17. Cloud-based hospital information system as a service for grassroots healthcare institutions. (United States)

    Yao, Qin; Han, Xiong; Ma, Xi-Kun; Xue, Yi-Feng; Chen, Yi-Jun; Li, Jing-Song


    Grassroots healthcare institutions (GHIs) are the smallest administrative levels of medical institutions, where most patients access health services. The latest report from the National Bureau of Statistics of China showed that 96.04 % of 950,297 medical institutions in China were at the grassroots level in 2012, including county-level hospitals, township central hospitals, community health service centers, and rural clinics. In developing countries, these institutions are facing challenges involving a shortage of funds and talent, inconsistent medical standards, inefficient information sharing, and difficulties in management during the adoption of health information technologies (HIT). Because of the necessity and gravity for GHIs, our aim is to provide hospital information services for GHIs using Cloud computing technologies and service modes. In this medical scenario, the computing resources are pooled by means of a Cloud-based Virtual Desktop Infrastructure (VDI) to serve multiple GHIs, with different hospital information systems dynamically assigned and reassigned according to demand. This paper is concerned with establishing a Cloud-based Hospital Information Service Center to provide hospital information software as a service (HI-SaaS) with the aim of providing GHIs with an attractive and high-performance medical information service. Compared with individually establishing all hospital information systems, this approach is more cost-effective and affordable for GHIs and does not compromise HIT performance.

  18. Gender Inequalities in Remote Settings: Analysis of 105,025 Medical Records of a Rural Hospital in Ethiopia (2005-2015). (United States)

    Accorsi, Sandro; Somigliana, Edgardo; Farese, Pasquale; Ademe, Tsegaye; Desta, Yonas; Putoto, Giovanni; Manenti, Fabio


    Gender inequalities in Sub-Saharan Africa are deemed relevant but data to support this view are scanty. Retrospective analysis of a large dataset of 105,025 patients admitted to an Ethiopian rural private, non-for-profit hospital over a 11 years period (2005-2015). Since 2001, the hospital and the local community are involved in a long-term, comprehensive and externally-supported health care intervention. The total number of admissions was higher for females (61.9% of the total) mainly because of the high frequency of admissions for obstetrics conditions. The total male-to-female ratio (M:F) was 0.6. Except for malaria, men had more admissions for the other leading causes, with the highest M:F being found for injuries (2.7) and musculoskeletal diseases (1.7). Overall, excluding admissions for pregnancy-related issues, the M:F was 1.4. The frequency of admissions changed with age and gender. Female admissions prevailed in the reproductive age period (from 15 to 44 years of age) while males admissions prevailed in the younger and older age groups. The case fatality rate was higher for men (M:F = 2.0). The total M:F and the M:F excluding pregnancy-related admissions did not change during the study period. Gender inequalities do exist in rural remote setting but tend to affect women differently during their lifespan. Even if gender inequalities generally favor males, the substantial proportion of admissions for pregnancy-related situations is encouraging.

  19. Creating a new rural pharmacy workforce: Development and implementation of the Rural Pharmacy Health Initiative. (United States)

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


    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.

  20. Costs and consequences of a cash transfer for hospital births in a rural district of Uttar Pradesh, India. (United States)

    Coffey, Diane


    The Janani Suraksha Yojana, India's "safe motherhood program," is a conditional cash transfer to encourage women to give birth in health facilities. Despite the program's apparent success in increasing facility-based births, quantitative evaluations have not found corresponding improvements in health outcomes. This study analyses original qualitative data collected between January, 2012 and November, 2013 in a rural district in Uttar Pradesh to address the question of why the program has not improved health outcomes. It finds that health service providers are focused on capturing economic rents associated with the program, and provide an extremely poor quality care. Further, the program does not ultimately provide beneficiaries a large net monetary transfer at the time of birth. Based on a detailed accounting of the monetary costs of hospital and home deliveries, this study finds that the value of the transfer to beneficiaries is small due to costs associated with hospital births. Finally, this study also documents important emotional and psychological costs to women of delivering in the hospital. These findings suggest the need for a substantial rethinking of the program, paying careful attention to incentivizing health outcomes. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. Tensions between the local and the global: contemporary rural and teaching in rural schools

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    Elizeu Clementino de Souza


    Full Text Available The paper aims to investigate potential tensions between local and global context of contemporary ruralities, emphasizing the times, rhythms and spaces constructed from the experiences of teachers and students in the organization of the routines of rural schools. The paper presents theoretical considerations resulting from two studies in the Graduate Program in Education and Contemporary - PPGEduC / UNEB. The clipping and analysis undertaken focus on education developed in rural areas and tensions present in this context in view, discuss issues concerning the new ruralities contemporary. This discussion has as its central theme the issues of timing and the rhythm in schools with multigrade classes Island Tide that articulates with dilemmas and tensions surrounding the experience lived by teachers of geography of the city engaged in teaching in rural areas in semi-arid region of Bahia. Research has pointed to difficulties faced by rural school to consider the different temporalities that exist in rural areas in their educational processes, as well as difficulties of articulation in these contexts of learning, between the local-global dimensions through which passes the contemporary space. This movement creates stress for teachers’ work, since it complicates the relationship between the times established, standardized and rigid, with times of personal students and teachers, covering aspects such as age, life histories, movements and experiences socio-historical and geographical subjects involved in the processes of teaching and learning in rural settings in contemporary times.

  2. Rural Urban Cooperation on Water Management in the Context of ...

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

    Rural Urban Cooperation on Water Management in the Context of Climate Change in Burkina Faso. Cities greatly depend on rural areas for agricultural ... Coopération entre milieux ruraux et urbains dans la gestion de l'eau face aux changements climatiques au Burkina Faso. Les villes dépendent fortement des milieux ...

  3. [The evolution of nursing shortage and strategies to face it: a longitudinal study in 11 hospitals]. (United States)

    Stringhetta, Francesca; Dal Ponte, Adriana; Palese, Alvisa


    To describe the perception of the evolution of nursing shortage from 2000 to 2009 according to Nursing Coordinators and the strategies to face it. Nursing coordinators of 11 hospitals or districts of Friuli Venezia Giulia, Trentino Alto Adige and Veneto regions were interviewed in 2000, 2004 and 2009 to collect data and assess their perception on nurses' shortage. In the first interview the medium gap between staff planned and in service was -5.4%; in 2004 -9.4% and in 2009 -3.3%. The shortage, once with a seasonal trend is now constant and appreciated in all the wards. In years 2000 and 2004 on average 5 strategies to face the shortage were implemented, in 2009 7. No systematic strategies have been used with the exception of the unification of wards, mainly during summer for letting people go on holydays. According to Nursing Coordinators the effects of the shortage are already observable (although not quantified) on patients and nurses. The nurses' shortage has been one of the challenges of the last 10 years. Its causes have changed but not the strategies implemented.

  4. Exploring resilience in rural GP registrars--implications for training. (United States)

    Walters, Lucie; Laurence, Caroline O; Dollard, Joanne; Elliott, Taryn; Eley, Diann S


    Resilience can be defined as the ability to rebound from adversity and overcome difficult circumstances. General Practice (GP) registrars face many challenges in transitioning into general practice, and additional stressors and pressures apply for those choosing a career in rural practice. At this time of international rural generalist medical workforce shortages, it is important to focus on the needs of rural GP registrars and how to support them to become resilient health care providers. This study sought to explore GP registrars' perceptions of their resilience and strategies they used to maintain resilience in rural general practice. In this qualitative interpretive research, semi-structured interviews were recorded, transcribed and analysed using an inductive approach. Initial coding resulted in a coding framework which was refined using constant comparison and negative case analysis. Authors developed consensus around the final conceptual model. Eighteen GP registrars from: Australian College of Rural and Remote Medicine Independent Pathway, and three GP regional training programs with rural training posts. Six main themes emerged from the data. Firstly, rural GP registrars described four dichotomous tensions they faced: clinical caution versus clinical courage; flexibility versus persistence; reflective practice versus task-focused practice; and personal connections versus professional commitment. Further themes included: personal skills for balance which facilitated resilience including optimistic attitude, self-reflection and metacognition; and finally GP registrars recognised the role of their supervisors in supporting and stretching them to enhance their clinical resilience. Resilience is maintained as on a wobble board by balancing professional tensions within acceptable limits. These limits are unique to each individual, and may be expanded through personal growth and professional development as part of rural general practice training.

  5. The inequity of inpatient services in rural areas and the New-Type Rural Cooperative Medical System (NRCMS) in China: repeated cross sectional analysis. (United States)

    Pan, Bingbing; Towne, Samuel D; Chen, Yuxing; Yuan, ZhaoKang


    The main aim of the New-type Rural Cooperative Medical System (NRCMS) put into effect in 2003 was to reduce financial barriers in accessing health care services among vulnerable populations. The aim of this study was to assess the association between NRCMS and income related inequality in hospital utilization among rural inhabitants in Jiangxi Province, China. A multistage stratified random cluster sampling method was adopted to select 1838, 1879, and 1890 households as participants in 2003/2004, 2008 and 2014, respectively. The Erreygers Concentration index (EI) of two measures of hospital inpatient care including admission to hospital and hospital avoidance, were calculated to measure income-related inequality. The decomposition of the EI was performed to characterize the contributions of socioeconomic and need factors to the measured inequality. An affluent-focused (pro-rich) inequity was observed for hospital admission adjusting for need factors over time. The level of inequity for hospital admission decreased dramatically, while hospital avoidance decreased marginally, and with a high value (EI, -0.0176) in 2008. The implementation of the NRCMS was associated with decreased inequity in 2008 and in 2014, but the associations were limited. Income contributed the most to the inequality of hospital utilization each year. The coverage of the NRCMS expanded to cover nearly all rural inhabitants in Jiangxi province by 2014 and was associated with a very small reduction in inequalities in admission to hospital. In order to increase equitable access to health care, additional financial protections for vulnerable populations are needed. Improving the relatively low level of medical services in township hospitals, and low rate of reimbursement and financial assistance with the NRCMS is recommended. © 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

  6. Antiretroviral treatment for HIV in rural Uganda: two-year treatment outcomes of a prospective health centre/community-based and hospital-based cohort.

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    Walter Kipp

    Full Text Available In sub-Saharan Africa, a shortage of trained health professionals and limited geographical access to health facilities present major barriers to the expansion of antiretroviral therapy (ART. We tested the utility of a health centre (HC/community-based approach in the provision of ART to persons living with HIV in a rural area in western Uganda.The HIV treatment outcomes of the HC/community-based ART program were evaluated and compared with those of an ART program at a best-practice regional hospital. The HC/community-based cohort comprised 185 treatment-naïve patients enrolled in 2006. The hospital cohort comprised of 200 patients enrolled in the same time period. The HC/community-based program involved weekly home visits to patients by community volunteers who were trained to deliver antiretroviral drugs to monitor and support adherence to treatment, and to identify and report adverse reactions and other clinical symptoms. Treatment supporters in the homes also had the responsibility to remind patients to take their drugs regularly. ART treatment outcomes were measured by HIV-1 RNA viral load (VL after two years of treatment. Adherence was determined through weekly pill counts.Successful ART treatment outcomes in the HC/community-based cohort were equivalent to those in the hospital-based cohort after two years of treatment in on-treatment analysis (VL≤400 copies/mL, 93.0% vs. 87.3%, p = 0.12, and in intention-to-treat analysis (VL≤400 copies/mL, 64.9% and 62.0%, p = 0.560. In multivariate analysis patients in the HC/community-based cohort were more likely to have virologic suppression compared to hospital-based patients (adjusted OR = 2.47, 95% CI 1.01-6.04.Acceptable rates of virologic suppression were achieved using existing rural clinic and community resources in a HC/community-based ART program run by clinical officers and supported by lay volunteers and treatment supporters. The results were equivalent to those of a

  7. Stroke care challenges in rural India: Awareness of causes, preventive measures and treatment options of stroke among the rural communities

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    Kanaga Lakshmi


    Full Text Available Introduction: Management of stroke in the remote rural areas in India faces major challenges because of lack of awareness. Stroke care services can be optimally implemented only if the communities have an understanding of the disease. Method: A population based, cross sectional survey of an adult general population sample between the ages of 31-60 years in a rural block in Tamil Nadu, India was carried out to study their knowledge, attitude, beliefs about cause, signs and symptoms, preventive measures and treatment options of stroke. Results: Of the 174 subjects studied only 69% were aware of the term stroke and 63% were able to list the symptoms. Only a little more than half the participants (58% were aware that diabetes, smoking and hypertension are risk factors for stroke. None of the participants were aware of the endovascular thrombolysis injection for better recovery from stroke. About quarter (23% of the participants did not think that the stroke is an emergency condition and they need to take the patient urgently to the hospital. Only 56% of the participants had checked their blood pressure and 49% for diabetes. A history of having either hypertension or diabetes and stroke in the family was the only factor that was significantly associated with better awareness (p=<0.001 independent of other potential facilitating factors including age, occupation, education and gender. Conclusion: There is a need to educate the rural communities about the risk factors, how to recognize the onset, the preventive measures and optimum care of stroke to reduce the burden.

  8. A Survey of Rural Hospitals’ Perspectives on Health Information Technology Outsourcing (United States)

    Johnson, Nicholas; Murphy, Alison; McNeese, Nathan; Reddy, Madhu; Purao, Sandeep


    A survey of rural hospitals was conducted in the spring of 2012 to better understand their perspectives on health information technology (HIT) outsourcing and the role that hospital-to-hospital HIT partnerships (HHPs) can play as an outsourcing mechanism. The survey sought to understand how HHPs might be leveraged for HIT implementation, as well as the challenges with forming them. The results suggest that HHPs have the potential to address rural hospitals’ slow rate of HIT adoption, but there are also challenges to creating these partnerships. These issues, as well as avenues for further research, are then discussed. PMID:24551373

  9. Integrating Blog and Face-to-Face Instruction into an ESP Course: English for Hospitality and Tourism (United States)

    Shih, Ru-Chu


    With the rapid growth of international trade and globalization, English language has been emphasized in Asia countries, thus professionals with a good command of English has become essential and important. This study aimed to establish a blended model combining face-to-face (F2F) instruction for English for Specific Purposes (ESP) course: English…

  10. Making strides in women’s mental health care delivery in rural Ethiopia: demographics of a female outpatient psychiatric cohort at Jimma University Specialized Hospital (2006–2008

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    Chemali ZN


    Full Text Available Zeina N Chemali,1,2 Christina PC Borba,1,2 Tanya E Henderson,3 Markos Tesfaye41Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; 2Harvard Medical School, Boston, MA, USA; 3International and Human Rights Law Consultants, Cambridge, MA, USA; 4Department of Psychiatry, College of Public Health and Medical Sciences, Jimma University, Jimma, EthiopiaAbstract: This paper presents the delivery of mental health care to a sample of women living in Jimma, rural Ethiopia, and their access to mental health services. A total of 226 psychiatric charts were reviewed for women seen at Jimma University Specialized Hospital. The mental health charts included documentation ranging from one paragraph to a full note. No psychiatric chart recorded medication status, detailed substance abuse history, or a history of violence. Rendering appropriate mental health care for women requires concerted efforts by multiple stake holders. Using our results, we advance concrete and practical suggestions for improving women's mental health in rural Ethiopia. We point out that the health care system needs to be responsive, allowing for change starting with gender rights, so that rural women have access to basic mental health services.Keywords: global mental health, low income country, Africa, gender differences

  11. Rural settlements dynamics and the prospects of densification strategy in rural Bangladesh. (United States)

    Alam, A F M Ashraful; Asad, Rumana; Enamul Kabir, Md


    Given the year on year decrease of rural farmland and various forms of land degradation through the intrusion of non-farm land uses, the government of Bangladesh has drafted the agrarian reform strategies, primarily to protect the agricultural land from encroachment, conversion, and indiscriminate use. The draft Agricultural Land Protection and Land Use Bill since its inception in 2011 is facing serious uncertainties of implementation due to its borrowed nature from the developed contexts and inadequacy to recognize the local complexities. With a particular focus on the densification component of the draft bill, a semester-long design studio was conducted in consultation with the existing villagers to explore the practicability of the draft bill in the villages of Tetultala and Chhoygharia in the south-western coastal Bangladesh. The findings from the two villages hint that in Bangladesh, the unique and evolving nature of rural settlements dynamics that are disintegrating the rural society from farming practices and the farmland, thereby, unsettling the traditional village-morphology. The settlements dynamics vary from those of the western context; hence, there is an emerging need to build locally situated knowledge towards a feasible rural land reform.

  12. Implementation of emergency department transfer communication measures in Minnesota critical access hospitals. (United States)

    Klingner, Jill; Moscovice, Ira; Casey, Michelle; McEllistrem Evenson, Alex


    Previously published findings based on field tests indicated that emergency department patient transfer communication measures are feasible and worthwhile to implement in rural hospitals. This study aims to expand those findings by focusing on the wide-scale implementation of these measures in the 79 Critical Access Hospitals (CAHs) in Minnesota from 2011 to 2013. Information was obtained from interviews with key informants involved in implementing the emergency department patient transfer communication measures in Minnesota as part of required statewide quality reporting. The first set of interviews targeted state-level organizations regarding their experiences working with providers. A second set of interviews targeted quality and administrative staff from CAHs regarding their experiences implementing measures. Implementing the measures in Minnesota CAHs proved to be successful in a number of respects, but informants also faced new challenges. Our recommendations, addressed to those seeking to successfully implement these measures in other states, take these challenges into account. Field-testing new quality measure implementations with volunteers may not be indicative of a full-scale implementation that requires facilities to participate. The implementation team's composition, communication efforts, prior relationships with facilities and providers, and experience with data collection and abstraction tools are critical factors in successfully implementing required reporting of quality measures on a wide scale. © 2014 National Rural Health Association.

  13. Mental Health in Rural Caregivers of Persons With Dementia

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    Alexandra J. Werntz


    Full Text Available Informal caregiving for dementia is common and often affects caregiver mental health. In addition to typical stressors faced by caregivers of persons with dementia (PWDs, rural caregivers often face additional stressors associated with living in more remote locations; unfortunately, this group is largely understudied. Ninety-three caregiver–PWD dyads completed measures of social support, perceived control, self-efficacy, burden, and cognitive functioning. Measures of PWD activities of daily living and mental functioning were also collected. These variables were hypothesized to predict caregiver self-reported symptoms of depression, anxiety, and stress. Contrary to predictions, only caregiving-related self-efficacy and caregiver burden predicted the caregiver’s mental health. Future interventions for improving rural caregiver self-reported mental health should target cognitions associated with caregiving self-efficacy and caregiver burden. Health care providers for rural families should focus on ways to reduce feelings of caregiver burden and provide caregivers with useful skills and tools for caregiving.


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    Mariana IATAGAN


    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

  15. Determining the efficacy of national strategies aimed at addressing the challenges facing health personnel working in rural areas in KwaZulu-Natal, South Africa. (United States)

    Mburu, Grace; George, Gavin


    Shortages of Human Resources for Health (HRH) in rural areas are often driven by poor working and living conditions, inadequate salaries and benefits, lack of training and career development opportunities amongst others. The South African government has adopted a human resource strategy for the health sector in 2011 aimed at addressing these challenges. This study reviews the challenges faced by health personnel against government strategies aimed at attracting and retaining health personnel in these underserved areas. The study was conducted in six primary health care service sites in the Hlabisa sub-district of Umkhanyakude, located in northern KwaZulu-Natal, South Africa. The study population comprised 25 health workers including 11 professional nurses, 4 staff nurses and 10 doctors (4 medical doctors, 3 foreign medical doctors and 3 doctors undertaking community service). Qualitative data were collected from semi-structured interviews and analysed using thematic analysis. Government initiatives including the rural allowance, deployment of foreign medical doctors and the presence of health personnel undertaking their community service in rural areas are positively viewed by health personnel working in rural health facilities. However, poor living and working conditions, together with inadequate personal development opportunities, remain unresolved challenges. It is these challenges that will continue to dissuade experienced health personnel from remaining in these underserved areas. South Africa's HRH strategy for the Health Sector 2012/13-2015/16 had highlighted the key challenges raised by respondents and identified strategies aimed at addressing these challenges. Implementation of these strategies is key to improving both living and working conditions, and providing health personnel with opportunities for further development will require inter-ministerial collaboration if the HRH 2030 objectives are to be realised.

  16. Creating an Educational Partnership Environment between Rural Retailers and Graduate Students (United States)

    Jackson, Vanessa P.; Wesley, Scarlett C.


    The purpose of this paper is to describe an educational partnership experience between rural retailers and graduate students in a Merchandising, Apparel and Textiles program. Students were afforded an opportunity to work with small business owners in rural communities, giving them real world exposure to the actual challenges being faced by…

  17. Health-seeking behaviour of human brucellosis cases in rural Tanzania

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    MacMillan Alastair


    Full Text Available Abstract Background Brucellosis is known to cause debilitating conditions if not promptly treated. In some rural areas of Tanzania however, practitioners give evidence of seeing brucellosis cases with symptoms of long duration. The purpose of this study was to establish health-seeking behaviour of human brucellosis cases in rural Tanzania and explore the most feasible ways to improve it. Methods This was designed as a longitudinal study. Socio-demographic, clinical and laboratory data were collected from patients who reported to selected hospitals in rural northern Tanzania between June 2002 and April 2003. All patients with conditions suspicious of brucellosis on the basis of preliminary clinical examination and history were enrolled into the study as brucellosis suspects. Blood samples were taken and tested for brucellosis using the Rose-Bengal Plate Test (RBPT and other agglutination tests available at the health facilities and the competitive ELISA (c-ELISA test at the Veterinary Laboratory Agencies (VLA in the UK. All suspects who tested positive with the c-ELISA test were regarded as brucellosis cases. A follow-up of 49 cases was made to collect data on health-seeking behaviour of human brucellosis cases. Results The majority of cases 87.7% gave a history of going to hospital as the first point of care, 10.2% purchased drugs from a nearby drug shop before going to hospital and 2% went to a local traditional healer first. Brucellosis cases delayed going to hospital with a median delay time of 90 days, and with 20% of the cases presenting to hospitals more than a year after the onset of symptoms. Distance to the hospital, keeping animals and knowledge of brucellosis were significantly associated with patient delay to present to hospital. Conclusion More efforts need to be put on improving the accessibility of health facilities to the rural poor people who succumb to most of the diseases including zoonoses. Health education on brucellosis in

  18. Rural nurses' safeguarding work: reembodying patient safety. (United States)

    MacKinnon, Karen


    Practice-based evidence includes research that is grounded in the everyshift experiences of rural nurses. This study utilized institutional ethnography to reembody the work of rural nurses and to explore how nurses' work experiences are socially organized. Registered nurses who work in small acute care hospitals were observed and interviewed about their work with the focus on their experiences of providing maternity care. The safeguarding work of rural nurses included anticipating problems and emergencies and being prepared; careful watching, surveillance, and vigilance; negotiating safety; being able to act in emergency situations; and mobilizing emergency transport systems. Increased attention to inquiry about safeguarding as an embodied nursing practice and the textual organization of the work of rural nurses is warranted.

  19. Implementing Mobile Phone Solutions for Health in Resource Constrained Areas: Understanding the Opportunities and Challenges (United States)

    Manda, Tiwonge Davis; Herstad, Jo

    This paper presents results from a study on mobile phone use to connect two rural hospitals in Malawi with community health workers (CHWs), the hospitals work with. Mobile phone use at the hospitals has helped reduce the need for face-to-face communication to permit patient information exchange, meetings and appointments scheduling, as well as work coordination. On the other hand mobile phone use has proved paradoxical as it has introduced users to challenges, like recharging of phone batteries, they did not anticipate. The paper highlights use context-centric and solution based opportunities and challenges associated with mobile phone use in rural settings.

  20. Towards the collaborative hospital

    DEFF Research Database (Denmark)

    Prætorius, Thim; Hasle, Peter; Edwards, Kasper


    Hospitals are increasingly faced with conflicting demands as they have to respond to increasing patient demands as well as financial, clinical and quality challenges. To handle these demands the hospital need to reconfigure its organization, and we propose to build on a concept for the collaborat......Hospitals are increasingly faced with conflicting demands as they have to respond to increasing patient demands as well as financial, clinical and quality challenges. To handle these demands the hospital need to reconfigure its organization, and we propose to build on a concept...... of the collaborative hospital concern the creation of an appropriate balance between standardization and local autonomy, shared purpose centred around providing the best possible care, and use of enabling structures that sustain the new ways of collaborative work. The chapter builds on the theoretical framework...

  1. Approach to chronic low back pain in a Rural Mission Hospital: An audit report

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    Tapan Kumar Paraseth


    Full Text Available Background: Challenging psychological and ergonomic burden demands a streamlined approach to Chronic low back pain (LBP in rural population. Methodology: All patients with chronic LBP managed in the outpatient physiotherapy and occupational therapy clinic at the rural mission hospital from July 2015 to June 2016 were included in a retrospective chart audit. Patients' demographic data and diagnosis were statistically analyzed with t-test. Results: One hundred and fifty five patients were included in the study. 65 patients (42% had mechanical LBP, 46 patients (30% had chronic LBP with lumbar radiculopathy, 22 patients (14% had discogenic chronic LBP, 15 patients (10% had chronic LBP due to osteoporosis, 5 patients (3% had chronic infective spondylitis and 2 patients (1% had post-traumatic chronic LBP. 25 patients (16% were less than 30 years old, 106 patients (68% were between 30 and 60 years and 24 patients (16% were older than 60 years. Higher incidence of mechanical chronic LBP was noted in younger group (t [129] = 1.36, P = 0.17 and higher incidence of chronic LBP with lumbar radiculopathy (t [129] =1.181, P = 0.239 was noted in middle aged patients, respectively. Gender prevalence of osteoporosis was statistically significant (t [153] =2.188, P = 0.03. Conclusion: Chronic LBP constituted 23% of all patients managed at the PT/OT outpatient clinic and mechanical chronic LBP was the most common diagnosis. Highest incidence of chronic LBP was noted in the middle aged 'working class' group of patients. Higher proportion of osteoporosis was detected among the female patients.

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

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


    Objective Despite public interest in the rural workforce, there are few published data on the geographical distribution of Australia's rural surgeons, their practice skill set, career stage or work-life balance (on-call burden). Similarly, there has not been a peer-reviewed skills audit of rural training opportunities for surgical trainees. The present study undertook this baseline assessment for Western Australia (WA), which has some of the most remote practice areas in Australia. Methods Hospital staff from all WA Country Health Service hospitals with surgical service (20 of 89 rural health services) were contacted by telephone. A total of 18 of 20 provided complete data. The study questionnaire explored hospital and practice locations of practicing rural surgeons, on-call rosters, career stage, practice skill set and the availability of surgical training positions. Data were tabulated in excel and geographic information system geocoded. Descriptive statistics were calculated in Excel. Results Of the seven health regions for rural Western Australia, two (28.6%) were served by resident surgeons at a ratio consistent with Royal Australasian College of Surgeons (RACS) guidelines. General surgery was offered in 16 (89%) hospitals. In total, 16 (89%) hospitals were served by fly-in, fly-out (FIFO) surgical services. Two hospitals with resident surgeons did not use FIFO services, but all hospitals without resident surgeons were served by FIFO surgical specialists. The majority of resident surgeons (62.5%) and FIFO surgeons (43.2%) were perceived to be mid-career by hospital staff members. Three hospitals (16.7%) offered all eight of the identified surgical skill sets, but 16 (89%) offered general surgery. Conclusions Relatively few resident rural surgeons are servicing large areas of WA, assisted by the widespread provision of FIFO surgical services. The present audit demonstrates strength in general surgical skills throughout regional WA, and augers well for the

  3. There Are No Subways in Lickingville: Metropolitan Models Don't Work for Rural People. (United States)

    Hillman, Arnold

    This book presents an overview of the problems facing rural America and offers solutions at the national, state, and local levels. The combination of public lack of awareness and metropolitan-centered authority has created a view of rural America and its people that is contrary to both the data and actual living conditions. Rural education has…

  4. Study of knowledge, attitude and practices regarding dengue in the urban and rural field practice area of a tertiary care teaching hospital in Pune, India

    Directory of Open Access Journals (Sweden)

    Samir Singru


    Full Text Available Context: Dengue is the most common disease among all the arthropod-borne viral diseases. There is no specific treatment or vaccine available for dengue. The sole method of prevention and control is the knowledge attitude and practices (KAP for the same. Although, dengue is considered an urban- and semi-urban disease, in recent years, due to water storage practices and large-scale development activities in rural areas, dengue has become endemic in rural areas of India as well. Aims: To assess the KAP regarding dengue. Settings and Design: Urban and rural field practice area of a Tertiary Care Teaching Hospital in Pune, India. Materials and Methods: A pre-tested, semi-structured questionnaire was used to study the knowledge, attitude, and practices regarding dengue. Stratified random sampling technique was used. A modified B. G. Prasad criterion was used for socio-economic classification. Statistical Analysis Used: KAP represented as proportion (%. Chi-square test was used as a test of significance. P value < 0.05 was considered as statistically significant. Results: 68.4% in urban areas and 40.4% in rural area knew that dengue is transmitted by mosquito. 62.6% in urban areas and 48% in rural areas respectively stated fever as a symptom of dengue. The use of anti-adult mosquito measures was 48.05% and 51.42% in urban and rural area respectively Conclusions: There is a definite need to increase the information education communication activities for dengue in the study area.

  5. A comparative study of the costliness of Manitoba hospitals. (United States)

    Shanahan, M; Loyd, M; Roos, N P; Brownell, M


    In light of ongoing discussions about health care policy, this study offered a method of calculating costs at Manitoba hospitals that compared relative costliness of inpatient care provided in each hospital. This methodology also allowed comparisons across types of hospitals-teaching, community, major rural, intermediate and small rural, as well as northern isolated facilities. Data used in this project include basic hospital information, both financial and statistical, for each of the Manitoba hospitals, hospital charge information by case from the State of Maryland, and hospital discharge abstract information for Manitoba. The data from Maryland were used to create relative cost weights (RCWs) for refined diagnostic related groups (RDRGs) and were subsequently adjusted for Manitoba length of stay. These case weights were then applied to cases in Manitoba hospitals, and several other adjustments were made for nontypical cases. This case mix system allows cost comparisons across hospitals. In general, hospital case mix costing demonstrated variability in hospital costliness, not only across types of hospitals but also within hospitals of the same type and size. Costs at the teaching hospitals were found to be considerably higher than the average, even after accounting for acuity and case mix.

  6. Health insurance benefit design and healthcare utilization in northern rural China.

    Directory of Open Access Journals (Sweden)

    Hong Wang

    Full Text Available BACKGROUND: Poverty due to illness has become a substantial social problem in rural China since the collapse of the rural Cooperative Medical System in the early 1980s. Although the Chinese government introduced the New Rural Cooperative Medical Schemes (NRCMS in 2003, the associations between different health insurance benefit package designs and healthcare utilization remain largely unknown. Accordingly, we sought to examine the impact of health insurance benefit design on health care utilization. METHODS AND FINDINGS: We conducted a cross-sectional study using data from a household survey of 15,698 members of 4,209 randomly-selected households in 7 provinces, which were representative of the provinces along the north side of the Yellow River. Interviews were conducted face-to-face and in Mandarin. Our analytic sample included 9,762 respondents from 2,642 households. In each household, respondents indicated the type of health insurance benefit that the household had (coverage for inpatient care only or coverage for both inpatient and outpatient care and the number of outpatient visits in the 30 days preceding the interview and the number of hospitalizations in the 365 days preceding the household interview. People who had both outpatient and inpatient coverage compared with inpatient coverage only had significantly more village-level outpatient visits, township-level outpatient visits, and total outpatient visits. Furthermore, the increased utilization of township and village-level outpatient care was experienced disproportionately by people who were poorer, whereas the increased inpatient utilization overall and at the county level was experienced disproportionately by people who were richer. CONCLUSION: The evidence from this study indicates that the design of health insurance benefits is an important policy tool that can affect the health services utilization and socioeconomic equity in service use at different levels. Without careful

  7. Lack of CT scanner in a rural emergency department increases inter-facility transfers: a pilot study. (United States)

    Bergeron, Catherine; Fleet, Richard; Tounkara, Fatoumata Korika; Lavallée-Bourget, Isabelle; Turgeon-Pelchat, Catherine


    Rural emergency departments (EDs) are an important gateway to care for the 20% of Canadians who reside in rural areas. Less than 15% of Canadian rural EDs have access to a computed tomography (CT) scanner. We hypothesized that a significant proportion of inter-facility transfers from rural hospitals without CT scanners are for CT imaging. Our objective was to assess inter-facility transfers for CT imaging in a rural ED without a CT scanner. We selected a rural ED that offers 24/7 medical care with admission beds but no CT scanner. Descriptive statistics were collected from 2010 to 2015 on total ED visits and inter-facility transfers. Data was accessible through hospital and government databases. Between 2010 and 2014, there were respectively 13,531, 13,524, 13,827, 12,883, and 12,942 ED visits, with an average of 444 inter-facility transfers. An average of 33% (148/444) of inter-facility transfers were to a rural referral centre with a CT scan, with 84% being for CT scan. Inter-facility transfers incur costs and potential delays in patient diagnosis and management, yet current databases could not capture transfer times. Acquiring a CT scan may represent a reasonable opportunity for the selected rural hospital considering the number of required transfers.

  8. partnering, poverty reduction and rural enterprise advancement

    African Journals Online (AJOL)


    establishment of the Rural Enterprise Advancement Programme (REAP) and its ... poverty, enabling food security and managing natural resources in a sustainable ... Extending the area under sustainable land management and .... the challenges facing the implementation of poverty reduction .... perceived “most beneficial.

  9. Barriers to the implementation of programs for the prevention of mother-to-child transmission of HIV: A cross-sectional survey in rural and urban Uganda

    Directory of Open Access Journals (Sweden)

    Bajunirwe Francis


    Full Text Available Abstract Background Implementation of programs for the prevention of mother-to-child transmission (PMTCT of HIV faces a variety of barriers and challenges. The assessment of these challenges has generally been conducted in large urban health facilities. As programs expand into rural areas, the potential barriers that may be encountered there also need to be assessed. This study examines potential barriers that might affect the acceptability of interventions for PMTCT in rural and urban settings. Results Four hundred and four women at a large urban hospital and three rural clinics that had recently started implementing PMTCT were interviewed. Level of knowledge of MTCT and preference for rapid HIV testing were equally high in both areas, but rural women had a higher tendency to think that they should consult their husbands before testing, with borderline statistical significance (72% vs. 64% p = 0.09. Health facility-based deliveries were significantly lower among mothers in rural areas compared to those in the urban setting. Overall, significant predictors of willingness to test for HIV were post-primary education (OR = 3.1 95% CI 1.2, 7.7 and knowledge about rapid HIV tests (OR = 1.8, 95% CI 1.01, 3.4. The strongest predictor of willingness to accept an HIV test was the woman's perception that her husband would approve of her testing for HIV. Women who thought their husbands would approve were almost six times more likely to report a willingness to be tested compared to those who thought their husbands would not approve (OR = 5.6, 95% CI 2.8, 11.2. Conclusion Lessons learned in large urban hospitals can be generalized to rural facilities, but the lower proportion of facility-based deliveries in rural areas needs to be addressed. Same-day results are likely to ensure high uptake of HIV testing services but male spousal involvement should be considered, particularly for rural areas. Universal Primary Education will support the success of PMTCT

  10. ICT applications as e-health solutions in rural healthcare in the Eastern Cape Province of South Africa. (United States)

    Ruxwana, Nkqubela L; Herselman, Marlien E; Conradie, D Pieter

    Information and Communication Technology (ICT) solutions (e.g. e-health, telemedicine, e-education) are often viewed as vehicles to bridge the digital divide between rural and urban healthcare centres and to resolve shortcomings in the rural health sector. This study focused on factors perceived to influence the uptake and use of ICTs as e-health solutions in selected rural Eastern Cape healthcare centres, and on structural variables relating to these facilities and processes. Attention was also given to two psychological variables that may underlie an individual&s acceptance and use of ICTs: usefulness and ease of use. Recommendations are made with regard to how ICTs can be used more effectively to improve health systems at fi ve rural healthcare centres where questionnaire and interview data were collected: St. Lucy&s Hospital, Nessie Knight Hospital, the Tsilitwa Clinic, the Madzikane Ka-Zulu Memorial Hospital and the Nelson Mandela General Hospital.

  11. From the associative companies to the nuclei of rural entrepreneurs

    Directory of Open Access Journals (Sweden)

    Álvaro Parrado


    Full Text Available Since the second half of the twentieth century, the impulse to the creation of Rural Associative Organizations (RAOs has become one of the main tools to implement rural development policies. However, most of these efforts have ended in failure, and have been marked by both the paternalism of the institutions and the lack of active participation from the rural communities. Faced with this situation, other methodologies and approaches have started to emerge. These new views have provided rural people with tools to participate in their own development processes and recognize that rural issues go beyond agricultural production. The Rural Management and Development Research Group in the Department of Agronomy at Colombia's Universidad Nacional has been working within this conceptual framework that tends to focus not only on participatory methodologies, but also on gender focus, the new rural setting and the territorial development. The research group has been involved in rural areas of Bogotá and Cundinamarca, building proposals with the active participation from the Nuclei of Rural Entrepreneurs as an alternative model to the conventional rural associative enterprise


    Directory of Open Access Journals (Sweden)

    Nicolae BALTEŞ


    Full Text Available Rural tourism and agricultural tourism are activities, which generate alternative incomes, a fact that offers development possibilities to the rural space, due to the unique landscapes, large semi-natural areas, the inhabitants' born hospitality in the rural surroundings. From this perspective, a modernization, development and innovation process for the Romanian rural tourism is required. All these aspects, however, require financing. Therefore, a pre-accession financing source of the rural tourism was the SAPARD programme, a programme which "offered the opportunity" to many business people to start their business in this field. The paper shows the evolution of the rural boarding houses between 2003-2007, with analyses on the number, type of financing, development region.

  13. Rural schools and democratic education. The opportunity for community participation

    Directory of Open Access Journals (Sweden)

    Antonio Bustos Jiménez


    Full Text Available In the paper the notions of participation and community empowerment in rural schools are analysed through reflection on experiences conducted in different countries. Reference is made to ducational models of participatory development which, from the viewpoint of excellence, result in increasing educational outcomes and higher rates of satisfaction among the targeted rural populations. Taking as point of departure agents which are considered potential generators of knowledge in rural areas, we examine the process of incorporating the wealth of the rural context. The difficulties that the community group usually faces for its legitimacy as a source of input in rural areas are also shown. Finally, we discuss how the teaching staff can positively contribute to their process of joining the school life.




    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

  15. Demographic Ageing in Romania’s Rural Area


    Daniela Violeta Nancu; Liliana Guran-Nica; Mihaela Persu


    Europe has faced for several decades and is still facing an ageing process of its population. Within it, Romania, a country, striving to successfully integrate into the European Union, is also experiencing the same process. The ageing process of the Romanian population started at the beginning of the 20th century and evolved progressively, ever since, with significant visible rates in the rural areas. Romania’s population age structure, at the beginning of the Third Millennium, was, according...

  16. Challenges faced by primary care physicians when prescribing for patients with chronic diseases in a teaching hospital in Malaysia: a qualitative study. (United States)

    Sellappans, Renukha; Lai, Pauline Siew Mei; Ng, Chirk Jenn


    The aim of this study was to identify the challenges faced by primary care physicians (PCPs) when prescribing medications for patients with chronic diseases in a teaching hospital in Malaysia. 3 focus group discussions were conducted between July and August 2012 in a teaching primary care clinic in Malaysia. A topic guide was used to facilitate the discussions which were audio-recorded, transcribed verbatim and analysed using a thematic approach. PCPs affiliated to the primary care clinic were purposively sampled to include a range of clinical experience. Sample size was determined by thematic saturation of the data. 14 family medicine trainees and 5 service medical officers participated in this study. PCPs faced difficulties in prescribing for patients with chronic diseases due to a lack of communication among different healthcare providers. Medication changes made by hospital specialists, for example, were often not communicated to the PCPs leading to drug duplications and interactions. The use of paper-based medical records and electronic prescribing created a dual record system for patients' medications and became a problem when the 2 records did not tally. Patients sometimes visited different doctors and pharmacies for their medications and this resulted in the lack of continuity of care. PCPs also faced difficulties in addressing patients' concerns, and dealing with patients' medication requests and adherence issues. Some PCPs lacked time and knowledge to advise patients about their medications and faced difficulties in managing side effects caused by the patients' complex medication regimen. PCPs faced prescribing challenges related to patients, their own practice and the local health system when prescribing for patients with chronic diseases. These challenges must be addressed in order to improve chronic disease management in primary care and, more importantly, patient safety. Published by the BMJ Publishing Group Limited. For permission to use (where not

  17. Fifth-year medical students’ perspectives on rural training in Botswana: A qualitative approach

    Directory of Open Access Journals (Sweden)

    P Kebaabetswe


    Full Text Available Background. The curriculum of the Faculty of Medicine at the University of Botswana includes rural community exposure for students throughout their 5 years of training. In addition to community exposure during the first 2 years, students complete 16 weeks of family medicine and 8 weeks of public health medicine. However, as a new faculty, students’ experiences and perceptions regarding rural clinical training are not yet known. Objective. To describe the experiences and perceptions of the 5th-year medical students during their rural training and solicit their recommendations for improvement. Methods. This qualitative study used face-to-face interviews with 5th-year undergraduate medical students (N=36 at the end of their family medicine rotation in Mahalapye and Maun villages. We used a phenomenological paradigm to underpin the study. Voice-recorded interviews were transcribed and analysed using Atlas TI version 7 software (USA. Results. Three main themes were identified: (i experiences and perceptions of the rural training environment; (ii perceptions of the staff at rural sites; and (iii perceptions of clinical benefits and relevance during rural training. While the majority of students perceived rural training as beneficial and valuable, a few felt that learning was compromised by limited resources and processes, such as medical equipment, internet connectivity and inadequate supervision. Conclusion. While the majority of students perceived rural training as beneficial, students identified limitations in both resources and supervision that need to be improved. Understanding students’ rural training experiences and perceptions can help the Faculty of Medicine, stakeholders and site facilitators to guide future rural training implementation.

  18. Challenges to Early Childhood Education in Rural China: Lessons from the Hebei Province (United States)

    Hu, Bi Ying; Roberts, Sherron Killingsworth; Leng Ieong, Sylvia Sao; Guo, Haiying


    This research study examined the challenges faced by early childhood education (ECE) in rural China based on a qualitative study of 217 kindergarten classrooms in a large agricultural, rural province. This study utilised onsite teacher surveys, interviews, and observational field notes. This investigation's findings revealed important information…

  19. Rural maternity care. (United States)

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


    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

  20. Sanitation challenges of the poor in urban and rural settings: Case studies of Bengaluru City and rural North Karnataka

    NARCIS (Netherlands)

    Seshaiah, Manasi; Nagesh, Latha; Ramesh, Hemalatha


    Bengaluru city faces severe challenges in providing sanitation infrastructure for the urban poor. Similarly, we have villages in North Karnataka that encounter problems of toilet access and related challenges. This paper addresses concerns both in city and rural contexts. We surveyed 400 respondents

  1. The multiple-faces configuration illusion in schizophrenic patients


    Simas, Maria Lucia de Bustamante; Rocha, Christiane Delusia de Oliveira; Sedycias, Rafael Freitas Modesto; Amaral, Viviane Ferreira do; Menezes, Felipe Schuler de


    The Multiple-Faces Configuration Illusion is observed by staring at a black dot while paying attention to a face in the peripheral visual field (Simas, 2000). Changes of facial expressions, movements, depth (EMF) or different face identities (MF) are observed in this illusion. Forty participants took part in the study: 20 outpatients diagnosed with schizophrenia, and 20 people helping friends or relatives in a hospital clinic. The face-stimulus was placed in a partition stand and participants...

  2. Research on the Marketing of Rural Tourism on the Basis of Market Segmentation

    Institute of Scientific and Technical Information of China (English)


    With the development of modern agriculture and the further improvement in balancing urban and rural development, rural tourism ushered in a new opportunity for development. However, due to lack of market segmentation,rural tourism in China is facing many problems.The rural tourists will be classified based on the market segmentation in this article,and then put forward four aspects from the use of different target market strategy, develop network marketing, Implements the region brand strategy and international marketing strategy.The aim is to offer advices and suggestions to the sustainable development of the rural tourism.

  3. Determinants of Welfare Dynamics in Rural Nicaragua

    DEFF Research Database (Denmark)

    Jakobsen, Kristian Thor


    This article explores the determinants of poverty movements in rural Nicaragua by introducing a bivariate probate model, making it possible to treat the initial state of poverty as endogenous and thus avoiding introducing selection bias. The results indicate that this is relevant when exploring...... welfare dynamics in rural Nicaragua, as initially poor households face a higher probability of being poor in the subsequent period compared with non-poor households. It is also found that household composition, access to non-agriculture wage income and ownership of productive assets are important factors...

  4. Promoting Action on Research Implementation in Health Services framework applied to TeamSTEPPS implementation in small rural hospitals. (United States)

    Ward, Marcia M; Baloh, Jure; Zhu, Xi; Stewart, Greg L

    A particularly useful model for examining implementation of quality improvement interventions in health care settings is the PARIHS (Promoting Action on Research Implementation in Health Services) framework developed by Kitson and colleagues. The PARIHS framework proposes three elements (evidence, context, and facilitation) that are related to successful implementation. An evidence-based program focused on quality enhancement in health care, termed TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety), has been widely promoted by the Agency for Healthcare Research and Quality, but research is needed to better understand its implementation. We apply the PARIHS framework in studying TeamSTEPPS implementation to identify elements that are most closely related to successful implementation. Quarterly interviews were conducted over a 9-month period in 13 small rural hospitals that implemented TeamSTEPPS. Interview quotes that were related to each of the PARIHS elements were identified using directed content analysis. Transcripts were also scored quantitatively, and bivariate regression analysis was employed to explore relationships between PARIHS elements and successful implementation related to planning activities. The current findings provide support for the PARIHS framework and identified two of the three PARIHS elements (context and facilitation) as important contributors to successful implementation. This study applies the PARIHS framework to TeamSTEPPS, a widely used quality initiative focused on improving health care quality and patient safety. By focusing on small rural hospitals that undertook this quality improvement activity of their own accord, our findings represent effectiveness research in an understudied segment of the health care delivery system. By identifying context and facilitation as the most important contributors to successful implementation, these analyses provide a focus for efficient and effective sustainment of Team

  5. 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


    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.

  6. A novel organizational model to face the challenge of multimorbid elderly patients in an internal medicine setting: a case study from Parma Hospital, Italy. (United States)

    Meschi, Tiziana; Ticinesi, Andrea; Prati, Beatrice; Montali, Arianna; Ventura, Antonio; Nouvenne, Antonio; Borghi, Loris


    Continuous increase of elderly patients with multimorbidity and Emergency Department (ED) overcrowding are great challenges for modern medicine. Traditional hospital organizations are often too rigid to solve them without consistently rising healthcare costs. In this paper we present a new organizational model achieved at Internal Medicine and Critical Subacute Care Unit of Parma University Hospital, Italy, a 106-bed internal medicine area organized by intensity of care and specifically dedicated to such patients. The unit is partitioned into smaller wards, each with a specific intensity level of care, including a rapid-turnover ward (mean length of stay model, compared with other peer units of the hospital and of other teaching hospitals of the region, showed a better performance, efficacy and effectiveness indexes calculated on Regional Hospital Discharge Records database system, allowing a capacity to face a massive (+22 %) rise in medical admissions from the ED. Further studies are needed to validate this model from a patient outcome point of view.

  7. Health professional students' rural placement satisfaction and rural practice intentions: A national cross-sectional survey. (United States)

    Smith, Tony; Sutton, Keith; Pit, Sabrina; Muyambi, Kuda; Terry, Daniel; Farthing, Annie; Courtney, Claire; Cross, Merylin


    The aim of this study was to profile students undertaking placements at University Departments of Rural Health (UDRHs) and investigate factors affecting students' satisfaction and intention to enter rural practice. Cross-sectional survey comprising 21 core questions used by all UDRHs. Eleven UDRHs across Australia that support students' placements in regional, rural and remote locations. Medical, nursing and allied health students who participated in UDRH placements between July 2014 and November 2015 and completed the questionnaire. Key dependent variables were placement satisfaction and rural practice intention. Descriptive variables were age, gender, Aboriginal or Torres Strait Islander (ATSI) background, location of placement, healthcare discipline, year of study and type and length of placement. A total of 3328 students responded. The sample was predominantly female (79%), the mean age was 26.0 years and 1.8% identified as ATSI. Most placements (69%) were >2 but ≤12 weeks, 80% were in Modified Monash 3, 4 or 5 geographical locations. Public hospitals and community health made up 63% of placements. Students satisfied with their placement had 2.33 higher odds of rural practice intention. Those satisfied with Indigenous cultural training, workplace supervision, access to education resources and accommodation had higher odds of overall satisfaction and post-placement rural practice intention. The majority of students were highly satisfied with their placement and the support provided by rural clinicians and the UDRHs. UDRHs are well placed to provide health professional students with highly satisfactory placements that foster rural practice intention. © 2017 National Rural Health Alliance Inc.

  8. Haemodialysis in a rural area: a demanding form of treatment. (United States)

    Brammah, A; Young, G; Allan, A; Robertson, S; Norrie, J; Isles, C


    To determine distances travelled and time spent waiting for transport among hospital haemodialysis patients living in a rural area. Cross sectional survey comparing the subregional dialysis unit in south west Scotland with 12 of the other 13 Scottish Adult Renal Units. Forty three Dumfries and Galloway patients and 935 other Scottish patients receiving hospital haemodialysis in November 1999. At the time of the survey 8/43 (19%) Dumfries patients travelled in excess of 100 miles per dialysis day (15,000 miles per year) solely for the purpose of dialysis, compared to 20/935 (2%) elsewhere in Scotland (p Scottish Units relied on hospital car, Patient Transport Service bus or ambulance for the journey home after treatment. Dumfries patients who travelled by Patient Transport Service or hospital ambulance had to wait twice as long before they left the renal unit as patients using a dedicated hospital car or private car. Haemodialysis in a rural area has every reason to be considered a demanding form of treatment. Greater promotion of home based treatment would improve the quality of life for many of these patients, while dedicated hospital cars would reduce 'car to needle time' for those who remain on hospital haemodialysis.

  9. Rural youth in northern Zambia: straddling the rural-urban divide

    DEFF Research Database (Denmark)

    Birch-Thomsen, Torben


    reported for sub-Saharan Africa, young people are increasingly turning their backs on agriculture, seeing it as an occupation that is back-breaking and only fit for old people (FAO, 2014). The aim of this chapter is to explore the livelihood strategies and aspirations of young people living in a rural area...... how, contrary to the trend in much of sub-Saharan Africa, many young people are choosing to stay in their rural villages and engage in farming. This is partly due to the availability of land and government programmes that have been introduced to stimulate agriculture. Increasingly, however, young...... people are not relying solely on farming, but are also engaging in nonfarm activities. Some young people are shown to be highly entrepreneurial, managing to set up and run businesses despite facing constant and changing challenges. Whether they are based in the village or in the nearby small town, most...

  10. A Facebook Follow-Up Strategy for Rural Drug-Using Women. (United States)

    Dickson, Megan F; Staton-Tindall, Michele; Smith, Kirsten E; Leukefeld, Carl; Webster, J Matthew; Oser, Carrie B


    Facebook (FB) use has grown exponentially over the past decade, including in rural areas. Despite its popularity, FB has been underutilized as a research follow-up approach to maintain contact with research participants and may have advantages in less densely populated areas and among more hard-to-reach, at-risk groups. The overall goal of this study was to examine FB as a supplemental follow-up approach to other follow-up strategies with rural drug-using women. Face-to-face interviews were conducted with randomly selected women who completed baseline interviews in 3 rural jails in 1 state. Analyses focus on participants who were released from jail and were eligible for 3-month follow-up (n = 284). Bivariate analyses were used to examine differences between FB users and nonusers, and multivariate logistic regression models examined predictors of 3-month follow-up participation and being located for follow-up using FB. About two-thirds (64.4%) of participants were regular FB users. Bivariate analyses indicated that FB users were younger, more educated, and more likely to have used alcohol in the 30 days before incarceration but less likely to have a chronic health problem. Regression analyses indicated that rural FB users had more than 5 times the odds of being located for the 3-month follow-up interview, even after controlling for other variables. There were no significant predictors of being followed up using FB. Findings suggest that FB is widely used and well accepted among rural drug-using women. Among hard-to-reach populations, including those in rural, geographically isolated regions, FB serves as a method to improve participant follow-up. © 2016 National Rural Health Association.

  11. Path innovation of rural property mortgage financing in China

    Directory of Open Access Journals (Sweden)

    Wu Yongchao


    Full Text Available Rural property mortgage financing, as an important breakthrough to deepen the reform of rural property right system and financial system, is an important approach to increase the farmers’ property income. Besides, rural property mortgage financing is of great significance in implementing the rural land usufructuary right and meeting the demand of medium-and-long-term and large-scale operation of the funds used in agricultural production. Under the existing institutional arrangement, the property mortgage financing in the rural areas of our country still is faced with many obstacles, and it is still at the stage of low level development. In this paper, closely based on the acceptability and the difficulty in the mortgaged property involving in legal disposal, the author puts forward important methods: clearly define the ownership, unify the urban and rural markets, increase the participation enthusiasm of financing bodies, and improve the supporting policies to promote property mortgage financing in rural area. Finally, the government should give farmers more property rights and revitalize the usufructuary right of agricultural land and its derivative right.

  12. Sources of healthcare financing among surgical patients in a rural Niger Delta practice in Nigeria. (United States)

    Dienye, P O; Brisibe, S F; Eke, R


    The environmental degradation following crude oil exploration in the Niger Delta has resulted in poverty for local rural dwellers. For those who are ill, if herbal treatments and/or self-medication with orthodox drugs are unsuccessful, the only alternative is expensive medical treatment in clinics. Surgical patients in a rural clinic may have to stay beyond than the normal 7 days if they are unable to pay their hospital bill; because this limits bed availability, there is an impacts on the hospital's economic management. This study aimed to determine the pattern of hospital bill payment among rural surgical patients in a rural Nigerian community, including the sources of finance for bill payment, in order to determine ways to resolve this issue. This cross-sectional study was conducted in a rural community in the Niger Delta area (Bethesda Clinic Ngo) over 5 years (2005-2009). In the 5 year study period, 3712 patients were seen, of which 229 were surgical patients who consented to the study. Their ages ranged from 4 to 97 years (mean 45.6 ± 13.5 years) and most were fish farmers (79.91%), secondary-school leavers (56.33%) and of the Christian religion (86.03%). The association of these characteristics with a greater than 7 day hospital stay was statistically significant (p sources of finance for the hospital bill were multiple but mainly personal savings (71.18%). Few (3.06%) had knowledge of the National Health Insurance Scheme, but when informed about it 84.28% were willing to enroll. The sources of finance for payment of hospital bills were multiple but the most common were personal savings and family members.

  13. the biomedical waste management in selected hospitals of chittoor

    African Journals Online (AJOL)

    management in Government and Private Hospitals. Materials and .... supply of the color coded bags has many deficiencies in both types of .... Journal of Academy of Hospital Administration ... Resource Centre, National Rural Health. Mission: ...

  14. The role of university hospitals as centers of excellence for shared health-care-delivery of in- and outpatients

    International Nuclear Information System (INIS)

    Adelhard, K.; Matzko, M.; Bruening, R.; Holzknecht, N.; Stark, V.; Reiser, M.


    Problem. Health care delivery in Germany has to face severe challenges that will lead to a closer integration of services for in- and out-patients. University hospitals play an important role due to their activities in research, education and health care delivery. They are requested to promote and evaluate new means and ways for health care delivery. Methods. The Institute of Clinical Radiology at the University Hospital of the Ludwig-Maximilians-University started teleradiological services for hospitals and general practices in January 1999 in the framework of the ''Imaging services - teleradiological center of excellence''. Legal, technical and organizational prerequisites were analyzed. Results. Networks between university hospitals and general practices are not likely to solve all future problems. They will, however, increase the availability of the knowledge of experts even in rural areas and contribute to a quality ensured health care at the patients home. Future developments may lead to international co-operations and such services may be available to patients abroad. Conclusion. Legal, technical and organizational obstacles have to be overcome to create a framework for high quality telemedical applications. University hospitals will play an important role in promoting and evaluating teleradiological services. (orig.) [de

  15. Particularities of the Romanian rural education

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    Tecău Alina Simona


    Full Text Available The education of preschoolers, pupils or young people that are part of disadvantaged or at-risk groups is a priority objective of political, socio-economic, cultural and civic organizations in Romania. Romanian rural education is facing a sharp drop in the number of pupils. Causes may be related to a large number of families with socio-economic problems, distances, limited access to cutting-edge information, and migration to nearby cities. Identifying causes accurately and measuring the impact on the quality of rural education is also a challenge from the perspective of educational marketing. Case study may constitute a starting point for further research to propose effective solutions to improve education in rural areas. The present work is an analysis of the situation of preschool and gymnasium educational establishment in one of the communes of the county of Braşov.

  16. Developing better casemix education for rural New South Wales. (United States)

    Bridges, J F; Mazevska, D; Haas, M


    Casemix is now an important mechanism for the planning, evaluation and funding of health services in Australia. In New South Wales (NSW) it was believed that while staff from most hospitals in metropolitan Sydney had become both literate and vocal about casemix, staff from rural areas were less familiar and much less likely to participate in casemix initiatives. In conjunction with the NSW Casemix Clinical Committee (NCCC), NSW Health considered a special program of casemix education for rural NSW. Before an education program was attempted, NSW Health inquired into the specific needs for casemix education in rural NSW. Qualitative and quantitative methods of analysis were used. Results of the quantitative analysis indicate that the understanding of casemix classifications is highest among managers. Of concern were the relatively low proportion of Allied Health staff who had more than a vague understanding of the Sub- and Non-Acute Patient (SNAP) classification; the lack of any knowledge of the Mental Health Costing And Service Classification (MH-CASC) by nursing staff; and the lack of any knowledge of the emergency department classification: Urgency, Disposition and Age-related Groups (UDAG), either by clinical or nursing staff. The results of the qualitative analysis show that casemix education for rural areas needs to differ from metropolitan education programs. The analysis also highlights the perception of casemix in rural areas and the special circumstances in rural hospitals that place limits on the ability to use casemix more fully.

  17. Confronting Rapid Change: Exploring the Practices of Educational Leaders in a Rural Boomtown (United States)

    McHenry-Sorber, Erin; Provinzano, Kathleen


    Hydraulic fracturing has altered the face of rural communities across the United States, creating new demands for educational leaders. This in-depth qualitative study explores how rural educational leaders in a heavily drilled community experience and respond to these challenges with a focus on increased local student transiency, homelessness, and…

  18. Attracting and retaining doctors in rural Nepal. (United States)

    Shankar, P R


    In Nepal, a number of private sector medical schools have opened recently; although sufficient numbers of doctors are graduating there continues to be a doctor shortage in rural areas. This article analysed the rural doctor shortage in Nepal and reviewed the international literature for strategies that may be suitable for use in Nepal. Original research articles, reviews, magazine articles and project reports dealing with Nepal and other developing countries during the period 1995 to 2010 were sourced via Google, Google Scholar and Pubmed. Full text access was obtained via WHO's HINARI database. The health workforce in Nepal is unevenly distributed resulting in doctor shortages in rural areas. The recent introduction of mandatory rural service for scholarship students was aimed to reduce the loss of medical graduates to developed nations. High tuition fees in private medical schools and low Government wages prevent recent graduates from taking up rural positions, and those who do face many challenges. Potential corrective strategies include community-based medical education, selecting rural-background medical students, and providing a partial or complete tuition fee waiver for medical students who commit to rural service. Traditional healers and paramedical staff can also be trained for and authorized to provide rural health care. A range of strategies developed elsewhere could be used in Nepal, especially community-oriented medical education that involves rural doctors in training medical students. The reimbursement of tuition fees, assistance with relocation, and provision of opportunities for academic and professional advancement for rural doctors should also be considered. Government investment in improving working conditions in rural Nepal would assist rural communities to attract and retain doctors.

  19. Qualitative exploration of the career aspirations of rural origin health science students in South Africa. (United States)

    Diab, Paula N; Flack, Penny S; Mabuza, Langalibalele H; Reid, Stephen J Y


    There is evidence in the literature that rural background significantly encourages eventual rural practice. Given the shortage of healthcare providers in rural areas, we need to explore ways of ensuring throughput and success of rural-origin students in health sciences. It is therefore important to understand who these students are, what motivates them and the factors involved in the formation of their career choices. The aim of this study is to understand the aspirations of undergraduate health science students of rural origin with regard to their future career plans. The objectives of the study include to explore and identify the key issues facing rural-origin students with regard to their future career plans. Individual interviews were conducted with 15 health science students from two South African universities. Transcriptions were analyzed with the aid of Nvivo v8 ( The findings suggest health science students of rural origin studying at universities in the South African context face specific challenges related to the nature of the contrast between rural and urban life, in addition to the more generic adaptations that confront all students on entering tertiary education. In order to support rural students in their studies, academic, financial, emotional and social stressors need to be addressed. Universities should strengthen existing support structures as well as aid the development of further support that may be required.Key words: career plan, health science, rural background, South Africa.

  20. [Prevalence of hyperlipidemia and possible risk factors in rural Chinese adults: cohort study of health population in Yuhuan rural]. (United States)

    Su, Meifang; Fu, Chaowei; Li, Songtao; Ying, Xuhua; He, Na; Jiang, Qingwu


    To examine the prevalence of hyperlipidemia and its related factors in adults in rural Yuhuan, China. A cross-sectional study was carried out as a baseline study of Rural Yuhuan Health Population Cohort in all communities in Yuhuan County, Zhejiang Province, China. A total of 118,571 subjects aged 35 years old or above participated in this study. The trained health/medical workers collected the general information, health conditions and so on by the face-to-face interview. Totally, 5 ml blood samples were taken. Hyperlipidemia was defined as blood triglyceride > or = 1.70 mmol/L and/or total cholesterols > or = 5.18 mmol/L. SPSS 16.0 was used for statistical analysis. Data of the fifth China population census 2000 was used as the standard population. Among 118,571 eligible subjects, the averages of blood triglyceride and total cholesterols were (1.71 +/- 14.42) mmol/L and (5.48 +/- 40.25 ) mmol/L, respectively, and there was a statistical difference in gender on blood triglyceride (t = 4.163, P education levels, smoking, alcohol consumption and body mass index were significantly related to hyperlipidemia. Hyperlipidemia, especial hypercholesterolemia, was common in adults aged 35 years old or above living in rural China.


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    Zdzisław Brzeski


    Full Text Available In recent years changes have been noted in the motivations for acute suicidal poisonings among young people from various environments, which are due to psychosocial changes both in the urban and rural environments. Suicidal attempts are accompanied – especially in the rural environment – by low social status, difficulties with adapting to a free market economy, emotional tension within the family, at school, in the environment of young people, addiction to alcohol, drug overuse, including psychotropes. Based on clinical material concerning rural inhabitants hospitalized due to suicidal poisonings, the authors performed the analysis of attitudes, motivations and causes of acute poisonings among the young rural population. Among rural adolescents who continued school or university education the dominant causes of undertaking a suicidal attempt were: adolescent period problems, conflicts within the family, conflicts with mates, and disappointment in love. Among young adults the motivations were as follows: difficulties with finding employment in the place of residence, conflicts within the family, overuse of stimulants, and sometimes states of depression during the period of aggravation of a disease.


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    Inna Yurievna Yurova


    Full Text Available The article presents the analysis of factors that may influence the attitudes of rural population with occupational diseases to medical service. The analysis is based on the results of the survey that has been conducted in Saratov region in 2013-2014. Ten experts, doctors involved in treating rural population with occupational diseases in Saratov region, formed the sample.It was revealed that refusal from pre-arranged treatment and hospitalization as well as execution of documents on disability is often determined by financial factor, i.e. unwillingness of rural population to lose their job, the only source of income. According to the experts the main factors that may influence the incidence of in- and out-patient visits in rural regions are low accessibility to medical institutions due to isolated location of many rural territories, insufficiency of professional staff able to cope with occupational pathologies in central regional hospitals, lack of medical equipment and facilities. The factors preventing health-saving behavior are as follows: life style and educational level.

  3. Rural areas of Eastern Germany: modern challenges

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    Klüter Helmut


    Full Text Available After the German reunification the agricultural development of eastern territories seemed to have picked up its pace. Yet the main problems those territories are facing today hatched already in the mid-1990s. In our study we address the problems and challenges that hinder sustainable development of East German rural areas. We analyse agricultural statistics and describe the structure of agricultural enterprises, land-use, and other critical dimensions of agriculture. We discuss pros and cons of modern rural areas spatial planning policy and take a critical look at the current status of rural areas. We also put forward a number of concrete proposals aimed at the development of the area and counteracting the negative trends it is now experiencing. Even taking into account all ‘positive’ development trends that are postulated to have occurred since the unification, we underline the crucial necessity of diversification of labour forces and of changing the spatial planning policies in the rural areas of East Germany.

  4. Assessing the causes of under-five mortality in the Albert Schweitzer Hospital service area of rural Haiti. (United States)

    Perry, Henry B; Ross, Allen G; Fernand, Facile


    Limited information is available regarding the causes of under-five mortality in nearly all of the countries in which mortality is the highest. The purpose of this study was to use a standard computerized protocol for defining the leading causes of death among children in a high-mortality rural population of Haiti and to highlight the need for similar studies else-where in Haiti and throughout the high-mortality areas of Latin America and the Caribbean. In 2001 a standardized, closed-ended verbal autopsy questionnaire endorsed by the World Health Organization was administered to a representative, population-based sample of the mothers or other caregivers of 97 children who had died before reaching 5 years of age between 1995 and 1999 in the service area of the Albert Schweitzer Hospital, which is located in the rural Artibonite Valley of Haiti. With the data from the questionnaires we used a computerized algorithm to generate diagnoses of the cause of death; the algorithm made it possible to have more than one cause of death. Acute lower respiratory infection (ALRI) was the leading diagnosis, present in 45% of all under-five deaths, followed by enteric diseases, present in 21% of deaths. Neonatal tetanus, preterm birth, and other early neonatal causes unassociated with ALRI or diarrhea were present in 41% of the neonatal deaths. Among children 1-59 months of age, ALRI was present in 51% of the deaths, and enteric diseases in 30%. Deaths were concentrated during the first few months of life, with 35% occurring during the first month. Among the neonatal deaths, 27% occurred on the first day of life, and 80% occurred during the first 10 days of life. In the Albert Schweitzer Hospital program area--and presumably in other areas of Haiti as well--priority needs to be given to the prevention of and the early, effective treatment of ALRI, diarrhea, and early neonatal conditions. This study points to the need for more, similar standardized assessments to guide local

  5. Factors of U.S. Hospitals Associated with Improved Profit Margins: An Observational Study. (United States)

    Ly, Dan P; Cutler, David M


    Hospitals face financial pressure from decreased margins from Medicare and Medicaid and lower reimbursement from consolidating insurers. The objectives of this study are to determine whether hospitals that became more profitable increased revenues or decreased costs more and to examine characteristics associated with improved financial performance over time. The design of this study is retrospective analyses of U.S. non-federal acute care hospitals between 2003 and 2013. There are 2824 hospitals as subjects of this study. The main measures of this study are the change in clinical operating margin, change in revenues per bed, and change in expenses per bed between 2003 and 2013. Hospitals that became more profitable had a larger magnitude of increases in revenue per bed (about $113,000 per year [95% confidence interval: $93,132 to $133,401]) than of decreases in costs per bed (about - $10,000 per year [95% confidence interval: - $28,956 to $9617]), largely driven by higher non-Medicare reimbursement. Hospitals that improved their margins were larger or joined a hospital system. Not-for-profit status was associated with increases in operating margin, while rural status and having a larger share of Medicare patients were associated with decreases in operating margin. There was no association between improved hospital profitability and changes in diagnosis related group weight, in number of profitable services, or in payer mix. Hospitals that became more profitable were more likely to increase their admissions per bed per year. Differential price increases have led to improved margins for some hospitals over time. Where significant price increases are not possible, hospitals will have to become more efficient to maintain profitability.

  6. A self-supporting library service in a rural region: a new look at hospital consortia. (United States)

    Gillikin, P; Price, L; Lee, S; Sprinkle, M D; Leist, J C


    To meet the informational needs of health care practitioners and trainees in a four-county rural area of northwestern North Carolina, the eleven-member UNIFOUR Consortium was founded as a two-year experimental project from 1978 to 1980. The consortium has several unique features: (1) it is an organization of institutions, not libraries; (2) it employs its own professional librarian who manages a central library, coordinates consortium programs, and makes regular circuit visits to all affiliated institutions; (3) the central library, where the circuit is based, is a developing community hospital library, not an established academic medical center library; and (4) it is ultimately tied to the Northwest Area Health Education Center and that organization's emerging learning resources network, which includes the Bowman Gray School of Medicine, Library, two other subregional libraries, and the libraries of all member institutions. At the end of the experimental period in 1980, member institutions voted unanimously to continue the program and assume their share of the costs.

  7. The potentials for creating sustainable rural tourism in Bačka

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    Stankov Uglješa


    Full Text Available Average rural household in Bačka mostly depend on agricultural activities. Modern society changes, especially changes in agriculture production imply need for diversification of business activities. Rural tourism can be important part of rural economy for some villages in Bačka. Fertile plain, Danube, Tisa and other smaller rivers, animals and games represent base of natural tourist attractions of rural tourism. However, main competitive advantages of Bačka are anthropogenic values. Traditional pannonian houses, baroques churches, numerous rural festivities, and "melting point" of different nationalities make good base for rural tourism development. Different combinations of rural attractions create several tourist experiences of this region: authentic tourist experience at "szalashes", particular tourist experience in villages, intensive tourist experience of rural events and manifestations, not authentic tourist experiences of pseudo rural attractions and complex tourist experience in rural areas. Regarding to emitive centers of rural tourist demand can be specified tree regions for development of rural tourism - region of Novi Sad, Subotica, and Sombor. Rural tourism can make a valuable contribution to rural economies, job creation, landscape conservation, retention of rural population, support to rural culture and tradition, nature conservation and other. At the same time, rural tourism is facing various limitations. With in this context, rural tourism planning has to include principles of sustainable development.

  8. 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 ...

  9. Availability of thrombolytic therapy in rural Newfoundland and Labrador.


    Marshall, S; Godwin, M; Miller, R


    OBJECTIVE: To determine the availability of thrombolytic therapy in rural Newfoundland and Labrador. DESIGN: Self-administered questionnaire mailed to staff at health care facilities. Respondents were sent two reminders by mail, and questionnaires not returned were completed through telephone interviews. SETTING: Rural health care facilities, including hospitals, 24-hour clinics and satellite clinics. PARTICIPANTS: All chief medical officers, nursing supervisors and administrators in the 34 g...

  10. Not-for-profit hospitals fight tax-exempt challenges. (United States)

    Hudson, T


    The message being sent by local tax boards, state agencies, and the Internal Revenue Service is clear: Not-for-profit hospitals will have to justify their tax-exempt status. But complying with this demand can be a costly administrative burden. Just ask the executives who have been through the experience. CEO Richard Anderson, of St. Luke's Hospital, Bethlehem, PA, is luckier than some executives who have faced tax-exempt challenges. He won his hospital's case. But he still faces a yearly battle: The hospital must prove its compliance annually to the county board of assessors. Other executives report similar experiences. Our cover story takes an in-depth look at how administrators faced challenges to their hospital's tax status and what they learned about their relationship with their communities, as well as a complete state and federal legislative outlook for future developments.

  11. Rural-urban variation in injury-related hospitalisation, health outcomes and treatment cost in New South Wales. (United States)

    Mitchell, Rebecca J; Lower, Tony


    To compare differences in injury characteristics, health outcomes and treatment costs between urban and rural residents who were hospitalised following an injury. A retrospective examination of injury-linked hospitalisation and mortality data in New South Wales from 1 January 2010 to 30 June 2014. Urban (496 325) and rural (213 139) residents who were hospitalised following an injury. Demographic and injury characteristics, injury severity, hospital length of stay, 28-day hospital readmission, 90-day mortality and treatment cost. Rural residents had an increased likelihood of being hospitalised for injuries from motorcycles, vehicles, animate causes, venomous animals or plants and assault compared to urban residents. Rural residents were less likely to be readmitted to hospital within 28 days and had a lower length of stay and age-adjusted length of stay than urban residents. Injury-related hospitalisations for urban and rural residents cost $4.4 billion and $1.7 billion, respectively. Annually, acute injury treatment ($1.1 billion), rehabilitation ($130 million) and subacute non-acute patient care ($57 million) cost $1.3 billion ($990 million for urban and $384 million for rural residents) in New South Wales. Fall-related injuries and transport incidents were the costliest injury mechanisms for both urban and rural residents. Injuries contribute substantially to hospitalised morbidity and its cost. The development and implementation of injury prevention strategies targeting the most common injuries for urban and rural residents will go some way towards reducing hospitalised injury and its cost. © 2018 National Rural Health Alliance Ltd.

  12. Chagas cardiomyopathy and serologic testing in a small rural hospital in Chiapas, Mexico Miocardiopatía chagásica y pruebas serológicas de enfermedad de Chagas en un hospital rural pequeño de Chiapas, México

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    Linnea Capps


    Full Text Available OBJECTIVES: To conduct a study in a small rural hospital located in the state of Chiapas, Mexico, to: (1 examine the prevalence of chagasic cardiomyopathy among patients with the diagnosis of congestive heart failure and (2 assess the prevalence of positive serologic results in blood donors in the hospital, in an attempt to ascertain whether Chagas' disease remains an important cause of heart failure at least in some areas of Mexico. METHODS: The study of patients with cardiomyopathy was conducted by retrospective chart review of patients with the diagnosis of congestive heart failure treated at the hospital during the years 2000­2002. With the blood donors, the results of their serologic screening were reviewed for a six-month period beginning in April 2002. Serologic testing was done in both groups with either indirect hemagglutination (IHA or enzyme-linked immunosorbent assay (ELISA, or with both. RESULTS: Of 67 patients with heart failure and no risk factors for other causes of heart failure, 40 of them had serologic tests performed. Thirty-three of these 40 (82.5% were positive by ELISA, IHA, or both. With 97 blood donors, one or both serologic tests were positive in 17 of them (17.5%. CONCLUSIONS: This research adds to the evidence that Chagas' disease continues to be a major cause of heart failure in some areas of Mexico and that there continues to be a risk of transmission by blood transfusion if donated blood is not consistently screened.OBJETIVO: Llevar a cabo un estudio en un hospital rural pequeño del Estado de Chiapas, México, con el fin de: 1 examinar la prevalencia de miocardiopatía chagásica en pacientes con un diagnóstico de insuficiencia cardíaca congestiva y 2 estimar la prevalencia de positividad serológica en donantes de sangre del hospital, con objeto de determinar si la enfermedad de Chagas sigue siendo una causa importante de insuficiencia cardíaca en algunas partes de México. MÉTODOS: El estudio de los

  13. Grandparent caregiving among rural African Americans in a community in the American South: challenges to health and wellbeing. (United States)

    Clottey, Emmanuel N; Scott, Alison J; Alfonso, Moya L


    An increasing number of grandparents in rural USA are serving as primary caregivers for their grandchildren because of parental incarceration, addiction, joblessness, or illness. Low-income, African American women from the South are overrepresented in this growing population. There is a paucity of research exploring the challenges faced by rural grandparent caregivers, and past studies have not explicitly addressed the potential consequences of rural grandparent caregiving for health. The purpose of this qualitative study was to explore grandparent caregiving among rural, low-income, African American grandmothers in a community in the American South, and to identify challenges to health that arose in that context. McLeroy's social ecological model (SEM) was used to examine these challenges at multiple levels of influence. This qualitative interview-based study was conducted in a high-poverty community in rural Georgia. In-depth interviews were conducted with African American grandparent caregivers and key informants from local community-based organizations. A key informant assisted in identifying initial interview participants, and then snowball sampling was used to recruit additional participants. Interview questions were grouped under five domains (intrapersonal, interpersonal, community, organizational, and policy), according to the levels of the SEM. Iterative content analysis of interview transcripts was utilized. Transcripts were coded to identify text segments related to each domain of the SEM, which were grouped together for analysis by domain. Reflexive memo-writing aided in development of themes, and data quality was assessed using Lincoln and Guba's trustworthiness criteria. Rural African American grandparent caregivers faced a range of challenges to health. Direct physical challenges included chronic pain that interfered with sleep and daily functioning, mobility issues exacerbated by child care, and the pressure of managing their own medical conditions

  14. Examination of the relative importance of hospital employment in non-metropolitan counties using location quotients. (United States)

    Smith, Jon L


    The US Health Care and Social Services sector (North American Industrial Classification System 'sector 62') has become an extremely important component of the nation's economy, employing approximately 18 million workers and generating almost $753 billion in annual payrolls. At the county level, the health care and social services sector is typically the largest or second largest employer. Hospital employment is often the largest component of the sector's total employment. Hospital employment is particularly important to non-metropolitan or rural communities. A high quality healthcare sector serves to promote economic development and attract new businesses and to provide stability in economic downturns. The purpose of this study was to examine the intensity of hospital employment in rural counties relative to the nation as a whole using location quotients and to draw conclusions regarding how potential changes in Medicare and Medicaid might affect rural populations. Estimates for county-level hospital employment are not commonly available. Estimates of county-level hospital employment were therefore generated for all counties in the USA the Census Bureau's County Business Pattern Data for 2010. These estimates were used to generate location quotients for each county which were combined with demographic data to generate a profile of factors that are related to the magnitude of location quotients. The results were then used to draw inferences regarding the possible impact of the Patient Protection and Affordable Care Act 2010 (ACA) and the possible imposition of aspects of the Budget Control Act 2011 (BCA). Although a very high percentage of rural counties contain medically underserved areas, an examination of location quotients indicates that the percentage of the county workforce employed by hospitals in the most rural counties tends to be higher than for the nation as a whole, a counterintuitive finding. Further, when location quotients are regressed upon data

  15. An analysis of the agreement between financial data between the Medicare Cost Report and the audited hospital financial statement. (United States)

    Chen, Li-Wu; Stoner, Julie; Makhanu, Catherine; Minikus, Kathy; Mueller, Keith J


    Very few studies have thoroughly examined the discrepancies between the financial information in the Medicare Cost Report (MCR) and that in the audited hospital financial statement (FS). Furthermore, this type of study has never been conducted for rural hospitals. In this policy brief, we present the findings from our study, which used statistical methods to examine the agreement between the MCR and the FS of a series of financial measures in rural hospitals. The results are expected to inform policy makers of the limitation inherent in using MCR data as the single source of data to examine the financial performance of rural hospitals.

  16. A case control study of differences in non-work injury and accidents among sawmill workers in rural compared to urban British Columbia, Canada

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    Maggi Stefania


    Full Text Available Abstract Background Using a cohort of British Columbian male sawmill workers, we conducted a nested case-control study of the impact of rural compared to urban residence as well as rural/urban migration patterns in relation to hospitalization for non-work injury. We postulate that for many types of non-work injuries, rates will be higher in rural communities than in urban ones and that rates will also be higher for workers who migrate from urban to rural communities. Methods Using conditional logistic regression, univariate models were first run with each of five non-work injury outcomes. These outcomes were hospitalizations due to assault, accidental poisoning, medical mis-adventure, motor vehicle trauma, and other non-work injuries. In multivariate models marital status, ethnicity, duration of employment, and occupation were forced into the model and associations with urban, compared to rural, residence and various urban/migration patterns were tested. Results Urban or rural residence and migration status from urban to other communities, and across rural communities, were not associated with hospitalization for medical misadventure, assault, or accidental poisoning. The likelihood of a rural resident being hospitalized for motor vehicle trauma is higher than for an urban resident. The likelihood that a rural resident is hospitalized for "other" non-work injury is higher than for an urban resident. Conclusion In a relatively homogenous group of workers, and using a rigorous study design, we have demonstrated that the odds of other non-work injury are much higher for workers resident in and migrating to rural regions of Canada than they are for workers resident in or migrating to urban places.

  17. The role of performing life support courses in rural areas in improving pre-hospital physiologic conditions of patients with penetrating injuries. (United States)

    Nia, Masoud Saghafi; Naffisi, Nahid; Mohebbi, Hassan Ali; Moharamzadeh, Yashar


    To evaluate the impact of animal model based medical training courses for village healthcare workers on prehospital physiologic condition and prognosis of patients with penetrating injuries. Experimental study. This study was carried out in Mehran city and its neighbouring rural districts in western part of Iran from 2002 to 2004. Seventy-six village healthcare workers were trained and equipped to deliver in-field medical first cares. First group (226 patients) consisted of those who received this cares by the trained group and second group (245 patients) were those who received no in-field cares and were transported directly to the trauma center in provincial capital, Ilam. Physiologic Severity Score (PSS) was calculated to determine the physiologic condition of patients in both groups. The most prevalent cause of trauma in both groups was car accidents (61.6%). Controlling of hemorrhage was the most frequent provided initial medical care (40.6%). A significant improvement regarding the PSS score was observed in the first group of patients compared to the second group (7.505 vs. 6.799, 95% CI for difference: 0.3 to 0.9). The mortality rates of the first and second group of patients were 3% and 7.3%, respectively (p=0.051). Performing life support courses in rural areas of low-income countries where there is no pre-hospital triage and emergency medical system and provision of classic resuscitative measures are limited, has a significant impact on improvement of pre-hospital physiologic condition and prognosis of patients with penetrating injuries.

  18. Pediatric Mortality in a Rural Tertiary Care Center in Liberia

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    Carmelle Tsai


    Full Text Available Liberia is a low‐income country in West Africa that has faced significant challenges, including a civil war and the recent Ebola epidemic. Little data exists on the more current post‐war and pre‐Ebola trends of child health in Liberia in the rural setting. This study is a retrospective chart review of pediatric mortality in 2013 at a rural tertiary care center in Liberia, 10 years post‐war. From January 2013 to December 2013, there were 50 pediatric deaths, or 5.4% of the 920 total pediatric admissions. The most common cause of neonatal death was sepsis, and the most common cause of death under five years of age was malaria. The majority (82.0% of the deaths were in children under five. Pediatric mortality at this hospital was similar to other reported mortality six years post‐war, and lower than that reported immediately post‐war. Neonatal sepsis and malaria are two significant causes of pediatric mortality in this community and, therefore, further efforts to decrease childhood mortality should focus on these causes.

  19. Predictors of loss to follow-up among patients on ART at a rural hospital in KwaZulu-Natal, South Africa. (United States)

    Arnesen, Rachel; Moll, Anthony P; Shenoi, Sheela V


    Improved HIV outcomes as a result of expanded antiretroviral therapy (ART) access is threatened by increasing rates of loss to follow up (LTFU) among those on ART, largely reported in urban populations. Some reports suggest that LTFU rates are overestimated due to patient movement to other facilities and inadequate medical records. To define the proportion disengaging from HIV care as well as the characteristics of those LTFU in order to design and implement appropriate interventions to increase retention. We performed a retrospective review of patients who discontinued ART at a central hospital ART clinic in rural South Africa and compared with patients receiving care at the 15 primary health clinics (PHCs) to determine the true proportion of those who were LTFU. We also compared those who discontinued ART with those who did not at the central hospital ART clinic to determine predictors of loss to follow up. Among 3242 patients on ART, 820 were originally marked as LTFU. Among all patients, 272 (8.4%) were found at a clinic on treatment, 56 (1.7%) were found at a clinic from which they had since discontinued treatment, and 10 (0.3%) returned to care between June and July 2016, leaving 475 (14.7%) unaccounted for and thus categorized as 'true' LTFU. Factors found to be associated with discontinuation include being male, age 18-35, having a CD4 count under 200 cells/μL, and being on ART for under six months. Young men with low CD4 counts early after ART initiation are at highest risk of ART disengagement in this rural South African HIV clinic. Novel interventions targeting this group are needed to improve retention in care.

  20. Comparison of domestic violence against women in urban versus rural areas of southeast Nigeria

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    Ajah LO


    Full Text Available Leonard Ogbonna Ajah,1,2 Chukwuemeka Anthony Iyoke,1 Peter Onubiwe Nkwo,1 Boniface Nwakoby,3 Paul Ezeonu2 1Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria; 2Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria; 3Department of Community Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria Background: The perception and prevalence of domestic violence (DV in rural areas is poorly understood; the result is that most efforts at eradicating this harmful practice are concentrated in urban areas. The objective of the study was to compare the burden and perception of DV among women living in rural and urban Igbo communities of southeast Nigeria. Methods: This was a comparative, cross-sectional study of women residing in rural and urban communities in Enugu, Nigeria, who had gathered for an annual religious meeting from August 1–7, 2011. Data analysis involved descriptive and inferential statistics and was conducted with the Statistical Package for Social Sciences, software version 17.0, at a 95% level of confidence. Results: A total of 836 women who met the eligibility criteria participated in the survey. Of these, 376 were from Okpanku, a rural community, while 460 were from Ogui Nike, an urban community. The prevalence of DV among rural women was significantly higher than that among urban women (97% versus 81%, P<0.001. In particular, the prevalence of physical violence was significantly higher among rural women than among urban women (37.2% versus 23.5%; P=0.05. In contrast, rural and urban women did not differ significantly in the proportions that had experienced psychological or sexual violence. The proportion of women who believed that DV was excusable was significantly higher among rural dwellers than among urban dwellers (58.5% versus 29.6%; P=0.03. Conclusion: The burden of DV against women may be higher in rural

  1. Secular trends of blood isolates in patients from a rural area population hospitalized in a tertiary center in a small city in Greece

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    Holevas Pierros V


    Full Text Available Abstract Background Most of the studies evaluating the secular trends of blood isolates come from tertiary hospitals in urban areas. We sought to study the trends of the antimicrobial resistance of blood isolates in patients from a rural population hospitalized in a tertiary hospital in a small city in Greece. Methods We retrospectively collected and analysed data for the first positive blood culture obtained for each admission for each patient hospitalized in General Hospital of Tripolis, Tripolis, Peloponnesus, Greece during a 5 year period (16/05/2000 – 15/05/2005. Results Sixty-seven thousand and seventy patients were hospitalized during the study period from whom 3,206 blood cultures were obtained. A higher increase of the number of obtained blood cultures than the number of admissions was noted during the study period (p Escherichia coli (29%, and Staphylococcus aureus (18.2% were the most commonly isolated pathogens. Among the Staphylococcus aureus isolates, the proportion of methicillin-resistant Staphylococcus aureus (MRSA was 17.2% (5/29. The proportion of Escherichia coli resistant to trimethoprim and sulfamethoxazole, ampicillin and cefuroxime was 29.6% (32/108, 25.0% (27/108, and 8.3% (9/108 respectively. Imipenem-resistance was noted in 3.4% (1/29 of Pseudomonas aeruginosa isolates. There were only 6 (1.6% Acinetobacter baummanii blood isolates during the study period. Conclusion The antimicrobial resistance of isolates from patients receiving care at the studied tertiary hospital in a small city in Greece is considerably less compared to that noted in tertiary hospitals in larger cities of the country.

  2. 25 años de estudios rurales 25 years of rural studies

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    José Bengoa


    almost only to the analysis of the history of ideas - an indication of the aforesaid displacement. In reviewing literature one faces outmoded-sounding debates, with no current importance and sometimes even pointless. Besides, the inertia of current studies points to the lack of renovation and the absence of new approaches. That is why critique has to be exercised. This article assays the hypothesis that in this period the rural issue as well as the rural society have lost their autonomy and there emerges - or there should emerge - a new approach towards those subjects in order to understand the meaning that "rural" still has and will have in our societies. The rural issue is still relevant and it will be increasingly relevant, but perhaps not as a production system or a distinct society, but rather as a symbolic identitarian source and force to societies that are heading to a speedy process of globalization, anchoring them in their cultural profundities. It will probably refer to sociability relations, systems of belonging, an essence of basic relations, perhaps the only one to provide meaning in face of collective globalized action.

  3. The incidence, aetiology and outcome of acute seizures in children admitted to a rural Kenyan district hospital

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    Maitland Kathryn


    Full Text Available Abstract Background Acute seizures are a common cause of paediatric admissions to hospitals in resource poor countries and a risk factor for neurological and cognitive impairment and epilepsy. We determined the incidence, aetiological factors and the immediate outcome of seizures in a rural malaria endemic area in coastal Kenya. Methods We recruited all children with and without seizures, aged 0–13 years and admitted to Kilifi District hospital over 2 years from 1st December 2004 to 30th November 2006. Only incident admissions from a defined area were included. Patients with epilepsy were excluded. The population denominator, the number of children in the community on 30th November 2005 (study midpoint, was modelled from a census data. Results Seizures were reported in 900/4,921(18.3% incident admissions and at least 98 had status epilepticus. The incidence of acute seizures in children 0–13 years was 425 (95%CI 386, 466 per 100,000/year and was 879 (95%CI 795, 968 per 100,000/year in children Conclusion There is a high incidence of acute seizures in children living in this malaria endemic area of Kenya. The most important causes are diseases that are preventable with available public health programs.

  4. Physician Assistants and Nurse Practitioners in Rural Washington Emergency Departments. (United States)

    Nelson, Scott C; Hooker, Roderick S


    One role of physician assistants (PAs) and nurse practitioners (NPs) is to meet the growing demand for access to rural health care. Critical Access Hospitals, those with less than 25 beds, are usually located in rural communities, often providing continuity of care that clinics cannot deliver. Because little is known about staffing in these small hospital emergency departments, an exploratory study was undertaken using a mixed-methods approach. In Washington State, 18 of the 39 Critical Access Hospitals staff their emergency departments with PAs and NPs. Utilization data were collected through structured interviews by phone or in person on site. Most PAs and NPs lived within the community and staffing tended to be either 24 hours in-house or short notice if they lived or worked nearby. Emergency department visits ranged from 200 to 25,000 per year. All sites were designated level V or IV trauma centers and often managed cardiac events, significant injuries and, in some larger settings, obstetrics. In most instances, PAs were the sole providers in the emergency departments, albeit with physician backup and emergency medical technician support if a surge of emergency cases arose. Two-thirds of the PAs had graduated within the last 5 years. Most preferred the autonomy of the emergency department role and all expressed job satisfaction. Geographically, the more remote a Washington State Critical Access Hospital is, the more likely it will be staffed by PAs/NPs. The diverse utilization of semiautonomous PAs and NPs and their rise in rural hospital employment is a new workforce observation that requires broader investigation.

  5. Malaria deaths in a rural hospital

    African Journals Online (AJOL)

    An audit of all malaria deaths that occurred at Manguzi Hospital between 1 October 1998 to 30 September 1999 was performed. There were 41 deaths from malaria in this time period, which was many more than for the previous three years. The most common causes of death were cerebral malaria, pulmonary oedema, ...


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    A. S. Voshev


    Full Text Available Conditions for production activity vary considerably from region to region, from area to area, from settlement to settlement. In this connection, investors are challenged to choose an optimum site for a new enterprise. To make the decision, investors follow such references as: investment potential and risk level; their interrelation determines investment appeal of a country, region, area, city or rural settlement. At present Russia faces a problem of «black boxes» represented by a lot of rural settlements. No effective and suitable techniques of quantitative estimation of investment potential, rural settlement risks and systems to make the given information accessible for potential investors exist until now.

  7. Tobacco smoke exposure and impact of smoking legislation on rural and non-rural hospitality venues in North Dakota. (United States)

    Buettner-Schmidt, Kelly; Lobo, Marie L; Travers, Mark J; Boursaw, Blake


    The purpose of this cross-sectional study in a stratified random sample of 135 bars and restaurants in North Dakota was to describe factors that influenced tobacco smoke pollution levels in the venues; to compare the quantity of tobacco smoke pollution by rurality and by presence of local ordinances; and to assess compliance with state and local laws. In data collection in 2012, we measured the indoor air quality indicator of particulate matter (2.5 microns aerodynamic diameter or smaller), calculated average smoking density and occupant density, and determined compliance with state and local smoking ordinances using observational methods. As rurality increased, tobacco smoke pollution in bars increased. A significant association was found between stringency of local laws and level of tobacco smoke pollution, but the strength of the association varied by venue type. Compliance was significantly lower in venues in communities without local ordinances. Controlling for venue type, 69.2% of smoke-free policy's impact on tobacco smoke pollution levels was mediated by observed smoking. This study advances scientific knowledge on the factors influencing tobacco smoke pollution and informs public health advocates and decision makers on policy needs, especially in rural areas. © 2015 Wiley Periodicals, Inc.

  8. Work of female rural doctors. (United States)

    Wainer, Jo


    To identify the impact of family life on the ways women practice rural medicine and the changes needed to attract women to rural practice. Census of women rural doctors in Victoria in 2000, using a self-completed postal survey. General and specialist practice. Two hundred and seventy-one female general practitioners and 31 female specialists practising in Rural, Remote and Metropolitan Area Classifications 3-7. General practitioners are those doctors with a primary medical degree and without additional specialist qualifications. Interaction of hours and type of work with family responsibilities. Generalist and specialist women rural doctors carry the main responsibility for family care. This is reflected in the number of hours they work in clinical and non-clinical professional practice, availability for on-call and hospital work, and preference for the responsibilities of practice partnership or the flexibility of salaried positions. Most of the doctors had established a satisfactory balance between work and family responsibilities, although a substantial number were overworked in order to provide an income for their families or meet the needs of their communities. Thirty-six percent of female rural general practitioners and 56% of female rural specialists preferred to work fewer hours. Female general practitioners with responsibility for children were more than twice as likely as female general practitioners without children to be in a salaried position and less likely to be a practice partner. The changes needed to attract and retain women in rural practice include a place for everyone in the doctor's family, flexible practice structures, mentoring by women doctors and financial and personal recognition. Women make up less than a quarter of the rural general practice workforce and an even smaller percentage of the specialist rural medical workforce. As a result their experiences are not well articulated in research on rural medical practice and their needs are

  9. Risk factors for death among children less than 5 years old hospitalized with diarrhea in rural western Kenya, 2005-2007: a cohort study.

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    Ciara E O'Reilly

    Full Text Available BACKGROUND: Diarrhea is a leading cause of childhood morbidity and mortality in sub-Saharan Africa. Data on risk factors for mortality are limited. We conducted hospital-based surveillance to characterize the etiology of diarrhea and identify risk factors for death among children hospitalized with diarrhea in rural western Kenya. METHODS AND FINDINGS: We enrolled all children <5 years old, hospitalized with diarrhea (≥3 loose stools in 24 hours at two district hospitals in Nyanza Province, western Kenya. Clinical and demographic information was collected. Stool specimens were tested for bacterial and viral pathogens. Bivariate and multivariable logistic regression analyses were carried out to identify risk factors for death. From May 23, 2005 to May 22, 2007, 1,146 children <5 years old were enrolled; 107 (9% children died during hospitalization. Nontyphoidal Salmonella were identified in 10% (118, Campylobacter in 5% (57, and Shigella in 4% (42 of 1,137 stool samples; rotavirus was detected in 19% (196 of 1,021 stool samples. Among stools from children who died, nontyphoidal Salmonella were detected in 22%, Shigella in 11%, rotavirus in 9%, Campylobacter in 5%, and S. Typhi in <1%. In multivariable analysis, infants who died were more likely to have nontyphoidal Salmonella (adjusted odds ratio [aOR] = 6·8; 95% CI 3·1-14·9, and children <5 years to have Shigella (aOR = 5·5; 95% CI 2·2-14·0 identified than children who survived. Children who died were less likely to be infected with rotavirus (OR = 0·4; 95% CI 0·2-0·8. Further risk factors for death included being malnourished (aOR = 4·2; 95% CI 2·1-8·7; having oral thrush on physical exam (aOR = 2·3; 95% CI 1·4-3·8; having previously sought care at a hospital for the illness (aOR = 2·2; 95% CI 1·2-3·8; and being dehydrated as diagnosed at discharge/death (aOR = 2·5; 95% CI 1·5-4·1. A clinical diagnosis of malaria, and malaria parasites seen on

  10. Rural-Urban Disparities in Child Abuse Management Resources in the Emergency Department (United States)

    Choo, Esther K.; Spiro, David M.; Lowe, Robert A.; Newgard, Craig D.; Hall, Michael Kennedy; McConnell, Kenneth John


    Purpose: To characterize differences in child abuse management resources between urban and rural emergency departments (EDs). Methods: We surveyed ED directors and nurse managers at hospitals in Oregon to gain information about available abuse-related resources. Chi-square analysis was used to test differences between urban and rural EDs.…

  11. Poor long-term outcomes for cryptococcal meningitis in rural South ...

    African Journals Online (AJOL)

    Objectives. To explore linkage to and retention in HIV care after an episode of cryptococcal meningitis (CM) in rural South Africa. Design. A retrospective case series of adult individuals (≥16 years old) with laboratory-confirmed CM from January - December 2007 at Hlabisa Hospital – a district hospital in northern KwaZulu- ...

  12. RN work engagement in generational cohorts: the view from rural US hospitals. (United States)

    Sullivan Havens, Donna; Warshawsky, Nora E; Vasey, Joseph


    To describe staff nurse work engagement, identify predictors by generational cohort, present implications for nurse managers and suggest future research. A global nurse shortage looms. While an adequate supply of nurses is needed to ensure access to care, access to quality care may be enhanced by an adequate supply of highly engaged nurses-those who are dedicated, energized, and absorbed. Nurses have long reported the presence of energy depleting practice environments. Nurses practicing in professional practice environments may be more engaged. A non-experimental survey design was executed. Direct care Registered Nurses (n = 747) working in five rural acute care hospitals completed questionnaires to assess work engagement (Utrecht Work Engagement Scale-9), decisional involvement (Decisional Involvement Scale), relational coordination (Relational Coordination Survey) and the nursing practice environment (Practice Environment Scale of the Nursing Work Index). Descriptive, correlational and regression analyses examined work engagement and predictors by generational cohort. With the exception of the absorption component, no statistically significant differences in engagement emerged across generational cohorts. Predictors of engagement differed by cohort, however across all cohorts, professional nursing practice environments predicted nurse work engagement. Professional nursing practice environments are significantly associated with nurse work engagement. Enhancing nurse work engagement is a complex challenge. Generational cohorts may respond to different strategies to enhance engagement. © 2013 John Wiley & Sons Ltd.

  13. Decentralization and Participatory Rural Development: A Literature Review

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    Muhammad Shakil Ahmad


    Full Text Available Most of the developing nations are still struggling for efficient use of their resources. In order to overcome physical and administrative constraints of the development, it is necessary to transfer the power from the central government to local authorities. Distribution of power from improves the management of resources and community participation which is considered key to sustainable development. Advocates of decentralization argue that decentralized government is source to improve community participation in rural development. Decentralized government is considered more responsive towards local needs and development of poor peoples. There are many obstacles to expand the citizen participation in rural areas. There are many approaches for participatory development but all have to face the same challenges. Current paper highlights the literature about Decentralization and participatory rural development. Concept and modalities of Decentralization, dimensions of participation, types of rural participation and obstacles to participation are also the part of this paper.

  14. Knowledge of obstetric fistula prevention amongst young women in urban and rural Burkina Faso: a cross-sectional study.

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    Aduragbemi O Banke-Thomas

    Full Text Available Obstetric fistula is a sequela of complicated labour, which, if untreated, leaves women handicapped and socially excluded. In Burkina Faso, incidence of obstetric fistula is 6/10,000 cases amongst gynaecological patients, with more patients affected in rural areas. This study aims to evaluate knowledge on obstetric fistula among young women in a health district of Burkina Faso, comparing rural and urban communities. This cross-sectional study employed multi-stage sampling to include 121 women aged 18-20 years residing in urban and rural communities of Boromo health district. Descriptive statistics and multiple logistic regression analysis were used to compare differences between the groups and to identify predictors of observed knowledge levels. Rural women were more likely to be married (p<0.000 and had higher propensity to teenage pregnancy (p=0.006. The survey showed overall poor obstetric fistula awareness (36%. Rural residents were less likely to have adequate preventive knowledge than urban residents [OR=0.35 (95%-CI, 0.16-0.79]. This effect was only slightly explained by lack of education [OR=0.41 (95%-CI, 0.18-0.93] and only slightly underestimated due to previous pregnancy [OR=0.27 (95%-CI, 0.09-0.79]. Media were the most popular source of awareness amongst urban young women in contrast to their rural counterparts (68% vs. 23%. Most rural young women became 'aware' through word-of-mouth (68% vs. 14%. All participants agreed that the hospital was safer for emergency obstetric care, but only 11.0% believed they could face pregnancy complications that would require emergency treatment. There is urgent need to increase emphasis on neglected health messages such as the risks of obstetric fistula. In this respect, obstetric fistula prevention programs need to be adapted to local contexts, whether urban or rural, and multi-sectoral efforts need to be exerted to maximise use of other sectoral resources and platforms, including existing routine

  15. Leading Change for the Implementation of Common Core State Standards in Rural School Districts (United States)

    Lopez, Paul; Wise, Donald


    Rural school districts across the nation, with their limited resources, face daunting challenges posed by the implementation of the Common Core State Standards. This article presents a recent study of 13 rural school districts in the Central Valley of California and how these districts are responding to those challenges. A total of 352 teachers…

  16. Resilience in Rural Community-Dwelling Older Adults (United States)

    Wells, Margaret


    Context: Identifying ways to meet the health care needs of older adults is important because their numbers are increasing and they often have more health care issues. High resilience level may be one factor that helps older adults adjust to the hardships associated with aging. Rural community-dwelling older adults often face unique challenges such…

  17. Urban and rural implementation of pre-hospital diagnosis and direct referral for primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction

    DEFF Research Database (Denmark)

    Sørensen, Jacob Thorsted; Terkelsen, Christian Juhl; Nørgaard, Bjarne Linde


    Primary percutaneous coronary intervention (PCI) is the preferred treatment for ST-elevation myocardial infarction (STEMI). The distance to primary PCI centres and the inherent time delay in delivering primary PCI, however, limit widespread use of this treatment. This study aimed to evaluate...... the impact of pre-hospital diagnosis on time from emergency medical services contact to balloon inflation (system delay) in an unselected cohort of patients with STEMI recruited from a large geographical area comprising both urban and rural districts....

  18. Hospital capacity and management preparedness for pandemic influenza in Victoria. (United States)

    Dewar, Ben; Barr, Ian; Robinson, Priscilla


    This study was designed to investigate acute hospital pandemic influenza preparedness in Victoria, Australia, particularly focussing on planning and management efforts. A prospective study was conducted by questionnaire and semi-structured interview of health managers across the Victorian hospital system from July to October 2011. Participants with responsibility for emergency management, planning and operations were selected from every hospital in Victoria with an emergency department to complete a questionnaire (response rate 22/43 = 51%). Each respondent was invited to participate in a phone-based semi-structured interview (response rate 11/22 = 50%). Rural/regional hospitals demonstrated higher levels of clinical (86%) and non-clinical (86%) staff contingency planning than metropolitan hospitals (60% and 40% respectively). Pandemic plans were not being sufficiently tested in exercises or drills, which is likely to undermine their effectiveness. All respondents reported hand hygiene and standard precautions programs in place, although only one-third (33%) of metropolitan respondents and no rural/regional respondents reported being able to meet patient needs with high levels of staff absenteeism. Almost half Victoria's healthcare workers were unvaccinated against influenza. Hospitals across Victoria demonstrated different levels of influenza pandemic preparedness and planning. If a more severe influenza pandemic than that of 2009 arose, Victorian hospitals would struggle with workforce and infrastructure problems, particularly in rural/regional areas. Staff absenteeism threatens to undermine hospital pandemic responses. Various strategies, including education and communication, should be included with in-service training to provide staff with confidence in their ability to work safely during a future pandemic. © 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia.

  19. Population dynamics of rural Ethiopia. (United States)

    Bariabagar, H


    2 rounds of the national sample surveys, conducted by the central statistical office of Ethiopia during 1964-1967 and 1969-1971, provide the only comprehensive demographic data for the country and are the basis for this discussion of rural Ethiopia's population dynamics. The population of Ethiopia is predominantly rural. Agglomerations of 2000 and over inhabitants constitute about 14% of the population, and this indicates that Ethiopia has a low level of urbanization. In rural Ethiopia, international migration was negligent in the 1970's and the age structure can be assumed to be the results of past trends of fertility and mortality conditions. The reported crude birthrate (38.2), crude death rate (12.3) and infant mortality rate (90) of rural Ethiopia fall short of the averages for African countries. Prospects of population growth of rural Ethiopia would be immense. At the rate of natural increase of between 2.4 and 3.0% per annum, the population would double in 24-29 years. Regarding population issues, the programs of the National Democratic Revolution of Ethiopia faces the following main challenging problems: 1) carrying out national population censuses in order to obtain basic information for socialist planning; 2) minimizing or curtailing the existing high urban growth rates; 3) reducing rapidly growing population; and 5) mobilizing Ethiopian women to participate in the social, economic and political life of the country in order to create favorable conditions for future fertility reduction.

  20. Cultural Norms in Conflict: Breastfeeding Among Hispanic Immigrants in Rural Washington State. (United States)

    Hohl, Sarah; Thompson, Beti; Escareño, Monica; Duggan, Catherine


    Objectives To examine perceptions, experiences, and attitudes towards breastfeeding among Hispanic women living in rural Washington State. Methods Twenty parous Hispanic women of low acculturation, aged 25-48 years and residents in rural Washington State participated in an exploratory, face-to-face interview. Interviews were audio-recorded, translated and transcribed, and analyzed using a thematic content analysis approach. Results Nine emergent themes were grouped into three overarching categories: (1) Breast is best; (2) Hispanic cultural and familial expectations to breastfeed; and (3) Adapting to life in the United States: cultural norms in conflict. Women said they were motivated to breastfeed because of their knowledge and observations of its health benefits for mother and child. They said breastfeeding is ingrained in their Hispanic cultural heritage, and infant feeding choices of female family members were particularly influential in women's own decision to breastfeed. Women said they experienced embarrassment about breastfeeding in the United States and as a result, often chose to initiate formula feeding as a complement so as to avoid feelings of shame. Additionally, they faced economic pressure to work, key barriers for continued breastfeeding among Hispanics in the United States. Conclusions for Practice Knowledge of the benefits of breastfeeding for mother and child and longstanding cultural practices of breastfeeding are not enough to encourage exclusive breastfeeding to 6 months among this rural Hispanic population. Continued support through family-level interventions as well as work place policies that encourage breastfeeding are needed for rural Hispanics to reach optimal breastfeeding rates.

  1. Occurrence and location of Transmissible Venereal Tumors in Dogs seen at the Universidade Federal Rural do Rio de Janeiro Veterinary Hospital: Oncology Sector between 2010 and 2014.

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    Dayane Caicó Collares Araujo


    Full Text Available ABSTRACT. Araujo D.C.C., Antonioli T., Costa T.S., de Carvalho J.R.G., Laguna A.G.V., Ramadinha R.H.R. & Fernandes J.I. Occurrence and location of Transmissible Venereal Tumors in Dogs seen at the Universidade Federal Rural do Rio de Janeiro Veterinary Hospital: Oncology Sector between 2010 and 2014. [Ocorrência e localização do Tumor Venéreo Transmissível em cães atendidos entre 2010 e 2014 no Setor de Oncologia do Hospital Veterinário da Universidade Federal Rural do Rio de Janeiro, Brasil.] Revista Brasileira de Medicina Veterinária, 38(3:277-280, 2016. Programa de Residência em Medicina Veterinária, Instituto de Veterinária, Universidade Federal Rural do Rio de Janeiro, BR-465, Km 7, Seropédica, RJ 23851-970, Brasil. E-mail: The Transmissible Venereal Tumor (TVT is a round cell neoplasm mostly affecting the genital of dogs. They can affect both sexes, and most animals are sexually active. Metastases, which occur in less than 5% of cases, occur through lymphatic or hematogenous. Diagnosis can be made by cytology and the most effective treatment is chemotherapy with vincristine sulfate. This study reports the occurrence of TVT from January 2010 to December 2014 in the UFRRJ Veterinary Hospital at the Oncology sector; clinical records were reviewed: 1,522 animals were seen and 123 (8.08% presented TVT. Of 123 animals afflicted, 71.54% were adults, 23.57% were senior and 4.87% had less than a year. A higher frequency of females (74 was observed, when compared to males (49. A higher incidence in mutts (78.05% was found, followed by poodles (7.32%, pinscher and Labrador (3.25%. Genital location was most common (79.04%, followed by a genito-cutaneous presentation (8.94%, nasal (5.69%, cutaneous (5.69% and ocular (0.81%. It can be linked with large quantities of stray dogs and poor animal control policies in the region.

  2. Premises and Challenges of Entrepreneurship in Romanian Rural Areas

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    Raluca IGNAT


    Full Text Available The rural inhabitants need to face and survive structural changes in rural economy and, thus, to become more market oriented. Traditions and old skills were somehow lost and new activities were approached. In order to reach them, public policy intervened and supported several types of activities. The public authorities demand Romanian inhabitants from rural areas to be truly competitive in a fully shacked economy. Therefore, the research question is: what are the premises and challenges that Romanian inhabitants from rural areas confront to? Entrepreneurial skills of Romanians in rural areas are a matter of national interest. The problem of entrepreneurships has, at least, two meanings in the present paper: the premises and challenges of the free manifestation of private initiative and the importance of this manifestation for national economy. The approach is pragmatic, for public policy. The main objectives of the research are: to identify the premises and challenges of the entrepreneurship in Romanian rural areas and to elaborate relevant solution for public policy in order to conduct to robust rural economy as a result of entrepreneurial expression. Therefore, next financial plan of the Romanian national Rural Development Programme 2014-2020 needs to take into consideration the premises and challenges of entrepreneurship, as this is the only pertinent solution for added value creation in rural economy. And the strategic approach is to define the future profile of Romanian rural inhabitant.

  3. Attracting and retaining health workers in rural areas: investigating nurses’ views on rural posts and policy interventions

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    Goodman Catherine


    Full Text Available Abstract Background Kenya has bold plans for scaling up priority interventions nationwide, but faces major human resource challenges, with a lack of skilled workers especially in the most disadvantaged rural areas. Methods We investigated reasons for poor recruitment and retention in rural areas and potential policy interventions through quantitative and qualitative data collection with nursing trainees. We interviewed 345 trainees from four purposively selected Medical Training Colleges (MTCs (166 pre-service and 179 upgrading trainees with prior work experience. Each interviewee completed a self-administered questionnaire including likert scale responses to statements about rural areas and interventions, and focus group discussions (FGDs were conducted at each MTC. Results Likert scale responses indicated mixed perceptions of both living and working in rural areas, with a range of positive, negative and indifferent views expressed on average across different statements. The analysis showed that attitudes to working in rural areas were significantly positively affected by being older, but negatively affected by being an upgrading student. Attitudes to living in rural areas were significantly positively affected by being a student at the MTC furthest from Nairobi. During FGDs trainees raised both positive and negative aspects of rural life. Positive aspects included lower costs of living and more autonomy at work. Negative issues included poor infrastructure, inadequate education facilities and opportunities, higher workloads, and inadequate supplies and supervision. Particular concern was expressed about working in communities dominated by other tribes, reflecting Kenya’s recent election-related violence. Quantitative and qualitative data indicated that students believed several strategies could improve rural recruitment and retention, with particular emphasis on substantial rural allowances and the ability to choose their rural location

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

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    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.

  5. Analysis of factors affecting rural people's attitudes towards rural tourism: the case of Doroodzan District of the Marvdasht County

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    Madineh Khosrowjerdi


    Full Text Available Although different governments place a lot of interest in developing rural tourism targets and a lot of budgets are spend in this respect, less attention is paid to study the attitudes of the host communities towards tourism.  Thus, the aim of this study was to analyze the factors that can affect the attitudes of rural people towards rural tourism in the Doroodzan District of the Marvdasht County. The research was conducted in 2015.  The survey research method was used for this purpose and data were collected using a pre-designed questionnaire. The research sample included 250 villagers that were selected using Kerjcie and Morgan Sampling Table and the Random Sampling Technique. The Face validity of the questionnaire was verified by the expert faculty members and the staff of the Rural Development Management Department of the Yasouj University, and its reliability was also verified by calculating Cronbach's Alpha reliability coefficient (from 0.61 to 0.86 that was obtained from a pilot study.  The results of the Path Analysis showed that value of tourism is the most effective factor for predicting the respondents' attitudes towards rural tourism. Next to that there are other variables such as income from tourism and observation that have had the most effect on the respondents' attitudes. Finally, it is recommended that the means of mass media such as local radio and television broadcast services prepare programs and campaigns about rural tourism and related topics in order to improve the attitudes of the rural people towards rural tourism.

  6. Once an Outsider, Always an Outsider? The Accessibility of the Dutch Rural Housing Market among Locals and Non-Locals (United States)

    de Groot, Carola; Daalhuizen, Femke B. C.; van Dam, Frank; Mulder, Clara H.


    One of the most pressing questions in the rural gentrification literature is whether rural residents face difficulties in finding a home within their locality due to the influx of more wealthy newcomers. In this paper, we investigate the extent to which intended local movers and intended non-local movers have realised their rural residential…

  7. Effects of competition on hospital quality: an examination using hospital administrative data. (United States)

    Palangkaraya, Alfons; Yong, Jongsay


    This paper investigates the effects of competition on hospital quality using hospital administration data from the State of Victoria, Australia. Hospital quality is measured by 30-day mortality rates and 30-day unplanned readmission rates. Competition is measured by Herfindahl-Hirschman index and the numbers of competing public and private hospitals. The paper finds that hospitals facing higher competition have lower unplanned admission rates. However, competition is related negatively to hospital quality when measured by mortality, albeit the effects are weak and barely statistically significant. The paper also finds that the positive effect of competition on quality as measured by unplanned readmission differs greatly depending on whether the hospital is publicly or privately owned.

  8. Responding to rural health disparities in the United States

    Directory of Open Access Journals (Sweden)

    Ian Jones


    Full Text Available The paper focuses on the need to address territorial inequalities in American healthcare services. It shows how much the situation has become critical in the United States. It discusses to what extent telemedicine is a sustainable option to reduce the negative consequences of the economic, professional and physical barriers to care in rural areas. As far as healthcare is concerned, rural and urban environments in the United States do not have to face the same barriers and challenges. The article first details what specific health issues have to be dealt with in rural areas. The case of emergency care in Vermont is then developed to illustrate what could be the benefits of using ICTs to improve access to care.

  9. A cluster randomised trial to assess the impact of clinical pathways on AMI management in rural Australian emergency departments

    Directory of Open Access Journals (Sweden)

    Snow Pamela C


    Full Text Available Abstract Background People living in rural Australia are more likely to die in hospital following an acute myocardial infarction than those living in major cities. While several factors, including time taken to access hospital care, contribute to this risk, it is also partially attributable to the lower uptake of evidence-based guidelines for the administration of thrombolytic drugs in rural emergency departments where up to one-third of eligible patients do not receive this life-saving intervention. Clinical pathways have the potential to link evidence to practice by integrating guidelines into local systems, but their impact has been hampered by variable implementation strategies and sub-optimal research designs. The purpose of this study is to determine the impact of a five-step clinical pathways implementation process on the timely and efficient administration of thrombolytic drugs for acute myocardial infarctions managed in rural Australian emergency departments. Methods/Design The design is a two-arm, cluster-randomised trial with rural hospital emergency departments that treat and do not routinely transfer acute myocardial infarction patients. Six rural hospitals in the state of Victoria will participate, with three in the intervention group and three in the control group. Intervention hospitals will participate in a five-step clinical pathway implementation process: engagement of clinicians, pathway development according to local resources and systems, reminders, education, and audit and feedback. Hospitals in the control group will each receive a hard copy of Australian national guidelines for chest pain and acute myocardial infarction management. Each group will include 90 cases to give a power of 80% at 5% significance level for the two primary outcome measures: proportion of those eligible for thrombolysis receiving the drug and time to delivery of thrombolytic drug. Discussion Improved compliance with thrombolytic guidelines via

  10. Technology survey on video face tracking (United States)

    Zhang, Tong; Gomes, Herman Martins


    With the pervasiveness of monitoring cameras installed in public areas, schools, hospitals, work places and homes, video analytics technologies for interpreting these video contents are becoming increasingly relevant to people's lives. Among such technologies, human face detection and tracking (and face identification in many cases) are particularly useful in various application scenarios. While plenty of research has been conducted on face tracking and many promising approaches have been proposed, there are still significant challenges in recognizing and tracking people in videos with uncontrolled capturing conditions, largely due to pose and illumination variations, as well as occlusions and cluttered background. It is especially complex to track and identify multiple people simultaneously in real time due to the large amount of computation involved. In this paper, we present a survey on literature and software that are published or developed during recent years on the face tracking topic. The survey covers the following topics: 1) mainstream and state-of-the-art face tracking methods, including features used to model the targets and metrics used for tracking; 2) face identification and face clustering from face sequences; and 3) software packages or demonstrations that are available for algorithm development or trial. A number of publically available databases for face tracking are also introduced.

  11. Sustainable Energy Solutions for Rural Alaska

    Energy Technology Data Exchange (ETDEWEB)

    Allen, Riley [Regulatory Assistance Project, Montpelier, VT (United States); Brutkoski, Donna [Regulatory Assistance Project, Montpelier, VT (United States); Farnsworth, David [Regulatory Assistance Project, Montpelier, VT (United States); Larsen, Peter [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)


    The state of Alaska recognizes the challenges these rural communities face and provides financial support via the Power Cost Equalization (PCE) program. The PCE subsidizes the electricity prices paid by customers of these high-cost utilities. The PCE program is designed to spread the benefits of Alaska’s natural resources more evenly throughout the state. Yet even with this subsidy, electricity is still much more expensive for these rural customers. And beyond the PCE, other forms of assistance to rural utilities are becoming scarce given the state’s current fiscal environment. Nearly 90 percent of Alaska’s unrestricted budget funds in recent years have been tied to oil royalties—a sector experiencing significant declines in production and oil prices. Consequently, as Alaska looks to tighten budgets, the challenge of lowering rural utility costs, while encouraging self-sufficiency, has become more urgent.This study examines reliability, capital and strategic planning, management, workforce development, governance, financial performance and system efficiency in the various communities visited by the research team. Using those attributes, a tier system was developed to categorize rural Alaska utilities into Leading and Innovating Systems (Tier I), Advanced Diesel Systems (Tier II), Basic Systems (Tier III), and Underperforming Systems (Tier IV). The tier approach is not meant to label specific utilities, but rather to provide a general set of benchmarks and guideposts for improvement.

  12. High performance work systems and employee well-being: a two stage study of a rural Australian hospital. (United States)

    Young, Suzanne; Bartram, Timothy; Stanton, Pauline; Leggat, Sandra G


    This paper aims to explore the attitudes of managers and employees to high performance work practices (HPWS) in a medium sized rural Australian hospital. The study consists of two stages. Stage one involved a qualitative investigation consisting of interviews and focus group sessions with senior, middle and line management at the hospital. Bowen and Ostroffs framework was used to examine how strategic HRM was understood, interpreted and operationalised across the management hierarchy. Stage one investigates the views of managers concerning the implementation of strategic HRM/HPWS. Stage two consisted of a questionnaire administered to all hospital employees. The mediation effects of social identification on the relationship between high performance work systems and affective commitment and job satisfaction are examined. The purpose of stage two was to investigate the views and effects of SHRM/HPWS on employees. It should be noted that HPWS and strategic HRM are used inter-changeably in this paper. At the management level the importance of distinctiveness, consistency and consensus in the interpretation of strategic HRM/HPWS practices across the organization was discovered. Findings indicate that social identification mediates the relationship between HPWS and affective commitment and also mediates the relationship between HPWS and job satisfaction. High performance work systems may play a crucial role facilitating social identification at the unit level. Such practices and management support is likely to provide benefits in terms of high performing committed employees. The paper argues that team leaders and managers play a key role in building social identification within the team and that organizations need to understand this role and provide recognition, reward, education and support to their middle and lower managers.

  13. Interference with the clinical independence of doctors in hospitals faced with a shortage of resources: what should doctors do? (United States)

    McQuoid-Mason, D J


    In the face of interference with their clinical independence in hospitals with a shortage of resources, what should doctors do? The question can be answered by considering: (i) the constitutional right to healthcare and emergency treatment; (ii) the common-law position regarding unlawful homicide and the doctrine of 'superior orders'; (iii) the ethical rules of the Health Professions Council of South Africa; and (iv) whether there is any protection for doctors who refuse to carry out unprofessional, unethical or unlawful directives from their superiors. While this article focuses on the public sector, some of the legal principles, where relevant, apply equally to doctors in the private sector.

  14. Improving collected rainwater quality in rural communities. (United States)

    Garrido, S; Aviles, M; Ramirez, A; Gonzalez, A; Montellano, L; Gonzalez, B; de la Paz, J; Ramirez, R M


    The country of Mexico is facing serious problems with water quality and supply for human use and consumption in rural communities, mainly due to topographic and isolation. In Mexico the average annual precipitation is 1,500 cubic kilometers of water, if 3% of that amount were used, 13 million Mexicans could be supplied with drinking water that they currently do not have access. Considering the limited infrastructure and management in rural communities, which do not receive services from the centralized systems of large cities, a modified pilot multi-stage filtration (MMSF) system was designed, developed, and evaluated for treating collected rainwater in three rural communities, Ajuchitlan and Villa Nicolas Zapata (Morelos State) and Xacxamayo (Puebla State). The efficiencies obtained in the treatment system were: colour and turbidity >93%. It is worth mentioning that the water obtained for human use and consumption complies with the Mexican Standard NOM-127-SSA1-1994.

  15. Una escuela ¿Para qué idea de lo rural?

    Directory of Open Access Journals (Sweden)

    Nidia Yolive Vera-Angarita


    Full Text Available Starting from the assumption of a nonexistent rural school given that the current educational institution, which performs in that context, assumes an inappropriate vision of its reality which is identified by the possession of a set of economical and socio-cultural characteristics and defined as a form of existence both distinct and differentiable. This, therefore, brings forward the fact that rural schools need to adopt a rediscovery of the nature of the countryside realm as a basic condition for the elaboration of a suitable educational proposal able to cope with particularities, issues and expectations of the rural sphere, particularly, capable of facing the challenges that globalization processes set out to this form of existence.

  16. Community health workers in rural India: analysing the opportunities and challenges Accredited Social Health Activists (ASHAs) face in realising their multiple roles. (United States)

    Saprii, Lipekho; Richards, Esther; Kokho, Puni; Theobald, Sally


    Globally, there is increasing interest in community health worker's (CHW) performance; however, there are gaps in the evidence with respect to CHWs' role in community participation and empowerment. Accredited Social Health Activists (ASHAs), whose roles include social activism, are the key cadre in India's CHW programme which is designed to improve maternal and child health. In a diverse country like India, there is a need to understand how the ASHA programme operates in different underserved Indian contexts, such as rural Manipur. We undertook qualitative research to explore stakeholders' perceptions and experiences of the ASHA scheme in strengthening maternal health and uncover the opportunities and challenges ASHAs face in realising their multiple roles in rural Manipur, India. Data was collected through in-depth interviews (n = 18) and focus group discussions (n = 3 FGDs, 18 participants). Participants included ASHAs, key stakeholders and community members. They were purposively sampled based on remoteness of villages and primary health centres to capture diverse and relevant constituencies, as we believed experiences of ASHAs can be shaped by remoteness. Data were analysed using the thematic framework approach. Findings suggested that ASHAs are mostly understood as link workers. ASHA's ability to address the immediate needs of rural and marginalised communities meant that they were valued as service providers. The programme is perceived to be beneficial as it improves awareness and behaviour change towards maternal care. However, there are a number of challenges; the selection of ASHAs is influenced by power structures and poor community sensitisation of the ASHA programme presents a major risk to success and sustainability. The primary health centres which ASHAs link to are ill-equipped. Thus, ASHAs experience adverse consequences in their ability to inspire trust and credibility in the community. Small and irregular monetary incentives demotivate

  17. Improving mobility and transportation options for Michigan's rural seniors : research spotlight. (United States)


    Mobility challenges faced by older adults in : rural Michigan include long travel distances to obtain basic services or medical : care, and the limited availability of public, : private or volunteer transportation providers. Because of these challeng...

  18. Effects of telehealth by allied health professionals and nurses in rural and remote areas: A systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Renee Speyer


    Full Text Available Objective: To describe telehealth interventions delivered by allied health professionals and nurses in rural and remote areas, and to compare the effects of telehealth interventions with standard face-to-face interventions. Data sources: CINAHL, Embase, PsycINFO and PubMed databases were searched. The content of relevant journals and published articles were also searched. Study selection: Studies examining the effectiveness of allied health and nursing telehealth interventions for rural and remote populations were included in descriptive analyses. Studies comparing telehealth intervention with standard face-to-face interventions grouped by type of intervention approach were used to examine between-groups effect sizes. Data extraction: Methodological quality of studies was rated using the QualSyst critical appraisal tool and the National Health and Medical Research Council (NHMRC Evidence Hierarchy levels. Data synthesis: After quality ratings, 43 studies were included. A majority of studies had strong methodological quality. The disciplines of psychology and nursing were represented most frequently, as were studies using a cognitive intervention approach. Meta-analysis results slightly favoured telehealth interventions compared with face-to-face interventions, but did not show significant differences. Interventions using a combined physical and cognitive approach appeared to be more effective. Conclusion: Telehealth services may be as effective as face-to-face interventions, which is encouraging given the potential benefits of telehealth in rural and remote areas with regards to healthcare access and time and cost savings.

  19. The Balanced Budget Act of 1997 and U.S. hospital operations. (United States)

    Bazzoli, Gloria J; Lindrooth, Richard C; Hasnain-Wynia, Romana; Needleman, Jack

    The Balanced Budget Act (BBA) of 1997 initiated several changes to Medicare payment policy in an effort to slow the growth of hospital Medicare payments and ensure the future of the Medicare Hospital Insurance Trust Fund. Although subsequent federal legislation relaxed some original proposals, restored funds were limited and directed to specific types of hospitals. In addition, these Medicare policy changes came at a time when hospitals faced private sector payment constraints. This paper assesses the short-term effects of the BBA on operations of nonprofit hospitals in the United States and compares these effects to those observed in the early 1980s during implementation of the Medicare prospective payment system (PPS). We found that some operational changes instituted by hospitals facing financial pressures from the BBA were similar to those observed for hospitals that faced pressure from Medicare PPS, including efforts to contain Medicare cost growth, to expand outpatient service provision, and to contain hospital staffing. However, during PPS implementation hospitals experienced declining inpatient use and growing profit margins, whereas post-BBA hospitals experienced growing inpatient use and declining margins.

  20. Prolonged labour as indication for emergency caesarean section: a quality assurance analysis by criterion-based audit at two Tanzanian rural hospitals. (United States)

    Maaløe, N; Sorensen, B L; Onesmo, R; Secher, N J; Bygbjerg, I C


    To audit the quality of obstetric management preceding emergency caesarean sections for prolonged labour. A quality assurance analysis of a retrospective criterion-based audit supplemented by in-depth interviews with hospital staff. Two Tanzanian rural mission hospitals. Audit of 144 cases of women undergoing caesarean sections for prolonged labour; in addition, eight staff members were interviewed. Criteria of realistic best practice were established, and the case files were audited and compared with these. Hospital staff were interviewed about what they felt might be the causes for the audit findings. Prevalence of suboptimal management and themes emerging from an analysis of the transcripts. Suboptimal management was identified in most cases. Non-invasive interventions to potentially avoid operative delivery were inadequately used. When deciding on caesarean section, in 26% of the cases labour was not prolonged, and in 16% the membranes were still intact. Of the women with genuine prolonged labour, caesarean sections were performed with a fully dilated cervix in 36% of the cases. Vacuum extraction was not considered. Amongst the hospital staff interviewed, the awareness of evidence-based guidelines was poor. Word of mouth, personal experience, and fear, especially of HIV transmission, influenced management decisions. The lack of use and awareness of evidence-based guidelines led to misinterpretation of clinical signs, fear of simple interventions, and an excessive rate of emergency caesarean sections. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

  1. Chronic disease patients' experiences with accessing health care in rural and remote areas: a systematic review and qualitative meta-synthesis. (United States)

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


    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

  2. The Role and Challenges of Rural Tourism Development in Transition Countries: Montenegro Experiences

    Directory of Open Access Journals (Sweden)

    Ilija Moric


    Full Text Available Rural tourism is widely promoted as an efficient means of counteracting the social, economic and environmental challenges facing rural areas, primarily those associated with the decline of traditional agrarian industries. In line with this, the objective of this paper is to investigate the role and key challenges of rural tourism development in Montenegro as typical transitional economy. Using the extensive literature, available secondary and primary data collected from rural tourism operators, this paper throws light on the main components and issues about current situation in rural areas and rural tourism in Montenegro. Key findings indicate that three key factors of future success should be pulled out, as follows: support from government and international and/or national bodies/organizations, development of new and diversification of present tourist offers in rural areas and enhancement of government policy in the area of entrepreneurship and starting-up of new businesses in rural areas. Regarding practical implications, this paper provide the guidance and ideas for further rural and tourism development in Montenegro.

  3. Perceptions by medical students of their educational environment for obstetrics and gynaecology in metropolitan and rural teaching sites. (United States)

    Carmody, Dianne F; Jacques, Angela; Denz-Penhey, Harriet; Puddey, Ian; Newnham, John P


    Medical student education in Western Australia is expanding to secondary level metropolitan hospitals and rural sites to accommodate workforce demands and increasing medical student numbers. To determine if students' perceptions of the teaching environment for obstetrics and gynaecology differ between tertiary, secondary level metropolitan hospitals and rural sites, and to determine if students' perceptions of their learning environment are associated with improved academic performance. An evaluation was conducted of medical students' perceptions of their learning environment during an obstetrics and gynaecology program at a variety of sites across metropolitan and rural Western Australia. The evaluation was based on the Dundee Ready Education Environmental Measure (DREEM) questionnaire. There were no significant differences in students' perceptions of their learning environment between the tertiary hospital, combined programs involving a tertiary and secondary metropolitan hospital, rural sites with a population of more than 25,000 and rural sites with a population less than 25,000 people. Perceptions were similar in male and female students. The overall mean score for all perceptions of the learning environment in obstetrics and gynaecology were in the range considered to be favorable. Higher scores of perceptions of the learning environment were associated positively with the measures of academic achievement in the clinical, but not written, examination. Medical students' perceptions of their learning environment in obstetrics and gynaecology were not influenced by the geographical site of delivery or their gender but were positively related to higher academic achievement. Providing appropriate academic and clinical support systems have been put in place the education of medical students can be extended outside major hospitals and into outer metropolitan and rural communities without any apparent reduction in perceptions of the quality of their learning

  4. Muddy puddles - the microbiology of puddles located outside tertiary university teaching hospitals. (United States)

    Furukawa, M; McCaughan, J; Stirling, J; Millar, B C; Bell, J; Goldsmith, C E; Reid, A; Misawa, N; Moore, J E


    In the British Isles, the frequency of rain results in the formation of puddles on footpaths and roads in/around hospitals. No data are available demonstrating the microbiological composition of such puddles and therefore a study was undertaken to examine the microbiology of puddles in the grounds of two tertiary university-teaching hospitals (18 sites) and compared with control puddles from non-hospital rural environments (eight sites), estimating (i) total viable count; (ii) identification of organisms in puddles; (iii) enumeration of Escherichia coli: (iv) detection of Extended Spectrum β-Lactamase producing organisms and (v) direct antimicrobial susceptibility testing. A mean count of 2·3 × 10 3  CFU per ml and 1·0 × 10 9  CFU per ml was obtained for hospital and non-hospital puddles respectively. Isolates (n = 77; 54 hospital and 23 non-hospital) were isolated comprising of 23 species among 17 genera (hospital sites), where the majority (10/16; 62·5%) of genera identified were Gram-negative approximately, a fifth (20·6%) were shared by hospital and non-hospital rural samples. Escherichia coli was detected in half of the hospital puddles and under-half (37·5%) of the rural puddles extended spectrum β-lactamase organisms were not detected in any samples examined. Rainwater puddles from the hospital and non-hospital environments contain a diverse range of bacteria, which are capable of causing infections. This study demonstrated the presence of a wide diversity of bacterial taxa associated with rainwater puddles around hospitals, many of which are capable of causing human disease. Of clinical significance is the presence of Pseudomonas aeruginosa isolated from a hospital puddle, particularly for patients with cystic fibrosis. The presence of potentially disease-causing bacteria in puddles in and around hospitals identifies a new potential environmental reservoir of bacteria. Furthermore work is now needed to define their potential of entering or

  5. Exploring rural high school learners' experience of mathematics ...

    African Journals Online (AJOL)

    times, often, or always experience mathematics anxiety in academic settings. It is therefore ... South African Journal of Education, Volume 32(3), August 2012 in education and ... This study was conducted in rural school settings owing to the reality that I face as ..... European Journal of Social Sciences, 16:75-86. Leppavirta J ...

  6. Effect of post-discharge follow-up care on re-admissions among US veterans with congestive heart failure: a rural-urban comparison. (United States)

    Muus, Kyle J; Knudson, Alana; Klug, Marilyn G; Gokun, Jane; Sarrazin, Mary; Kaboli, Peter


    Hospital re-admissions for patients with congestive heart failure (CHF) are relatively common and costly occurrences within the US health infrastructure, including the Veterans Affairs (VA) healthcare system. Little is known about CHF re-admissions among rural veteran patients, including the effects of socio-demographics and follow-up outpatient visits on these re-admissions. To examine socio-demographics of US veterans with CHF who had 30 day potentially preventable re-admissions and compare the effect of 30 day VA post-discharge service use on these re-admissions for rural- and urban-dwelling veterans. The 2005-2007 VA data were analyzed to examine patient characteristics and hospital admissions for 36 566 veterans with CHF. The CHF patients who were and were not re-admitted to a VA hospital within 30 days of discharge were identified. Logistic regression was used to examine and compare the effect of VA post-acute service use on re-admissions between rural- and urban-dwelling veterans. Re-admitted veterans tended to be older (p=.002), had disability status (p=.024) and had longer hospital stays (precovery and good health among hospitalized veterans with CHF, regardless of their rural or urban residence. Older, rural veterans with CHF are in need of special attention for VA discharge planning and follow up with primary care providers.

  7. Boosting antenatal care attendance and number of hospital deliveries among pregnant women in rural communities: a community initiative in Ghana based on mobile phones applications and portable ultrasound scans. (United States)

    Amoah, Benjamin; Anto, Evelyn A; Osei, Prince K; Pieterson, Kojo; Crimi, Alessandro


    The World Health Organization has recommended at least four antenatal care (ANC) visits and skilled attendants at birth. Most pregnant women in rural communities in low-income countries do not achieve the minimum recommended visits and deliver without skilled attendants. With the aim of increasing number of ANC visits, reducing home deliveries, and supplementing care given by ANC clinics, a proposed system based on low-cost mobile phones and portable ultrasound scan machines was piloted. A sample of 323 pregnant women from four rural communities in the Central Region of Ghana were followed within a 11-month project. In each community, at least one health worker was trained and equipped with a mobile phone to promote ANC and hospital deliveries in her own community. If women cannot attend ANC, technicians acquired scans by using portable ultrasound machines in her community directly and sent them almost in real time to be analyzed by a gynecologist in an urban hospital. A preliminary survey to assess ANC status preceding the pilot study was conducted. During this, one hundred women who had had pregnancies within five years prior to the study were interviewed. The preliminary survey showed that women who attended ANC were less likely to have a miscarriage and more likely to have delivery at hospital or clinic than those who did not, and women who attained at least four ANC visits were less likely to practice self-medication. Among the women involved in the project, 40 gave birth during the period of observation. The proposed prenatal care approach showed that 62.5 % of pregnant women who gave birth during the observation period included in the project (n=40) had their labor attended in clinics or hospitals as against 37.5 % among the cases reported in the pre-survey. One case of ectopic and two cases of breech pregnancies were detected during the pilot through the proposed approach, and appropriate medical interventions were sought. Our results show that the proposed

  8. Impact of Rotavirus Vaccine Introduction and Postintroduction Etiology of Diarrhea Requiring Hospital Admission in Haydom, Tanzania, a Rural African Setting (United States)

    Platts-Mills, James A.; Amour, Caroline; Gratz, Jean; Nshama, Rosemary; Walongo, Thomas; Mujaga, Buliga; Maro, Athanasia; McMurry, Timothy L; Liu, Jie; Mduma, Estomih; Houpt, Eric R


    Abstract Background No data are available on the etiology of diarrhea requiring hospitalization after rotavirus vaccine introduction in Africa. The monovalent rotavirus vaccine was introduced in Tanzania on 1 January 2013. We performed a vaccine impact and effectiveness study as well as a quantitative polymerase chain reaction (qPCR)–based etiology study at a rural Tanzanian hospital. Methods We obtained data on admissions among children <5 years to Haydom Lutheran Hospital between 1 January 2010 and 31 December 2015 and estimated the impact of vaccine introduction on all-cause diarrhea admissions. We then performed a vaccine effectiveness study using the test-negative design. Finally, we tested diarrheal specimens during 2015 by qPCR for a broad range of enteropathogens and calculated pathogen-specific attributable fractions (AFs). Results Vaccine introduction was associated with a 44.9% (95% confidence interval [CI], 17.6%–97.4%) reduction in diarrhea admissions in 2015, as well as delay of the rotavirus season. The effectiveness of 2 doses of vaccine was 74.8% (95% CI, –8.2% to 94.1%) using an enzyme immunoassay–based case definition and 85.1% (95% CI, 26.5%–97.0%) using a qPCR-based case definition. Among 146 children enrolled in 2015, rotavirus remained the leading etiology of diarrhea requiring hospitalization (AF, 25.8% [95% CI, 24.4%–26.7%]), followed by heat-stable enterotoxin-producing Escherichia coli (AF, 18.4% [95% CI, 12.9%–21.9%]), Shigella/enteroinvasive E. coli (AF, 14.5% [95% CI, 10.2%–22.8%]), and Cryptosporidium (AF, 7.9% [95% CI, 6.2%–9.3%]). Conclusions Despite the clear impact of vaccine introduction in this setting, rotavirus remained the leading etiology of diarrhea requiring hospitalization. Further efforts to maximize vaccine coverage and improve vaccine performance in these settings are warranted. PMID:28575304

  9. Tradition as an initiator of rural tourism destinations development

    Directory of Open Access Journals (Sweden)

    Antić Aleksandar


    Full Text Available Rural tourism is a form of tourism that best illustrates the importance of tradition in the development of tourist destinations. Music, dance, clothing, culinary specialties of local cuisine, unique natural beauty and the very mentality and hospitality of people in rural areas, represent some of the factors that influence the tourist's consciousness when choosing this type of holiday. The research is focused on the main hypothesis that the tradition is an initiator of rural tourism destinations development. Furthermore, this would imply positive effects in the field of tourism and economy in general and the economy of the region. The goal of the paper is to show the importance of tradition in the cultural identity of rural areas and potentials of tradition in the role of initiating rural tourism destinations development. The interview with staff members in Pozarevac Tourism Organization has helped in the SWOT analysis of the observed rural destination. An empirical research is conducted on a random sample of 232 participants in order to highlight the benefits of rural tourism development in Pozarevac and its surrounding area. The data were processed in SPSS program (version 17.0.

  10. Rural telemedicine project in northern New Mexico

    Energy Technology Data Exchange (ETDEWEB)

    Zink, S.; Hahn, H.; Rudnick, J.; Snell, J.; Forslund, D. [Los Alamos National Lab., NM (United States); Martinez, P. [Northern New Mexico Community Coll., Espanola, NM (United States)


    A virtual electronic medical record system is being deployed over the Internet with security in northern New Mexico using TeleMed, a multimedia medical records management system that uses CORBA-based client-server technology and distributed database architecture. The goal of the NNM Rural Telemedicine Project is to implement TeleMed into fifteen rural clinics and two hospitals within a 25,000 square mile area of northern New Mexico. Evaluation of the project consists of three components: job task analysis, audit of immunized children, and time motion studies. Preliminary results of the evaluation components are presented.

  11. Development of community plans to enhance survivorship from colorectal cancer: community-based participatory research in rural communities. (United States)

    Lengerich, Eugene J; Kluhsman, Brenda C; Bencivenga, Marcyann; Allen, Regina; Miele, Mary Beth; Farace, Elana


    In 2002, 10.4% of the 10 million persons alive who have ever been diagnosed with cancer had colorectal cancer (CRC). Barriers, such as distance, terrain, access to care and cultural differences, to CRC survivorship may be especially relevant in rural communities. We tested the hypothesis that teams from rural cancer coalitions and hospitals would develop a Community Plan (CP) to enhance CRC survivorship. We used community-based participatory research and the PRECEDE-PROCEED model to train teams from rural cancer coalitions and hospitals in Pennsylvania and New York. We measured knowledge at three points in time and tested the change with McNemar's test, corrected for multiple comparisons (p < 0.0167). We also conducted a qualitative review of the CP contents. Fourteen (93.3%) of the 15 coalitions or hospitals initially recruited to the study completed a CP. Knowledge in public health, sponsorship of A National Action Plan for Cancer Survivorship, and CRC survivorship and treatment increased. Teams identified perceived barriers and community assets. All teams planned to increase awareness of community assets and almost all planned to enhance treatment-related care and psychosocial care for the CRC survivor; 50% planned to enhance primary care and CRC screening. The study demonstrated the interest and ability of rural organizations to plan to enhance CRC survivorship, including linkage of CRC survivorship to primary care. Rural cancer coalitions and hospitals may be a vehicle to develop local action for A National Action Plan. Access to more comprehensive care for CRC cancer survivors in rural communities appears to be facilitated by the community-based initiative described and investigated in this study. Efforts such as these could be replicated in other rural communities and may impact the care and quality of life of survivors with many types of cancers. While access to health services may be increased through community-based initiatives, we still need to measure

  12. Emerging regulatory challenges facing the Indian rural electrification programme

    International Nuclear Information System (INIS)

    Bhattacharyya, Subhes C.; Srivastava, Leena


    The purpose of this paper is to present and analyse the regulatory issues emerging from the newly launched programme of rural electricity access in India. We focus on two broad areas, namely regulatory issues related to the organisation/structuring of the activities and issues related to subsidy and tariffs. The paper looks into the alternative organisational arrangements being used by the programme and identifies problem areas through a responsibility mapping. The tariff principle being followed by the programme is then analysed considering the alternative organisational forms and issues related to such pricing policies are identified. Possible alternative pricing options are then suggested. The paper finds that while the franchisee model is an innovative idea, it raises issues that the regulators should be concerned with. The programme has so far relied on the simplest franchisee model because of its ease of implementation but a transition to more complex alternatives would require careful considerations

  13. Health problems and the health care provider choices: A comparative study of urban and rural households in Egypt

    Directory of Open Access Journals (Sweden)

    Salma B. Galal


    Conclusion: Urban families have less health complaints than rural; however, rural families recover sooner. Families bypass often public primary health care services. Urban families overuse outpatient clinics in public hospitals.



    Mulchand Shende *, Sneha Gawali , Kanchan Bhongade , Vivek Bhuskade , Abhijit Nandgaonkar


    Snake bite is a common predominant problem of the rural and periurban areas, neglected and frequently devastating environmental and occupational disease, especially in rural areas of tropical developing countries. This study aimed to investigate of the adverse drug reaction profile of anti-snake venom (ASV) in a district general hospital. An observational study was conducted in hospital for six months. A total number of 142 indoor case papers of snake bite from October 2016 to April 2017 were...

  15. Wonsuom--a rural communication project in Ghana. (United States)

    Boafo, S T


    The urban bias of the communication infrastructure in most parts of sub-Saharan Africa has comprised a major obstacle to the participation of the rural population in development decsion making. This article describes the Wonsuom rural communication pilot project in Ghana, aimed at providing communication technologies at the grassroots level to enhance the contribution of communication in rural development. When fully operational, the project will use a combination of a rural newspaper published in the local Fante language, rural radio broadcasts, radio listening clubs, and slide projectors to carry development-oriented information to rural communities and mobilize people for development programs. The project, which is carried out by the School of Journalism and Communication of the University of Ghana, covers 22 rural communities with a population of 150,000. The radio programs, started in 1983, include local and national news; discussions involving local community leaders, farmers, fishermen, and extension agents on problems facing the community and on issues such as primary health care and family planning; and features on the achievements of individual community members and development activities. Radio listening clubs meet on a regular basis to listen to the broadcasts, discuss issues highlighted, and deliberate on ways to generate development projects in their community. The discussions are recorded for subsequent broadcast on the program, creating a 2-way communication process. The listening clubs also serve as the focus of social and cultural life in the communities. Publication of the newspaper has been delayed by problems stemming from Ghana's socioeconomic crisis, but newspaper reading clubs are also projected.

  16. Food availability and livelihood strategies among rural households across Uganda

    NARCIS (Netherlands)

    Wichern, Jannike; Wijk, van Mark T.; Descheemaeker, Katrien; Frelat, Romain; Asten, van Piet J.A.; Giller, Ken E.


    Despite continuing economic growth, Uganda faces persistent challenges to achieve food security. The effectiveness of policy and development strategies to help rural households achieve food security must improve. We present a novel approach to relate spatial patterns of food security to livelihood

  17. Rural extension in Uruguay: problems and approaches from the point of view of their extensionists

    Directory of Open Access Journals (Sweden)

    Fernando Landini


    Full Text Available Understanding the problems faced by rural extension in Uruguay as well as the conceptions used by the development agents to conduct their practices constitutes a contribution to both, the Uruguayan rural development policies and the wider space of the MERCOSUR. A quali-quantitative research was conducted, during which 32 Uruguayan extensionists replied to a questionnaire. Replies underwent content and statistic analysis. Results suggest that the Uruguayan rural extensionists posses a complex conception of their practice, which articulates productive and social dimensions and relates to a critical and participatory way of understanding rural extension. Nevertheless, a diffusionist conception of rural extension is also present in some cases. Finally, problems related to group dynamics are highlighted.

  18. Acute admissions to medical departments. A comparison between an urban and a rural district

    DEFF Research Database (Denmark)

    Hilsted, J C; Evald, T; Elbrønd, R


    of admissions for social reasons was 13 percent to the city hospital versus 3 percent to the district hospital. Relevant alternatives to hospitalization seemed to exist in 50 percent of the admissions to the city hospital versus only 3 percent to the district hospital. Since patients admitted for social reasons...... block hospital beds for a longer time period than those admitted for other reasons, these differences may to some extent explain why length of hospital stay is longer in city hospitals than in rural ones....

  19. Rainfall Patterns and U.S. Migration from Rural Mexico (United States)

    Hunter, Lori M.; Murray, Sheena; Riosmena, Fernando


    In many rural regions of developing countries, natural resource dependency means changes in climate patterns hold tremendous potential to impact livelihoods. When environmentally-based livelihood options are constrained, migration can become an important adaptive strategy. Using data from the Mexican Migration Project, we model U.S. emigration from rural communities as related to community, household and climate factors. The results suggest that households subjected to recent drought conditions are far more likely to send a U.S. migrant, but only in communities with strong migration histories. In regions lacking such social networks, rainfall deficits actually reduce migration propensities, perhaps reflecting constraints in the ability to engage in migration as a coping strategy. Policy implications emphasize diversification of rural Mexican livelihoods in the face of contemporary climate change. PMID:25473143

  20. Hospital benchmarking: are U.S. eye hospitals ready? (United States)

    de Korne, Dirk F; van Wijngaarden, Jeroen D H; Sol, Kees J C A; Betz, Robert; Thomas, Richard C; Schein, Oliver D; Klazinga, Niek S


    Benchmarking is increasingly considered a useful management instrument to improve quality in health care, but little is known about its applicability in hospital settings. The aims of this study were to assess the applicability of a benchmarking project in U.S. eye hospitals and compare the results with an international initiative. We evaluated multiple cases by applying an evaluation frame abstracted from the literature to five U.S. eye hospitals that used a set of 10 indicators for efficiency benchmarking. Qualitative analysis entailed 46 semistructured face-to-face interviews with stakeholders, document analyses, and questionnaires. The case studies only partially met the conditions of the evaluation frame. Although learning and quality improvement were stated as overall purposes, the benchmarking initiative was at first focused on efficiency only. No ophthalmic outcomes were included, and clinicians were skeptical about their reporting relevance and disclosure. However, in contrast with earlier findings in international eye hospitals, all U.S. hospitals worked with internal indicators that were integrated in their performance management systems and supported benchmarking. Benchmarking can support performance management in individual hospitals. Having a certain number of comparable institutes provide similar services in a noncompetitive milieu seems to lay fertile ground for benchmarking. International benchmarking is useful only when these conditions are not met nationally. Although the literature focuses on static conditions for effective benchmarking, our case studies show that it is a highly iterative and learning process. The journey of benchmarking seems to be more important than the destination. Improving patient value (health outcomes per unit of cost) requires, however, an integrative perspective where clinicians and administrators closely cooperate on both quality and efficiency issues. If these worlds do not share such a relationship, the added


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


    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.

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

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


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

  3. Empirical study on regional differentiation of rural household energy use in Northwest China (United States)

    Wu, Wenheng; Zhang, Xin; Guo, Xiaodong


    To better understand regional differentiation of rural household energy use, data of energy use of 232 rural households in the Linwei District located in the lower reaches of the Weihe River of Northwest China were collected by questionnaires combined with face-to-face interview. Location quotient of energy use (LQEU) method is adopted in the paper. The results show that multiple energy sources are utilized due to market orientation in the plain area, and biogas is prominent as a result of policy orientation in the loess tableland, whereas firewood is dominant due to the influence of natural environment in the Qinling mountainous area. Regional differentiation of energy use is comprehensively affected by income level, air temperature, development conditions, energy policy, etc.

  4. Measuring the attractiveness of rural communities in accounting for differences of rural primary care workforce supply. (United States)

    McGrail, Matthew R; Wingrove, Peter M; Petterson, Stephen M; Humphreys, John S; Russell, Deborah J; Bazemore, Andrew W


    Many rural communities continue to experience an undersupply of primary care doctor services. While key professional factors relating to difficulties of recruitment and retention of rural primary care doctors are widely identified, less attention has been given to the role of community and place aspects on supply. Place-related attributes contribute to a community's overall amenity or attractiveness, which arguably influence both rural recruitment and retention relocation decisions of doctors. This bi-national study of Australia and the USA, two developed nations with similar geographic and rural access profiles, investigates the extent to which variations in community amenity indicators are associated with spatial variations in the supply of rural primary care doctors. Measures from two dimensions of community amenity: geographic location, specifically isolation/proximity; and economics and sociodemographics were included in this study, along with a proxy measure (jurisdiction) of a third dimension, environmental amenity. Data were chiefly collated from the American Community Survey and the Australian Census of Population and Housing, with additional calculated proximity measures. Rural primary care supply was measured using provider-to-population ratios in 1949 US rural counties and in 370 Australian rural local government areas. Additionally, the more sophisticated two-step floating catchment area method was used to measure Australian rural primary care supply in 1116 rural towns, with population sizes ranging from 500 to 50 000. Associations between supply and community amenity indicators were examined using Pearson's correlation coefficients and ordinary least squares multiple linear regression models. It was found that increased population size, having a hospital in the county, increased house prices and affluence, and a more educated and older population were all significantly associated with increased workforce supply across rural areas of both countries

  5. Rural Residents’ Perception of Construction Project Delays in Pakistan

    Directory of Open Access Journals (Sweden)

    Shahid Hussain


    Full Text Available The construction industry is one of the key sectors that facilitate sustainable economic and social development in the region. Currently, community development mechanisms are adopted by many developed and developing nations, aimed at enhancing economic growth and quality of life along with social welfare of the local community. This study reviews the rural residents’ perception of public construction project delays and aims to explore economic and social challenges confronted by residents, especially in rural areas in Pakistan. A questionnaire with 26 factors identified from the literature was sent to rural educated residents. Through a questionnaire survey, the opinions of rural residents were sought and tested. Based on 366 (73% valid responses, this study examined the socio-economic influencing factors. The findings of the study revealed that problems faced while traveling, increase the price of consumer goods, high transportation costs, lack of educational opportunities, more expenditures on education, and barriers to primary healthcare access were the top most important factors. Research results confirmed that the delays in construction projects negatively affect the socio-economic conditions of the rural community, which directly influence the rural dwells’ sustainable life. The research findings suggest that the practitioners in public sector organization make sure to execute the project on time and within the quality. Otherwise, it has negative socio-economic implications for the rural community.

  6. Rural-to-urban migration and its implication for new cooperative medical scheme coverage and utilization in China

    Directory of Open Access Journals (Sweden)

    Zhang Juying


    in 2006. Among those using in-patient medical services, 54.3% of migrants in comparison with 17.5% of non-migrants used out-of-county hospitals, many of which were not designated hospitals (Designated hospitals refer to hospitals where, if people use in patient health care, could receive reimbursement from the NCMS.; and 55.2% of migrants in comparison with 24.6% of non-migrants, who had the NCMS in 2006, received no reimbursement from the NCMS. The three main reasons of not receiving reimbursement were: staying in a hospital not designated by the NCMS, lack of knowledge of NCMS policies, and encountering difficulties obtaining reimbursement. Conclusion Migrants to urban centers improve the economic status of their rural household economic of origin. However, obtaining reimbursement under the current NCMS for the cost of hospital services provided by undesignated providers in urban centers is limited. Addressing this challenge is an emerging policy priority.

  7. Use of traditional cooking fuels and the risk of young adult cataract in rural Bangladesh: a hospital-based case-control study

    Directory of Open Access Journals (Sweden)

    Geater Alan F


    Full Text Available Abstract Background This study aimed to investigate the independent relationship between the use of various traditional biomass cooking fuels and the occurrence of cataract in young adults in rural Bangladesh. Methods A hospital-based age- and sex-matched case-control study incorporating two control groups was conducted. Cases were cataract patients aged 18 and 49 years diagnosed on the basis of any opacity of the crystalline lens or its capsule and visual acuity poorer than 6/18 on the Log Mar Visual Acuity Chart in either eye, or who had a pseudophakic lens as a result of cataract surgery within the previous 5 years. Non-eye-disease (NE controls were selected from patients from ENT or Orthopaedics departments and non-cataract eye-disease (NC controls from the Ophthalmology department. Data pertaining to history of exposure to various cooking fuels and to established risk factors for cataract were obtained by face-to-face interview and analyzed using conditional logistic regression. Results Clean fuels were used by only 4% of subjects. A majority of males (64-80% depending on group had never cooked, while the rest had used biomass cooking fuels, mainly wood/dry leaves, with only 6 having used rice straw and/or cow dung. All females of each group had used wood/dry leaves for cooking. Close to half had also used rice straw and/or cow dung. Among females, after controlling for family history of cataract and education and combining the two control groups, case status was shown to be significantly related to lifetime exposure to rice straw, fitted as a trend variable coded as never, ≤ median of all exposed, > median of all exposed (OR = 1.52, 95%CI 1.04-2.22, but not to lifetime exposure to wood/dry leaves. Case status among females showed an inverse association with ever use of cow dung as a cooking fuel (OR 0.43, 95%CI 0.22-0.81. Conclusions In this population, where cooking is almost exclusively done using biomass fuels, cases of young adult

  8. Use of traditional cooking fuels and the risk of young adult cataract in rural Bangladesh: a hospital-based case-control study (United States)


    Background This study aimed to investigate the independent relationship between the use of various traditional biomass cooking fuels and the occurrence of cataract in young adults in rural Bangladesh. Methods A hospital-based age- and sex-matched case-control study incorporating two control groups was conducted. Cases were cataract patients aged 18 and 49 years diagnosed on the basis of any opacity of the crystalline lens or its capsule and visual acuity poorer than 6/18 on the Log Mar Visual Acuity Chart in either eye, or who had a pseudophakic lens as a result of cataract surgery within the previous 5 years. Non-eye-disease (NE) controls were selected from patients from ENT or Orthopaedics departments and non-cataract eye-disease (NC) controls from the Ophthalmology department. Data pertaining to history of exposure to various cooking fuels and to established risk factors for cataract were obtained by face-to-face interview and analyzed using conditional logistic regression. Results Clean fuels were used by only 4% of subjects. A majority of males (64-80% depending on group) had never cooked, while the rest had used biomass cooking fuels, mainly wood/dry leaves, with only 6 having used rice straw and/or cow dung. All females of each group had used wood/dry leaves for cooking. Close to half had also used rice straw and/or cow dung. Among females, after controlling for family history of cataract and education and combining the two control groups, case status was shown to be significantly related to lifetime exposure to rice straw, fitted as a trend variable coded as never, ≤ median of all exposed, > median of all exposed (OR = 1.52, 95%CI 1.04-2.22), but not to lifetime exposure to wood/dry leaves. Case status among females showed an inverse association with ever use of cow dung as a cooking fuel (OR 0.43, 95%CI 0.22-0.81). Conclusions In this population, where cooking is almost exclusively done using biomass fuels, cases of young adult cataract among females

  9. The devil is in the details: trends in avoidable hospitalization rates by geography in British Columbia, 1990–2000

    Directory of Open Access Journals (Sweden)

    Penning Margaret J


    Full Text Available Abstract Background Researchers and policy makers have focussed on the development of indicators to help monitor the success of regionalization, primary care reform and other health sector restructuring initiatives. Certain indicators are useful in examining issues of equity in service provision, especially among older populations, regardless of where they live. AHRs are used as an indicator of primary care system efficiency and thus reveal information about access to general practitioners. The purpose of this paper is to examine trends in avoidable hospitalization rates (AHRs during a period of time characterized by several waves of health sector restructuring and regionalization in British Columbia. AHRs are examined in relation to non-avoidable and total hospitalization rates as well as by urban and rural geography across the province. Methods Analyses draw on linked administrative health data from the province of British Columbia for 1990 through 2000 for the population aged 50 and over. Joinpoint regression analyses and t-tests are used to detect and describe trends in the data. Results Generally speaking, non-avoidable hospitalizations constitute the vast majority of hospitalizations in a given year (i.e. around 95% with AHRs constituting the remaining 5% of hospitalizations. Comparing rural areas and urban areas reveals that standardized rates of avoidable, non-avoidable and total hospitalizations are consistently higher in rural areas. Joinpoint regression results show significantly decreasing trends overall; lines are parallel in the case of avoidable hospitalizations, and lines are diverging for non-avoidable and total hospitalizations, with the gap between rural and urban areas being wider at the end of the time interval than at the beginning. Conclusion These data suggest that access to effective primary care in rural communities remains problematic in BC given that rural areas did not make any gains in AHRs relative to urban areas

  10. The epidemiology of Scottish trauma: A comparison of pre-hospital and in-hospital deaths, 2000 to 2011. (United States)

    Morrison, Jonathan J; Yapp, Liam Z; Beattie, Anne; Devlin, Eimar; Samarage, Milan; McCaffer, Craig; Jansen, Jan O


    To characterise the temporal trends and urban-rural distribution of fatal injuries in Scotland through the analysis of mortality data collected by the National Records of Scotland. The prospectively collected NRS database was queried using ICD-10 codes for all Scottish trauma deaths during the period 2000 to 2011. Patients were divided into pre-hospital and in-hospital groups depending on the location of death. Incidence was plotted against time and linear regression was used to identify temporal trends. A total of 13,100 deaths were analysed. There were 4755 (36.3%) patients in the pre-hospital group with a median age (IQR) of 42 (28-58) years. The predominant cause of pre-hospital death related to vehicular injury (27.8%), which had a decreasing trend over the study period (p = 0.004). In-hospital, patients had a median age of 80 (58-88) years and the majority (67.0%) of deaths occurred following a fall on the level. This trend was shown to increase over the decade of study (p = 0.020). In addition, the incidence of urban incidents remained static, but the rate of rural fatal trauma decreased (p Scottish trauma patients die prior to hospital admission and the predominant mechanism of injury is due to road traffic accidents. This contrasts with in-hospital deaths, which are mainly observed in elderly patients following a fall from standing height. Further research is required to determine the preventability of fatal traumatic injury in Scotland. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  11. Rural electrification in Zambia: A policy and institutional analysis

    International Nuclear Information System (INIS)

    Haanyika, Charles M.


    Zambia is well endowed with hydropower and other energy resources, which could facilitate production of electricity for both urban and rural areas of the country. The country has an installed electricity generation capacity of 1786 MW and undeveloped hydropower potential of over 6000 MW. In the last few years, demand has been growing and it is anticipated to outstrip supply in 2008. The load growth is attributed to increased mining activities and development of the industrial base. The country is also endowed with abundant natural resources such as arable land, water, minerals and wildlife. With the available resource base, electricity along with other social and economic infrastructure such as roads and telecommunications could facilitate increased economic activities. In rural areas, electricity could be used for crop irrigation, agro-processing, small-scale mining and to facilitate tourism. However, rural electrification (RE) faces many challenges such as long distances from existing power stations to targeted rural areas, low population densities, high poverty levels and low skills availability. These and other factors have contributed to continued low levels of access to electricity in rural areas of the country. Measures so far undertaken to facilitate access to electricity in rural areas of Zambia include the adoption of a new National Energy Policy (NEP) in 1994. With regard to the electricity sector and RE in particular, the NEP was aimed at facilitating increased access by liberalising and restructuring the electricity market and promoting the use of low-cost technologies and decentralised renewable energies. To facilitate implementation of the new policy, the government established a legal and institutional framework by enacting new legislation, namely, the Electricity Act and the Energy Regulation Act in 1995. The Electricity Act provided for liberalisation and regulation of the electricity sector, while the Energy Regulation Act provided for the

  12. Improving paediatric and neonatal care in rural district hospitals in the highlands of Papua New Guinea: a quality improvement approach. (United States)

    Sa'avu, Martin; Duke, Trevor; Matai, Sens


    In developing countries such as Papua New Guinea (PNG), district hospitals play a vital role in clinical care, training health-care workers, implementing immunization and other public health programmes and providing necessary data on disease burdens and outcomes. Pneumonia and neonatal conditions are a major cause of child admission and death in hospitals throughout PNG. Oxygen therapy is an essential component of the management of pneumonia and neonatal conditions, but facilities for oxygen and care of the sick newborn are often inadequate, especially in district hospitals. Improving this area may be a vehicle for improving overall quality of care. A qualitative study of five rural district hospitals in the highlands provinces of Papua New Guinea was undertaken. A structured survey instrument was used by a paediatrician and a biomedical technician to assess the quality of paediatric care, the case-mix and outcomes, resources for delivery of good-quality care for children with pneumonia and neonatal illnesses, existing oxygen systems and equipment, drugs and consumables, infection-control facilities and the reliability of the electricity supply to each hospital. A floor plan was drawn up for the installation of the oxygen concentrators and a plan for improving care of sick neonates, and a process of addressing other priorities was begun. In remote parts of PNG, many district hospitals are run by under-resourced non-government organizations. Most hospitals had general wards in which both adults and children were managed together. Paediatric case-loads ranged between 232 and 840 patients per year with overall case-fatality rates (CFR) of 3-6% and up to 15% among sick neonates. Pneumonia accounts for 28-37% of admissions with a CFR of up to 8%. There were no supervisory visits by paediatricians, and little or no continuing professional development of staff. Essential drugs were mostly available, but basic equipment for the care of sick neonates was often absent or

  13. Nonlinear Differential Equations and Feedback Control Design for the Urban-Rural Resident Pension Insurance in China (United States)

    Wang, Lijian


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

  14. Staff perception on biomedical or health care waste management: a qualitative study in a rural tertiary care hospital in India.

    Directory of Open Access Journals (Sweden)

    Sudhir Chandra Joshi

    Full Text Available Health care or biomedical waste, if not managed properly, can be of high risk to the hospital staff, the patients, the community, public health and the environment, especially in low and middle income settings where proper disposal norms are often not followed. Our aim was to explore perceptions of staff of an Indian rural tertiary care teaching hospital on hospital waste management.A qualitative study was conducted using 10 focus group discussions (FGDs, with different professional groups, cleaning staff, nurses, medical students, doctors and administrators. The FGD guide included the following topics: (i role of Health Care Waste Management (HCWM in prevention of health care associated infections, (ii awareness of and views about HCWM-related guidelines/legislation, (iii current HCWM practices, (iv perception and preparedness related to improvements of the current practices, and (v proper implementation of the available guidelines/legislation. The FGDs were recorded, transcribed verbatim, translated to English (when conducted in Hindi and analysed using content analysis.Two themes were identified: Theme (A, 'Challenges in integration of HCWM in organizational practice,' with the categories (I Awareness and views about HCWM, (II Organizational practices regarding HCWM, and (III Challenges in Implementation of HCWM; and Theme (B, 'Interventions to improve HCWM,' with three categories, (I Educational and motivational interventions, (II Organizational culture change, and (III Policy-related interventions.A gap between knowledge and actual practice regarding HCWM was highlighted in the perception of the hospital staff. The participants suggested organizational changes, training and monitoring to address this. The information generated is relevant not merely to the microsystem studied but to other institutions in similar settings.

  15. The tremendous cost of seeking hospital obstetric care in Bangladesh. (United States)

    Afsana, Kaosar


    In Bangladesh, maternal mortality is estimated to be 320 per 100,000 live births, among the highest in the world, and most deliveries in rural areas occur at home. Women with obstetric complications fear to seek hospital care for various reasons; one of which is the tremendous cost. This paper shows how cost impedes rural, poor women's access to emergency obstetric care. The data are from a larger ethnographic study of childbirth practices in 2000--01 in Apurbabari village, the adjacent sub-district health complex and more distant tertiary hospitals at district level. Families had to spend what for them added up to a fortune for a caesarean section and other surgery, medicines, laboratory investigations, blood transfusion, food, travel and other expenses. Corruption in the form of demands for under-the-table payments to obtain these aspects of essential care is rife. Adequate resources should be allocated to the different health facilities, including for emergency obstetric treatment. Thana health complexes (sub-district hospitals) should be upgraded to provide comprehensive obstetric care. The system for prescribing drugs should be reformed and the causes of corruption investigated and addressed. Hospital care should not be allowed to further impoverish the poor. Addressing these issues will help to encourage rural, poor women to seek skilled delivery and post-partum care, particularly in emergency situations.

  16. Paediatric organophosphate poisoning - a rural hospital experience ...

    African Journals Online (AJOL)

    Objectives. To document the presentation and course of organophosphate poisoning (OPP) in children and to record the frequency of atropine toxicity during treatment. Design. A retrospective observational study was conducted of all recorded paediatric cases of OPP admitted to a regional hospital over a 5-year period from ...

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

    International Nuclear Information System (INIS)

    Slough, Tara; Urpelainen, Johannes; Yang, Joonseok


    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.

  18. Impact and management of dual relationships in metropolitan, regional and rural mental health practice. (United States)

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


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

  19. Hospital 360°. (United States)

    Giraldo Valencia, Juan Carlos; Delgado, Liliana Claudia


    There are forces that are greater than the individual performance of each hospital institution and of the health system structural of each country. The world is changing and to face up to the future in the best possible way, we need to understand how contexts and emerging trends link up and how they affect the hospital sector. The Columbian Association of Hospitals and Clinics, ACHC, has thus come up with the Hospital 360° concept which uses hospitals capable of anticipating changing contexts by means of the transition between present and future and takes on board the experience of global, socio-economic, demographic, political, environmental and technological fields as its model. Hospital 360° is an invitation to reinvent processes and institution themselves allowing them to adapt and incorporate a high degree of functional flexibility. Hospital 360° purses goals of efficiency, effectiveness and relevance, but also of impact and sustainability, and is coherent with the internal needs of hospital institutions and society for long-term benefits.

  20. Professional Development for Rural and Remote Teachers Using Video Conferencing (United States)

    Maher, Damian; Prescott, Anne


    Teachers in rural and remote schools face many challenges including those relating to distance, isolation and lack of professional development opportunities. This article examines a project where mathematics and science teachers were provided with professional development opportunities via video conferencing to help them use syllabus documents to…

  1. Adverse drug reaction profile of anti-snake venom in a rural tertiary care teaching hospital (United States)

    Deshpande, Rushikesh Prabhakar; Motghare, Vijay Motiram; Padwal, Sudhir Laxman; Pore, Rakesh Ramkrishna; Bhamare, Chetanraj Ghanshyam; Deshmukh, Vinod Shivaji; Pise, Harshal Nutan


    Objectives The study was carried out with the aim of evaluation of the adverse drug reaction profile of anti-snake venom serum (ASV) in a rural tertiary care hospital. Methods An observational study was conducted in SRTR Medical College, Ambajogai, Maharashtra, India. A total number of 296 indoor case papers of snake bite from February to September 2011 and June to August 2012 were retrieved from the record section and the antivenom reactions were assessed. In addition, basic epidemiological data and prescribing practices of ASV were also analyzed. Results Vasculotoxic snake bites were more common (50.61%) than neuroparalytic ones (22.56%). Mild envenomation was the commonest presentation. A total of 92 (56.10%) patients who received ASV suffered from antivenom reactions. The most common nature of reaction was chills, rigors (69.56%) followed by nausea and vomiting (34.8%). 10-15% patients suffered from moderate to severe reactions like hypotension and sudden respiratory arrest. We did not find any dose response relationship of ASV to risk of reactions (odds ratio 0.37). Intradermal sensitivity test was performed in about 72% cases. Conclusion Our study showed a higher incidence of reactions to ASV at our institute. PMID:24396245

  2. Demographic Ageing in Romania’s Rural Area

    Directory of Open Access Journals (Sweden)

    Daniela Violeta Nancu


    Full Text Available Europe has faced for several decades and is still facing an ageing process of its population. Within it, Romania, a country, striving to successfully integrate into the European Union, is also experiencing the same process. The ageing process of the Romanian population started at the beginning of the 20th century and evolved progressively, ever since, with significant visible rates in the rural areas. Romania’s population age structure, at the beginning of the Third Millennium, was, according to international experts, not significantly aged compared to populations of the economically advanced countries of Europe. Due to falling birth-rates and the labor emigration rush, the ageing process of the Romanian population has become increasingly serious, argued by a rate of 19.4% over 60-year-old population, of which 24.5% (2008 belongs to the rural area. The main responsible reason for this demographic and social situation is the replacement of the traditional reproduction pattern, mainly characterized by high birth and death rates, with a modern one, characterized by very low rates of the same kind. Low values in natality were, on one hand, the result of a steady regression of fertility, and on the other of, a drop in general mortality, hence the lengthening of the average life-span. To be able to cope with a relatively new phenomenon such as ageing of population, Romania needs to seriously consider adequate measures and steps towards achieving balance. Visionary strategy and plans require, well-grounded medium-and-long-term development programmes especially for the Romanian rural area.

  3. Role of Bhabhatron in rural cancer care

    International Nuclear Information System (INIS)

    Singh, Manjit


    Radiotherapy, using cobalt-60 is the most cost-effective and the most relevant method of cancer treatment in India. However, there is acute shortage of radiotherapy machines in the country, due the high cost of imported machines. As most of the radiotherapy machines in the country are located in urban areas, patients from rural areas have to travel a long distance and stay there to get treatment. BARC has developed Bhabhatron to meet the demand for affordable telecobalt machines. Compared to any imported unit, the indigenous machine is cheaper, superior in features and more suitable for rural use. Bhabhatrons are installed in many cancer hospitals in the country. (author)

  4. Nursing Personnel Planning for Rural Hospitals in Burdwan District, West Bengal, India, Using Workload Indicators of Staffing Needs (United States)

    Roy, Rabindra Nath; Dasgupta, Samir; Bhattacharyya, Krishna Das; Misra, Raghu Nath; Roy, Sima; Saha, Indranil


    ABSTRACT Lack of appropriate human resources planning is an important factor in the inefficient use of the public health facilities. Workforce projections can be improved by using objective methods of staffing needs based on the workload and actual work undertaken by workers, a guideline developed by Peter J. Shipp in collaboration with WHO—Workload Indicators of Staffing Need (WISN). A cross-sectional study was carried out to estimate the nursing stuff requirement for the rural hospitals and provide a quantitative description of imbalances, if there is any, in the allocation at the district level during 2011. The average WISN turns out to be 0.35 for entire district, which means only 35% of the required nurses is available or 65% understaffed. So, there is an urgent need for more allocations and deployment of staff so that workload can be tackled and evenly distributed among all nursing personnel. PMID:25895199

  5. Comparative Study on Rural Electrification Policies in Emerging Economies

    Energy Technology Data Exchange (ETDEWEB)



    Brazil, China, India and South Africa have each worked to improve access to electricity services. While many of the challenges faced by these countries are similar, the means of addressing them varied in their application and effectiveness. This report analyses the four country profiles, determining the pre-requisites to successful rural electrification policies.

  6. Impact of rotavirus vaccine introduction and post-introduction etiology of diarrhea requiring hospital admission in Haydom, Tanzania, a rural African setting. (United States)

    Platts-Mills, James A; Amour, Caroline; Gratz, Jean; Nshama, Rosemary; Walongo, Thomas; Mujaga, Buliga; Maro, Athanasia; McMurry, Timothy L; Liu, Jie; Mduma, Estomih; Houpt, Eric R


    No data are available on the etiology of diarrhea requiring hospitalization after rotavirus vaccine introduction in Africa. The monovalent rotavirus vaccine was introduced in Tanzania on January 1, 2013. We performed a vaccine impact and effectiveness study as well as a qPCR-based etiology study at a rural Tanzanian hospital. We obtained data on admissions among children under 5 years to Haydom Lutheran Hospital between January 1, 2010 and December 31, 2015, and estimated the impact of vaccine introduction on all-cause diarrhea admissions. We then performed a vaccine effectiveness study using the test-negative design. Finally, we tested diarrheal specimens during 2015 by qPCR for a broad range of enteropathogens and calculated pathogen-specific attributable fractions. Vaccine introduction was associated with a 44.9% (95% CI 17.6 - 97.4) reduction in diarrhea admissions in 2015, as well as delay of the rotavirus season. The effectiveness of two doses of vaccine was 74.8% (-8.2 - 94.1) using an enzyme immunoassay-based case definition and 85.1% (26.5 - 97.0) using a qPCR-based case definition. Among 146 children enrolled in 2015, rotavirus remained the leading etiology of diarrhea requiring hospitalization (AF 25.8%, 95% CI: 24.4 - 26.7), followed by heat-stabile enterotoxin-producing E. coli (18.4%, 12.9 - 21.9), Shigella/enteroinvasive E. coli (14.5%, 10.2 - 22.8), and Cryptosporidium (7.9%, 6.2 - 9.3). Despite the clear impact of vaccine introduction in this setting, rotavirus remained the leading etiology of diarrhea requiring hospitalization. Further efforts to maximize vaccine coverage and improve vaccine performance in these settings are warranted. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

  7. Rural versus urban differences in end-of-life care for lung cancer patients in Germany. (United States)

    Walter, Julia; Tufman, Amanda; Leidl, Reiner; Holle, Rolf; Schwarzkopf, Larissa


    To assess rural-urban differences in healthcare utilization and supportive care at the end-of-life in German lung cancer patients. We identified 12,929 patients with incident lung cancer in 2009 from claims data and categorized them to four district types (major city, urban, rural, remote rural). We compared site of death, unplanned hospitalizations, hospital days, outpatient doctor, general practitioner (GP) and home visits, structured palliative care, therapy with antidepressants, pain relief medication and chemotherapy, and therapeutic puncturing in the last 30 and 14 days of life using mixed models with logistic link function for binary outcomes and log link function for count data. We adjusted all models by age, sex, comorbidities, metastases location and presence of multiple tumors at diagnosis, survival in months, and type of tumor-directed treatment. We found significant differences in two of the outcomes measured. The likelihood of > 14 hospital days in the last 30 days was significantly higher in rural districts than in remote rural districts (1.27 [1.05, 1.52], p = 0.0003). The number of visits to the GP in the last 30 days of life was significantly lower in urban districts than in remote rural districts (β = - 0.19 [- 0.32, - 0.06], p = <0.0001). No other endpoints were associated with regional differences. Triggering factors for high and low utilization of healthcare were mostly age, comorbidities, and prior anticancer treatment. Healthcare utilization and supportive care did not differ significantly between different district types. Results reject the hypothesis of regional inequity in end-of-life care of lung cancer patients in Germany.

  8. Incidence and Epidemiology of Hospitalized Influenza Cases in Rural Thailand during the Influenza A (H1N1)pdm09 Pandemic, 2009–2010 (United States)

    Baggett, Henry C.; Chittaganpitch, Malinee; Thamthitiwat, Somsak; Prapasiri, Prabda; Naorat, Sathapana; Sawatwong, Pongpun; Ditsungnoen, Darunee; Olsen, Sonja J.; Simmerman, James M.; Srisaengchai, Prasong; Chantra, Somrak; Peruski, Leonard F.; Sawanpanyalert, Pathom; Maloney, Susan A.; Akarasewi, Pasakorn


    Background Data on the burden of the 2009 influenza pandemic in Asia are limited. Influenza A(H1N1)pdm09 was first reported in Thailand in May 2009. We assessed incidence and epidemiology of influenza-associated hospitalizations during 2009–2010. Methods We conducted active, population-based surveillance for hospitalized cases of acute lower respiratory infection (ALRI) in all 20 hospitals in two rural provinces. ALRI patients were sampled 1∶2 for participation in an etiology study in which nasopharyngeal swabs were collected for influenza virus testing by PCR. Results Of 7,207 patients tested, 902 (12.5%) were influenza-positive, including 190 (7.8%) of 2,436 children aged incidence of hospitalized influenza cases was 136 per 100,000, highest in ages 75 years (407 per 100,000). The incidence of influenza A(H1N1)pdm09 was 62 per 100,000 (214 per 100,000 in children <5 years). Eleven influenza-infected patients required mechanical ventilation, and four patients died, all adults with influenza A(H1N1)pdm09 (1) or H3N2 (3). Conclusions Influenza-associated hospitalization rates in Thailand during 2009–10 were substantial and exceeded rates described in western countries. Influenza A(H1N1)pdm09 predominated, but H3N2 also caused notable morbidity. Expanded influenza vaccination coverage could have considerable public health impact, especially in young children. PMID:23139802

  9. Building the Capacity of States to Ensure Inclusion of Rural Communities in State and Local Primary Violence Prevention Planning (United States)

    Cook-Craig, Patricia G.; Lane, Karen G.; Siebold, Wendi L.


    Rural, frontier, and geographically isolated communities face unique challenges associated with ensuring that they are equal partners in capacity-building and prevention planning processes at the state and local level despite barriers that can inhibit participation. By their nature, rural, frontier, and geographically isolated communities and…

  10. Interaction between Rural People’s Basic Needs and Forest Products: A Case Study of the Katha District of Myanmar

    Directory of Open Access Journals (Sweden)

    Zar Chi Hlaing


    Full Text Available The understanding of interaction between rural people and forest products is one of the challenges faced while balancing forest product utilization with forest conservation in Myanmar. This study aims to contribute an effort to such challenges by analyzing the interaction of rural households with forest products in Myanmar. Data were collected using face-to-face questionnaire interviews with 218 households and conducting a rapid tree inventory across 132 circular random plots in selected rural communities around four townships of the Katha District. The empirical results indicate that the 95% of rural households were entirely dependent on forest products. The survey documented 13 main forest products and 54 tree species, which were primarily used for household consumption. Low-income households compared with medium- and high-income households with low educational level (p<0.05 and a small agricultural land area (p<0.05 were found to be more forest-dependent households. Illegal logging, mining, fuel-wood collection, slash-and-burn agriculture, and the establishment of forest plantations were reported as the main causes of forest products depletion. Findings from this study, although at a microlevel, can be used by the Myanmar Forestry Department as baseline information to improve community-based forest management activities.

  11. Face Detection and Face Recognition in Android Mobile Applications

    Directory of Open Access Journals (Sweden)

    Octavian DOSPINESCU


    Full Text Available The quality of the smartphone’s camera enables us to capture high quality pictures at a high resolution, so we can perform different types of recognition on these images. Face detection is one of these types of recognition that is very common in our society. We use it every day on Facebook to tag friends in our pictures. It is also used in video games alongside Kinect concept, or in security to allow the access to private places only to authorized persons. These are just some examples of using facial recognition, because in modern society, detection and facial recognition tend to surround us everywhere. The aim of this article is to create an appli-cation for smartphones that can recognize human faces. The main goal of this application is to grant access to certain areas or rooms only to certain authorized persons. For example, we can speak here of hospitals or educational institutions where there are rooms where only certain employees can enter. Of course, this type of application can cover a wide range of uses, such as helping people suffering from Alzheimer's to recognize the people they loved, to fill gaps persons who can’t remember the names of their relatives or for example to automatically capture the face of our own children when they smile.

  12. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Policy Changes and Fiscal Year 2016 Rates; Revisions of Quality Reporting Requirements for Specific Providers, Including Changes Related to the Electronic Health Record Incentive Program; Extensions of the Medicare-Dependent, Small Rural Hospital Program and the Low-Volume Payment Adjustment for Hospitals. Final rule; interim final rule with comment period. (United States)


    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2016. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Pathway for Sustainable Growth Reform(SGR) Act of 2013, the Protecting Access to Medicare Act of 2014, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, and other legislation. We also are addressing the update of the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2016.As an interim final rule with comment period, we are implementing the statutory extensions of the Medicare dependent,small rural hospital (MDH)Program and changes to the payment adjustment for low-volume hospitals under the IPPS.We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2016 and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014.In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific providers (acute care hospitals,PPS-exempt cancer hospitals, and LTCHs) that are participating in Medicare, including related provisions for eligible hospitals and critical access hospitals participating in the Medicare Electronic Health Record (EHR)Incentive Program. We also are updating policies relating to the

  13. Recruitment of Physicians to Rural America: A View through the Lens of Transaction Cost Theory (United States)

    Fannin, J. Matthew; Barnes, James N.


    Context: Many rural hospitals in the United States continue to have difficulties recruiting physicians. While several studies have examined some of the factors affecting the nature of this problem, we know far less about the role of economic incentives between rural providers and physicians. Purpose: This conceptual article describes an economic…

  14. Do HMO penetration and hospital competition impact quality of hospital care? (United States)

    Rivers, P A; Fottler, M D


    This study examines the impact of HMO penetration and competition on hospital markets. A modified structure-conduct-performance paradigm was applied to the health care industry in order to investigate the impact of HMO penetration and competition on risk-adjusted hospital mortality rates (i.e. quality of hospital care). Secondary data for 1957 acute care hospitals in the USA from the 1991 American Hospital Association's Annual Survey of Hospitals were used. The outcome variables were risk-adjusted mortality rates in 1991. Predictor variables were market characteristics (i.e. managed care penetration and hospital competition). Control variables were environmental, patient, and institutional characteristics. Associations between predictor and outcome variables were investigated using statistical regression techniques. Hospital competition had a negative relationship with risk-adjusted mortality rates (a negative indicator of quality of care). HMO penetration, hospital competition, and an interaction effect of HMO penetration and competition were not found to have significant effects on risk-adjusted mortality rates. These findings suggest that when faced with intense competition, hospitals may respond in ways associated with reducing their mortality rates.

  15. Factors Impacting on Organisational Learning in Three Rural Health ...

    African Journals Online (AJOL)

    ... assessment of hospital leadership as being supportive of learning were significant predictors of attendance among doctors. Conclusions: Despite severe staff shortages in these rural districts, at facilities where there was a perception of leadership and teamwork the professional staff generally attended learning sessions.

  16. Analysis of Home Safety of the Elderly Living in City and Rural Areas

    Directory of Open Access Journals (Sweden)

    Nihal Buker


    Full Text Available BACKGROUND: Physiological changes and chronic diseases arising during aging process increase risk of accident of the elderly, especially the elderly living alone at their homes. Home accidents are the most commonly health problem in the elderly. This study was carried out to describe home safety of the elderly living in a city or rural area using a home safety checklist. MEDHODS: 512 living in Turkey (330 in city; 182 in rural area were evaluated via face-to-face interview using a home safety checklist during a period between December and March in 2007. In addition to sociodemographics, a questionnaire including home characteristics and life style of participants was applied. To describe home safety level, Home Safety Checklist was used. RESULTS: 51.8% of the participants living in a city and 42.8% living in rural area were aged 65-69 years. Of the participants living in a city, 59.4% were living with their partners (61.5% of the participants living in rural area. While 63.9% of the participants living in a city reported that they had a private room in their homes, 53.8% of the participants living in rural area reported that they had a private room in their homes. 2.1% of participants living in a city had an excellent home safety score. Percentage for participants living in rural area was 0.5. CONCLUSION: The results obtained from this study show that majority of houses of the elderly living in Turkey were unsafe and hazardous. Therefore, health providers and architects should work together to prevent home accidents. [TAF Prev Med Bull 2008; 7(4.000: 297-300

  17. Knowledge, Attitudes, and Practices of Voluntary HIV Counseling and Testing among Rural Migrants in Shanghai, China (United States)

    He, Na; Zhang, Jinling; Yao, Jinjian; Tian, Xiuhong; Zhao, Genming; Jiang, Qingwu; Detels, Roger


    A study of knowledge, attitudes and practices (KAP) of voluntary HIV counseling and testing (VCT) among rural migrants was conducted in Shanghai, China. An anonymous questionnaire was administered face-to-face. Among 2,690 participants, 78% reported having had lifetime sexual intercourse with 41.3% of singles reporting sexual intercourse, 9.2%…

  18. Retention of health workers in rural Sierra Leone: findings from life histories. (United States)

    Wurie, Haja R; Samai, Mohamed; Witter, Sophie


    Sierra Leone has faced a shortage and maldistribution of staff in its post-conflict period. This long-standing challenge is now exacerbated by the systemic shock and damage wrought by Ebola. This study aimed to investigate the importance of different motivation factors in rural areas in Sierra Leone and thus to contribute to better decisions on financial and non-financial incentive packages, here and in similar contexts. This article is based on participatory life histories, conducted in 2013 with 23 health workers (doctors, nurses, midwives and Community Health Officers) in four regions of Sierra Leone who had worked in the sector since 2000. Although the interviews covered a wide range of themes, here we present findings on motivating and demotivating factors for staff, especially those in rural areas, based on thematic analysis of transcripts. Rural health workers face particular challenges, some of which stem from the difficult terrain, which add to common disadvantages of rural living (poor social amenities, etc.). Poor working conditions, emotional and financial costs of separation from families, limited access to training, longer working hours (due to staff shortages) and the inability to earn from other sources make working in rural areas less attractive. Moreover, rules on rotation which should protect staff from being left too long in rural areas are not reported to be respected. By contrast, poor management had more resonance in urban areas, with reports of poor delegation, favouritism and a lack of autonomy for staff. Tensions within the team over unclear roles and absenteeism are also significant demotivating factors in general. This study provides important policy-focused insights into motivation of health workers and can contribute towards building a resilient and responsive health system, incorporating the priorities and needs of health workers. Their voices and experiences should be taken into account as the post-Ebola landscape is shaped.

  19. Hospital infections waste and its proper disposal

    International Nuclear Information System (INIS)

    Bhatti, A.Q.; Memon, A.A.; Mahar, R.B.


    Hazardous hospital waste is a unique in several ways. There are a large variety of wastes but volume is a small relative to industrial wastes. Hospital infections solid waste is getting to be serious problem day by day. This waste contribute to the overall pollution in the city; much of it is also hazardous, thus putting at risk the health of those who come into contact with it. This paper addresses the various aspects of incineration, recycling and landfill process with detailed illustration. Hospital waste management in rural hospitals of Pakistan with particular reference to Gambat Hospital is discussed in this paper, including study of existing waste management system, estimation of waste production per day from different sources of Hospital and suitable waste management system is recommended. (author)

  20. Rural Areas: The Real Home of the Nigerian Economy

    Directory of Open Access Journals (Sweden)

    Raji Abdullateef


    Full Text Available The current troubles facing the Nigerian economy seem insurmountable. Should we speak of the current recession or the oil crash experienced in the international market? Should the case of oil-pipe vandalization as well as that of insurgency be breached? We could as well debate on the fall of the naira as against the US dollars and other recognized currencies in the international market. This could go on and on. It is as a consequence of this that this study tried to look at the central position of rural communities in finding lasting solutions to these economic woes. The utilitarian theory was employed in examining the phenomenon. The study revealed that rural areas can go a long way to advance the Nigerian economy if properly taken care of but if the current underuse of rural resources continues, the economy could be derailed. It is therefore recommended that renewed efforts should be made to explore the resources available in rural areas in order to tremendously increase the wealth of the nation as soon as possible.

  1. Social exclusion and people with intellectual disabilities: a rural-urban comparison. (United States)

    Nicholson, L; Cooper, S-A


    Research suggests that social exclusion is a problem both for people with intellectual disabilities (ID) and for people living in rural areas. This may give rise to a double disadvantage for people with ID living in rural areas. Conversely, aspects of rural life such as community spirit and social support may protect against social exclusion in this population. This study was designed to compare a number of measures of social exclusion in adults with ID living in rural and urban areas, with the aim of identifying whether a double disadvantage exists. Adults with ID were recruited from a rural and an urban area in Scotland. Participants participated in a face-to-face interview and their medical notes were accessed. Social exclusion was investigated using a number of measures comprising: daytime opportunities and physical access to community facilities (using part of the British Institute of Learning Disabilities questionnaire), recent contact with others and the quality of personal relationships (using a modified Interview Measure of Social Relationships questionnaire) and area deprivation by postcode (using the Scottish Index of Multiple Deprivation). The data were analysed using a series of binary logistic regression models that adjusted for variables including age, gender, level of ID, mental illhealth and common physical co-morbidities. A representative sample of adults with ID from rural (n = 39) and urban (n = 633) areas participated. Participants from rural areas were significantly more likely to have any regular daytime opportunity [odds ratio (OR) = 10.8, 95% CI = 2.3-51.5] including employment (OR = 22.1, 95% CI = 5.7-85.5) and attending resource centres (OR = 6.7, 95% CI = 2.6-17.2) than were participants from urban areas. They were also more likely to have been on holiday (OR = 17.8, 95% CI = 4.9-60.1); however, were less likely to use community facilities on a regular basis. Participants from urban and rural areas had a similar number of contacts with

  2. Rural-urban migration and urban unemployment in Nigeria. (United States)

    Aigbokhan, B E


    This paper argues that urban unemployment in Nigeria has been due largely to a failure on the part of the government to pursue policies that reflect commitment on its part to its stated objectives, particularly with regard to employment opportunities. Rural-urban migration has been taking place in the country since the 1960s and at an increasing rate since the 1970s. Economic policies have contributed to this, notably the rural-urban imbalance resulting from the pattern of allocation of public investment expenditures and the wages determination process which tends to concentrate more on the urban sector. These have contributed to the widening urban-rural income differentials. In the face of such migration, the urban industrial sector has been able to absorb only a negligible proportion of migrants. A major factor that has contributed to this is the increased capital-intensity of the sector. Some laudable measures have been introduced this year, notably the establishment of the Directorate of Employment and the Directorate of Food, Road, and Rural infrastructure. The latter, if effectively implemented, should enhance rural income and thereby reduce the rural-urban income gap. The former should reduce the problem of open unemployment. While it is too early to assess the effects of these 2 measures on urban unemployment, they may not improve urban unemployment significantly. There is still the need to design policies to increase labor absorption in general.

  3. American Hospital Association (United States)

    ... Central Office-Coding Resources AHA Team Training Health Career Center Health Forum Connect More Regulatory Relief The regulatory burden faced by hospitals is substantial and unsustainable. Read the report . More AHA Opioid Toolkit Stem the Tide: Addressing the Opioid Epidemic More ...

  4. Doctors' views of working conditions in rural hospitals in the Western ...

    African Journals Online (AJOL)

    management support impact negatively on doctors' views of working in district hospitals. Unless these ... and skills gap of district hospital practitioners in .... or tertiary hospitals, were highly regarded as a means of updating skills. Practical hands-on training was preferred to lectures. Lack of time, need for locums, remoteness.

  5. Hospital all-risk emergency preparedness in Ghana | Norman ...

    African Journals Online (AJOL)

    (2) The hospitals' respective abilities to handle large scale RTA's were ... The biggest challenge facing the hospitals in their emergency intervention is the lack of preemergency and emergency preparedness plans as well as the coordination of the hospitals response mechanisms. Conclusion: The paper ended with ...

  6. Faces of Change. Visual Evidence: An Instructional Approach. Instructor's Notes: Film/Essay Series. (United States)

    Miller, Norman N.

    Designed for use with the multidisciplinary film project, "Faces of Change, Five Rural Societies in Transition" for the college social studies curriculum, this manual contains an overview of the material and its underlying philosophy and suggests teaching strategies. The first section discusses the overall approach, the use of films in…

  7. Distance-mediated mentoring: A telecommunication-supported model for novice rural mathematics and science teachers (United States)

    Luebeck, Jennifer Lyn

    Rural educators face unique professional challenges and limitations. This study investigated the effectiveness of an innovative distance-mediated mentoring program for rural novice mathematics and science teachers. Four purposes were pursued: (1) characterize and document the nature and development of the mentor-novice relationship; (2) describe how discourse influenced the novice teachers' perceptions about mathematics and science teaching; (3) determine whether telecommunication effectively supported a distance-mediated mentoring relationship for novice rural teachers; and (4) investigate program effects on novice teachers' attitudes, concerns, and professional growth. A qualitative research design was implemented during academic years 1996-98. Primary data collection focused on nine rural novice teachers and their mentors and included three sets of interviews spanning three semesters, field observation of classrooms, schools, and communities, and analysis of electronic mail messages over a four-month period. Supporting data were collected during observation of workshops and training sessions, and through surveys administered to all program participants in early 1997 and 1998. Categories of mentor-novice communication were identified: curriculum and content, validation of teaching practice, classroom and school issues, moral support, and social talk. Impact on mathematics and science teaching was accomplished by: sharing materials and activities; planning units and projects; locating resources; classroom and student concerns; long-range curriculum design, and improvement of teaching practices. Professional growth (for both novices and mentors) occurred through individual contact with partners and interaction within the larger mentoring community in both face-to-face and on-line venues. Telecommunication was highly valued by successful users. Technical difficulty curtailed access for a significant number of teachers, but they maintained successful relationships

  8. Rural self-reliance: the impact on health experiences of people living with type II diabetes in rural Queensland, Australia. (United States)

    Page-Carruth, Althea; Windsor, Carol; Clark, Michele


    The objective of the study was to explore whether and how rural culture influences type II diabetes management and to better understand the social processes that rural people construct in coping with diabetes and its complications. In particular, the study aimed to analyse the interface and interactions between rural people with type II diabetes and the Australian health care system, and to develop a theoretical understanding that reflects constructs that may be more broadly applicable. The study applied constructivist grounded theory methods within an interpretive interactionist framework. Data from 39 semi-structured interviews with rural and urban type II diabetes patients and a mix of rural health care providers were analysed to develop a theoretical understanding of the social processes that define diabetes management in that context. The analysis suggests that although type II diabetes imposes limitations that require adjustment and adaptation, these processes are actively negotiated by rural people within the environmental context to fit the salient social understandings of autonomy and self-reliance. Thus, people normalized self-reliant diabetes management behaviours because this was congruent with the rural culture. Factors that informed the actions of normalization were relationships between participants and health care professionals, support, and access to individual resources. The findings point to ways in which rural self-reliance is conceived as the primary strategy of diabetes management. People face the paradox of engaging with a health care system that at the same time maximizes individual responsibility for health and minimizes the social support by which individuals manage the condition. The emphasis on self-reliance gives some legitimacy to a lack of prevention and chronic care services. Success of diabetes management behaviours is, however, contingent on relative resources. Where there is good primary care, there develops a number of downstream

  9. Rural self-reliance: the impact on health experiences of people living with type II diabetes in rural Queensland, Australia

    Directory of Open Access Journals (Sweden)

    Althea Page-Carruth


    Full Text Available Objective: The objective of the study was to explore whether and how rural culture influences type II diabetes management and to better understand the social processes that rural people construct in coping with diabetes and its complications. In particular, the study aimed to analyse the interface and interactions between rural people with type II diabetes and the Australian health care system, and to develop a theoretical understanding that reflects constructs that may be more broadly applicable. Methods: The study applied constructivist grounded theory methods within an interpretive interactionist framework. Data from 39 semi-structured interviews with rural and urban type II diabetes patients and a mix of rural health care providers were analysed to develop a theoretical understanding of the social processes that define diabetes management in that context. Results: The analysis suggests that although type II diabetes imposes limitations that require adjustment and adaptation, these processes are actively negotiated by rural people within the environmental context to fit the salient social understandings of autonomy and self-reliance. Thus, people normalized self-reliant diabetes management behaviours because this was congruent with the rural culture. Factors that informed the actions of normalization were relationships between participants and health care professionals, support, and access to individual resources. Conclusions: The findings point to ways in which rural self-reliance is conceived as the primary strategy of diabetes management. People face the paradox of engaging with a health care system that at the same time maximizes individual responsibility for health and minimizes the social support by which individuals manage the condition. The emphasis on self-reliance gives some legitimacy to a lack of prevention and chronic care services. Success of diabetes management behaviours is, however, contingent on relative resources. Where

  10. Characterizing Rural Food Access in Remote Areas. (United States)

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


    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 identifie