Pathways to rural family practice at Memorial University of Newfoundland.

Science.gov (United States)

Rourke, James; O'Keefe, Danielle; Ravalia, Mohamed; Moffatt, Scott; Parsons, Wanda; Duggan, Norah; Stringer, Katherine; Jong, Michael; Walsh, Kristin Harris; Hippe, Janelle

2018-03-01

To assess Memorial University of Newfoundland's (MUN's) commitment to a comprehensive pathways approach to rural family practice, and to determine the national and provincial effects of applying this approach. Analysis of anonymized secondary data. Canada. Memorial's medical degree (MD) graduates practising family medicine in Newfoundland and Labrador as of January 2015 (N = 305), MUN's 2011 and 2012 MD graduates (N = 120), and physicians who completed family medicine training programs in Canada between 2004 and 2013 and who were practising in Canada 2 years after completion of their postgraduate training (N = 8091). National effect was measured by the proportion of MUN's family medicine program graduates practising in rural Canada compared with those from other Canadian family medicine training programs. Provincial effect was measured by the location of MUN's MD graduates practising family medicine in Newfoundland and Labrador as of January 2015. Commitment to a comprehensive pathways approach to rural family practice was measured by anonymized geographic data on admissions, educational placements, and practice locations of MUN's 2011 and 2012 MD graduates, including those who completed family medicine residencies at MUN. Memorial's comprehensive pathways approach to training physicians for rural practice was successful on both national and provincial levels: 26.9% of MUN family medicine program graduates were in a rural practice location 2 years after exiting their post-MD training from 2004 to 2013 compared with the national rate of 13.3% (national effect); 305 of MUN's MD graduates were practising family medicine in Newfoundland and Labrador as of 2015, with 36% practising in rural areas (provincial effect). Of 114 MD students with known background who graduated in 2011 and 2012, 32% had rural backgrounds. Memorial's 2011 and 2012 MD graduates spent 20% of all clinical placement weeks in rural areas; of note, 90% of all first-year placements and 95% of

CURRENT TRENDS OF ROMANIAN RURAL FAMILY

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Adina IORGA

2013-01-01

Full Text Available The profound changes experienced by the Romanian society had a profound social impact on the structure and functions of the rural family. The paper aims to highlight the main trends recorded using a number of indicators: ruralization rate, birth rate, infant mortality rate, percentage of children born outside marriage, fertility rate, percentage of population aged 65 and over. Statistics from censuses and statistical yearbooks were processed to identify the trends of the Romanian rural family: changes in reproductive behavior, increased aging, declining birth rates.

Impact of the rural pipeline in medical education: practice locations of recently graduated family physicians in Ontario.

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Wenghofer, Elizabeth F; Hogenbirk, John C; Timony, Patrick E

2017-02-20

The "rural pipeline" suggests that students educated in rural, or other underserviced areas, are more likely to establish practices in such locations. It is upon this concept that the Northern Ontario School of Medicine (NOSM) was founded. Our analysis answers the following question: Are physicians who were educated at NOSM more likely to practice in rural and northern Ontario compared with physicians who were educated at other Canadian medical schools? We used data from the College of Physicians and Surgeons of Ontario. We compared practice locations of certified Ontario family physicians who had graduated from NOSM vs. other Canadian medical schools in 2009 or later. We categorized the physicians according to where they completed their undergraduate (UG) and postgraduate (PG) training, either at NOSM or elsewhere. We used logistic regression models to determine if the location of UG and PG training was associated with rural or northern Ontario practice location. Of the 535 physicians examined, 67 had completed UG and/or PG medical education at NOSM. Over two thirds of physicians with any NOSM education were practicing in northern areas and 25.4% were practicing in rural areas of Ontario compared with those having no NOSM education, with 4.3 and 10.3% in northern and rural areas, respectively. Physicians who graduated from NOSM-UG were more likely to have practices located in rural Ontario (OR = 2.57; p = 0.014) whereas NOSM-PG physicians were more likely to have practices in northern Ontario (OR = 57.88; p education was associated with an increased likelihood of practicing in rural (NOSM-UG) and northern (NOSM-PG) Ontario.

Human transportation needs in rural Oklahoma.

Science.gov (United States)

2012-09-01

Mobility is extremely important, especially in rural areas, which have dispersed populations and locations. : This study was conducted among rural minority populations to evaluate human transportation needs of the : underserved rural population in Ok...

Collaboration with pharmacy services in a family practice for the medically underserved

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Campbell K

2009-12-01

Full Text Available Objectives: Pharmacist-managed collaborative services in a family practice setting are described, and diabetes and hypertension outcomes are assessed.Methods: Pharmacist-managed clinics, pharmacotherapy consultations, and drug information services are provided for a medically underserved, predominantly African American population. A pharmacy residency director, an ambulatory care pharmacy resident and three PharmD candidate student pharmacists work directly with physicians, nurse practitioners, nurses, and social workers to form an interdisciplinary health care team. Providers utilize pharmacy services through consultations and referrals. Collaboration outcomes were evaluated in twenty-two patients with diabetes and thirty hypertensive patients. Patients were retrospectively followed throughout their history with pharmacy service. Hemoglobin A1c (A1C was tracked before referral to pharmacy services, 3 to 6 months after, and as the most current measure after at least 6 months. Blood pressure (BP was observed before pharmacy involvement, 2 to 4 months later, and then currently for at least 4 months with the service. The mean of the most current markers was calculated, and the percent of patients at their goal marker was compared to national averages.Results: Fifty percent of pharmacy service patients met the American Diabetes Association hemoglobin A1c goal of less than 7% in our evaluation compared to the national mean of 49.8% overall and 44% in African Americans. Thirty percent of patients were at their BP goal while 33.1% of patients without diabetes and 33.2% of patients with diabetes nationally are at goal. Conclusion: The medically underserved patients under the care of pharmacy services achieved a higher percentage at their A1C goal than the national mean. The percentage of patients who achieved their BP goals was comparable to the national average. Increasing utilization of pharmacy services in the family practice setting allows for

Retaining health workforce in rural and underserved areas of India: What works and what doesn't? A critical interpretative synthesis.

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Goel, Sonu; Angeli, Federica; Bhatnagar, Nidhi; Singla, Neetu; Grover, Manoj; Maarse, Hans

2016-01-01

Human resource for health is critical in quality healthcare delivery. India, with a large rural population (68.8%), needs to urgently bridge the gaps in health workforce deployment between urban and rural areas. We did a critical interpretative synthesis of the existing literature by using a predefined selection criteria to assess relevant manuscripts to identify the reasons for retaining the health workforce in rural and underserved areas. We discuss different strategies for retention of health workforce in rural areas on the basis of four major retention interventions, viz. education, regulation, financial incentives, and personal and professional support recommended by WHO in 2010. This review focuses on the English-language material published during 2005-14 on human resources in health across low- and middle-income countries. Healthcare in India is delivered through a diverse set of providers. Inequity exists in health manpower distribution across states, area (urban-rural), gender and category of health personnel. India is deficient in health system development and financing where health workforce education and training occupy a low priority. Poor governance, insufficient salary and allowances, along with inability of employers to provide safe, satisfying and rewarding work conditions-are causing health worker attrition in rural India. The review suggests that the retention of health workers in rural areas can be ensured by multiplicity of interventions such as medical schools in rural areas, rural orientation of medical education, introducing compulsory rural service in lieu of incentives providing better pay packages and special allowances, and providing better living and working conditions in rural areas. A complex interplay of factors that impact on attraction and retention of health workforce necessitates bundling of interventions. In low-income countries, evidence- based strategies are needed to ensure context-specific, field- tested and cost

Understanding Contexts of Family Violence in Rural, Farming Communities: Implications for Rural Women's Health

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Wendt, Sarah; Hornosty, Jennie

2010-01-01

Research on family violence in rural communities in Australia and Canada has shown that women's experience of family violence is shaped by social and cultural factors. Concern for economic security and inheritance for children, closeness and belonging, and values of family unity and traditional gender roles are factors in rural communities that…

Food insecurity and physical activity insecurity among rural Oregon families

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Katherine B. Gunter

2017-12-01

Full Text Available Among rural families, rates of both child obesity and household food insecurity (FI are higher compared to non-rural families. These disparities result from a complex interplay of social and environmental conditions that influence behavior. The Transtheoretical Model suggests individual readiness to change underlies success in modifying obesity-preventing behaviors; however, whether an association between readiness to change obesity-related behaviors and FI status among rural families exists is unknown. We examined the association between readiness to change family-level nutrition and physical activity (PA behaviors that predict child obesity and family FI status within a sample of rural families to better understand these relationships. Families (n=144 were recruited from six rural Oregon communities in 2013. Families completed a FI screener and the Family Stage of Change Survey (FSOC, a measure of readiness to change family-level nutrition and PA behaviors associated with obesity. Demographic differences by FI status were explored, and regression was applied to examine relationships between FI and FSOC scores, adjusting for relevant covariates. Among FI families (40.2%, more were non-white (77.8% vs. 22.2%; p=0.036 and had lower adult education (30.4% vs. 11.8% with >high school degree; p=0.015 compared to non-FI families. After adjusting for education, race, ethnicity, and eligibility for federal meal programs, readiness to provide opportunities for PA was lower among FI families (p=0.002. These data highlight a need to further investigate how food insecurity and low readiness to provide PA opportunities, i.e. “physical activity insecurity” may be contributing to the higher obesity rates observed among rural children and families. Keywords: Food insecurity, Physical activity, Rural, Childhood obesity

Self-collected cervicovaginal sampling for site-of-care primary HPV-based cervical cancer screening: a pilot study in a rural underserved Greek population.

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Chatzistamatiou, Kimon; Chatzaki, Εkaterini; Constantinidis, Τheocharis; Nena, Evangelia; Tsertanidou, Athena; Agorastos, Theodoros

2017-11-01

In the present pilot study, the feasibility of a site-of-care cervicovaginal self-sampling methodology for HPV-based screening was tested in 346 women residing in underserved rural areas of Northern Greece. These women provided self-collected cervicovaginal sample along with a study questionnaire. Following molecular testing, using the cobas ® HPV Test, Roche ® , HPV positive women, were referred to colposcopy and upon abnormal findings, to biopsy and treatment. Participation rate was 100%. Regular pap-test examination was reported for 17.1%. Among hrHPV testing, 11.9% were positive and colposcopy/biopsy revealed 2 CIN3 cases. Non-compliance was the most prevalent reason for no previous attendance. Most women reported non-difficulty and non-discomfort in self-sampling (77.6% and 82.4%, respectively). They would choose self-sampling over clinician-sampling (86.2%), and should self-sampling being available, they would test themselves more regularly (92.3%). In conclusion, self-sampling is feasible and well-accepted for HPV-based screening, and could increase population coverage in underserved areas, helping towards successful prevention.

Potential use of mobile phones in improving animal health service delivery in underserved rural areas: experience from Kilosa and Gairo districts in Tanzania.

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Karimuribo, Esron D; Batamuzi, Emmanuel K; Massawe, Lucas B; Silayo, Richard S; Mgongo, Frederick O K; Kimbita, Elikira; Wambura, Raphael M

2016-10-07

Sub-optimal performance of the animal health delivery system in rural areas is common in developing countries including Tanzania. However, penetration of mobile phones and availability of good road network and public transport systems offer opportunities for improving the access of rural communities to diagnostic and advisory services from facilities and expertise located in urban areas. A questionnaire survey on possession and use of mobile phones by pastoral and agro-pastoral communities in Kilosa and Gairo districts was carried out between November and December 2015. A total number of 138 livestock keepers from three villages of Chakwale (54), Mvumi (41) and Parakuyo (43) participated in the study. An e-based system was designed and tested to link rural communities with urban diagnostic facilities. It was observed that the average number of phones possessed by individuals interviewed and household families was 1.1 ± 0.26 (1-2) and 3.5 ± 2.23 (1-10), respectively. It was further observed that out of 138 livestock keepers interviewed, 133 (96.4 %) had feature phones while 10 (7.2 %) of them possessed smartphones. Mobile phone is currently used to support livestock production by communicating on animal health in Parakuyo (18, 41.9 %), Mvumi (18, 43.9 %) and Chakwale (14, 25.9 %). Other contributions of mobile phones in livestock and crop agriculture observed in the study area include: exchange of livestock price information, crop price information, communicating on plant health/diseases, livestock extension and advisory services as well as crop farming extension and advisory services. We also designed and tested an e-based SUAVetDiag® system to support timely diagnosis of infectious disease conditions and prompt advice on case management in veterinary underserved areas. Availability of mobile phones in rural areas, in combination with supporting infrastructure and facilities in urban areas, has potential to stimulate local development and improving

FHFA Underserved Areas

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Department of Housing and Urban Development — Federal Housing Finance Agency's (FHFA) Underserved Areas establishes underserved area designations for census tracts in Metropolitan Areas (MSAs), nonmetropolitan...

Children Education Investment of Rural Families in Hechuan District of Chongqing Municipality

Institute of Scientific and Technical Information of China (English)

Xiaoling SONG; Dan YANG; Xiaohong SONG

2015-01-01

Taking 20 relative poor families in Hechuan District of Chongqing Municipality as survey samples,taking 275 households of rural families selected by stratified sampling method as research objects,and taking family education investment behavior of this rural area as research content,this paper studied current situations of rural family education investment behavior in Hechuan District,difference in investment behavior and related influence factors. It is intended to provide references for family education investment of rural areas in Hechuan District and even Chongqing Municipality,and promote development of rural education undertaking in China.

Family Reunions: Broadened Kinship, Celebrated Rurality

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Renata Menasche

2014-12-01

Full Text Available This articletakes family reunions held among peasants as a focus of study. During these events,keycultural categories come to light from which the analyzed group builds up ideas about kinship and also the relations that are implied in it. We observe that, in these cases, there are also indications of specific elements through which people express a valorization of rurality. To carry out this study, we collected data as part of an ethnographic research project conducted at a family reunion and in a rural community settled by German descendent immigrants, located in Rio Grande do Sul, southern Brazil

Bringing cutting-edge Earth and ocean sciences to under-served and rural audiences through informal science education

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Cooper, S. K.; Petronotis, K. E.; Ferraro, C.; Johnson, K. T. M.; Yarincik, K.

2017-12-01

The International Ocean Discovery Program (IODP) is an international marine research collaboration that explores Earth's history and dynamics using ocean-going research platforms to recover data recorded in seafloor sediments and rocks and to monitor subseafloor environments. The JOIDES Resolution is the flagship vessel of IODP and is operated by the National Science Foundation. It is an inspirational hook for STEM Earth and ocean topics for children and the general public of all ages, but is not easily accessible due to its international travels and infrequent U.S. port calls. In response, a consortium of partners has created the Pop-Up/Drill Down Science project. The multi-year project, funded by NSF's Advancing Informal Science Learning program, aims to bring the JR and its science to under-served and rural populations throughout the country. Consisting of an inflatable walk-through ship, a multi-media experience, a giant interactive seafloor map and a series of interactive exhibit kiosks, the exhibit, entitled, In Search of Earth's Secrets: A Pop-Up Science Encounter, will travel to 12 communities throughout the next four years. In each community, the project will partner with local institutions like public libraries and small museums as hosts and to train local Girl Scouts to serve as exhibit facilitators. By working with local communities to select events and venues for pop-up events, the project hopes to bring cutting edge Earth and ocean science in creative new ways to underserved populations and inspire diverse audiences to explore further. This presentation will provide details of the project's goals, objectives and development and provide avenues to become involved.

Underserved Areas and Pediatric Resident Characteristics: Is There Reason for Optimism?

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Laraque-Arena, Danielle; Frintner, Mary Pat; Cull, William L

2016-01-01

To examine whether resident characteristics and experiences are related to practice in underserved areas. Cross-sectional survey of a national random sample of pediatric residents (n = 1000) and additional sample of minority residents (n = 223) who were graduating in 2009 was conducted. Using weighted logistic regression, we examined relationships between resident characteristics (background, values, residency experiences, and practice goals) and reported 1) expectation to practice in underserved area and 2) postresidency position in underserved area. Response rate was 57%. Forty-one percent of the residents reported that they had an expectation of practicing in an underserved area. Of those who had already accepted postresidency positions, 38% reported positions in underserved areas. Service obligation in exchange for loans/scholarships and primary care/academic pediatrics practice goals were the strongest predictors of expectation of practicing in underserved areas (respectively, adjusted odds ratio 4.74, 95% confidence interval 1.87-12.01; adjusted odds ratio 3.48, 95% confidence interval 1.99-6.10). Other significant predictors include hospitalist practice goals, primary care practice goals, importance of racial/ethnic diversity of patient population in residency selection, early plan (before medical school) to care for underserved families, mother with a graduate or medical degree, and higher score on the Universalism value scale. Service obligation and primary care/academic pediatrics practice goal were also the strongest predictors for taking a postresidency job in underserved area. Trainee characteristics such as service obligations, values of humanism, and desire to serve underserved populations offer the hope that policies and public funding can be directed to support physicians with these characteristics to redress the maldistribution of physicians caring for children. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All

Impact of Potential Accreditation and Certification in Family Medicine Maternity Care.

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Eden, Aimee R; Peterson, Lars E

2017-01-01

Advanced maternity care training in family medicine is highly variable at both the residency and fellowship levels. Declining numbers of family physicians providing maternity care services may exacerbate disparities in access to maternal and child care, especially in rural and other underserved communities. Accreditation of maternity care fellowships and board certification may be one potential avenue to address this trend. This study sought to understand the perceptions and beliefs of key family medicine stakeholders in advanced maternity care regarding the formalization of maternity care training through fellowship accreditation and the creation of a certificate of added qualification (CAQ). In 2014 and 2015, the authors conducted semi-structured interviews with 51 key stakeholders in family medicine maternity care. Transcribed interviews were coded using an iterative process to identify themes and patterns until saturation was reached. Participants generally supported both maternity care fellowship accreditation and a CAQ and recognized multiple advantages such as legitimization of training. Many had concerns about potential negative unintended consequences such as a loss of curricular flexibility; however, most felt that these could be mediated. Only a few did not support one or both aspects of formalization. Most participants interviewed support formalizing maternity care fellowship training in family medicine through accreditation and a subsequent CAQ, if implemented with attention to minimizing the potential negative consequences. Such formalization would recognize the advanced skill and training of family physicians practicing advanced maternity care and could address some access issues to essential maternity care services for rural and other underserved populations.

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

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

2016-05-01

Women family physicians experience challenges in maintaining work-life balance while practicing in rural communities. We sought to better understand the personal and professional strategies that enable women in rural family medicine to balance work and personal demands and achieve long-term career satisfaction. Women family physicians practicing in rural communities in the United States were interviewed using a semistructured format. Interviews were recorded, professionally transcribed, and analyzed using an immersion and crystallization approach, followed by detailed coding of emergent themes. The 25 participants described a set of strategies that facilitated successful work-life balance. First, they used reduced or flexible work hours to help achieve balance with personal roles. Second, many had supportive relationships with spouses and partners, parents, or other members of the community, which facilitated their ability to be readily available to their patients. Third, participants maintained clear boundaries around their work lives, which helped them to have adequate time for parenting, recreation, and rest. Women family physicians can build successful careers in rural communities, but supportive employers, relationships, and patient approaches provide a foundation for this success. Educators, employers, communities, and policymakers can adapt their practices to help women family physicians thrive in rural communities. © 2016 Annals of Family Medicine, Inc.

Knowledgeable Neighbors: a mobile clinic model for disease prevention and screening in underserved communities.

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Hill, Caterina; Zurakowski, David; Bennet, Jennifer; Walker-White, Rainelle; Osman, Jamie L; Quarles, Aaron; Oriol, Nancy

2012-03-01

The Family Van mobile health clinic uses a "Knowledgeable Neighbor" model to deliver cost-effective screening and prevention activities in underserved neighborhoods in Boston, MA. We have described the Knowledgeable Neighbor model and used operational data collected from 2006 to 2009 to evaluate the service. The Family Van successfully reached mainly minority low-income men and women. Of the clients screened, 60% had previously undetected elevated blood pressure, 14% had previously undetected elevated blood glucose, and 38% had previously undetected elevated total cholesterol. This represents an important model for reaching underserved communities to deliver proven cost-effective prevention activities, both to help control health care costs and to reduce health disparities.

Examining Empowerment, Family-School Partnerships, and Advocacy among Rural and Urban Latino Families of Children with Disabilities

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Burke, Meghan M.

2017-01-01

Latino students and their families are the fastest growing minority group in the country, yet it is unclear whether rural (vs. urban) Latino families of students with disabilities have different needs. In this pilot study, 65 Latino family members of students with disabilities (15 rural; 50 urban) responded to a questionnaire about empowerment,…

Teaching Health Center Graduate Medical Education Locations Predominantly Located in Federally Designated Underserved Areas.

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Barclift, Songhai C; Brown, Elizabeth J; Finnegan, Sean C; Cohen, Elena R; Klink, Kathleen

2016-05-01

Background The Teaching Health Center Graduate Medical Education (THCGME) program is an Affordable Care Act funding initiative designed to expand primary care residency training in community-based ambulatory settings. Statute suggests, but does not require, training in underserved settings. Residents who train in underserved settings are more likely to go on to practice in similar settings, and graduates more often than not practice near where they have trained. Objective The objective of this study was to describe and quantify federally designated clinical continuity training sites of the THCGME program. Methods Geographic locations of the training sites were collected and characterized as Health Professional Shortage Area, Medically Underserved Area, Population, or rural areas, and were compared with the distribution of Centers for Medicare and Medicaid Services (CMS)-funded training positions. Results More than half of the teaching health centers (57%) are located in states that are in the 4 quintiles with the lowest CMS-funded resident-to-population ratio. Of the 109 training sites identified, more than 70% are located in federally designated high-need areas. Conclusions The THCGME program is a model that funds residency training in community-based ambulatory settings. Statute suggests, but does not explicitly require, that training take place in underserved settings. Because the majority of the 109 clinical training sites of the 60 funded programs in 2014-2015 are located in federally designated underserved locations, the THCGME program deserves further study as a model to improve primary care distribution into high-need communities.

Social Work Practice in a Rural Health Care Setting: Farm Families.

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Durham, Judith A.; Miah, M. Mizanur Rahman

1993-01-01

Literature review addresses the status of farm families; farm stresses and their effects; dysfunctional family relationships; and the unique attitudes, behaviors, and perceptions of rural culture toward social service intervention. By implementing coordinated service programs and initiating new legislation that addresses rural health care issues,…

Health-Related Quality of Life of Rural Clients Seeking Telepsychology Services

Directory of Open Access Journals (Sweden)

Kevin R. Tarlow

2014-01-01

Full Text Available Sixty million US residents live in rural areas, but health policies and interventions developed from an urban mindset often fail to address the significant barriers to health experienced by these local communities. Telepsychology, or psychological services delivered by distance via technology, is an emerging treatment modality with special implications for underserved rural areas. This study found that a sample of rural residents seeking telepsychology services (n=94 had low health-related quality of life (HRQOL, often due to cooccurring physical and mental health diagnoses including high rates of depression. However, a brief telepsychology treatment delivered to rural clients (n=40 was associated with an improvement in mental health-related quality of life (d = 0.70,  P<.001. These results indicate that despite the complex health needs of these underserved communities, telepsychology interventions may help offset the disparities in health service access in rural areas.

The experience of rural families in the face of cancer.

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Girardon-Perlini, Nara Marilene Oliveira; Ângelo, Margareth

2017-01-01

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.

Better Together: Expanding Rural Partnerships to Support Families

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Shaklee, Harriet; Bigbee, Jeri; Wall, Misty

2012-01-01

Chronic shortages of health, social service, and mental health professionals in rural areas necessitate creative partnerships in support of families. Cooperative extension professionals in Family and Consumer Sciences and community health nurses, who can bring critical skills to human services teams, are introduced as trusted professionals in…

Family planning and fertility decline in rural Iran: the impact of rural health clinics.

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Salehi-Isfahani, Djavad; Abbasi-Shavazi, M Jalal; Hosseini-Chavoshi, Meimanat

2010-09-01

During the first few years of the Islamic Revolution of 1979, and aided by pro-natal government policies, Iranian fertility was on the rise. In a reversal of its population policy, in 1989, the government launched an ambitious and innovative family planning program aimed at rural families. By 2005, the program had covered more than 90% of the rural population and the average number of births per rural woman had declined to replacement level from about 8 births in the mid 1980s. In this paper, we evaluate the impact of a particular feature of the program - health houses - on rural fertility, taking advantage of the variation in the timing of their construction across the country. We use three different methods to obtain a range of estimates for the impact of health houses on village-level fertility: difference-in-differences (DID), matching DID, and length of exposure. We find estimates of impact ranging from 4 to 20% of the decline in fertility during 1986-1996. (c) 2010 John Wiley & Sons, Ltd.

Perceptions of cardiovascular health in underserved communities.

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Bryant, Lucinda L; Chin, Nancy P; Cottrell, Lesley A; Duckles, Joyce M; Fernandez, I Diana; Garces, D Marcela; Keyserling, Thomas C; McMilin, Colleen R; Peters, Karen E; Samuel-Hodge, Carmen D; Tu, Shin-Ping; Vu, Maihan B; Fitzpatrick, Annette L

2010-03-01

Cardiovascular disease is the leading cause of deaths and illnesses in US adults, and the prevalence is disproportionately high in underserved populations. In this study, we assessed respondents' understanding of context-specific differences in knowledge and perceptions of disease, risk, and prevention in 6 underserved communities, with the longer-term goal of developing appropriate interventions. Thirty-nine small-group sessions and 14 interviews yielded data from 318 adults. Each site's researchers coded, analyzed, and extracted key themes from local data. Investigators from all sites synthesized results and identified common themes and differences. Themes clustered in 3 areas (barriers to cardiovascular health, constraints related to multiple roles, and suggestions for effective communications and programs). Barriers spanned individual, social and cultural, and environmental levels; women in particular cited multiple roles (eg, competing demands, lack of self-care). Programmatic suggestions included the following: personal, interactive, social context; information in language that people use; activities built around cultural values and interests; and community orientation. In addition, respondents preferred health-related information from trusted groups (eg, AARP), health care providers (but with noticeable differences of opinion), family and friends, and printed materials. Interventions to decrease barriers to cardiovascular health are needed; these strategies should include family and community context, small groups, interactive methods, culturally sensitive materials, and trusted information sources. New-immigrant communities need culturally and linguistically tailored education before receiving more substantive interventions.

Cost-Effectiveness of a Family Planning Voucher Program in Rural Pakistan.

Science.gov (United States)

Broughton, Edward Ivor; Hameed, Waqas; Gul, Xaher; Sarfraz, Shabnum; Baig, Imam Yar; Villanueva, Monica

2017-01-01

This study reports on the effectiveness and efficiency from the program funder's perspective of the Suraj Social Franchise (SSF) voucher program in which private health-care providers in remote rural areas were identified, trained, upgraded, and certified to deliver family planning services to underserved women of reproductive age in 29 districts of Sindh and 3 districts of Punjab province, Pakistan between October 2013 and June 2016. A decision tree compared the cost of implementing SSF to the program funder and its effects of providing additional couple years of protection (CYPs) to targeted women, compared to business-as-usual. Costs included vouchers given to women to receive a free contraceptive method of their choice from the SSF provider. The vouchers were then reimbursed to the SSF provider by the program. A total of 168,206 married women of reproductive age (MWRA) received SSF vouchers between October 2013 and June 2016, costing $3,278,000 ($19.50/recipient). The average effectiveness of the program per voucher recipient was an additional 1.66 CYPs, giving an incremental cost-effectiveness of the program of $4.28 per CYP compared to not having the program (95% CI: $3.62-5.31). The result compares favorably to other interventions with similar objectives and appears affordable for the Pakistan national health-care system. It is therefore recommended to help address the unmet need for contraception among MWRA in these areas of Pakistan and is worthy of trial implementation in the country more widely.

Big Pharma on the Farm: Students Are Exposed to Pharmaceutical Marketing More Often in Rural Clinics.

Science.gov (United States)

Evans, David V; Keys, Toby; Desnick, Laurel; A Andrilla, C Holly; Bienz, Danielle; Rosenblatt, Roger

2016-07-01

Pharmaceutical marketing techniques are effective in changing the behavior of health care providers in ways that deviate from evidence-based practices. To mitigate the influence of pharmaceutical marketing on learners, academic medical centers (AMCs) have adopted policies to limit student/industry interaction. Many clinical experiences occur outside of the AMC. The purpose of this study was to compare medical students' exposure to pharmaceutical marketing in off-campus rural and urban underserved clinical sites. The University of Washington School of Medicine Rural and Underserved Opportunities Program (RUOP) places rising second-year medical students in underserved clinical sites in five northwestern states. We surveyed RUOP students to evaluate their exposure to pharmaceutical marketing. Of 120 students, 86 (72%) completed surveys. Sixty-five (76%) did their RUOP rotation in rural areas. Students in rural locations were more likely to report exposure to pharmaceutical marketing. Distribution of free drug samples was reportedly three times higher in rural than urban sites (54% versus 15%). Doctors meeting with sales representatives were reported as four times higher in rural clinics (40% versus 10%). Students at rural sites reported exposure to pharmaceutical marketing more than those in urban settings. Rural medical educators should provide faculty development for community clinicians on the influences of pharmaceutical marketing on learners. Medical schools must review local clinic and institution-wide policies to limit pharmaceutical marketing exposure to learners in the rural learning environment.

Sharing Gravity's Microscope: Star Formation and Galaxy Evolution for Underserved Arizonans

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Knierman, Karen A.; Monkiewicz, Jacqueline A.; Bowman, Catherine DD; Taylor, Wendy

2016-01-01

Learning science in a community is important for children of all levels and especially for many underserved populations. This project combines HST research of galaxy evolution using gravitationally lensed galaxies with hands-on activities and the Starlab portable planetarium to link astronomy with families, teachers, and students. To explore galaxy evolution, new activities were developed and evaluated using novel evaluation techniques. A new set of galaxy classification cards enable inquiry-based learning about galaxy ages, evolution, and gravitational lensing. Activities using new cylinder overlays for the Starlab transparent cylinder will enable the detailed examination of star formation and galaxy evolution as seen from the viewpoint inside of different types of galaxies. These activities were presented in several Arizona venues that enable family and student participation including ASU Earth and Space Open House, Arizona Museum of Natural History Homeschooling Events, on the Salt River Pima-Maricopa Indian Community, and inner city Phoenix schools serving mainly Hispanic populations. Additional events targeted underserved families at the Phoenix Zoo, in Navajo County, and for the Pascua Yaqui Tribe. After evaluation, the activities and materials will also be shared with local teachers and nationally.

Relationship of body mass index and psychosocial factors on physical activity in underserved adolescent boys and girls.

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Kitzman-Ulrich, Heather; Wilson, Dawn K; Van Horn, M Lee; Lawman, Hannah G

2010-09-01

Previous research indicates that body mass index (BMI) and sex are important factors in understanding physical activity (PA) levels. The present study examined the influence of BMI on psychosocial variables (self-efficacy, social support) and PA in underserved (ethnic minority, low income) boys in comparison with girls. Participants (N = 669; 56% girls; 74% African American) were recruited from the "Active by Choice Today" trial. BMI ʐ score was calculated from objectively collected height and weight data, and PA was assessed with 7-day accelerometry estimates. Self-report questionnaires were used to measure self-efficacy and social support (family, peers) for PA. A 3-way interaction between BMI z score, sex, and family support on PA was shown such that family support was positively associated with PA in normal-weight but not overweight or obese boys, and was not associated with PA in girls. Self-efficacy had the largest effect size related to PA in comparison with the other psychosocial variables studied. Self-efficacy was found to be an important variable related to PA in underserved youth. Future studies should evaluate possible barriers to PA in girls, and overweight youth, to provide more effective family support strategies for underserved adolescents' PA. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Attitude of Women towards Family Planning in Selected Rural ...

African Journals Online (AJOL)

... the desired attitudinal and behavioral changes towards family planning is yet to be ... from selected rural areas in Ibadan towards family planning using the Health ... The study revealed that the socio-economic status of mothers significantly ...

Attitude of Rural Youths towards Family Farming in Dass, Bauchi ...

African Journals Online (AJOL)

Attitude of Rural Youths towards Family Farming in Dass, Bauchi State, Nigeria and the ... Majority were males (88 %), single (51 %), literate (99 %) and had rural ... most of them (78 %) said was learned through parents (non-formal sources).

Maternity Care Services Provided by Family Physicians in Rural Hospitals.

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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.

Ageing in rural China: impacts of increasing diversity in family and community resources.

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Joseph, A E; Phillips, D R

1999-06-01

The majority of China's population lives in rural areas and a pattern is emerging of very uneven provision of support for rural elderly people. Local economic conditions and broad demographic trends are creating diversity in the ability both of rural families to care for their elderly kin and in the capacity of communities to support their elderly residents and family carers. In part as a consequence of China's population policy and the 'one-child policy', future Chinese families will have fewer members and be 'older', but they will continue to be regarded emotionally and in policy as the main source of economic and social support for the elderly. The increasing involvement of women in the paid workforce and the changing geographical distribution of family members resulting from work-related migration, are reducing the ability of families to care for their elderly relatives. The availability of resources other than the family for the care of older persons therefore becomes a key issue. Communities in more prosperous, modernising rural areas are often able to provide their elderly residents with welfare and social benefits previously found almost exclusively in urban areas. However, in poorly developed rural areas, provision is either very patchy or non-existent and the local economy cannot support expansion or improvement. A case study in Zhejiang Province illustrates the favourable provision for ageing in a prosperous modernising rural community, in which entitled elderly residents are provided with an impressive array of financial and social benefits. The paper concludes with a consideration of the policy implications of the growing differentiation of the social and economic capacity of rural communities to support their elderly members.

Motivations for childbearing and fertility behavior among urban and rural families of Iran.

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Hekmat, F; Kabacoff, R I; Klein, H E

1983-01-01

A sample of 384 husbands and wives were randomly selected and interviewed to investigate the implication of fertility norms and motivations for childbearing on fertility and family planning behavior among Iranian families in urban and rural areas of Iran, after the Islamic Revolution of 1979. The term "fertility behavior" refers to actual family size, which is defined as number of children the respondent has living at the time of the interview. "Family planning behavior" refers to the duration of time that the subject has used any birth control method(s). Rural families demonstrated larger actual and ideal family sizes than urban families. The rural sample had a median actual family size of 3.5 children and a median ideal family size of 4.7 children. For the urban sample these figures were 2.2 and 2.3, respectively. The median number of years married was 12.33 for rural and 13.91 for urban respondents. Urban respondents tended to emphasize the psychological and emotional benefits and liabilities associated with having children while rural respondents tended to emphasize both economic and security related motivations. Both groups endorsed infant mortality as a motivation for having more children. Male and female respondents were remarkably similar in their endorsed motivations. There was a significant positive correlation between desired and ideal family size. The correlations among ideal/desired family size and practicing birth control methods were the same and significant at the .001 level. The relationship between motivations for childbearing and years of practicing birth control methods was also significant at the .001 level. Stepwise regression analyses were performed to examine the important predictors of fertility and family planning behavior. For both actual family size and years on birth control, males and females were very similar in terms of predictor importance. Those respondents with less education and large ideal family size tended to have larger

Cost-Effectiveness of a Family Planning Voucher Program in Rural Pakistan

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Edward Ivor Broughton

2017-09-01

Full Text Available IntroductionThis study reports on the effectiveness and efficiency from the program funder’s perspective of the Suraj Social Franchise (SSF voucher program in which private health-care providers in remote rural areas were identified, trained, upgraded, and certified to deliver family planning services to underserved women of reproductive age in 29 districts of Sindh and 3 districts of Punjab province, Pakistan between October 2013 and June 2016.MethodA decision tree compared the cost of implementing SSF to the program funder and its effects of providing additional couple years of protection (CYPs to targeted women, compared to business-as-usual. Costs included vouchers given to women to receive a free contraceptive method of their choice from the SSF provider. The vouchers were then reimbursed to the SSF provider by the program.ResultsA total of 168,206 married women of reproductive age (MWRA received SSF vouchers between October 2013 and June 2016, costing $3,278,000 ($19.50/recipient. The average effectiveness of the program per voucher recipient was an additional 1.66 CYPs, giving an incremental cost-effectiveness of the program of $4.28 per CYP compared to not having the program (95% CI: $3.62–5.31.ConclusionThe result compares favorably to other interventions with similar objectives and appears affordable for the Pakistan national health-care system. It is therefore recommended to help address the unmet need for contraception among MWRA in these areas of Pakistan and is worthy of trial implementation in the country more widely.

Planning a Family: Priorities and Concerns in Rural Tanzania ...

African Journals Online (AJOL)

Planning a Family: Priorities and Concerns in Rural Tanzania. T Marchant, AK Mushi, R Nathan, O Mukasa, S Abdulla, C Lengeler, JRM Armstrong Schellenberg. Abstract. A fertility survey using qualitative and quantitative techniques described a high fertility setting (TFR 5.8) in southern Tanzania where family planning use ...

[Effect of development of rural commodity economy on family planning].

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Chen, X

1986-05-01

The paper discusses the effects of the changes of rural income level on family planning practice based a survey of 200 rural families in a affluent vegetable producing area of suburban Beijing. In 1984, 99.7% of child birth followed the local birth planning, and 99.1% of families with one child received One Child Certificates. The annual per capita income of the 200 families was 1,092 yuan (1 US$ = 3.7 yuan) in 1984 even higher than the community average. The number of children was negatively associated with the per capita income and per capita consumption except families with 4 children, most of whom have grown up. The rural mechanization in the community has greatly increased the need for skills and technology rather than strong laborers. The provision of community welfare programs and the increased living standard changed the value of children and also changed people's perception in favor of gender equality. Among families with 1 or 2 children, most preferred to have girls. And among families with more children, the preferred family size is smaller than the actual size, which shows a tendency towards favoring a small family. Among 1 child families, 58.7% considered 1 boy and 1 girl to be ideal, and 37.7% was happy with the only child. As the community becomes richer, both the community and individual families increased their investment in education. The spending on education per child was over 2 times as high in 1 child families than the families with more children. The educational status of parents is positively associated with the exception of children's future education and current spending on education. The concern of parents over children's education is an important factor in improving the quality of labor force. Women of higher education status are more acceptable to contraception and family planning policy. The relatively high level of education of the community has been conducive to it fertility decline.

Navigating the digital divide: A systematic review of eHealth literacy in underserved populations in the United States.

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Chesser, Amy; Burke, Anne; Reyes, Jared; Rohrberg, Tessa

2016-01-01

eHealth provides an important mechanism to connect medically underserved populations with health information, but little is known about gaps in eHealth literacy research in underserved adult populations within the U.S. Between June and July 2013, three systematic literature reviews of five databases were conducted and a subsequent hand search was completed. Identified literature was screened and studies meeting exclusion and inclusion criteria were synthesized and analyzed for common themes. Of the 221 articles critically appraised, 15 met these criteria. Thirty-five of these studies were excluded due to international origin. Of the articles meeting the inclusion criteria, underserved populations assessed included immigrant women, the elderly, low-income, the un- and underemployed, and African-American and Hispanic populations. eHealth literacy assessments utilized included one or two item screeners, the eHEALS scale, health information competence and cognitive task analysis. Factors examined in relation to eHealth literacy included age, experience, overall health literacy, education, income and culture. The majority did not assess the impact of locality and those that did were predominately urban. These data suggest that there is a gap in the literature regarding eHealth literacy knowledge for underserved populations, and specifically those in rural locations, within the U.S.

Son preference in rural China: patrilineal families and socioeconomic change.

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Murphy, Rachel; Tao, Ran; Lu, Xi

2011-01-01

This article draws on a survey conducted in six provinces in summer 2008 to investigate the determinants of son preference in rural China. The analysis confirms the conventional wisdom that son preference is embedded within patrilineal family structures and practices. We extend our analysis by exploring specific aspects of variation within patrilineal family culture. We find that the patrilineal group (clan) composition of villages and family participation in practices such as building ancestral halls and updating genealogies significantly influence son preference. Yet even though son preference is embedded within patrilineal family culture, our analysis suggests that over time the attenuation of son preference is likely. This is because determinants associated with socioeconomic change—for instance, higher levels of education, direct exposure to official policy education materials, higher income (a proxy for rural industrialization), and agricultural mechanization—all attenuate son preference. Being younger and female are also associated with weaker son preference, and both characteristics are likely to interact with education and industrialization to further dilute son preference in the longer term. Nevertheless, our findings suggest that concerted efforts are needed to ameliorate institutional discrimination against rural people in welfare provisioning and in labor markets, and to promote multiple dimensions of gender equality, including in land rights, wage rates, and education.

Risk projection and the fertility of rural families.

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Song, R

1991-01-01

The author comments on the theories and empirical evidence which aid in understanding the determinants of the reproductive behavior of farmers in China. The issues are defined, and discussion expands on the needs for a specific number of children in rural versus urban areas, M. Cain's risk insurance hypothesis, the importance of modes of production for the farm family, the farmer's security versus risks, and the balance between risk projection and the maximization of interest. The significance of risk projection is presented as are the implications for policy making. Neither theory of farmer's reproductive behavior, 1) the economic cost and benefit theory or 2) the need for labor theory is considered suitable. The idea that benefits exceed the costs of rearing children cannot justify the repeated cycle of poverty among farmers with many children. The Hubei Province, Danjiankou City, study which estimates rearing costs of 3360 yuan/child benefits of 305 yuan/year to the parents in old age is considered incorrect. The second theory agrees that children are needed for production but recognized surplus labor and does not account for the fact that the more children, the poorer the family. Micro demographic theories identify factors affecting demographic behavior, the extent to which factors affect fertility, and the interrelatedness of factors. The rural family feels jeopardized with one child, and the lowest tolerable number of children is 2-3 in rural areas. Manual labor is the basis of the traditional peasant economy. In this economy, loss of income is a threat whether due to crop failure, weather changes, or market changes. Payment occurs at the end of the year only. Child health is a risk due to poor nutrition and poor health facilities. Following a one-child policy might jeopardize perpetuation of the family line and provision for parents by sons. Urban risks are different. Rural families limit risk by keeping material resources, enlarging and strengthening the

Strategies for Estonian rural family enterprises. Eesti maapiirkonna pereettevõtete strateegia

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Maret Kirsipuu

2013-01-01

Full Text Available The paper seeks to analyse family businesses in rural areas, family business strategies and re-registration of sole proprietors with the Centre of Registers and Information Systems (hereinafter Commercial Register in 2009, and to provide an overview of entrepreneurship policies targeted at Estonian rural businesses. Layoffs have increased the number of unemployed; some of those who have lost employment opt for social assistance benefits, but some others decide to become entrepreneurs. Many enterprising people in Estonia have set up a family enterprise, mainly in the sphere of services, agriculture and tourism. The Estonian entrepreneurship policy supports enterprising people and approves of entrepreneurship as a promoter of national economic development. One of the most positive qualities of family enterprises is their short decision-making chain, which ensures rapid implementation of the strategy.

Women, microcredit and family planning practices: a case study from rural Ghana.

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Norwood, Carolette

2011-01-01

This paper examines the influence of informal banking club participation on family planning practices in rural Ghana. Research from Asia suggests that family planning practices are improved by club participation. This study examines this thesis in an African context, using rural Ghana as a case study. A sample of 204 women (19 years and older) was drawn from Abokobi village, Ghana. Multivariate analyses of direct, mediating and moderating effects of women’s demographic background characteristics, membership status and length, and women’s empowerment status as predictors of family planning practices are assessed. Findings suggest that club membership and membership length is not associated with family planning practices; however, age, education level, number of children and empowerment status are.

Rural Family Physicians Are Twice as Likely to Use Telehealth as Urban Family Physicians.

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Jetty, Anuradha; Moore, Miranda A; Coffman, Megan; Petterson, Stephen; Bazemore, Andrew

2018-04-01

Telehealth has the potential to reduce health inequities and improve health outcomes among rural populations through increased access to physicians, specialists, and reduced travel time for patients. Although rural telehealth services have expanded in several specialized areas, little is known about the attitudes, beliefs, and uptake of telehealth use in rural American primary care. This study characterizes the differences between rural and urban family physicians (FPs), their perceptions of telehealth use, and barriers to further adoption. Nationally representative randomly sampled survey of 5,000 FPs. Among the 31.3% of survey recipients who completed the survey, 83% practiced in urban areas and 17% in rural locations. Rural FPs were twice as likely to use telehealth as urban FPs (22% vs. 10%). Logistic regressions showed rural FPs had greater odds of reporting telehealth use to connect their patients to specialists and to care for their patients. Rural FPs were less likely to identify liability concerns as a barrier to using telehealth. Telemedicine allows rural patients to see specialists without leaving their communities and permits rural FPs to take advantage of specialist expertise, expand their scope of practice, and reduce the feeling of isolation experienced by rural physicians. Efforts to raise awareness of current payment policies for telehealth services, addressing the limitations of current reimbursement policies and state regulations, and creating new avenues for telehealth reimbursement and technological investments are critical to increasing primary care physician use of telehealth services.

Prevalence of Low Calorie Intake by Rural Families in Palpa District of Nepal

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Madhusudhan Ghimire

2013-12-01

Full Text Available Background: Healthy population is indispensable for national development. Adequate food intake by people is the key determinant to keep up their health. Malnutrition nevertheless remains pervasive in developing countries, undermining people’s health, productivity, and often their survival. Food insecurity and hunger remain persistent in Nepal. Prevalence of low calories intake by rural family is widespread throughout the country population. Mainly marginalized communities, ethnic group with poor economic status, traditional societies and lower cast people are exposed to food defi cit. Objective: to investigate the prevalence of low calories intake by rural families and its associated determinants in Palpa district. Materials and methods: The cross-sectional study was designed to achieve objective of the research. A random sample of 339 families was selected from rural areas (DUMRE, DAMKADA, GORKHEKOT and TELGHA villages of this district. Data were analyzed by using the SPSS software for Windows (version 16.0. Results: The existence of inadequate food calorie intake among rural families was most common. Most of them were malnourished. Conclusion: low calorie intake by ethnic group was considerably higher than other groups in community.

Who steers the ship? Rural family physicians' views on collaborative care models for patients with dementia.

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Kosteniuk, Julie; Morgan, Debra; Innes, Anthea; Keady, John; Stewart, Norma; D'Arcy, Carl; Kirk, Andrew

2014-01-01

Little is known about the views of rural family physicians (FPs) regarding collaborative care models for patients with dementia. The study aims were to explore FPs' views regarding this issue, their role in providing dementia care, and the implications of providing dementia care in a rural setting. This study employed an exploratory qualitative design with a sample of 15 FPs. All rural FPs indicated acceptance of collaborative models. The main disadvantages of practicing rural were accessing urban-based health care and related services and a shortage of local health care resources. The primary benefit of practicing rural was FPs' social proximity to patients, families, and some health care workers. Rural FPs provided care for patients with dementia that took into account the emotional and practical needs of caregivers and families. FPs described positive and negative implications of rural dementia care, and all were receptive to models of care that included other health care professionals.

Parental encouragement of initiative-taking and adjustment in Chinese children from rural, urban, and urbanized families.

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Chen, Xinyin; Li, Dan

2012-12-01

Due to the requirements of the competitive, market-oriented urban society, parents in urban and urbanized families are more likely than parents in rural families to encourage initiative-taking in child rearing in China. The socialization experiences of children from different types of families may be related to their adjustment. This study examined parental socialization attitudes, social and school adjustment, and their relations in Chinese children from rural, urban, and urbanized families. Participants were elementary school students (N = 1,033; M age = 11 years) and their parents in China. Data were obtained from parental reports, peer evaluations, teacher ratings, and school records. A multivariate analysis of variance revealed that parents in urban and urbanized families had higher scores than parents in rural families on encouragement of initiative-taking. Urban children, particularly girls, were more sociable, obtained higher social status, and had fewer school problems than their rural counterparts. Children from urbanized families were different from rural children and similar to urban children in social and school adjustment. Moreover, multigroup invariance tests showed that parental encouragement of initiative-taking was associated more strongly with children's sociable-assertive behavior and social standing in the urban and urbanized groups than in the rural group. The results indicate that particular socialization attitudes may vary in their adaptive value in child development as a function of specific social and cultural requirements in changing societies. PsycINFO Database Record (c) 2012 APA, all rights reserved.

Dermatologic care in the homeless and underserved populations: observations from the Venice Family Clinic.

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Grossberg, Anna L; Carranza, Dafnis; Lamp, Karen; Chiu, Melvin W; Lee, Catherine; Craft, Noah

2012-01-01

Dermatologic care in the homeless and impoverished urban underserved populations is rarely described despite the wide prevalence of skin concerns in this population. Because the homeless population may be subject to increased sun exposure compared to the nonhomeless population, they also may be at increased risk for skin cancer. We sought to describe the spectrum of dermatologic diseases seen in a free clinic in Venice, California--the Venice Family Clinic (VFC)--as well as the differences in diagnoses between the homeless and nonhomeless patients seen at this clinic. A retrospective chart review was performed of dermatology patients (N = 82) seen at VFC throughout the 2006 calendar year. The homeless population (n = 22) was found to have more diagnoses of malignant/premalignant growths (25% [16/64] of all homeless diagnoses) compared to their nonhomeless (n = 60) counterparts (6.1% [8/132] of all nonhomeless diagnoses; P < .0001). This difference was sustained when ethnicity was controlled, with 29.6% [16/54] of diagnoses in the homeless white group consisting of malignant/ premalignant growths compared to 8.9% [4/45] of diagnoses in the nonhomeless white cohort (P < .005). Homeless patients may have a higher incidence of skin cancers and precancerous skin lesions due to increased sun exposure and/or limited access to dermatologic care.

A "Medical Mission" at Home: The Needs of Rural America in Terms of Otolaryngology Care

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Winters, Ryan; Pou, Anna; Friedlander, Paul

2011-01-01

Objectives: Describe the population, Medicaid, uninsured, and otolaryngology practice demographics for 7 representative rural Southeastern states, and propose academic-affiliated outreach clinics as a service to help meet the specialty care needs of an underserved rural population, based on the "medical mission" model employed in…

Precommitting to Serve the Underserved

Science.gov (United States)

Eyal, Nir; Bärnighausen, Till

2014-01-01

In many countries worldwide, especially in Sub-Saharan Africa, a shortage of physicians limits the provision of lifesaving interventions. One existing strategy to increase the number of physicians in areas of critical shortage is conditioning medical school scholarships on a precommitment to work in medically underserved areas later. Current practice is usually to demand only one year of service for each year of funded studies. We show the effectiveness of scholarships conditional on such precommitment for increasing physician supplies in underserved areas. Then we defend these scholarships against ethical worries that they constitute slavery contracts; rely on involuntary, biased, or unauthorized early consent by a young signatory; put excessive strains on signed commitments; give rise to domination; and raise suspicion of slavery contracts. Importantly, we find that scholarships involving far longer commitment than current practice allows would also withstand these worries. Policymakers should consider introducing conditional scholarships, including long-term versions, as a means to increasing the supply of physicians to medically underserved areas. PMID:22548519

Precommitting to serve the underserved.

Science.gov (United States)

Eyal, Nir; Bärnighausen, Till

2012-01-01

In many countries worldwide, especially in sub-Saharan Africa, a shortage of physicians limits the provision of lifesaving interventions. One existing strategy to increase the number of physicians in areas of critical shortage is conditioning medical school scholarships on a precommitment to work in medically underserved areas later. Current practice is usually to demand only one year of service for each year of funded studies. We show the effectiveness of scholarships conditional on such precommitment for increasing physician supplies in underserved areas. Then we defend these scholarships against ethical worries that they constitute slavery contracts; rely on involuntary, biased, or unauthorized early consent by a young signatory; put excessive strains on signed commitments; give rise to domination; and raise suspicion of slavery contracts. Importantly, we find that scholarships involving far longer commitment than current practice allows would also withstand these worries. Policymakers should consider introducing conditional scholarships, including long-term versions, as a means to increasing the supply of physicians to medically underserved areas.

5 CFR 894.801 - Will benefits be available in underserved areas?

Science.gov (United States)

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Will benefits be available in underserved... Underserved Areas § 894.801 Will benefits be available in underserved areas? (a) Dental and vision plans under FEDVIP will include underserved areas in their service areas and provide benefits to enrollees in...

The Synergy of Family and Neighborhood on Rural Dating Violence Victimization.

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Foshee, Vangie A; Chang, Ling-Yin; McNaughton Reyes, H Luz; Chen, May S; Ennett, Susan T

2015-09-01

Rural adolescents are at high risk for dating violence victimization (DVV), which has serious negative consequences. Understanding more about the conditions that increase DVV risk for rural adolescents is needed to inform prevention efforts. In response to calls for examining the influence of upper levels of the social ecology on adolescent dating violence, this study examined whether associations between the family context and physical DVV were conditioned by the characteristics of the neighborhoods in which the family resided. Data were from a multi-wave longitudinal study of 3,236 rural adolescents nested in 65 block groups, which defined neighborhoods. Data were collected between 2003 and 2005. Multilevel growth curve modeling was conducted in 2014 to test hypothesized synergistic effects of the family and neighborhood on trajectories of physical DVV from grade 8 to 12. Low parental closeness was a DVV risk in residentially stable (pFamily aggression was a DVV risk, regardless of neighborhood characteristics (p=0.001). Low parental monitoring and rule setting were not DVV risks and their effects were not moderated by neighborhood characteristics. Neighborhood ethnic heterogeneity was significantly (pviolence were not associated with DVV. None of the effects varied by sex of the adolescent, across time (grade), or by the combination of sex and time. Findings demonstrate the importance of considering the family and neighborhood, and particularly their synergistic effects in efforts to prevent adolescent DVV. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Corporal punishment in rural Colombian families: prevalence, family structure and socio-demographic variables.

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González, Martha Rocío; Trujillo, Angela; Pereda, Noemí

2014-05-01

To reveal the prevalence of corporal punishment in a rural area of Colombia and its correlates to family structure and other socio-demographic variables. A survey about childrearing and childcare was developed for this study, including a specific question about corporal punishment that was developed based on the Conflict Tactics Scale (CTS). Family structure was categorized as follows, based on previous literature: 'nuclear family,' 'single parent' family, 'extended family,' 'simultaneous family' and 'composed family.' Forty-one percent of the parents surveyed admitted they had used corporal punishment of their children as a disciplinary strategy. The type of family structure, the number of children living at home, the age of the children, the gender of the parent who answered the survey, and the age and gender of the partner were significant predictors of corporal punishment. Family structure is an important variable in the understanding of corporal punishment, especially in regard to nuclear families that have a large number of children and parents who started their parental role early in life. Copyright © 2013 Elsevier Ltd. All rights reserved.

The Regional Asthma Disease Management Program (RADMP) for low income underserved children in rural western North Carolina: a National Asthma Control Initiative Demonstration Project.

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Shuler, Melinda S; Yeatts, Karin B; Russell, Donald W; Trees, Amy S; Sutherland, Susan E

2015-01-01

A substantial proportion of low-income children with asthma living in rural western North Carolina have suboptimal asthma management. To address the needs of these underserved children, we developed and implemented the Regional Asthma Disease Management Program (RADMP); RADMP was selected as one of 13 demonstration projects for the National Asthma Control Initiative (NACI). This observational intervention was conducted from 2009 to 2011 in 20 rural counties and the Eastern Band Cherokee Indian Reservation in western North Carolina. Community and individual intervention components included asthma education in-services and environmental assessments/remediation. The individual intervention also included clinical assessment and management. Environmental remediation was conducted in 13 childcare facilities and 50 homes; over 259 administrative staff received asthma education. Fifty children with mild to severe persistent asthma were followed for up to 2 years; 76% were enrolled in Medicaid. From 12-month pre-intervention to 12-month post-intervention, the total number of asthma-related emergency department (ED) visits decreased from 158 to 4 and hospital admissions from 62 to 1 (p < 0.0001). From baseline to intervention completion, lung function FVC, FEV1, FEF 25-75 increased by 7.2%, 13.2% and 21.1%, respectively (all p < 0.001), and average school absences dropped from 17 to 8.8 days. Healthcare cost avoided 12 months post-intervention were approximately $882,021. The RADMP program resulted in decreased ED visits, hospitalizations, school absences and improved lung function and eNO. This was the first NACI demonstration project to show substantial improvements in healthcare utilization and clinical outcomes among rural asthmatic children.

Multicultural Milky Way: Ethnoastronomy and Planetarium Shows for Under-served Arizonans

Science.gov (United States)

Knierman, Karen

2018-01-01

The astronomy outreach initiative, Multicultural Milky Way, partners the School of Earth and Space Exploration (SESE) at Arizona State University (ASU) with under-served populations in Arizona in learning about our Milky Way and other galaxies. Arizona is home to many diverse populations with rich cultural histories such as Mayan, Navajo, and Apache. Linking astronomy practiced by one’s indigenous culture to that of Western astronomy may increase the interest in science. Through multicultural planetarium shows and associated hands-on activities, under-served students and families will learn how the Milky Way is represented in different cultures and about the science of galaxies. New planetarium shows using the Mesa Community College (MCC) Digital Planetarium and STARLAB portable planetarium explore how the Milky Way is interpreted in different cultures. STARLAB shows and associated new hands-on activities have been featured during school visits, teacher trainings, and Community Astronomy Nights around Arizona. For authentic assessment, evaluation techniques and procedures were developed.

Human Capital of Family and Social Mobility in Rural Areas-Evidence from China

Institute of Scientific and Technical Information of China (English)

ZHANG Jin-hua; YU Mei-lian; WU Fang-wei; CHEN Wei

2013-01-01

This research focuses on the impact of family’s human capital on social mobility in China’s rural community. Empirical research is conducted based on data from surveying a typical rural community in the past 20 yr. The study indicates that social mobility in rural area is active in the past 20 yr, and the human capital of family, represented by primary labor’s education level, has played an essential role in mobility of low social class. Meanwhile, socio-economic development and the change of supply and demand in labor market dims the signaling role of degree education, but the impact of occupational training is increasingly remarkable. Therefore, the change from sole degree education to multi-leveled education including occupational education and training is a main way for China’s rural families in low class to realize social mobility.

My Future, My Family, My Freedom: Meanings of Schooling for Poor, Rural Chinese Youth

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Xiang, Xin

2018-01-01

In this article, Xin Xiang investigates what dushu, or "schooling," means for rural senior secondary school students in a high-poverty county in southwestern China. With the persistence of China's rural-urban education inequality and alarming reports about secondary school dropout rates, rural students' and their families' attitudes…

Circuits of Education, Rural Gentrification, and Family Migration from the Global City

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Smith, Darren P.; Higley, Rebecca

2012-01-01

Although there is recurring empirical evidence of gentrifier families with young children, the importance of education-related factors in the migration and residential decision-making of rural gentrifiers have yet to be fully examined. Using the case study of Cranbrook, Kent, processes of education-led rural gentrification are revealed that are…

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

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Caffrey, Rosalie A

2005-10-01

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

Trickling Down: Are Rural and Rural Poor Family Incomes Responsive to Regional Economic Growth? Institute for Research on Poverty, Discussion Papers No. 210-74.

Science.gov (United States)

Weber, Bruce A.

The past decade has seen a number of studies of how the poverty incidence (the percentage of families below the poverty line) of certain demographic groups changes in response to economic growth. The question of whether regional economic growth trickles down to rural and rural poor families was examined by statistically estimating the relationship…

Rural Latinos' mental wellbeing: a mixed-methods pilot study of family, environment and social isolation factors.

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Stacciarini, Jeanne-Marie R; Smith, Rebekah; Garvan, Cynthia Wilson; Wiens, Brenda; Cottler, Linda B

2015-05-01

Upon immigration to the rural areas in the US, Latino families may experience cultural, geographic, linguistic and social isolation, which can detrimentally affect their wellbeing by acting as chronic stressors. Using a community engagement approach, this is a pilot mixed-method study with an embedded design using concurrent qualitative and quantitative data. The purpose of this study is to evaluate family and social environments in terms of protective factors and modifiable risks associated with mental well-being in Latino immigrants living in rural areas of Florida. Latino immigrant mother and adolescent dyads were interviewed by using in-depth ethnographic semistructured interviews and subsequent quantitative assessments, including a demographic questionnaire and three structured instruments: the Family Environment Scale Real Form, the SF-12v2™ Health Survey and the short version (eight items) of PROMIS Health Organization Social Isolation. This mixed-method pilot study highlighted how family, rural, and social environments can protect or impair wellbeing in rural Latino immigrant mother and adolescent dyads.

Rural end-of-life care from the experiences and perspectives of patients and family caregivers: A systematic literature review.

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Rainsford, Suzanne; MacLeod, Roderick D; Glasgow, Nicholas J; Phillips, Christine B; Wiles, Robert B; Wilson, Donna M

2017-12-01

End-of-life care must be relevant to the dying person and their family caregiver regardless of where they live. Rural areas are distinct and need special consideration. Gaining end-of-life care experiences and perspectives of rural patients and their family caregivers is needed to ensure optimal rural care. To describe end-of-life care experiences and perspectives of rural patients and their family caregivers, to identify facilitators and barriers to receiving end-of-life care in rural/remote settings and to describe the influence of rural place and culture on end-of-life care experiences. A systematic literature review utilising the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Four databases (PubMed, CINAHL, Scopus and Web of Science) were searched in January 2016, using a date filter of January 2006 through January 2016; handsearching of included article references and six relevant journals; one author contacted; pre-defined search terms and inclusion criteria; and quality assessment by at least two authors. A total of 27 articles (22 rural/remote studies) from developed and developing countries were included, reporting rural end-of-life care experiences and perspectives of patients and family caregivers. Greatest needs were informational (developed countries) and medications (developing countries). Influence of rural location included distances, inaccessibility to end-of-life care services, strong community support and importance of home and 'country'. Articulation of the rural voice is increasing; however, there still remain limited published rural studies reporting on patient and family caregivers' experiences and perspectives on rural end-of-life care. Further research is encouraged, especially through national and international collaborative work.

Effects of rural-urban youth migration on farm families in Benue state, Nigeria

Directory of Open Access Journals (Sweden)

E.N. Mbah

2016-06-01

Full Text Available The study was assessed to determine the effects of rural-urban youth migration on farm families in Benue state, Nigeria during November 2014 to June 2015. Interview schedule was used to collect data from a sample of 80 respondents. Data were analyzed using frequency, percentage, mean scores and standard deviation. Results indicate that majority (76.3% of the respondents were males, middle aged and married. Major causes of rural-urban youth migration indicated by the respondents include inadequate employment opportunities in rural areas (M=3.6, search for better education (M=3.5, inadequate social infrastructure such as schools (M=3.4, poor medical care services in rural areas (M=3.4, looking for money through labour (M=3.4, apprenticeship programme (M=3.2, etc. Findings of the study also indicate that reduction of agricultural labour force (M=3.5, low agricultural productivity (M=3.3, high cost of labour (M= 3.3, reduction on demand for locally grown foods (M=2.9, decrease in dependency ratio in the rural areas (M=2.7, reduction on number of mouths to feed (M=2.7, among others were major effects of rural-urban youth migration among farm families. The study recommends that Nigerian government should provide adequate physical and social infrastructure in rural areas in order to encourage youths to remain in agriculture, reduce rural-urban youth migration as well as sustain agriculture for enhanced food security.

Family planning among women in urban and rural areas in Serbia

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Antić Ljiljana

2013-01-01

Full Text Available Introduction. Family planning is an important aspect of population policy at the state level, because the demographic trends in Serbia are very unfavorable. Objective. The objective of this study was to examine the differences in family planning between the women in rural and urban areas of Serbia. Methods. This study represents the secondary analysis of the National Health Survey of the population in Serbia from 2006, which was conducted as a cross sectional study, on a representative sample of the population. Results. The respondents who used condoms as a method of contraception, were often younger, better educated, had better financial status, lived in Vojvodina, and had no children. Conclusion. Our study showed that there were differences in terms of family planning between the women of urban and rural areas, however, these differences could be explained by differences in age and education. [Projekat Ministarstva nauke Republike Srbije, br. 175025: National Health Survey of the Population of Serbia

The Role of Family Background for Earnings in Rural China

DEFF Research Database (Denmark)

Eriksson, Tor Viking; Qiang, Zhang Ying

This paper provides estimates of brother income correlations for rural China. Brother correlations are a parsimonious measure of the importance of family and community background as determinants of individuals' economic status. We find internationally high levels of income similarity for brothers...

Eroding students' rural motivation: first do no harm?

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Hurst, Samia

2014-01-01

Migration of health professionals is one of the drivers of vast inequalities in access to healthcare, as medical graduates tend to move away from both poorer countries and rural areas. One of the central ethical problems raised in attempting to alleviate these inequalities is the tension between the healthcare needs of under-served patients and the rights of medical graduates to choose their place of work and specialty. If medical graduates had greater motivation to work in under-served rural areas, this tension would decrease accordingly. Medical schools have a duty to avoid eroding existing motivation for such training and practice. This duty has practical implications. Medical students' motivation regarding their choice of specialty changes during medical training, turning them away from choices such as primary care and rural practice towards more highly specialised, more hospital based specialties. Although students may be victims of a number of biases in the initial assessment, this is unlikely to be the whole story. Students' priorities are likely to change based on their admiration for specialist role models and the visibility of the financial and non-financial rewards attached to these specialties. Students may also have a false expectation upon admission that they will be proficient in rural medicine on graduation, and change their mind once they realise the limits of their skills in that area. Although the measures required to reverse this effect currently lack a solid evidence base, they are plausible and supported by the available data.

Re-Presenting Slavery: Underserved Questions in Museum Collections

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Levenson, Cyra

2014-01-01

This article looks at the notion of what, not who, is underserved in museum education. The importance of looking through, in, and from objects in order to uncover underserved questions and themes is vital. A willingness to consider new ways to approach collections and display is necessary to have a dialogue with our audiences about how museums can…

Geographical Mobility, Income, Life Satisfaction and Family Size Preferences: An Empirical Study on Rural Households in Shaanxi and Henan Provinces in China.

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Chen, Jiangsheng; Yang, Hong

Employing data from the China rural-urban mobility survey conducted in 2010, this study investigates the influence of family demographic characteristics on the income, life satisfaction, and potential for rural-urban mobility at the rural household level of two provinces of China: Shaanxi and Henan. A larger labor force in a rural household was found to reduce a family's ability or inclination to move to a city. The findings reveal that family size negatively affects the average income per family member and reduces the marginal income of the labor force and that minor children can improve the life satisfaction of family members. We conclude that a larger family size does not translate to more benefits for a rural household. Family size preference is found to be a reflection of parents' concerns about elderly care and is deemed to be unfavorable for urbanization in P. R. China.

Governance in agribusiness organizations: challenges in the management of rural family firms

Directory of Open Access Journals (Sweden)

Cláudio Pinheiro Machado Filho

Full Text Available Abstract The rural production in Brazil has experienced a significant competitive impact with the stabilization of the economy promoted by the Real Plan in 1994. Indeed, the Brazilian agriculture has achieved efficiency gains in terms of technology, economies of scale and general modernization of the activity in the field. In this context, the professional management of rural production evolved. However, the governance process does not evolve in the same dimension, and the “governance risk” is still poorly addressed in the rural environment, which often limits the potential of operations. In this study, we sought to deepen the understanding of the factors that impact the implementation of governance practices in rural properties in Brazil. Based on a convenience and non-probability sample, this study seeks to understand the evolution of the governance process on farms and its correlation with the management practices. This study found a correlation between the existence of some formal management processes (for example, strategic planning and more robust accounting systems and advances in the governance mechanisms and processes, such as the establishment of a board of directors, clearer rules regarding the separation between corporate and family assets and more transparency in income statements. This study also found a lack of clarity in the separation of return on capital (dividend and compensation for work (compensation for services provided for partners, heirs and other family members. In summary, we concluded that there is the adoption of some governance mechanisms in the rural sector, but they are still poorly developed among rural producers, hence the need to stimulate them.

The Role of Responses to Experiences of Rural Population Decline in the Social Capital of Families

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Elshof, Hans; Bailey, Ajay

2015-01-01

Population decline in rural areas has an impact on rural villages. This research investigates to what extent families with children in rural villages experience consequences of population decline, in which ways they respond to these experiences, and how that plays a role in their individual social

OBSTACLES TO FAMILY PLANNING USE AMONG RURAL WOMEN IN ATIAK HEALTH CENTER IV, AMURU DISTRICT, NORTHERN UGANDA

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Ouma, S.; Turyasima, M.; Acca, H.; Nabbale, F.; Obita, K. O.; Rama, M.; Adong, C. C.; Openy, A.; Beatrice, M. O.; Odongo-Aginya, E. I.; Awor, S.

2016-01-01

Background Uganda’s rapid population growth (3.2%) since 1948 has placed more demands on health sector and lowered living standard of Ugandans resulting into 49% of people living in acute poverty especially in post conflict Northern Uganda. The population rise was due to low use of contraceptive methods (21% in rural areas and 43% in urban areas) and coupled with high unmet need for family planning (41%). This indicated poor access to reproductive health services. Effective use of family planning could reduce the rapid population growth. Objective To determine obstacles to family planning use among rural women in Northern Uganda. Design A descriptive cross-sectional analytical study. Setting Atiak Health Centre IV, Amuru District, rural Northern Uganda. Subjects Four hundred and twenty four females of reproductive ages were selected from both Inpatient and Outpatient Departments of Atiak Health Centre IV. Results There was high level of awareness 418 (98.6%), positive attitude 333 (78.6%) and fair level of utilisation 230 (54.2%) of family planning. However, significant obstacles to family planning usage included; long distance to Health facility, unavailability of preferred contraceptive methods, absenteeism of family planning providers, high cost of managing side effects, desire for big family size, children dying less than five years old, husbands forbidding women from using family planning and lack of community leaders’ involvement in family planning programme. Conclusions In spites of the high level of awareness, positive attitude, and free family planning services, there were obstacles that hindered family planning usage among these rural women. However, taking services close to people, reducing number of children dying before their fifth birthday, educating men about family planning, making sure family planning providers and methods are available, reducing cost of managing side effects and involving community leaders will improve utilisation of family

OBSTACLES TO FAMILY PLANNING USE AMONG RURAL WOMEN IN ATIAK HEALTH CENTER IV, AMURU DISTRICT, NORTHERN UGANDA.

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Ouma, S; Turyasima, M; Acca, H; Nabbale, F; Obita, K O; Rama, M; Adong, C C; Openy, A; Beatrice, M O; Odongo-Aginya, E I; Awor, S

Uganda's rapid population growth (3.2%) since 1948 has placed more demands on health sector and lowered living standard of Ugandans resulting into 49% of people living in acute poverty especially in post conflict Northern Uganda. The population rise was due to low use of contraceptive methods (21% in rural areas and 43% in urban areas) and coupled with high unmet need for family planning (41%). This indicated poor access to reproductive health services. Effective use of family planning could reduce the rapid population growth. To determine obstacles to family planning use among rural women in Northern Uganda. A descriptive cross-sectional analytical study. Atiak Health Centre IV, Amuru District, rural Northern Uganda. Four hundred and twenty four females of reproductive ages were selected from both Inpatient and Outpatient Departments of Atiak Health Centre IV. There was high level of awareness 418 (98.6%), positive attitude 333 (78.6%) and fair level of utilisation 230 (54.2%) of family planning. However, significant obstacles to family planning usage included; long distance to Health facility, unavailability of preferred contraceptive methods, absenteeism of family planning providers, high cost of managing side effects, desire for big family size, children dying less than five years old, husbands forbidding women from using family planning and lack of community leaders' involvement in family planning programme. In spites of the high level of awareness, positive attitude, and free family planning services, there were obstacles that hindered family planning usage among these rural women. However, taking services close to people, reducing number of children dying before their fifth birthday, educating men about family planning, making sure family planning providers and methods are available, reducing cost of managing side effects and involving community leaders will improve utilisation of family planning and thus reduce the rapid population growth and poverty.

Decline of traditional family system and reproductive behaviour in rural Bangladesh.

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Sarker, P C

1993-01-01

This paper is based on data taken from the study entitled Social Structure and Fertility Behavior in a Rural Community of Bangladesh. The field-work was carried out during 1985-86 in Kamnagar, a village in the north-eastern corner of Rajshahi metropolitan city, with a total population of 884. 54.4% of the villagers had no education. Basic information was collected from every household by questionnaires interviewing the head of the household. In the 2nd phase questionnaires were administered to 140 eligible husbands and 140 wives separately to collect information on fertility behavior. 56.8% of the families were nuclear. 12.1% of the families were supplementary nuclear, with parents and their unmarried children including 1 or more additional members. 24.9% of the families were joint, in which related males belonging to 2 or 3 generations lived together with their dependents. 6.2% of the families were extended. As far as the authority structure was concerned, 68.1% of the families were patriarchal, 9.9% of the families were matriarchal, and 22% of the families were egalitarian. The egalitarian authority system is increasing with the spread of female literacy, economic activities outside the home, and women's mobility. Couples in nuclear families are more free to decide on the number of children, birth spacing, and adoption of contraception than those in joint, extended, and supplementary nuclear families with patriarchal and matriarchal authority structures. In nuclear families with an egalitarian authority structure, husband-wife communication can help decide about the number of children wanted, the acceptance of contraceptives, and child spacing. Nuclear families favor lower fertility than supplementary nuclear, joint, and extended families with a patriarchal or matriarchal authority structure. The number of traditional joint and extended families is on the decline with the trend to nuclear families as a result of the increasing landlessness in rural Bangladesh

Women in rural family medicine: a qualitative exploration of practice attributes that promote physician satisfaction.

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

2018-04-01

The USA needs more rural physicians. Although women represent half of all US trained medical students, the rural physician workforce has remained predominantly male. Insight is needed into what makes rural practice attractive for women and which practice characteristics allow women physicians to practice successfully in rural areas. This study's purpose was to examine aspects of the practice environment that impact women physicians' professional satisfaction and commitment to rural medicine. Twenty-five women family physicians practicing in rural areas of the USA were interviewed by phone using a semi-structured format. Transcribed interviews were analyzed using an immersion and crystallization approach. Emergent themes were identified, coded, and discussed until team consensus was attained. Interviews continued until saturation of themes was reached. Three themes emerged from the data, in relationship to practice and employment attributes that contribute to US women physicians' professional satisfaction and willingness to remain in a rural setting: professional relationships, practice characteristics, and support during times of transition. Participants placed high importance on professional relationships, both within and outside of their rural practice. Rural women physicians enjoyed practicing an expanded scope of care, valued loan repayment opportunities, and appreciated supportive practice partners. Importantly, women physicians who found themselves struggling to maintain rural careers often had experienced difficulty during times of practice transition, including maternity leaves. Understanding practice attributes valued by successful rural women family physicians in the USA will help rural health systems, practices, and physicians-in-training to develop and evaluate opportunities that will best contribute to successful rural practice. Supporting women physicians during periods of practice transition may improve retention.

Measuring financial protection for health in families with chronic conditions in Rural China.

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Jiang, Chunhong; Ma, Jingdong; Zhang, Xiang; Luo, Wujin

2012-11-16

As the world's largest developing country, China has entered into the epidemiological phase characterized by high life expectancy and high morbidity and mortality from chronic diseases. Cardiovascular diseases, chronic obstructive pulmonary diseases, and malignant tumors have become the leading causes of death since the 1990s. Constant payments for maintaining the health status of a family member who has chronic diseases could exhaust household resources, undermining fiscal support for other necessities and eventually resulting in poverty. The purpose of this study is to probe to what degree health expenditure for chronic diseases can impoverish rural families and whether the New Cooperative Medical Scheme can effectively protect families with chronic patients against catastrophic health expenditures. We used data from the 4th National Health Services Survey conducted in July 2008 in China. The rural sample we included in the analysis comprised 39,054 households. We used both households suffering from medical impoverishment and households with catastrophic health expenditures to compare the financial protection for families having a chronic patient with different insurance coverage statuses. We used a logistic regression model to estimate the impact of different benefit packages on health financial protection for families having a chronic patient. An additional 10.53% of the families with a chronic patient were impoverished because of healthcare expenditure, which is more than twice the proportion in families without a chronic patient. There is a higher catastrophic health expenditure incidence in the families with a chronic patient. The results of logistic regression show that simply adding extra benefits did not reduce the financial risks. There is a lack of effective financial protection for healthcare expenditures for families with a chronic patient in rural China, even though there is a high coverage rate with the New Cooperative Medical Schemes. Given the

Differential Adjustment Among Rural Adolescents Exposed to Family Violence

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Sianko, Natallia; Hedge, Jasmine M.; McDonell, James R.

2016-01-01

This study examines differences in psychological adjustment in a sample of rural adolescents who have been exposed to family violence. Self-report questionnaires were administered to 580 adolescents and their primary caregivers. The results revealed that over two thirds of the study participants (68.8%) had been exposed to violence in their families. As hypothesized, cluster analysis identified several profiles among adolescents, distinguished by their psychological and emotional functioning: well adjusted (46.2%), moderately adjusted (44.3%), and struggling (9.5%). Discriminant function analysis confirmed the groupings and revealed that family functioning was among the most influential factors explaining adjustment differences. Multivariate analyses of variance (MANOVAs) further showed that adolescents from each of the three adjustment profiles reported significantly different levels of family social support, parental involvement, and perceived neighborhood safety. Overall, the results confirm heterogeneity of adolescent adaptation in the aftermath of family violence and provide insights into family and neighborhood factors that account for variability in adolescents’ reactions to violence. Implications for future research and practical interventions are discussed. PMID:27106255

Differential Adjustment Among Rural Adolescents Exposed to Family Violence.

Science.gov (United States)

Sianko, Natallia; Hedge, Jasmine M; McDonell, James R

2016-04-22

This study examines differences in psychological adjustment in a sample of rural adolescents who have been exposed to family violence. Self-report questionnaires were administered to 580 adolescents and their primary caregivers. The results revealed that over two thirds of the study participants (68.8%) had been exposed to violence in their families. As hypothesized, cluster analysis identified several profiles among adolescents, distinguished by their psychological and emotional functioning: well adjusted (46.2%), moderately adjusted (44.3%), and struggling (9.5%). Discriminant function analysis confirmed the groupings and revealed that family functioning was among the most influential factors explaining adjustment differences. Multivariate analyses of variance (MANOVAs) further showed that adolescents from each of the three adjustment profiles reported significantly different levels of family social support, parental involvement, and perceived neighborhood safety. Overall, the results confirm heterogeneity of adolescent adaptation in the aftermath of family violence and provide insights into family and neighborhood factors that account for variability in adolescents' reactions to violence. Implications for future research and practical interventions are discussed. © The Author(s) 2016.

Rural families' interpretations of experiencing unexpected transition in the wake of a natural disaster.

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Fernandes, Gisele Cristina Manfrini; Boehs, Astrid Eggert; Denham, Sharon A; Nitschke, Rosane Gonçalves; Martini, Jussara Gue

2017-02-13

Natural disasters affect populations in various parts of the world. The impacts of disasters can cause many problems to the health of people and disruption to family life, potentially leading to an unexpected transition. The objective of this paper is to present the unexpected transitional experiences of rural families following a natural disaster. A multiple case study of six families was conducted with children and adolescents in a rural area affected by a 2008 disaster in southern Brazil. For data collection, we used participant observation, narrative interviews, genograms, ecomaps and an instrument called calendar routine. The analysis of the data resulted in different family interpretations about the changes resulting from the storm and compared life before and after the disaster. The loss of homes and loved ones, migration, unemployment, and losses from the farm were the main changes associated with new development tasks. The experiences of family transition after the disaster revealed that losses influenced social lives, daily routines and the preservation of cultural values.

Pathways out of poverty in lagging regions: evidence from rural western China

NARCIS (Netherlands)

Christiaensen, L.; Pan, L.; Wang, S.G.

2013-01-01

How to reduce poverty in lagging regions remains much debated and underserved with solid empirical evidence. This study illustrates an empirical methodology to analyze the pathways households followed out of poverty and to explore their potential in the future using 20002004 rural household panel

Caregiver's depressive symptoms and asthma control in children from an underserved community.

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Rioseco, Andrea; Serrano, Carolina; Celedón, Juan C; Padilla, Oslando; Puschel, Klaus; Castro-Rodriguez, Jose A

2017-12-01

Caregiver's or maternal depression has been associated with increased asthma morbidity in children from prosperous nations, but little is known about this link in low and middle-income countries. To examine if caregiver's depressive symptoms are associated with poor asthma control and abnormal immune responses in school-aged children. Case-control study of 87 asthmatic children (aged 4-11 years) attending a primary care clinic in an underserved area of Santiago (Chile). Cases were children with poor asthma control (Child Asthma Control Test [cACT] asthma control (cACT ≥20 points). The Beck Depression Inventory-II (BDI) and a locally validated family health vulnerability test (SALUFAM) were used to assess caregivers' depression and family health vulnerability. Serum from participating children was assayed for IFN-γ, IL-4, IL-13, TGF-β, cortisol, and total IgE. The mean (SD) age of study participants was 8.23 (2.15 years), and 55.2% were females. Use of inhaled corticosteroids (ICS), family health vulnerability, and caregiver's depressive symptoms were significantly more common in cases than in controls (65.4% vs. 34.6%, p = 0.003; 41.3% vs. 24.8%, p = 0.07; and 39.1% vs. 19.5%, p = 0.04, respectively). There was no significant difference in the level of any serum biomarkers between groups. In a multivariate analysis, only ICS use was significantly associated with better asthma control (OR = 3.56 [1.34-9.48], p = 0.01). Presence of caregiver's depressive symptoms is associated with poor asthma control among children from an underserved community, but this association was no longer significant after accounting for ICS use.

Bridging the Rural-Urban Literacy Gap in China: A Mediation Analysis of Family Effects

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Wang, Jingying; Li, Hui; Wang, Dan

2018-01-01

This study examines the effects of family involvement on the literacy gap between rural and urban Chinese primary students via mediation analysis. Altogether, 1080 students in Grades 1, 3, and 5 were randomly sampled from three urban and three rural primary schools from Shandong and Guizhou Provinces, representing eastern and western China,…

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

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

2017-01-01

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

Grandparent-grandchild family capital and self-rated health of older rural Chinese adults: the role of the grandparent-parent relationship.

Science.gov (United States)

Lou, Vivian W Q; Lu, Nan; Xu, Ling; Chi, Iris

2013-07-01

This study tested the relationship between grandparent-grandchild family capital and self-rated health of older rural Chinese adults and the mediating role of the grandparent-parent relationship in terms of grandparent-grandchild family capital and self-rated health. Data were derived from a random sample of 1,027 adults aged 60 and older who were interviewed in the rural Chaohu region in 2009. Structural equation modeling was used to examine the direct effect of grandparent-grandchild family capital in terms of relations with the first child's family on self-rated health among respondents, as well as the mediating effect of the grandparent-parent relationship. The results showed the direct effect of grandparent-grandchild family capital on self-rated health of older rural Chinese adults. The grandparent-parent relationship had a partial mediation effect on the relationship between grandparent-grandchild family capital and self-rated health of respondents. Grandparent-grandchild family capital had a unique direct effect on the self-rated health of older rural Chinese adults, enriching our theoretical understanding of sources of family capital and their impacts in a collectivist cultural context that emphasizes intergenerational interaction and exchange. The findings also highlighted the mediation effects of grandparent-parent relationships on the relationship between grandparent-grandchild family capital and self-rated health of older rural Chinese adults, supporting the "grandchild-as-linkage" hypothesis in understanding the social determination of self-rated health in China.

Empowering underserved populations through cancer prevention and early detection.

Science.gov (United States)

Rivera-Colón, Venessa; Ramos, Roberto; Davis, Jenna L; Escobar, Myriam; Inda, Nikki Ross; Paige, Linda; Palencia, Jeannette; Vives, Maria; Grant, Cathy G; Green, B Lee

2013-12-01

It is well documented that cancer is disproportionately distributed in racial/ethnic minority groups and medically underserved communities. In addition, cancer prevention and early detection represent the key defenses to combat cancer. The purpose of this article is to showcase the comprehensive health education and community outreach activities at the H. Lee Moffitt Cancer Center and Research Institute (Moffitt) designed to promote and increase access to and utilization of prevention and early detection services among underserved populations. One of Moffitt's most important conduits for cancer prevention and early detection among underserved populations is through its community education and outreach initiatives, in particular, the Moffitt Program for Outreach Wellness Education and Resources (M-POWER). M-POWER works to empower underserved populations to make positive health choices and increase screening behaviors through strengthening collaboration and partnerships, providing community-based health education/promotion, and increasing access to care. Effective, empowering, and culturally and linguistically competent health education and community outreach, is key to opening the often impenetrable doors of cancer prevention and early detection to this society's most vulnerable populations.

Insecure Land Rights, Obstacles to Family Farming, and the Weakness of Protest in Rural Russia

NARCIS (Netherlands)

Visser, A.

2010-01-01

After short-lived growth in the early 1990s, Russia’s private family farming sector has been characterized by stagnation, while ownership of former collective and state farms is increasingly concentrated in the hands of the rural elite. This accumulation turns the rural dwellers, who (formally) had

A National Longitudinal Survey of Medical Students' Intentions to Practice Among the Underserved.

Science.gov (United States)

O'Connell, Thomas F; Ham, Sandra A; Hart, Theodore G; Curlin, Farr A; Yoon, John D

2018-01-01

To explore students' intentions to practice in medically underserved areas. In January 2011, 960 third-year medical students from 24 MD-granting U.S. medical schools were invited to participate in a survey on their intention to practice in a medically underserved area. A follow-up survey was sent to participants in September 2011. Covariates included student demographics, medical school characteristics, environmental exposures, work experiences, sense of calling, and religious characteristics. Adjusted response rates were 564/919 (61.4%, first survey) and 474/564 (84.0%, follow-up survey). Among fourth-year medical students, an estimated 34.3% had an intention to practice among the underserved. In multivariate logistic regression modeling, predictors for intentions to practice among the underserved included growing up in an underserved setting (odds ratio [OR] range: 2.96-4.81), very strong sense of calling (OR range: 1.86-3.89), and high medical school social mission score (in fourth year: OR = 2.34 [95% confidence interval (CI), 1.31-4.21]). International experience was associated with favorable change of mind in the fourth year (OR = 2.86 [95% CI, 1.13-7.24]). High intrinsic religiosity was associated with intentions to practice primary care in underserved settings (in fourth year: OR = 2.29 [95% CI = 1.13-4.64]). Growing up in medically underserved settings, work experience in religiously affiliated organizations, very strong sense of calling, and high medical school social mission score were associated with intentions to practice in underserved areas. Lack of formative educational experiences may dissuade students from considering underserved practice.

Analysis on Imbalance of Family Intergenerational Exchange in China Rural Area

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Liguo Liu

2014-04-01

Full Text Available In China rural area, intergenerational exchange on supporting each other between parents and offspring is uneven. Parents pay much more than the return they’ll get when they’re old, which mainly relates to the utilities of children. In countryside, the utilities of children (especially sons manifest in following aspects: continuing the family line, emotional comfort, laborer and supporting for old age. To some extent, these factors influence the rural intergenerational injustice respectively and together. From the prospective of trend of social and economic development, the caring of the retired will be taken by social insurance system; the intergeneration exchange on supporting each other between parents and offspring will no longer be a social issue, but in the vast rural areas, the influence of traditional culture family lineage is still powerful. The need of caring of the old becomes so weak that emotional effect becomes much more urgent. The weak status of the old generation bring the fathers’ generation in a weak social status, which seriously affect the living conditions of the old generations. Therefore, when focusing the caring issue in the country, besides that we should ensure the old be cared materially, what matters most is keep the balance between the exchanging two sides

Family Planning Practice Among Rural Reproductive-Age Married Women in Myanmar.

Science.gov (United States)

Jirapongsuwan, Ann; Latt, Kyaw Thu; Siri, Sukhontha; Munsawaengsub, Chokchai

2016-05-01

A cross-sectional study was undertaken to investigate family planning (FP) practices and associated factors among reproductive-age married women. Data were collected by interviewing the 300 married women living in a rural area of Myanmar. The questionnaire had reliability coefficients ranging from .8 to .9. Results indicated that 73.3% of women performed FP, and contraceptive injection was the most common method. Significant associations were found with age 21 to 35 years (adjusted odds ratio [adj OR] = 3.748, 95% CI = 2.179-6.445), adequacy of income (adj OR = 2.520, 95% CI = 1.477-4.290), good attitude toward FP (adj OR = 0.386, 95% CI = 0.228-0.656), good support from health care providers (adj OR = 0.129, 95% CI = 0.054-0.313), good support from family (adj OR = 0.304, 95% CI = 0.163-0.565), good support from friends (adj OR = 0.344, 95% CI = 0.193-0.613), and FP practice. It is recommended that designing FP programs with peers and family involvement could increase the practice of FP among rural Myanmar women. © 2016 APJPH.

Improving Maternal and Child Health in Underserved Rural Areas of ...

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

Maternal and child health is a priority for Nigeria, but there are significant challenges and opportunities at state levels that influence efforts to reduce deaths. This project will contribute to government efforts in Delta State to improve delivery and use of maternal and child healthcare services in three marginalized rural ...

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

Science.gov (United States)

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

2015-01-01

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

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

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Mahasti Alizadeh

2015-12-01

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

Rural families' interpretations of experiencing unexpected transition in the wake of a natural disaster

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Gisele Cristina Manfrini Fernandes

Full Text Available Abstract: Natural disasters affect populations in various parts of the world. The impacts of disasters can cause many problems to the health of people and disruption to family life, potentially leading to an unexpected transition. The objective of this paper is to present the unexpected transitional experiences of rural families following a natural disaster. A multiple case study of six families was conducted with children and adolescents in a rural area affected by a 2008 disaster in southern Brazil. For data collection, we used participant observation, narrative interviews, genograms, ecomaps and an instrument called calendar routine. The analysis of the data resulted in different family interpretations about the changes resulting from the storm and compared life before and after the disaster. The loss of homes and loved ones, migration, unemployment, and losses from the farm were the main changes associated with new development tasks. The experiences of family transition after the disaster revealed that losses influenced social lives, daily routines and the preservation of cultural values.

Child health, nutrition and family size: a comparative study of rural and urban children.

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Balderama-guzman, V

1978-01-01

771 children from Baras, Rizal, and Pasay City, Philippines were studied. House interviews of mothers using precoded questionnaires were conducted and the children were given a complete physical examination. The study objectives were to compare the health and nutritional status of children in a rural and an urban area in greater Manila and to determine how family size affects the nutritional status of children 3 years and younger. The following were among the study results: 1) the weight curves of both urban and rural groups were similar until age 4-1/2 years, but beyond this age the mean weight curve of the rural group exceeded that of the urban group; 2) urban children between ages 1-5 enjoyed a height advantage; 3) there was a positive correlation between malnutrition and excessive family size; 4) the high prevalence of malnutrition among children 1-4 years of age was due to food deprivation because of poverty, parental ignorance, inappropriate folklores, oversized families, high episodes of illnesses, and inadequate medical care; and 5) dietary assessment of both groups showed the inadequacy of the quality and quantity of basic nutrients and elements needed for growth, development, and repair of tissues.

Telemed: Ehealth applications applied to underserved areas in Latin America

International Nuclear Information System (INIS)

Sachpazidis, Ilias; Ohl, Roland; Binotto, Alecio Pedro Delazari; Torres, Marcio Soares; Messina, Luiz Ary; Sales, Alexandre; Gomes, Ricardo; Sakas, Georgios

2006-01-01

Access to medical care is sometimes very difficult to be reached from people living in rural and underserved areas. This problem is very well known in rural areas in Brazil. Citizens have no access to health care. They have to travel hundreds of kilometres to receive medical care. In this paper, we will propose a medical network based on state-of-the-art medical imaging application that addresses the problems of providing health care from a distance. Additionally, we are going to show preliminarily results of the first year of the system deployment and utilization in undeserved regions in Brazil. The total number of patients submitted to ultrasound examinations, during the 10 months of projects' medical trials, is 321. The exams have begun with the elderly people (hypertension and diabetes cases) with 90% above 50-years-old. Fifty-four percent were male and 46% were female. From those exams, 67 exams (21%) needed a second medical opinion and were transmitted to Santa Casa hospital in Porto Alegre, Brazil, one of the referral medical centres. From those second opinions of Santa Casa, 12 exams had to be repeated since the acquired images were not sufficient to give a correct diagnosis. The Lagoa Tres Cantos medical doctor performed also preventive exams with patients who had not presented any symptoms (70%)

Telemed: Ehealth applications applied to underserved areas in Latin America

Energy Technology Data Exchange (ETDEWEB)

Sachpazidis, Ilias [Fraunhofer Institute for Computer Graphics, Fraunhoferstr. 5, D-64283, Darmstadt (Germany)]. E-mail: Ilias.Sachpazidis@igd.fraunhofer.de; Ohl, Roland [MedCom Gesellschaft fuer medizinische Bildverarbeitung mbH, Rundeturmstr. 12, D-64283, Darmstadt (Germany); Binotto, Alecio Pedro Delazari [Centro de Excelencia em Tecnologias Avancadas Av. Assis Brasil, 8450, 91, 140-000 Porto Alegre (Brazil); Torres, Marcio Soares [Centro de Excelencia em Tecnologias Avancadas Av. Assis Brasil, 8450, 91, 140-000 Porto Alegre (Brazil); Messina, Luiz Ary [Messina Informatica e Comercio Ltda., Rua Castelo Branco 330, 29100-040 Praia da Costa, Vila Velha (Brazil); Sales, Alexandre [Fundacao de Apoio ao Hospital Universitario da UFES-Fahucam, Av. Marechal Campos 1355, 29042-715 Santos Dumont, Vitoria (Brazil); Gomes, Ricardo [Complexo Hospitalar Santa Casa de Porto Alegre Rua Prof. Annes Dias 285, Porto Alegre (Brazil); Sakas, Georgios [Fraunhofer Institute for Computer Graphics, Fraunhoferstr. 5, D-64283, Darmstadt (Germany)

2006-12-20

Access to medical care is sometimes very difficult to be reached from people living in rural and underserved areas. This problem is very well known in rural areas in Brazil. Citizens have no access to health care. They have to travel hundreds of kilometres to receive medical care. In this paper, we will propose a medical network based on state-of-the-art medical imaging application that addresses the problems of providing health care from a distance. Additionally, we are going to show preliminarily results of the first year of the system deployment and utilization in undeserved regions in Brazil. The total number of patients submitted to ultrasound examinations, during the 10 months of projects' medical trials, is 321. The exams have begun with the elderly people (hypertension and diabetes cases) with 90% above 50-years-old. Fifty-four percent were male and 46% were female. From those exams, 67 exams (21%) needed a second medical opinion and were transmitted to Santa Casa hospital in Porto Alegre, Brazil, one of the referral medical centres. From those second opinions of Santa Casa, 12 exams had to be repeated since the acquired images were not sufficient to give a correct diagnosis. The Lagoa Tres Cantos medical doctor performed also preventive exams with patients who had not presented any symptoms (70%)

An approach to rural distribution network design for sub-Saharan Africa

International Nuclear Information System (INIS)

Sebitosi, A.B.; Pillay, P.; Khan, M.A.

2006-01-01

The bulk of rural populations in sub-Saharan Africa have no access to electricity and are under-served by any other form of modern infrastructure. The cost of infrastructure to mainly scattered communities has been perennially cited as largely to blame. Quite often rural networks are overdesigned, resulting in under utilization and, therefore, costly overheads. One reason often cited for the overspecification is anticipation of load growth. In most sub-Sahara African rural areas, however, economic growth rates are low, and a designer has no justification in specifying an infrastructure capacity exceeding more than a few percent of existing consumer requirements. This paper proposes methods that critically look at the geometry of small grid network designs to address the construction challenges in rural sub-Saharan Africa

Family caregivers in rural Uganda: the hidden reality.

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Kipp, Walter; Tindyebwa, Denis; Rubaale, Tom; Karamagi, Ednah; Bajenja, Ellen

2007-01-01

We conducted 16 in-depth interviews with family caregivers of AIDS patients in three rural districts in western Uganda. They were selected from a client visitation list of the home-based care program for AIDS patients, based on volunteer participation. Family caregivers reported huge problems associated with providing the necessary psychological, social, and economic care. They also said that the physical and emotional demands of caregiving are overwhelming daily challenges. Most support to AIDS patients provided by family, friends, and the churches. The study highlights the great burden of caregivers, in sub-Saharan Africa who most often are elderly women and young girls. This study examine, the burden and related health issues of family caregivers, primarily women, for AIDS patients in Uganda. It was part of a broad research project using qualitative methods on family caregiving in the home environment in sub-Saharan Africa. As the requirements for family care giving are often overwhelming for women under the conditions as they exist in Uganda and in other developing countries, it constitutes a gender issue of great importance that has not been appreciated fully in the international literature. Family caregiving is also of international relevance, as HIV/AIDS is a global pandemic of previously unknown proportions. In many poor countries, family caregiving is the most common and often the only care that AIDS patients receive, because clinic-based care often is not available close to home or is not affordable. Therefore, family caregiver support programs to alleviate this burden are essential for all those countries where HIV/AIDS is prevalent. Family caregiver burden encompasses medical, social, and economic issues at the household level, which requires an interdisciplinary approach in order to fully understand and appreciate the different dimensions of the family caregiver burden and its negative impact on the lives of so many women in so many countries.

Husband and Wife Interaction and Family Regulation in Rural Uruguay.

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De Winter, A. M.

Decision-making and family planning were studied in the rural city of Durazno, Uruguay, by means of answers to questions by both husbands and wives. A sample size of 268 couples in which at least one partner was between 21 and 50 years of age was used. Data were collected by means of a pretested and precoded interview schedule. Major conclusions…

Information sharing with rural family caregivers during care transitions of hip fracture patients

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Jacobi Elliott

2014-06-01

Full Text Available Introduction: Following hip fracture surgery, patients often experience multiple transitions through different care settings, with resultant challenges to the quality and continuity of patient care. Family caregivers can play a key role in these transitions, but are often poorly engaged in the process. We aimed to: (1 examine the characteristics of the family caregivers’ experience of communication and information sharing and (2 identify facilitators and barriers of effective information sharing among patients, family caregivers and health care providers.Methods: Using an ethnographic approach, we followed 11 post-surgical hip fracture patients through subsequent care transitions in rural Ontario; in-depth interviews were conducted with patients, family caregivers (n = 8 and health care providers (n = 24.Results: Priority areas for improved information sharing relate to trust and respect, involvement, and information needs and expectations; facilitators and barriers included prior health care experience, trusting relationships and the rural setting.Conclusion: As with knowledge translation, effective strategies to improve information sharing and care continuity for older patients with chronic illness may be those that involve active facilitation of an on-going partnership that respects the knowledge of all those involved.

Information sharing with rural family caregivers during care transitions of hip fracture patients

Directory of Open Access Journals (Sweden)

Jacobi Elliott

2014-06-01

Full Text Available Introduction: Following hip fracture surgery, patients often experience multiple transitions through different care settings, with resultant challenges to the quality and continuity of patient care. Family caregivers can play a key role in these transitions, but are often poorly engaged in the process. We aimed to: (1 examine the characteristics of the family caregivers’ experience of communication and information sharing and (2 identify facilitators and barriers of effective information sharing among patients, family caregivers and health care providers. Methods: Using an ethnographic approach, we followed 11 post-surgical hip fracture patients through subsequent care transitions in rural Ontario; in-depth interviews were conducted with patients, family caregivers (n = 8 and health care providers (n = 24. Results: Priority areas for improved information sharing relate to trust and respect, involvement, and information needs and expectations; facilitators and barriers included prior health care experience, trusting relationships and the rural setting. Conclusion: As with knowledge translation, effective strategies to improve information sharing and care continuity for older patients with chronic illness may be those that involve active facilitation of an on-going partnership that respects the knowledge of all those involved.

analysis of poverty status of rural farm families in akwa ibom state

African Journals Online (AJOL)

PROF. BARTH EKWEME

This study was conducted to provide empirical evidence of the effect of farming on the poverty status of rural farm families in Uyo, Akwa ... Reducing poverty in developing economies is a ... is one of the poorest among the poor countries of the.

Social franchising and vouchers to promote long-term methods of family planning in rural Pakistan: a qualitative stocktaking with stakeholders.

Science.gov (United States)

Azmat, Syed Khurram; Mustafa, Ghulam; Hameed, Waqas; Asghar, Jamshaid; Ahmed, Aftab; Shaikh, Babar T

2013-04-01

The overall use of modern contraception in Pakistan is quite low, especially in rural areas. Several studies have demonstrated the effectiveness of social franchising (SF) approaches in increasing access to modern contraception and improving the quality of healthcare in resource-poor areas in Asia and Africa. Drawing on best practices in SF, the Marie Stopes Society (MSS) implemented an SF model in certain rural areas of Pakistan to increase access to affordable and quality family planning (FP) services. The model was branded as Suraj (sun) and complemented with an innovative voucher scheme for intrauterine contraceptive devices (IUCDs). This paper describes the perspectives of Suraj clients, field workers mobilization (FWMs), and providers on various components of the Suraj model. A qualitative exploratory study was conducted in six randomly selected intervention districts in the Sindh and Punjab provinces. Data were collected using focus group discussions (FGDs) with clients and in-depth interviews (IDIs) with providers and FWMs. Data were manually analyzed using constant comparison and the thematic analysis approach. Clients showed positive attitudes towards modern contraceptive methods and identified Suraj FWMs and signboards as sources of information. Almost all clients reported IUCDs as effective methods as they have manageable side effects and require fewer visits to clinics. They spoke highly of voucher schemes as these enabled them to avail free IUCD services. Clients also appreciated many components of Suraj clinics, including cleanliness, privacy, confidentiality, the sterilization of instruments, and courteous Suraj providers and FWMs. Most Suraj providers said that IUCD insertion and infection-prevention training enhanced their ability to provide IUCD services and increased their standing in local communities. They reported that the role of FWMs was crucial in mobilizing the community and increasing their FP clientele. The FWMs said that attitudes

The Family Life Project: an epidemiological and developmental study of young children living in poor rural communities.

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Vernon-Feagans, Lynne; Cox, Martha

2013-10-01

About 20% of children in the United States have been reported to live in rural communities, with child poverty rates higher and geographic isolation from resources greater than in urban communities. There have been surprisingly few studies of children living in rural communities, especially poor rural communities. The Family Life Project helped fill this gap by using an epidemiological design to recruit and study a representative sample of every baby born to a mother who resided in one of six poor rural counties over a 1-year period, oversampling for poverty and African American. 1,292 children were followed from birth to 36 months of age. This monograph described these children and used a cumulative risk model to examine the relation between social risk and children's executive functioning, language development, and behavioral competence at 36 months. Using both the Family Process Model of development and the Family Investment Model of development, observed parenting was examined over time in relation to child functioning at 36 months. Different aspects of observed parenting were examined as mediators/moderators of risk in predicting child outcomes. Results suggested that cumulative risk was important in predicting all three major domains of child outcomes and that positive and negative parenting and maternal language complexity were mediators of these relations. Maternal positive parenting was found to be a buffer for the most risky families in predicting behavioral competence. In a final model using both family process and investment measures, there was evidence of mediation but with little evidence of the specificity of parenting for particular outcomes. Discussion focused on the importance of cumulative risk and parenting in understanding child competence in rural poverty and the implications for possible intervention strategies that might be effective in maximizing the early development of these children.

Stated preferences of doctors for choosing a job in rural areas of Peru: a discrete choice experiment.

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J Jaime Miranda

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

Development and pilot evaluation of novel genetic educational materials designed for an underserved patient population.

Science.gov (United States)

Lubitz, Rebecca Jean; Komaromy, Miriam; Crawford, Beth; Beattie, Mary; Lee, Robin; Luce, Judith; Ziegler, John

2007-01-01

Genetic counseling for BRCA1 and BRCA2 mutations involves teaching about hereditary cancer, genetics and risk, subjects that are difficult to grasp and are routinely misunderstood. Supported by a grant from the Avon Foundation, the UCSF Cancer Risk Program started the first genetic testing and counseling service for a population of traditionally underserved women of varied ethnic and social backgrounds at the San Francisco General Hospital (SFGH). Informed by educational theory and clinical experience, we devised and piloted two simplified explanations of heredity and genetic risk, with the aim of uncovering how to best communicate genetics and risk to this underserved population. A "conventional" version comprised pictures of genes, pedigrees, and quantitative representations of risk. A "colloquial" pictorial version used an analogy of the "information book" of genes, family stories and vignettes, and visual representations of risk, without using scientific words such as genes or chromosomes. A verbal narrative accompanied each picture. We presented these modules to four focus groups of five to eight women recruited from the SFGH Family Practice Clinic. Overall, women preferred a picture-based approach and commented that additional text would have been distracting. The majority of women preferred the colloquial version because it was easier to understand and better conveyed a sense of comfort and hope. We conclude that simplicity, analogies, and familiarity support comprehension while vignettes, family stories, and photos of real people provide comfort and hope. These elements may promote understanding of complex scientific topics in healthcare, particularly when communicating with patients who come from disadvantaged backgrounds.

The prevalence of visual impairment and blindness in underserved rural areas: a crucial issue for future.

Science.gov (United States)

Hashemi, H; Yekta, A; Jafarzadehpur, E; Doostdar, A; Ostadimoghaddam, H; Khabazkhoob, M

2017-08-01

PurposeTo determine the prevalence of visual impairment and blindness in underserved Iranian villages and to identify the most common cause of visual impairment and blindness.Patients and methodsMultistage cluster sampling was used to select the participants who were then invited to undergo complete examinations. Optometric examinations including visual acuity, and refraction were performed for all individuals. Ophthalmic examinations included slit-lamp biomicroscopy and ophthalmoscopy. Visual impairment was determined according to the definitions of the WHO and presenting vision.ResultsOf 3851 selected individuals, 3314 (86.5%) participated in the study. After using the exclusion criteria, the present report was prepared based on the data of 3095 participants. The mean age of the participants was 37.6±20.7 years (3-93 years). The prevalence of visual impairment and blindness was 6.43% (95% confidence interval (CI): 3.71-9.14) and 1.18% (95% CI: 0.56-1.79), respectively. The prevalence of visual impairment varied from 0.75% in participants aged less than 5 years to 38.36% in individuals above the age of 70 years. Uncorrected refractive errors and cataract were the first and second leading causes of visual impairment; moreover, cataract and refractive errors were responsible for 35.90 and 20.51% of the cases of blindness, respectively.ConclusionThe prevalence of visual impairment was markedly high in this study. Lack of access to health services was the main reason for the high prevalence of visual impairment in this study. Cataract and refractive errors are responsible for 80% of visual impairments which can be due to poverty in underserved villages.

Sleep duration of underserved minority children in a cross-sectional study

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Short sleep duration has been shown to associate with increased risk of obesity. Childhood obesity is more prevalent among underserved minority children. The study measured the sleep duration of underserved minority children living in a large US urban environment using accelerometry and its relation...

Understanding the strategies employed to cope with increased numbers of AIDS-orphaned children in families in rural settings: a case of Mbeya Rural District, Tanzania.

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Fauk, Nelsensius Klau; Mwakinyali, Silivano Edson; Putra, Sukma; Mwanri, Lillian

2017-02-07

The purpose of this study was to understand the strategies employed by families that adopt Acquired Immune Deficiency Syndrome (AIDS)-orphaned children (Adoptive families) for coping with and mitigating the impact of AIDS in Mbeya Rural District, Tanzania. High numbers of AIDS-orphaned children aged below 18 years in Mbeya Region have led to increasing the burden of families caring for them. Understanding the coping strategies and impact mitigation activities employed by adoptive families is important in order to develop programmes to help them. This study employed a qualitative method for data collection (one-on-one in-depth interviews). The respondents included 12 male and 8 female heads of families that provide essential care for AIDS-orphaned children in Mbeya Rural District in Tanzania. The framework approach was used to analyse the data that were collected from 15 July to 15 August 2010. The study findings revealed that adoptive families faced several challenges including financial constraints due to increased needs for basic essentials such as health care expenses, school fees and food. Further impacts on adoptive families included shortage of work opportunities and limited time to address these challenges. To mitigate these challenges, adoptive families employed a range of coping strategies including selling family assets and renting out parts of cultivable land for extra cash. Task reallocation which involved the AIDS-orphaned children entering the labour force was also employed as a strategy to mitigate challenges and involved de-enrolling of children from schools so they could take part in income-generating activities in order to earn supplementary family income. The creation of additional income-generating activities such as poultry farming were other coping mechanisms employed, and these received support from both non-governmental organisations (NGOs) and governmental organisations, including the Isangati Agricultural Development Organization (local

Family planning practices of rural community dwellers in cross River State, Nigeria.

Science.gov (United States)

Etokidem, A J; Ndifon, W; Etowa, J; Asuquo, E F

2017-06-01

Nigeria is the most populous nation in Africa and the seventh most populous in the world. Despite a high fertility rate of 5.5 per woman and a high population growth rate of 3.2%, Nigeria's contraceptive prevalence is 15%, which is one of the lowest in the world. The objective of this study was to determine the knowledge of family planning and family planning preferences and practices of rural community women in Cross River State of Nigeria. This was a cross-sectional study involving 291 rural women. Convenience sampling method was used. The women were assembled in a hall and a semi-structured questionnaire was administered to every consenting woman until the sample size was attained. Data obtained from the study were analyzed using the Statistical Package for the Social Sciences version 20 and presented in tables as frequencies and percentages as well as figures. Association between categorical variables was explored using chi-square test. Binary logistic regression was also performed to determine predictors of use of at least one family planning method at some point in time. Fifty (17.2%) respondents were using at least one family planning method. One hundred and ninety-eight (68.3%) respondents had used at least one family planning method at some point in time. Reasons given for not using any family planning method included "Family planning is against my religious beliefs" (56%); "it is against our culture" (43.8%); "I need more children" (64.9%); "my partner would not agree" (35.3%); "family planning does not work" (42.9%); "it reduces sexual enjoyment" (76%); and "it promotes unfaithfulness/infidelity" (59%). Binary logistic regression conducted to predict the use of at least one family planning method at some point in time using some independent variables showed that who makes the decision regarding family planning use was the strongest predictor of family planning use (OR = 0.567; 95% CI = 0.391-0.821). This suggests that family planning uptake is more

Ideal family size in a rural Tswana population | De Villiers | South ...

African Journals Online (AJOL)

A questionnaire was used to discover what 350 rural Tswanas believed the ideal number of children to be; results were tabulated according to age and sex. It appears· that older people tend to want more children and, more surprisingly, that men and women agree on the ideal number of children in a family; this is contrary to ...

Admission Factors Predicting Family Medicine Specialty Choice: A Literature Review and Exploratory Study among Students in the Rural Medical Scholars Program

Science.gov (United States)

Avery, Daniel M., Jr.; Wheat, John R.; Leeper, James D.; McKnight, Jerry T.; Ballard, Brent G.; Chen, Jia

2012-01-01

Purpose: The Rural Medical Scholars Program (RMSP) was created to increase production of rural family physicians in Alabama. Literature review reveals reasons medical students choose careers in family medicine, and these reasons can be categorized into domains that medical schools can address through admission, curriculum, and structural…

Correlates of Community-Based Colorectal Cancer Screening in a Rural Population: The Role of Fatalism.

Science.gov (United States)

Crosby, Richard A; Collins, Tom

2017-09-01

One largely unexplored barrier to colorectal cancer (CRC) screening is fatalistic beliefs about cancer. The purpose of this study was to identify correlates of ever having endoscopy screenings for CRC and to determine whether fatalism plays a unique role. Because evidence suggests that cancer-associated fatalistic beliefs may be particularly common among rural Americans, the study was conducted in a medically underserved area of rural Appalachia.  METHODS: Rural residents (N = 260) between 51 and 75 years of age, from a medically underserved area of Appalachia, Kentucky, were recruited for a cross-sectional study. The outcome measure was assessed by a single item asking whether participants ever had a colonoscopy or flexible sigmoidoscopy. Demographic and health-related correlates of this outcome were selected based on past studies of rural populations. A single item assessed perceptions of fatalism regarding CRC. Age-adjusted analyses of correlates testing significant at the bivariate level were conducted.  RESULTS: The analytic sample was limited to 135 rural residents indicating they had ever had CRC endoscopy and 107 indicating never having endoscopy. In age-adjusted analyses, only the measure of fatalism had a significant association with having endoscopy. Those endorsing the statement pertaining to fatalism were 2.3 times more likely (95% CI = 1.24-4.27, P = .008) than the remainder to indicate never having endoscopy.  CONCLUSIONS: A community-based approach to the promotion of endoscopy for CRC screening could focus on overcoming CRC-associated fatalism, thereby potentially bringing more unscreened people to endoscopy clinics. © 2017 National Rural Health Association.

T@lemed: Ehealth applications applied to underserved areas in Latin America

Science.gov (United States)

Sachpazidis, Ilias; Ohl, Roland; Binotto, Alécio Pedro Delazari; Torres, Márcio Soares; Messina, Luiz Ary; Sales, Alexandre; Gomes, Ricardo; Sakas, Georgios

2006-12-01

Access to medical care is sometimes very difficult to be reached from people living in rural and underserved areas. This problem is very well known in rural areas in Brazil. Citizens have no access to health care. They have to travel hundreds of kilometres to receive medical care. In this paper, we will propose a medical network based on state-of-the-art medical imaging application that addresses the problems of providing health care from a distance. Additionally, we are going to show preliminarily results of the first year of the system deployment and utilization in undeserved regions in Brazil. The total number of patients submitted to ultrasound examinations, during the 10 months of projects' medical trials, is 321. The exams have begun with the elderly people (hypertension and diabetes cases) with 90% above 50-years-old. Fifty-four percent were male and 46% were female. From those exams, 67 exams (21%) needed a second medical opinion and were transmitted to Santa Casa hospital in Porto Alegre, Brazil, one of the referral medical centres. From those second opinions of Santa Casa, 12 exams had to be repeated since the acquired images were not sufficient to give a correct diagnosis. The Lagoa Tres Cantos medical doctor performed also preventive exams with patients who had not presented any symptoms (70%).

City mouse, country mouse: a mixed-methods evaluation of perceived communication barriers between rural family physicians and urban consultants in Newfoundland and Labrador, Canada.

Science.gov (United States)

Renouf, Tia; Alani, Sabrina; Whalen, Desmond; Harty, Chris; Pollard, Megan; Morrison, Megan; Coombs-Thorne, Heidi; Dubrowski, Adam

2016-05-06

To examine perceived communication barriers between urban consultants and rural family physicians practising routine and emergency care in remote subarctic Newfoundland and Labrador (NL). This study used a mixed-methods design. Quantitative and qualitative data were collected through exploratory surveys, comprised of closed and open-ended questions. The quantitative data was analysed using comparative statistical analyses, and a thematic analysis was applied to the qualitative data. 52 self-identified rural family physicians and 23 urban consultants were recruited via email. Rural participants were also recruited at the Family Medicine Rural Preceptor meetings in St John's, NL. Rural family physicians and urban consultants in NL completed a survey assessing perceived barriers to effective communication. Data confirmed that both groups perceived communication difficulties with one another; with 23.1% rural and 27.8% urban, rating the difficulties as frequent (p=0.935); 71.2% rural and 72.2% urban as sometimes (p=0.825); 5.8% rural and 0% urban acknowledged never perceiving difficulties (p=0.714). Overall, 87.1% of participants indicated that perceived communication difficulties impacted patient care. Primary trends that emerged as perceived barriers for rural physicians were time constraints and misunderstanding of site limitations. Urban consultants' perceived barriers were inadequate patient information and lack of native language skills. Barriers to effective communication are perceived between rural family physicians and urban consultants in NL. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

The role of a family for internal dose formation in rural community

International Nuclear Information System (INIS)

Vlasova, N.V.; Rozhko, A.V.; Stavrov, V.V.

2008-01-01

Full text: Despite correct evaluation of agricultural land contamination of a settlement and the activity of foodstuffs, it is impossible to explain dose formation in rural community. And without this knowledge it is impossible to estimate correctly decision-making. The dose formation research was provided earlier in rural community based on the concept describing that the individual with his personal characteristics, social and economic statuses during his practical activity interacting with the contaminated environment, actively contributes to dose formation. Such approach only partly allows revealing dose formation mechanisms though there are some unclear issues: for example, high doses at some children. At the same time children, as well as all residents are the members of families. Direct consumption of food stuffs is provided within a family. It is preceded with the formation of psycho-emotional perception of radiation danger factor. There have been used the data of internal doses of the inhabitants obtained by the results of WBC-measurements. Simultaneously with performing of WBC measurements by interviewing of adult members of a family there was revealed the frequency of visits to forest and consumption rate of its 'gifts'. The method of a family analysis of internal dose formation is the classification of families by set of the informative attributes describing dose formation in a family such as an average internal dose at a member of a family; family total dose; the description of a family 'contact' with a forest; the number of family members; the number of children in a family; average age and the educational level of adult members of a family; gender and occupation of the head of a family; age and education of the head of a family. As a result of multivariate classification of families in the settlement there was obtained 10 different classes providing complete imagination about a variety of families' types. The average doses in classes essentially

Creating A Sustainable Model of Spine Care in Underserved Communities

DEFF Research Database (Denmark)

Haldeman, Scott; Nordin, Margareta; Outerbridge, Geoff

2015-01-01

The world lacks sustainable models of care to manage spinal disorders in poor and underserved communities. The purpose of this article is to: (1) review the rationale and importance of developing a sustainable evidence-based model of care at low cost for people with spinal disorders in underserved...... adequate care, World Spine Care (WSC) was established to "improve lives in underserved communities through sustainable, integrated, evidence-based, spinal care." WSC is comprised of volunteers and institutions from 6 continents and several countries, and incorporates a Board of Directors, an executive...... are adapted to and integrated within each community in collaboration with local decision makers, existing health care workers and traditional healers. Cornerstones of WSC's emphasis on long-term sustainability are (1) education of community partners, governments and local health professionals, and (2...

Cultivating men's interest in family planning in rural El Salvador.

Science.gov (United States)

Lundgren, Rebecka I; Gribble, James N; Greene, Margaret E; Emrick, Gail E; de Monroy, Margarita

2005-09-01

A pilot project in rural El Salvador tested the integration of family planning into a water and sanitation program as a strategy for increasing male involvement in family planning decison making and use. The organizations involved posited that integrating family planning into a resource management and community development project would facilitate male involvement by diffusing information, by referring men and women to services, and by expanding method choice to include the new Standard Days Method through networks established around issues men cared about and were already involved in. This article examines data from a community-based household survey to assess the impact of the intervention and finds significant changes in contraceptive knowledge, attitudes, and behavior from baseline to endline. Because the differences between baseline and endline are greater than the differences between participants and nonparticipants at endline, the study demonstrates the power of informal networks for spreading information.

Child development in rural China: children left behind by their migrant parents and children of nonmigrant families.

Science.gov (United States)

Wen, Ming; Lin, Danhua

2012-01-01

Using recent cross-sectional data of rural children aged from 8 to 18 in Hunan Province of China, this article examines psychological, behavioral, and educational outcomes and the psychosocial contexts of these outcomes among children left behind by one or both of their rural-to-urban migrant parents compared to those living in nonmigrant families. The results showed that left-behind children were disadvantaged in health behavior and school engagement but not in perceived satisfaction. The child's psychosocial environment, captured by family socioeconomic status, socializing processes, peer and school support, and psychological traits, were associated with, to varying extent, child developmental outcomes in rural China. These influences largely remain constant for the sampled children regardless of their parents' migrant status. © 2011 The Authors. Child Development © 2011 Society for Research in Child Development, Inc.

The progress of family health nursing in remote and rural Scotland.

Science.gov (United States)

Macduff, Colin

2005-12-01

Since 2001 the World Health Organization Europe's family health nurse (FHN) role has been developing in remote and rural areas of Scotland. In 2003, an independent evaluation identified a need for facilitation of the FHN role and family-health orientated approaches with local primary health care teams. The Scottish Executive Health Department appointed three part-time, regionally-based family health practice development facilitators (FHPDFs) in December 2003 to work over an 18-month period. This article presents findings from a small study which sought these FHPDFs' judgements on individual FHN autonomy and supportive colleague action at 24 sites where FHNs were practising. These judgements reveal a picture of mixed progress that is consistent with findings from other related research. This collective overview is presented in the form of a new typology and the resultant implications for future development of family health nursing are discussed.

Coaching mental health peer advocates for rural LGBTQ people.

Science.gov (United States)

Willging, Cathleen E; Israel, Tania; Ley, David; Trott, Elise M; DeMaria, Catherine; Joplin, Aaron; Smiley, Verida

Lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) people are affected by mental health disparities, especially in rural communities. We trained peer advocates in rural areas in the fundamentals of mental health, outreach, education, and support for this population. The peer advocates were coached by licensed mental health professionals. We evaluated this process through iterative qualitative analysis of semi-structured interviews and written logs from coaches and advocates. The six major themes comprising the results centered on (1) coaching support, (2) peer advocate skills and preparation, (3) working with help seekers, (4) negotiating diversity, (5) logistical challenges in rural contexts, and (6) systemic challenges. We concluded that peer advocacy for LGBTQ people with mental distress offers an affirmative, community-based strategy to assist the underserved. To be successful, however, peer advocates will likely require ongoing training, coaching, and infrastructural support to negotiate contextual factors that can influence provision of community resources and support to LGBTQ people within rural communities.

HPV Vaccine Acceptance in a Clinic-Based Sample of Women in the Rural South

Science.gov (United States)

Brandt, Heather M.; Sharpe, Patricia A.; McCree, Donna H.; Wright, Marcie S.; Davis, Jennifer; Hutto, Brent E.

2009-01-01

Background: Human papillomavirus (HPV) is a very common sexually transmitted infection linked to cervical disease. Vaccines for some types of HPV were in development at the time of the study. Purpose: The study examined HPV vaccine acceptability among underserved women in a rural region of the southeastern U.S. with high rates of cervical cancer…

Information needs of rural health professionals: a review of the literature.

Science.gov (United States)

Dorsch, J L

2000-10-01

This review analyzes the existing research on the information needs of rural health professionals and relates it to the broader information-needs literature to establish whether the information needs of rural health professionals differ from those of other health professionals. The analysis of these studies indicates that rural health practitioners appear to have the same basic needs for patient-care information as their urban counterparts, and that both groups rely on colleagues and personal libraries as their main sources of information. Rural practitioners, however, tend to make less use of journals and online databases and ask fewer clinical questions; a difference that correlates with geographic and demographic factors. Rural practitioners experience pronounced barriers to information access including lack of time, isolation, inadequate library access, lack of equipment, lack of skills, costs, and inadequate Internet infrastructure. Outreach efforts to this group of underserved health professionals must be sustained to achieve equity in information access and to change information-seeking behaviors.

77 FR 43127 - Federal Employees Health Benefits Program: Medically Underserved Areas for 2013

Science.gov (United States)

2012-07-23

... OFFICE OF PERSONNEL MANAGEMENT Federal Employees Health Benefits Program: Medically Underserved... determination of the States that qualify as Medically Underserved Areas under the Federal Employees Health... law that mandates special consideration for enrollees of certain FEHB plans who receive covered health...

78 FR 50119 - Federal Employees Health Benefits Program: Medically Underserved Areas for 2014

Science.gov (United States)

2013-08-16

... OFFICE OF PERSONNEL MANAGEMENT Federal Employees Health Benefits Program: Medically Underserved... determination of the states that qualify as Medically Underserved Areas under the Federal Employees Health... law that mandates special consideration for enrollees of certain FEHB plans who receive covered health...

Financial incentives for return of service in underserved areas: a systematic review

Directory of Open Access Journals (Sweden)

Bärnighausen Till

2009-05-01

Full Text Available Abstract Background In many geographic regions, both in developing and in developed countries, the number of health workers is insufficient to achieve population health goals. Financial incentives for return of service are intended to alleviate health worker shortages: A (future health worker enters into a contract to work for a number of years in an underserved area in exchange for a financial pay-off. Methods We carried out systematic literature searches of PubMed, the Excerpta Medica database, the Cumulative Index to Nursing and Allied Health Literature, and the National Health Services Economic Evaluation Database for studies evaluating outcomes of financial-incentive programs published up to February 2009. To identify articles for review, we combined three search themes (health workers or students, underserved areas, and financial incentives. In the initial search, we identified 10,495 unique articles, 10,302 of which were excluded based on their titles or abstracts. We conducted full-text reviews of the remaining 193 articles and of 26 additional articles identified in reference lists or by colleagues. Forty-three articles were included in the final review. We extracted from these articles information on the financial-incentive programs (name, location, period of operation, objectives, target groups, definition of underserved area, financial incentives and obligation and information on the individual studies (authors, publication dates, types of study outcomes, study design, sample criteria and sample size, data sources, outcome measures and study findings, conclusions, and methodological limitations. We reviewed program results (descriptions of recruitment, retention, and participant satisfaction, program effects (effectiveness in influencing health workers to provide care, to remain, and to be satisfied with work and personal life in underserved areas, and program impacts (effectiveness in influencing health systems and health outcomes

Are the cause(s) responsible for urban-rural differences in schizophrenia risk rooted in families or individuals?

DEFF Research Database (Denmark)

Pedersen, Carsten Bøcker; Mortensen, Preben Bo

2006-01-01

Many studies have identified urban-rural differences in schizophrenia risk. Hypothetical underlying cause(s) may include toxic exposures, diet, infections, and selective migration. The authors investigated whether the underlying cause(s) responsible for the urban-rural differences were rooted...... evaluated whether the nearest older sibling's place of birth had an independent effect on schizophrenia risk. If the cause(s) responsible for the urban-rural differences are rooted in individuals only, the nearest older sibling's place of birth should have no independent effect. In this analysis....... Some of the cause(s) responsible for the urban-rural differences in schizophrenia risk are rooted in families, but some might also be rooted in individuals....

76 FR 31998 - Federal Employees Health Benefits Program: Medically Underserved Areas for 2012

Science.gov (United States)

2011-06-02

... OFFICE OF PERSONNEL MANAGEMENT Federal Employees Health Benefits Program: Medically Underserved... Underserved Areas under the Federal Employees Health Benefits (FEHB) Program for calendar year 2012. This is... certain FEHB plans who receive covered health services in States with critical shortages of primary care...

75 FR 32972 - Federal Employees Health Benefits Program; Medically Underserved Areas for 2011

Science.gov (United States)

2010-06-10

... OFFICE OF PERSONNEL MANAGEMENT Federal Employees Health Benefits Program; Medically Underserved... Underserved Areas under the Federal Employees Health Benefits (FEHB) Program for calendar year 2011. This is... certain FEHB plans who receive covered health services in States with critical shortages of primary care...

Normative influence and desired family size among young people in rural Egypt.

Science.gov (United States)

Harbour, Catherine

2011-06-01

Research has identified the lack of acceptance of a two-child-family norm as the biggest obstacle to achieving replacement-level fertility in Egypt. This analysis examines norms about desired family size for 1,366 males and 1,367 females aged 15-24 in 2004 in rural Minya governorate. Two-level random-effects multivariate logistic regression models, stratified by sex and grouped by neighborhood, are used to assess normative influence at the household and neighborhood levels, controlling for individual- and household-level covariates. In the final model, young males in neighborhoods where more people desire a small family are 33 percent more likely to desire a small family than are young males in other neighborhoods. Young females in households with one or more adults preferring a small family are 78 percent more likely to desire a small family, and young females in households with one or more young people who prefer a small family are 37 percent more likely to desire a small family themselves, compared with those living with adults or with young people, respectively, who do not prefer a small family. Programs aiming to reduce fertility should be aware of gender differences in the sources of normative influence on desired family size.

Work of female rural doctors.

Science.gov (United States)

Wainer, Jo

2004-04-01

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

Occupational safety and health education and training for underserved populations.

Science.gov (United States)

O'Connor, Tom; Flynn, Michael; Weinstock, Deborah; Zanoni, Joseph

2014-01-01

This article presents an analysis of the essential elements of effective occupational safety and health education and training programs targeting underserved communities. While not an exhaustive review of the literature on occupational safety and health training, the paper provides a guide for practitioners and researchers to the key factors they should consider in the design and implementation of training programs for underserved communities. It also addresses issues of evaluation of such programs, with specific emphasis on considerations for programs involving low-literacy and limited-English-speaking workers.

Family sources of educational gender inequality in rural china: A critical assessment.

Science.gov (United States)

Hannum, Emily; Kong, Peggy; Zhang, Yuping

2009-09-01

In this paper, we investigate the gender gap in education in rural northwest China. We first discuss parental perceptions of abilities and appropriate roles for girls and boys; parental concerns about old-age support; and parental perceptions of different labor market outcomes for girls' and boys' education. We then investigate gender disparities in investments in children, children's performance at school, and children's subsequent attainment. We analyze a survey of 9-12-year-old children and their families conducted in rural Gansu Province in the year 2000, along with follow-up information about subsequent educational attainment collected 7 years later. We complement our main analysis with two illustrative case studies of rural families drawn from 11 months of fieldwork conducted in rural Gansu between 2003 and 2005 by the second author.In 2000, most mothers expressed egalitarian views about girls' and boys' rights and abilities, in the abstract. However, the vast majority of mothers still expected to rely on sons for old-age support, and nearly one in five mothers interviewed agreed with the traditional saying, "Sending girls to school is useless since they will get married and leave home." Compared to boys, girls faced somewhat lower (though still very high) maternal educational expectations and a greater likelihood of being called on for household chores than boys. However, there was little evidence of a gender gap in economic investments in education. Girls rivaled or outperformed boys in academic performance and engagement. Seven years later, boys had attained just about a third of a year more schooling than girls-a quite modest advantage that could not be fully explained by early parental attitudes and investments, or student performance or engagement. Fieldwork confirmed that parents of sons and daughters tended to have high aspirations for their children. Parents sometimes viewed boys as having greater aptitude, but tended to view girls as having more

Mental Health of Children Living in Foster Families in Rural Rwanda: The Role of HIV and the Family Environment.

Science.gov (United States)

Nduwimana, Estella; Mukunzi, Sylvere; Ng, Lauren C; Kirk, Catherine M; Bizimana, Justin I; Betancourt, Theresa S

2017-06-01

Fostering children is common in sub-Saharan Africa, but few studies examine these children's mental health needs. This study investigated the impact of living in a foster family on the mental health of HIV-positive, HIV-affected and HIV-unaffected children (n = 681 aged 10-17) in rural Rwanda. Regression analyses assessed the impact of living in a foster family on mental health, parenting, and daily hardships; multiple mediation analyses assessed whether family factors mediated the association between foster status and mental health. HIV-positive children were eight times more likely to live in foster families than HIV-unaffected children. Being HIV-affected was predictive of depression and irritability symptoms after controlling for family factors. Controlling for HIV-status, foster children had more symptoms of depression, anxiety, and irritability than non-fostered children. Positive parenting fully mediated the association between foster status and mental health. Mental health and parenting interventions for foster children and HIV-affected children may improve child outcomes.

Designing financial-incentive programmes for return of medical service in underserved areas: seven management functions

Directory of Open Access Journals (Sweden)

Bärnighausen Till

2009-06-01

Full Text Available Abstract In many countries worldwide, health worker shortages are one of the main constraints in achieving population health goals. Financial-incentive programmes for return of service, whereby participants receive payments in return for a commitment to practise for a period of time in a medically underserved area, can alleviate local and regional health worker shortages through a number of mechanisms. First, they can redirect the flow of those health workers who would have been educated without financial incentives from well-served to underserved areas. Second, they can add health workers to the pool of workers who would have been educated without financial incentives and place them in underserved areas. Third, financial-incentive programmes may improve the retention in underserved areas of those health workers who participate in a programme, but who would have worked in an underserved area without any financial incentives. Fourth, the programmes may increase the retention of all health workers in underserved areas by reducing the strength of some of the reasons why health workers leave such areas, including social isolation, lack of contact with colleagues, lack of support from medical specialists and heavy workload. We draw on studies of financial-incentive programmes and other initiatives with similar objectives to discuss seven management functions that are essential for the long-term success of financial-incentive programmes: financing (programmes may benefit from innovative donor financing schemes, such as endowment funds, international financing facilities or compensation payments; promotion (programmes should use tested communication channels in order to reach secondary school graduates and health workers; selection (programmes may use selection criteria to ensure programme success and to achieve supplementary policy goals; placement (programmes should match participants to areas in order to maximize participant satisfaction and

Designing financial-incentive programmes for return of medical service in underserved areas: seven management functions.

Science.gov (United States)

Bärnighausen, Till; Bloom, David E

2009-06-26

In many countries worldwide, health worker shortages are one of the main constraints in achieving population health goals. Financial-incentive programmes for return of service, whereby participants receive payments in return for a commitment to practise for a period of time in a medically underserved area, can alleviate local and regional health worker shortages through a number of mechanisms. First, they can redirect the flow of those health workers who would have been educated without financial incentives from well-served to underserved areas. Second, they can add health workers to the pool of workers who would have been educated without financial incentives and place them in underserved areas. Third, financial-incentive programmes may improve the retention in underserved areas of those health workers who participate in a programme, but who would have worked in an underserved area without any financial incentives. Fourth, the programmes may increase the retention of all health workers in underserved areas by reducing the strength of some of the reasons why health workers leave such areas, including social isolation, lack of contact with colleagues, lack of support from medical specialists and heavy workload. We draw on studies of financial-incentive programmes and other initiatives with similar objectives to discuss seven management functions that are essential for the long-term success of financial-incentive programmes: financing (programmes may benefit from innovative donor financing schemes, such as endowment funds, international financing facilities or compensation payments); promotion (programmes should use tested communication channels in order to reach secondary school graduates and health workers); selection (programmes may use selection criteria to ensure programme success and to achieve supplementary policy goals); placement (programmes should match participants to areas in order to maximize participant satisfaction and retention); support (programmes

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

Science.gov (United States)

Ajuwon, G A; Komolafe-Opadeji, H O; Ikhizama, B

2013-01-01

The objective of this study was to meet the HIV/AIDS information and service needs of citizens living in selected rural, underserved communities in Oyo State, Nigeria. This was a librarian-initiated intervention program (pre-post) study of heads of rural households in Oyo State. A questionnaire was used for pre- and post-intervention assessment. The education covered knowledge about HIV/AIDS, routes of transmission, prevention strategies, and attitude toward persons living with HIV. It increased participants' knowledge about AIDS and improved attitude toward those living with HIV. Provision and dissemination of information on HIV/AIDS through librarians to rural settlers is an important prevention strategy and librarians can make major contributions.

Monetary Value of a Prescription Assistance Program Service in a Rural Family Medicine Clinic

Science.gov (United States)

Whitley, Heather P.

2011-01-01

Purpose: To quantify the monetary value of medications provided to rural Alabamians through provision of pharmaceutical manufacturer-sponsored prescription assistance programs (PAPs) provided by a clinical pharmacist in a private Black Belt family medicine clinic during 2007 and 2008. Methods: Patients struggling to afford prescription medications…

Developing e-banking services for rural India: making use of socio-technical prototypes

OpenAIRE

Dittrich, Yvonne; Vaidyanathan, Lakshmi; Gonsalves, Timothy A; Jhunjhunwala, Ashok

2017-01-01

Information and Communication Technology (ICT) is one of the key enablers for including underserved communities in economic and societal development across the world. Our research analyzes several banking service projects developing technical solutions for rural India. This poster presents an experience report based on systematic debriefing of involved project leaders and initiators, triangulated with additional documentation. The concept of Socio-Technical Prototype is developed and used to ...

Family life course transitions and rural household economy during China's market reform.

Science.gov (United States)

Chen, Feinian; Korinek, Kim

2010-11-01

This article investigates the effect of family life course transitions on labor allocation strategies in rural Chinese households. We highlight three types of economic activity that involve reallocation of household labor oriented toward a more diversified, nonfarm rural economy: involvement in wage employment, household entrepreneurship, and/or multiple activities that span economic sectors. With the use of data from the China Health and Nutrition Survey (CHNS 1997, 2000, and 2004), our longitudinal analyses of rural household economic activity point to the significance of household demography, life course transitions, and local economic structures as factors facilitating household labor reallocation. First, as expected, a relatively youthful household structure is conducive to innovative economic behavior. Second, household entrances and exits are significant, but their impacts are not equal. Life events such as births, deaths, marriage, or leaving home for school or employment affect household economy in distinctive ways. Finally, the reallocations of household labor undertaken by households are shaped by local economic structures: in particular, the extent of village-level entrepreneurial activity, off-farm employment, and out-migration.

Household food insecurity and dietary patterns in rural and urban American Indian families with young children

Directory of Open Access Journals (Sweden)

Emily J. Tomayko

2017-06-01

Full Text Available Abstract Background High food insecurity has been demonstrated in rural American Indian households, but little is known about American Indian families in urban settings or the association of food insecurity with diet for these families. The purpose of this study was to examine the prevalence of food insecurity in American Indian households by urban-rural status, correlates of food insecurity in these households, and the relationship between food insecurity and diet in these households. Methods Dyads consisting of an adult caregiver and a child (2–5 years old from the same household in five urban and rural American Indian communities were included. Demographic information was collected, and food insecurity was assessed using two validated items from the USDA Household Food Security Survey. Factors associated with food insecurity were examined using logistic regression. Child and adult diets were assessed using food screeners. Coping strategies were assessed through focus group discussions. These cross-sectional baseline data were collected from 2/2013 through 4/2015 for the Healthy Children, Strong Families 2 randomized controlled trial of a healthy lifestyles intervention for American Indian families. Results A high prevalence of food insecurity was determined (61% and was associated with American Indian ethnicity, lower educational level, single adult households, WIC participation, and urban settings (p = 0.05. Food insecure adults had significantly lower intake of vegetables (p < 0.05 and higher intakes of fruit juice (<0.001, other sugar-sweetened beverages (p < 0.05, and fried potatoes (p < 0.001 than food secure adults. Food insecure children had significantly higher intakes of fried potatoes (p < 0.05, soda (p = 0.01, and sports drinks (p < 0.05. Focus group participants indicated different strategies were used by urban and rural households to address food insecurity. Conclusions The prevalence of food insecurity in

Rural Communatcation: legitimizing digital inclusion in rural field

Directory of Open Access Journals (Sweden)

Juliana Correa Bernardes

2016-03-01

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

Household food insecurity and dietary patterns in rural and urban American Indian families with young children.

Science.gov (United States)

Tomayko, Emily J; Mosso, Kathryn L; Cronin, Kate A; Carmichael, Lakeesha; Kim, KyungMann; Parker, Tassy; Yaroch, Amy L; Adams, Alexandra K

2017-06-30

High food insecurity has been demonstrated in rural American Indian households, but little is known about American Indian families in urban settings or the association of food insecurity with diet for these families. The purpose of this study was to examine the prevalence of food insecurity in American Indian households by urban-rural status, correlates of food insecurity in these households, and the relationship between food insecurity and diet in these households. Dyads consisting of an adult caregiver and a child (2-5 years old) from the same household in five urban and rural American Indian communities were included. Demographic information was collected, and food insecurity was assessed using two validated items from the USDA Household Food Security Survey. Factors associated with food insecurity were examined using logistic regression. Child and adult diets were assessed using food screeners. Coping strategies were assessed through focus group discussions. These cross-sectional baseline data were collected from 2/2013 through 4/2015 for the Healthy Children, Strong Families 2 randomized controlled trial of a healthy lifestyles intervention for American Indian families. A high prevalence of food insecurity was determined (61%) and was associated with American Indian ethnicity, lower educational level, single adult households, WIC participation, and urban settings (p = 0.05). Food insecure adults had significantly lower intake of vegetables (p insecure children had significantly higher intakes of fried potatoes (p insecurity. The prevalence of food insecurity in American Indian households in our sample is extremely high, and geographic designation may be an important contributing factor. Moreover, food insecurity had a significant negative influence on dietary intake for families. Understanding strategies employed by households may help inform future interventions to address food insecurity. ( NCT01776255 ). Registered: January 16, 2013. Date of enrollment

Maternal Resources, Parenting Practices, and Child Competence in Rural, Single-Parent African American Families.

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Brody, Gene H.; Flor, Douglas L.

1998-01-01

Tested a model linking maternal/family characteristics to child cognitive and psychosocial competence in African-American 6- to 9-year olds in rural single-mother-headed households. Found that maternal education, religiosity, and financial resources were linked with parenting style, mother-child relationship, and maternal school involvement.…

Determinants of family planning service uptake and use of contraceptives among postpartum women in rural Uganda.

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Sileo, Katelyn M; Wanyenze, Rhoda K; Lule, Haruna; Kiene, Susan M

2015-12-01

Uganda has one of the highest unmet needs for family planning globally, which is associated with negative health outcomes for women and population-level public health implications. The present cross-sectional study identified factors influencing family planning service uptake and contraceptive use among postpartum women in rural Uganda. Participants were 258 women who attended antenatal care at a rural Ugandan hospital. We used logistic regression models in SPSS to identify determinants of family planning service uptake and contraceptive use postpartum. Statistically significant predictors of uptake of family planning services included: education (AOR = 3.03, 95 % CI 1.57-5.83), prior use of contraceptives (AOR = 7.15, 95 % CI 1.58-32.37), partner communication about contraceptives (AOR = 1.80, 95 % CI 1.36-2.37), and perceived need of contraceptives (AOR = 2.57, 95 % CI 1.09-6.08). Statistically significant predictors of contraceptive use since delivery included: education (AOR = 2.04, 95 % CI 1.05-3.95), prior use of contraceptives (AOR = 10.79, 95 % CI 1.40-83.06), and partner communication about contraceptives (AOR = 1.81, 95 % CI 1.34-2.44). Education, partner communication, and perceived need of family planning are key determinants of postpartum family planning service uptake and contraceptive use, and should be considered in antenatal and postnatal family planning counseling.

Community based study on married couples' family planning knowledge, attitude and practice in rural and urban Gambia.

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Jammeh, Sulayman S S; Liu, Chieh-Yu; Cheng, Su-Fen; Lee-Hsieh, Jane

2014-06-01

Family planning services have been free of charge and available in all the health facilities in the Gambia since 1975 yet contraceptive prevalence is only 17.5% and even 6% in some areas. Since the last census in 2003, there existed no available data on married couples' contraception status. To explore married couples' family planning knowledge, attitudes, and practices in rural and urban Gambia and to analyze what factors may affect such knowledge, attitudes and practices. Quantitative cross-sectional study design was used. Through convenience sampling, 176 men and 235 women representing a total of 176 couples participated. A structured questionnaire was used for data collection. The mean scores of the married couples family planning knowledge, attitudes, and practices were 19.00 ± 6.11(ranging from 0 to 64), 6.90 ± 3.08 (0 to 14) and 4.69 ± 3.3 (0 to 19) respectively. Urban residents had higher scores on family planning practice than rural residents (pfamily planning knowledge, attitude and practice in Gambia", as well as suggesting broader health intervention programs in health education and promotion.

Factors affecting the cultural competence of visiting nurses for rural multicultural family support in South Korea.

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Suk, Min Hyun; Oh, Won-Oak; Im, YeoJin

2018-01-01

With the recent growth of multicultural families in the Korean society, the importance of the role of qualified visiting nurses in the delivery of culturally sensitive health care has grown dramatically. As the primary health care provider for multicultural families enrolled in public community-based health care centers, the cultural competence of visiting nurses is an essential qualification for the provision of quality health care for multicultural families, especially in rural areas. Cultural competence of visiting nurses is based on their cultural awareness and empathetic attitude toward multicultural families. This study aimed to examine the levels of cultural competence, empowerment, and empathy in visiting nurses, and to verify the factors that affect the cultural competence of visiting nurses working with rural multicultural families in South Korea. Employing a cross-sectional descriptive study design, data from 143 visiting nurses working in rural areas were obtained. Data collection took place between November 2011 and August 2012. The measurement tools included the modified Korean version of the Cultural Awareness Scale, the Text of Items Measuring Empowerment, and the Interpersonal Reactivity Index to measure the level of empathy of visiting nurses. Analyses included descriptive statistics, a t-test, an ANOVA, a Pearson correlation coefficient analysis, and a multiple linear regression analysis. The cultural competence score of the visiting nurses was 3.07 on a 5-point Likert scale (SD = 0.30). The multiple regression analysis revealed that the cultural competence of visiting nurses was significantly influenced by experience of cultural education, empathy, and scores on the meaning subscale of the empowerment tool (R 2  = 10.2%). Institutional support to enhance visiting nurses' empowerment by assuring the significance of their job and specific strategies to enhance their empathy would be helpful to improve the cultural competence of visiting

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

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Saber Azami-Aghdash

2016-12-01

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

Determinants of unmet need for family planning in rural Burkina Faso: a multilevel logistic regression analysis.

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Wulifan, Joseph K; Jahn, Albrecht; Hien, Hervé; Ilboudo, Patrick Christian; Meda, Nicolas; Robyn, Paul Jacob; Saidou Hamadou, T; Haidara, Ousmane; De Allegri, Manuela

2017-12-19

Unmet need for family planning has implications for women and their families, such as unsafe abortion, physical abuse, and poor maternal health. Contraceptive knowledge has increased across low-income settings, yet unmet need remains high with little information on the factors explaining it. This study assessed factors associated with unmet need among pregnant women in rural Burkina Faso. We collected data on pregnant women through a population-based survey conducted in 24 rural districts between October 2013 and March 2014. Multivariate multilevel logistic regression was used to assess the association between unmet need for family planning and a selection of relevant demand- and supply-side factors. Of the 1309 pregnant women covered in the survey, 239 (18.26%) reported experiencing unmet need for family planning. Pregnant women with more than three living children [OR = 1.80; 95% CI (1.11-2.91)], those with a child younger than 1 year [OR = 1.75; 95% CI (1.04-2.97)], pregnant women whose partners disapproves contraceptive use [OR = 1.51; 95% CI (1.03-2.21)] and women who desired fewer children compared to their partners preferred number of children [OR = 1.907; 95% CI (1.361-2.672)] were significantly more likely to experience unmet need for family planning, while health staff training in family planning logistics management (OR = 0.46; 95% CI (0.24-0.73)] was associated with a lower probability of experiencing unmet need for family planning. Findings suggest the need to strengthen family planning interventions in Burkina Faso to ensure greater uptake of contraceptive use and thus reduce unmet need for family planning.

The garden dying: Commoditization of agriculture and changes in practices of self-consumption among rural families of southern gaucho

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Flávio Sacco dos Anjos

2009-12-01

Full Text Available The article is based on qualitative research carried out in the southern extreme of the Rio Grande do Sul state and explores the transformations on the practices of self-consumption production in the context of familiar agriculture, essentially, under the impacts of the process of commoditization of agriculture and the rural life. The self-consumption practices present a cultural matrix among rural families, in spite of the symbolic value attributed to products generated within the very rural establishment, as compared to the ones which are acquired externally in usual commerce or from other units of production. The field-work was performed within thirty family agricultural establishments whose main commercial activity lies on the milk, peach and tobacco production. The authors discuss the impacts of the commoditization of agriculture on the practical of self-consumption production.

Maternal mental health and the persistence of food insecurity in poor rural families.

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Lent, Megan D; Petrovic, Lindsay E; Swanson, Josephine A; Olson, Christine M

2009-08-01

Little is known about the causal relationship between and the mechanisms linking depression and food insecurity. Our purpose was to examine these knowledge gaps. Chi-squared analysis of longitudinal data from 29 rural upstate New York families followed for three years and qualitative analysis of interviews were used to identify associations and mechanisms. Depressive symptoms (p=.009) and poor mental health (p=.01) in mothers limited the likelihood families would leave food insecurity. This relationship was mediated through limiting the employment of adult family members and operated in three ways: preventing the depressed household member from working, preventing a different household member from working, and limiting access to childcare for depressed children so adults could work. Poor mental health is associated with keeping families food-insecure by limiting their employment. High-quality, accessible mental health care is needed for poverty-associated food insecurity to be alleviated.

Rural Resilience: Youth "Making a Life" in Regions of High Unemployment.

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Abbott-Chapman, Joan

2001-01-01

In rural Australia, education beyond year 10 involves leaving home. Rural families may influence young people to stay home. Family influence and culture should not always be considered a deficit, for the family provides support when jobs are scarce. Rural families' social capital and rural resilience should be considered in developing rural school…

Delivering New Malaria Drugs through Grassroots Private Sector ...

African Journals Online (AJOL)

Objective: To demonstrate that micro-franchising system is an effective way of improving access to effective health care such as the introduction of first line antimalarias in populations living in underserved rural areas in Kenya. Design: A descriptive study. Setting: Child and family wellness (CFW) micro-franchised nurse run ...

Leadership Advocacy: Bringing Nursing to the Homeless and Underserved.

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Porter-OʼGrady, Tim

Nurses have historically played a key role in advocacy and service for all members of the community, including those who are traditionally underserved by other providers or the health system. Nurses from a local Atlanta community health system, both clinical and administrative, have continued this tradition by developing an advocacy and service program for the downtown homeless of Atlanta. From its beginnings as a highly informal volunteer program to its current structure as a strongly integrated community health center for the underserved and homeless of Atlanta, local nurses have demonstrated their strong value of service advocacy. Their leadership, insight, discipline, and strategic development have facilitated the growth of a focused, viable health service network for marginalized people of the city of Atlanta.

The Importance of Broadband for Socio-Economic Development: A Perspective from Rural Australia

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Julie Freeman

2016-10-01

Full Text Available Advanced connectivity offers rural communities prospects for socio-economic development. Despite Australia’s national broadband infrastructure plans, inferior availability and quality of rural Internet connections remain persistent issues. This article examines the impact of limited connectivity on rural socio-economic opportunities, drawing from the views of twelve citizens from the Boorowa local government area in New South Wales. The available fixed wireless and satellite connections in Boorowa are slow and unreliable, and remote regions in the municipality are still without any Internet access. Participants identified four key areas in their everyday lives that are impacted by insufficient connectivity: business development, education, emergency communication, and health. Rural citizens often already face challenges in these areas, and infrastructure advancements in urban spaces can exacerbate rural-urban disparities. Participants’ comments demonstrated apprehension that failure to improve connectivity would result in adverse long-term consequences for the municipality. This article suggests that current broadband policy frameworks require strategic adaptations to account for the socio-economic and geographic contexts of rural communities. In order to narrow Australia’s rural-urban digital divide, infrastructure developments should be prioritised in the most underserved regions.

A rural Appalachian faith-placed smoking cessation intervention.

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Schoenberg, Nancy E; Bundy, Henry E; Baeker Bispo, Jordan A; Studts, Christina R; Shelton, Brent J; Fields, Nell

2015-04-01

Although health promotion programming in faith institutions is promising, most faith-based or placed health projects focus on diet, exercise, or cancer screening and many have been located in urban environments. This article addresses the notable absence of faith programming for smoking cessation among underserved rural US residents who experience tobacco-related health inequities. In this article, we describe our faith-oriented smoking cessation program in rural Appalachia, involving 590 smokers in 26 rural churches randomized to early and delayed intervention groups. We present three main themes that account for participants' positive evaluation of the program; the program's ability to leverage social connections; the program's convenience orientation; and the program's financial support for smoking cessation. We also present themes on the roles of faith and church in smoking cessation programming, including some mixed perceptions on smoking stigma and comfort in church settings; challenges in faith-placed smoking cessation recruitment; and the positive perception of such programming by church leaders. We conclude that faith-placed smoking cessation programs offer great potential, although they must be administered with great sensitivity to individual and community norms.

Integration and Optimization of Renewables and Storages for Rural Electrification

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Morris Brenna

2016-09-01

Full Text Available The electricity access in Sub-Saharan African countries is below 10%; thus, introducing a microgrid for rural electrification can overcome the endemic lack of modern electricity access that hampers the provision of basic services such as education, healthcare, safety, economic and social growth for rural communities. This work studies different possible comparison methods considering variations such as land area required, location for the storage, efficiency, availability and reliability of energy resources, and technology cost variability (investment cost and levelized cost of electricity, which are among the major key parameters used to assess the best possible utilization of renewables and storage system, either using them in the form of integrated, hybrid or independent systems. The study is carried out largely with the help of the Micropower optimization modeling simulator called HOMER for Ethiopia. As a result, the study proposes the use of Photovoltaic (PV–Wind–Hydro–Battery hybrid system model that concludes the optimal configuration of power systems at affordable price for underserved rural communities.

Patient, staff, and clinician perspectives on implementing electronic communications in an interdisciplinary rural family health practice.

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Chang, Feng; Paramsothy, Thivaher; Roche, Matthew; Gupta, Nishi S

2017-03-01

Aim To conduct an environmental scan of a rural primary care clinic to assess the feasibility of implementing an e-communications system between patients and clinic staff. Increasing demands on healthcare require greater efficiencies in communications and services, particularly in rural areas. E-communications may improve clinic efficiency and delivery of healthcare but raises concerns about patient privacy and data security. We conducted an environmental scan at one family health team clinic, a high-volume interdisciplinary primary care practice in rural southwestern Ontario, Canada, to determine the feasibility of implementing an e-communications system between its patients and staff. A total of 28 qualitative interviews were conducted (with six physicians, four phone nurses, four physicians' nurses, five receptionists, one business office attendant, five patients, and three pharmacists who provide care to the clinic's patients) along with quantitative surveys of 131 clinic patients. Findings Patients reported using the internet regularly for multiple purposes. Patients indicated they would use email to communicate with their family doctor for prescription refills (65% of respondents), appointment booking (63%), obtaining lab results (60%), and education (50%). Clinic staff expressed concerns about patient confidentiality and data security, the timeliness, complexity and responsibility of responses, and increased workload. Clinic staff members are willing to use an e-communications system but clear guidelines are needed for successful adoption and to maintain privacy of patient health data. E-communications might improve access to and quality of care in rural primary care practices.

Digital Storytelling in Adult Education and Family Literacy: A Case Study from Rural Ireland

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Prins, Esther

2017-01-01

Previous research on digital storytelling (DST) has focused chiefly on children and youth, but we know little about how it is used in non-formal adult education. This article analyzes a DST class in rural Ireland, which was organized by a family literacy program and offered for parents at an elementary school. Data sources included fieldnotes,…

Assessing predictors of contraceptive use and demand for family planning services in underserved areas of Punjab province in Pakistan: results of a cross-sectional baseline survey.

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Azmat, Syed Khurram; Ali, Moazzam; Ishaque, Muhammad; Mustafa, Ghulam; Hameed, Waqas; Khan, Omar Farooq; Abbas, Ghazunfer; Temmerman, Marleen; Munroe, Erik

2015-03-28

Although Pakistan was one of the first countries in Asia to launch national family planning programs, current modern contraceptive use stands at only 26% with a method mix skewed toward short-acting and permanent methods. As part of a multiyear operational research study, a baseline survey was conducted to understand the predictors of contraceptive use and demand for family planning services in underserved areas of Punjab province in Pakistan. This paper presents the baseline survey results; the outcomes of the intervention will be presented in a separate paper after the study has been completed. A cross-sectional baseline household survey was conducted with randomly selected 3,998 married women of reproductive age (MWRA) in the Chakwal, Mianwali, and Bhakkar districts of Punjab. The data were analyzed on SPSS 17.0 using simple descriptive and logistic regression. Most of the women had low socio-economic status and were younger than 30 years of age. Four-fifths of the women consulted private sector health facilities for reproductive health services; proximity, availability of services, and good reputation of the provider were the main predicators for choosing the facilities. Husbands were reported as the key decision maker regarding health-seeking and family planning uptake. Overall, the current contraceptive use ranged from 17% to 21% across the districts: condoms and female sterilization were widely used methods. Woman's age, husband's education, wealth quintiles, spousal communication, location of last delivery, and favorable attitude toward contraception have an association with current contraceptive use. Unmet need for contraception was 40.6%, 36.6%, and 31.9% in Chakwal, Mianwali, and Bhakkar, respectively. Notably, more than one fifth of the women across the districts expressed willingness to use quality, affordable long-term family planning services in the future. The baseline results highlight the need for quality, affordable long-term family planning

Achieving success with family planning in rural Afghanistan.

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Huber, Douglas; Saeedi, Nika; Samadi, Abdul Khalil

2010-03-01

Afghan women have one of the world's highest lifetime risks of maternal death. Years of conflict have devastated the country's health infrastructure. Total fertility was one of the world's highest, contraceptive use was low and there were no Afghan models of success for family planning. We worked closely with communities, providing information about the safety and non-harmful side-effects of contraceptives and improving access to injectable contraceptives, pills and condoms. Regular interaction with community leaders, mullahs (religious leaders), clinicians, community health workers and couples led to culturally acceptable innovations. A positive view of birth spacing was created by the messages that contraceptive use is 300 times safer than pregnancy in Afghanistan and that the Quran (the holy book of Islam) promotes two years of breastfeeding. Community health workers initiated the use of injectable contraceptives for the first time. The non-for-profit organization, Management Sciences for Health, Afghan nongovernmental organizations and the Ministry of Public Health implemented the Accelerating Contraceptive Use project in three rural areas with different ethnic populations. The contraceptive prevalence rate increased by 24-27% in 8 months in the project areas. Men supported modern contraceptives once they understood contraceptive safety, effectiveness and non-harmful side-effects. Injectable contraceptives contributed most to increases in contraceptive use. Community health workers can rapidly increase contraceptive use in rural areas when given responsibility and guidance. Project innovations were adopted as best practices for national scale-up.

Does rural generalist focused medical school and family medicine training make a difference? Memorial University of Newfoundland outcomes.

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Rourke, James; Asghari, Shabnam; Hurley, Oliver; Ravalia, Mohamed; Jong, Michael; Graham, Wendy; Parsons, Wanda; Duggan, Norah; O'Keefe, Danielle; Moffatt, Scott; Stringer, Katherine; Sturge Sparkes, Carolyn; Hippe, Janelle; Harris Walsh, Kristin; McKay, Donald; Samarasena, Asoka

2018-03-01

Rural recruitment and retention of physicians is a global issue. The Faculty of Medicine at Memorial University of Newfoundland, Canada, was established as a rural-focused medical school with a social accountability mandate that aimed to meet the healthcare needs of a sparse population distributed over a large landmass as well as the needs of other rural and remote areas of Canada. This study aimed to assess whether Memorial medical degree (MD) and postgraduate (PG) programs were effective at producing physicians for their province and rural physicians for Canada compared with other Canadian medical schools. This retrospective cohort study included medical school graduates who completed their PG training between 2004 and 2013 in Canada. Practice locations of study subjects were georeferenced and assigned to three geographic classes: Large Urban; Small City/Town; and Rural. Analyses were performed at two levels. (1) Provincial level analysis compared Memorial PG graduates practicing where they received their MD and/or PG training with other medical schools who are the only medical school in their province (n=4). (2) National-level analysis compared Memorial PG graduates practicing in rural Canada with all other Canadian medical schools (n=16). Descriptive and bivariate analyses were performed. Overall, 18 766 physicians practicing in Canada completed Canadian PG training (2004-2013), and of those, 8091 (43%) completed Family Medicine (FM) training. Of all physicians completing Canadian PG training, 1254 (7%) physicians were practicing rurally and of those, 1076 were family physicians. There were 379 Memorial PG graduates and of those, 208 (55%) completed FM training and 72 (19%) were practicing rurally, and of those practicing rurally, 56 were family physicians. At the national level, the percentage of all Memorial PG graduates (19.0%) and FM PG graduates (26.9%) practicing rurally was significantly better than the national average for PG (6.4%, p<0.000) and FM (12

Impact of a regional distributed medical education program on an underserved community: perceptions of community leaders.

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Toomey, Patricia; Lovato, Chris Y; Hanlon, Neil; Poole, Gary; Bates, Joanna

2013-06-01

To describe community leaders' perceptions regarding the impact of a fully distributed undergraduate medical education program on a small, medically underserved host community. The authors conducted semistructured interviews in 2007 with 23 community leaders representing, collectively, the education, health, economic, media, and political sectors. They reinterviewed six participants from a pilot study (2005) and recruited new participants using purposeful and snowball sampling. The authors employed analytic induction to organize content thematically, using the sectors as a framework, and they used open coding to identify new themes. The authors reanalyzed transcripts to identify program outcomes (e.g., increased research capacity) and construct a list of quantifiable indicators (e.g., number of grants and publications). Participants reported their perspectives on the current and anticipated impact of the program on education, health services, the economy, media, and politics. Perceptions of impact were overwhelmingly positive (e.g., increased physician recruitment), though some were negative (e.g., strains on health resources). The authors identified new outcomes and confirmed outcomes described in 2005. They identified 16 quantifiable indicators of impact, which they judged to be plausible and measureable. Participants perceive that the regional undergraduate medical education program in their community has broad, local impacts. Findings suggest that early observed outcomes have been maintained and may be expanding. Results may be applicable to medical education programs with distributed or regional sites in similar rural, remote, and/or underserved regions. The areas of impact, outcomes, and quantifiable indicators identified will be of interest to future researchers and evaluators.

The Impact of Family Setting and Local Opportunities on Leaving Home and Migration Destinations of Rural Youths, The Netherlands 1860-1940

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Bastian Mönkediek

2015-11-01

Full Text Available In this article we aim to study how Dutch children’s individual destinies result from the complex interplay of family setting and local conditions in a rural environment. We focus on their final move from the parental home, and we will analyse not only timing and incidence of leaving, but also the destinations. To do this, we propose a multi-level competing risk analysis of migration destinations. We focus on two groups: the children of farmers and those of rural workers. Dutch farmers and workers differ in the type of family economy in which children were integrated, and contrasting them will allow us to explain the speed, the directions, and the individual and family backgrounds of the process of leaving agriculture. We make use of the Historical Sample of the Netherlands to analyse last migrations of 8,338 children of farmers and rural workers. As we cover the entire country, we can study the full impact of regional differences on type of agriculture and inheritance, in combination with the family composition. Our results indicate significant effects of specialised versus traditional, mixed farming on the migration behaviour of farmers’ and rural workers’ children, as well as the importance of the number of siblings of the same sex and birth order. The variations in the effects of the sibship among regions with different agricultural systems demonstrate the importance of gender-specific divisions of labour on leaving home.

Adoption Of Small Family Norms In A Rural Community Of West Bengal

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Biswas A.K

1994-01-01

Full Text Available Research Questions: 1. To what extent do rural eligible couples accept the small family norm? 2. What are the factors which influence the adoption of small family norm by these couples? Objectives: 1. To determine the extent of adoption of small norm among family planning service acceptors (2 To identify factors influencing adoption of small family norm. Study Design: Cross sectional Study Setting: 2 villages- a PHC village and one 5 kms away of Block Sonarpur. Participants: 312 eligible couples of these villages. Study Variables: Socio â€" economics status, literacy of the wives, type of family, religion, number of children, type of family planning method. Outcome Variables: Prevalence of contraceptive method use, reasons for not using family planning methods. Statistical Analysis: Proportions Results : The prevalence of contraceptive use was 44.9% but the Effective Couple Protection Rate was only 20.5% and the Crude Birth Rate was still high (35/1000. This was because 40% of the couples had more then 2 children and of them 38% were still exposed to the risk of conception. Muslim couples had a lower contraceptive acceptance rate than Hindu couples. The more literate the wife, the greater the acceptance of the small family norm. Male preference pressure from elders and fear about contraception were the main reasons for non acceptance of family planning methods: The health teams were the main source of information to these couples. Recommendations: There is an urgent need to increase the emphasis on the 2 child family norm. The IEC activities of the health team should be strengthened.

Effects of a psychological skills training programme for underserved ...

African Journals Online (AJOL)

Effects of a psychological skills training programme for underserved rugby ... The development of psychological skills is an important, but often neglected part of ... Repeated measures two-way ANOVAs revealed significant main time effects, ...

"Dark Skies, Bright Kids" - First Year Of Outreach In Rural Virginia

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Ries, Paul; Johnson, K.; Zasowski, G.; Beaton, R.; Carlberg, J.; Czekala, I.; de Messieres, G.; Drosback, M.; Gugliucci, N.; Jackson, L.; Lynch, R.; Romero, C.; Sivakoff, G.; Whelan, D.; Wong, A.

2010-10-01

Dark Skies, Bright Kids (DSBK) is an educational/public outreach program at the University of Virginia directed primarily towards rural elementary school students in grades 3-5. The program, which is run by a diverse community of volunteers (faculty, postdocs, grad students, and undergrads), targets schools in the rural areas surrounding UVa in southern Albemarle County. While these schools are privileged with remarkably dark skies, these same schools are also home to an economically under-privileged and educationally under-served population. DSBK seeks to use those dark skies, among other resources, to create excitement and interest in science and engineering as part of a weekly after-school program. A typical afternoon consists of 1.5-2.5 hours of science activities specifically centered around space and astronomy. Each week has a theme (e.g., rockets, invisible light) and we incorporate a mix of activities on that theme, such as hands-on experiments, stories, games, and creative play. We also encourage family involvement, so that the parents are actively involved in their children's education. Every other week, we hold a family observing night, so both the students and their parents can learn about the night sky together. The program lasts for one semester at each school, and we have just completed our second semester of work. Each new semester brings on new challenges, but also new lessons to make our program better in future semesters. Our group actively writes and then rewrites our own lesson plans as we learn what works best with the students. We are now in the process of putting our lesson plans online so other groups can take advantage of what we have learned and apply this program at other schools. On the web: http://www.astro.virginia.edu/dsbk/

Mobile and Portable Dental Services Catering to the Basic Oral Health Needs of the Underserved Population in Developing Countries: A Proposed Model

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Ganavadiya, R; Chandrashekar, BR; Goel, P; Hongal, SG; Jain, M

2014-01-01

India is the second most populous country in the world with an extensive rural population (68.8%). Children less than 18 years constitute about 40% of the population. Approximately, 23.5% of the urban population resides in urban slums. The extensive rural population, school children and the urban slum dwellers are denied of even the basic dental services though there is continuous advancement in the field of dentistry. The dentist to population ratio has dramatically improved in the last one to two decades with no significant improvement in the oral health status of the general population. The various studies have revealed an increasing trend in oral diseases in the recent times especially among this underserved population. Alternate strategies have to be thought about rather than the traditional oral health-care delivery through private dentists on fee for service basis. Mobile and portable dental services are a viable option to take the sophisticated oral health services to the doorsteps of the underserved population. The databases were searched for publications from 1900 to the present (2013) using terms such as Mobile dental services, Portable dental services and Mobile and portable dental services with key articles obtained primarily from MEDLINE. This paper reviews the published and unpublished literature from different sources on the various mobile dental service programs successfully implemented in some developed and developing countries. Though the mobile and portable systems have some practical difficulties like financial considerations, they still seem to be the only way to reach every section of the community in the absence of national oral health policy and organized school dental health programs in India. The material for the present review was obtained mainly by searching the biomedical databases for primary research material using the search engine with key words such as mobile and/or portable dental services in developed and developing countries

Mobile and portable dental services catering to the basic oral health needs of the underserved population in developing countries: a proposed model.

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Ganavadiya, R; Chandrashekar, Br; Goel, P; Hongal, Sg; Jain, M

2014-05-01

India is the second most populous country in the world with an extensive rural population (68.8%). Children less than 18 years constitute about 40% of the population. Approximately, 23.5% of the urban population resides in urban slums. The extensive rural population, school children and the urban slum dwellers are denied of even the basic dental services though there is continuous advancement in the field of dentistry. The dentist to population ratio has dramatically improved in the last one to two decades with no significant improvement in the oral health status of the general population. The various studies have revealed an increasing trend in oral diseases in the recent times especially among this underserved population. Alternate strategies have to be thought about rather than the traditional oral health-care delivery through private dentists on fee for service basis. Mobile and portable dental services are a viable option to take the sophisticated oral health services to the doorsteps of the underserved population. The databases were searched for publications from 1900 to the present (2013) using terms such as Mobile dental services, Portable dental services and Mobile and portable dental services with key articles obtained primarily from MEDLINE. This paper reviews the published and unpublished literature from different sources on the various mobile dental service programs successfully implemented in some developed and developing countries. Though the mobile and portable systems have some practical difficulties like financial considerations, they still seem to be the only way to reach every section of the community in the absence of national oral health policy and organized school dental health programs in India. The material for the present review was obtained mainly by searching the biomedical databases for primary research material using the search engine with key words such as mobile and/or portable dental services in developed and developing countries

Rural food insecurity: When cooking skills, homegrown food, and perseverance aren't enough to feed a family.

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Buck-McFadyen, Ellen V

2015-03-12

More than 1 in 10 Canadians experience food insecurity, and a growing number of families rely on food banks each month. This ethnographic study aimed to give voice to rural families about their experiences with food insecurity while situating the findings within the broader social, political and economic context. Semi-structured interviews were conducted with women who had children living at home, and interviewer observations within the food bank were recorded as field notes. Content analysis was combined with the constant comparison method of data analysis to identify common themes regarding the experience of living with food insecurity and the influence of public policy. Seven female participants described the emotional toll that food insecurity had on their well-being and relationships, with stress and depression common to many women. Strategies used to stretch resources included cooking from scratch, growing produce, stocking up on sale items, hunting and fishing, and paying half-bills. Many participants described going without food so that their children could eat first, and three participants went without prescription medications. Rurality and social programs were identified as both supports and barriers to overcoming food insecurity. Participants in this study were highly skilled in attempting to feed their families with limited resources, although this proved inadequate to overcome their food insecurity. This highlights the need for policy initiatives to address the root causes of food insecurity and health inequities, including access to rural employment and high-quality child care, drug benefits and guaranteed annual income programs.

Men's Educational Group Appointments in Rural Nicaragua.

Science.gov (United States)

Campbell, Bruce B; Gonzalez, Hugo; Campbell, McKenzie; Campbell, Kent

2017-03-01

Men's preventive health and wellness is largely neglected in rural Nicaragua, where a machismo culture prevents men from seeking health care. To address this issue, a men's educational group appointment model was initiated at a rural health post to increase awareness about hypertension, and to train community health leaders to measure blood pressure. Men's hypertension workshops were conducted with patient knowledge pretesting, didactic teaching, and posttesting. Pretesting and posttesting performances were recorded, blood pressures were screened, and community leaders were trained to perform sphygmomanometry. An increase in hypertension-related knowledge was observed after every workshop and community health leaders demonstrated proficiency in sphygmomanometry. In addition, several at-risk patients were identified and follow-up care arranged. Men's educational group appointments, shown to be effective in the United States in increasing patient knowledge and satisfaction, appear to function similarly in a resource-constrained environment and may be an effective mechanism for reaching underserved men in Nicaragua.

Importance of cattle breeding in the nourishment safety of families in the rural area of Paipa, Boyaca

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Diana Milena Soler Fonseca

2011-05-01

Full Text Available In the rural municipality of Paipa, Boyaca many families rely on cattle breeding to obtain from this activity, suficient income and resources to meet their basic needs, however little is known about the true role of this species in the nourishment safety of rural families in the municipality of Paipa in Boyacá, for that reason, this study aimed to analyze the importance of general breeding cattle in the nourishment safety of thirty peasant families in the municipality of Paipa, Boyacá and get to know the social and cultural roles that are generated by this livestock activity. The obtained result was that the cale are raised as a second choice in the pursuit of economic resources, after the birds. In cattle production an average of  five animals per farm are raised, the widely used breeds are the Normando, Holstein and crosses between them; milk production dominates with an average yield of 150 liters/week per family; income and costs production depend on the number of cattle raised, the gained income is used to purchase food for home, but savings are not encouraged; the consumption of dairy products is very low and beef cattle is not consumed within the household; animals management is in charge of all family members (both genders. In general, cattle farming make interesting economic contributions to the countryside families, but these revenues are used to purchase food of high nutritional value, also a2ecting the nourishment safety of the studied families.

Mission-driven marketing: a rural example.

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Rohrer, J E; Vaughn, T; Westermann, J

1999-01-01

Marketing receives little attention in the academic healthcare management literature, possibly because it is associated with pursuit of profit rather than community benefit. However, a marketing perspective can be applied to the pursuit of the traditional missions of healthcare delivery organizations. Mission-oriented market selection criteria could include characteristics such as relevance to mission, underserved or vulnerable population status, resistance to care, limited resources, and low accessibility. A survey conducted in a rural county is used to demonstrate ways that underserved market segments can be identified and targeted. In the market surveyed, men used less medical care than women; depressed people and those with low levels of education used less medical care than people without these characteristics. Consumers were more likely to defer care because of cost if they lacked health insurance coverage, were female, were under age 55, had fair health status, were depressed, and were chronically ill. Marketing strategies worthy of consideration relate to price (e.g., free care, coupons and sales for eligible individuals), distribution (e.g., visiting nurses, malls and fairs, occupational medicine programs), product (e.g., satisfaction, waiting time, attractiveness, assertive follow-up), and promotion (education about insurance benefits, facilitating development of regular sources of care, health education).

Conducting a randomized trial in rural and urban safety-net health centers: Added value of community-based participatory research

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Meera Muthukrishnan

2018-06-01

Full Text Available Background: Colorectal cancer (CRC is the second most common cancer in the US. Despite evidence that screening reduces CRC incidence and mortality, screening rates are sub-optimal with disparities by race/ethnicity, income, and geography. Rural-urban differences in CRC screening are understudied even though approximately one-fifth of the US population lives in rural areas. This focus on urban populations limits the generalizability and dissemination potential of screening interventions. Methods: Using community-based participatory research (CBPR principles, we designed a cluster-randomized trial, adaptable to a range of settings, including rural and urban health centers. We enrolled 483 participants across 11 health centers representing 2 separate networks. Both networks serve medically-underserved communities; however one is primarily rural and one primarily urban. Results: Our goal in this analysis is to describe baseline characteristics of participants and examine setting-level differences. CBPR was a critical for recruiting networks to the trial. Patient respondents were predominately female (61.3%, African-American (66.5%, and earned <$1200 per month (87.1%. The rural network sample was older; more likely to be female, white, disabled or retired, and have a higher income, but fewer years of education. Conclusions: Variation in the samples partly reflects the CBPR process and partly reflects inherent differences in the communities. This confirmed the importance of using CBPR when planning for eventual dissemination, as it enhanced our ability to work within diverse settings. These baseline findings indicate that using a uniform approach to implementing a trial or intervention across diverse settings might not be effective or efficient. Keywords: Colorectal cancer screening, Community-based participatory research, Health disparities, Medically underserved populations, Dissemination and implementation, Randomized trial

Teaching the content in context: Preparing "highly qualified" and "high quality" teachers for instruction in underserved secondary science classrooms

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Tolbert, Sara E.

2011-12-01

This dissertation research project presents the results of a longitudinal study that investigates the knowledge, beliefs, and practices of 13 preservice secondary science teachers participating in a science teacher credentialing/Masters program designed to integrate issues of equity and diversity throughout coursework and seminars. Results are presented in the form of three papers: The first paper describes changes in preservice teacher knowledge about contextualization in science instruction, where contextualization is defined as facilitating authentic connections between science learning and relevant personal, social, cultural, ecological, and political contexts of students in diverse secondary classrooms; the second paper relates changes in the self-efficacy and content-specific beliefs about science, science teaching, diversity, and diversity in science instruction; and the final paper communicates the experiences and abilities of four "social justice advocates" learning to contextualize science instruction in underserved secondary placement classrooms. Results indicate that secondary student teachers developed more sophisticated understandings of how to contextualize science instruction with a focus on promoting community engagement and social/environmental activism in underserved classrooms and how to integrate science content and diversity instruction through student-centered inquiry activities. Although most of the science teacher candidates developed more positive beliefs about teaching science in underrepresented classrooms, many teacher candidates still attributed their minority students' underperformance and a (perceived) lack of interest in school to family and cultural values. The "social justice advocates" in this study were able to successfully contextualize science instruction to varying degrees in underserved placement classrooms, though the most significant limitations on their practice were the contextual factors of their student teaching

Cultural health beliefs in a rural family practice: a Malaysian perspective.

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Ariff, Kamil M; Beng, Khoo S

2006-02-01

Understanding the sociocultural dimension of a patient's health beliefs is critical to a successful clinical encounter. Malaysia with its multi-ethnic population of Malay, Chinese and Indian still uses many forms of traditional health care in spite of a remarkably modern rural health service. The objective of this paper is discuss traditional health care in the context of some of the cultural aspects of health beliefs, perceptions and practices in the different ethnic groups of the author's rural family practices. This helps to promote communication and cooperation between doctors and patients, improves clinical diagnosis and management, avoids cultural blind spots and unnecessary medical testing and leads to better adherence to treatment by patients. Includes traditional practices of 'hot and cold', notions of Yin-Yang and Ayurveda, cultural healing, alternative medicine, cultural perception of body structures and cultural practices in the context of women's health. Modern and traditional medical systems are potentially complementary rather than antagonistic. Ethnic and cultural considerations can be integrated further into the modern health delivery system to improve care and health outcomes.

The challenges of working in underserved areas: a qualitative exploratory study of views of policy makers and professionals.

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AbuAlRub, Raeda F; El-Jardali, Fadi; Jamal, Diana; Iblasi, Abdulkareem S; Murray, Susan F

2013-01-01

The inadequate number of health care providers, particularly nurses, in underserved areas is one of the biggest challenges for health policymakers. There is a scarcity of research in Jordan about factors that affect nurse staffing and retention in underserved areas. To elucidate the views of staff nurses working in underserved areas, directors of health facilities in underserved areas and key informants from the policy and education arena on issues of staffing and retention of nurses in underserved areas. An exploratory study using a qualitative approach with semi-structured interviews was utilized to elucidate the views of 22 key informants from the policy and education arena, 11 directors of health centers, and 19 staff nurses on issues that contribute to low staffing and retention of nurses in underserved areas. The five stage 'framework approach' proposed by Bryman et al. (1993) was utilized for data analysis. Nursing shortage in underserved areas in Jordan are exacerbated by a lack of financial incentives, poor transportation and remoteness of these areas, bad working conditions, and lack of health education institutions in these areas, as well as by opportunities for internal and external migration. Young Jordanian male nurses usually grab any opportunity to migrate and work outside the country to improve their financial conditions; whereas, female nurses are more restricted and not encouraged to travel abroad to work. Several strategies are suggested to enhance retention in these areas, such as promoting financial incentives for staff to work there, enhancing the transportation system, and promoting continuous and academic education. Nurses' administrators and health care policy makers could utilize the findings of the present study to design and implement comprehensive interventions to enhance retention of staff in underserved areas. Copyright © 2012 Elsevier Ltd. All rights reserved.

Benefits of family planning: an assessment of women's knowledge in rural Western Kenya.

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Mutombo, Namuunda; Bakibinga, Pauline; Mukiira, Carol; Kamande, Eva

2014-03-18

The last two decades have seen an increase in literature reporting an increase in knowledge and use of contraceptives among individuals and couples in Kenya, as in the rest of Africa, but there is a dearth of information regarding knowledge about benefits of family planning (FP) in Kenya. To assess the factors associated with knowledge about the benefits of FP for women and children, among women in rural Western Kenya. Data are drawn from the Packard Western Kenya Project Baseline Survey, which collected data from rural women (aged 15-49 years). Ordinal regression was used on 923 women to determine levels of knowledge and associated factors regarding benefits of FP. Women in rural Western Kenya have low levels of knowledge about benefits of FP and are more knowledgeable about benefits for the mother rather than for the child. Only age, spousal communication and type of contraceptive method used are significant. Women's level of knowledge about benefits of FP is quite low and may be one of the reasons why fertility is still high in Western Kenya. Therefore, FP programmes need to focus on increasing women's knowledge about the benefits of FP in this region.

Farmers or rural workers? A current social characterization of rural families of Atamisqui Department, Santiago del Estero ¿Campesinos o asalariados rurales? Una caracterización social actual de las familias rurales del Departamento de Atamisqui, Santiago del Estero

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Agustina Desalvo

2011-01-01

Full Text Available It is often said that Santiago del Estero concentrates a large number of farmers. In this paper, we present a first approach to the subject in order to begin to demystify the idea. To do this, we use data obtained from the Familiar Characterization Form prepared by PROINDER in 2009 - implemented by the Secretariat for Family Agriculture and Rural Development, Delegation Santiago del Estero- and interviews conducted in villages of Atamisqui department in April 2010. The form used allows us, among other things, measure the weight that have different sources of income in total household income. This, together with the evidence gathered in interviews, allows us to know how live analyzed families. It notes that the most important support comes from the seasonal employee working developed in different rural activities (though especially in the deflowering of corn and harvesting blueberries and various transfers (pensions, social benefits, remittances. These data would indicate, in this particular case, that the subject usually characterized as farmer hides, in reality, the atamisqueña rural working class.Suele afirmarse que Santiago del Estero concentra un elevado número de campesinos. En este artículo presentamos una primera aproximación al tema con el propósito de comenzar a desmitificar dicha idea. Para ello, recurrimos a datos arrojados por el Formulario de Caracterización Familiar del PROINDER, año 2009 -ejecutado desde la Subsecretaría de Desarrollo Rural y Agricultura Familiar de Santiago del Estero- y entrevistas realizadas en parajes rurales del departamento de Atamisqui en abril del 2010. El Formulario utilizado nos permite, entre otras cosas, mensurar el peso que las distintas fuentes de ingreso tienen en el total del ingreso familiar. Esto, junto a los testimonios recogidos en las entrevistas, nos permite conocer de qué viven las familias analizadas. Se observa que el sustento más importante proviene del trabajo estacional

Crowdsourced Microfinance for Energy Efficiency in Underserved Communities

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Baird, Donnel [BlocPower LLC, New York, NY (United States); Cox, Morris [BlocPower LLC, New York, NY (United States); Harmarneh, Sarey [BlocPower LLC, New York, NY (United States); Zheng, Chen [BlocPower LLC, New York, NY (United States)

2017-06-21

BlocPower’s mission is to provide access to energy efficiency financing for underserved communities across the United States. This project, “Crowdsourced Microfinance for Energy Efficiency in Underserved Communities,” is an extension of that goal and is grounded in the principles of providing engineering and financing services to those in need. The project is based on the creation of a BlocPower Marketplace as a central hub for connecting shovel-ready green buildings to institutional investors. This ‘connection’ entails using online crowdfunding to aggregate debt and equity capital from institutional investors to connect to customers (building owners) across various financial portfolios. BlocPower Marketplace is intended to bring social, environmental, and financial returns to investors while also decreasing investor risk by loaning out funds for energy installations in individual buildings. In detail, the intended benefits of crowdsourcing are two-sided. Firstly, for building owners, clean energy retrofit installations improve building operations, reduce utility costs, and reduce harmful impacts to their surrounding environment. Secondly, for institutional investors, they gain access to a new market of energy efficiency and are able to provide debt or equity capital with high financial returns. This gives investors the opportunity to create social and environmental impact in communities around the country as well. With this in mind, BlocPower designed the marketplace to specifically answer exploratory research questions with respect to the pricing of energy financing. Institutional investors typically charge high rates on project financing solutions in the energy space, particularly in low and middle-income communities, because of fears that required debt service will not be made. This makes access to energy capital exorbitantly difficult for those that need it the most. Through this project, BlocPower tested investor appetite to determine if

A psychosocial approach to dentistry for the underserved: incorporating theory into practice.

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Flaer, Paul J; Younis, Mustafa Z; Benjamin, Paul L; Al Hajeri, Maha

2010-01-01

Dentistry for the underserved is more than an egalitarian social issue--it is a key factor in the health and social progress of our nation. The first signs or manifestations of several diseases such as varicella (i.e., chicken pox and shingles), STDs, and influenza become apparent in the oral cavity. The value of access to quality dentistry is an immeasurable factor in maintaining general medical health of people and fulfilling their psychosocial needs of pain reduction and enhanced cosmetics. In the United States, for the most part, only the middle and upper classes receive non-extraction, restorative, and prosthetic dentistry that is economically within their ability to pay. In addition, uninsured and poverty-level individuals often must face overwhelming long waiting lists, unnecessary referrals, lack of choice, and bureaucratic hurdles when seeking primary dental care. Therefore, it seems pertinent to put forth the question: What are the critical values and beliefs of psychosocial theory that can underscore the practice of dentistry for underserved populations in the United States? The widely employed public health theory, the health belief model (HBM), is applied to evaluate psychosocial factors in dental care for the underserved. The HBM is used to predict and explain behavioral changes in dental health and associated belief patterns. The HBM as applied to dentistry for the underserved predicts self-perceptions of susceptibility and seriousness of dental disease, health status, cues to action, and self-efficacy. Furthermore, patients can make judgments about benefits, costs, and risks of dental treatment. A theoretical approach to dentistry employing the HBM, mediated by values and culture, can provide significant insights into patient thinking, beliefs, and perceptions. These insights can mediate access to and use of primary care dental services by underserved populations. Evidence-based practice (i.e., based on research using the scientific method) has been

Remote care of a patient with stroke in rural Trinidad: use of telemedicine to optimise global neurological care.

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Reyes, Antonio Jose; Ramcharan, Kanterpersad

2016-08-02

We report a patient driven home care system that successfully assisted 24/7 with the management of a 68-year-old woman after a stroke-a global illness. The patient's caregiver and physician used computer devices, smartphones and internet access for information exchange. Patient, caregiver, family and physician satisfaction, coupled with outcome and cost were indictors of quality of care. The novelty of this basic model of teleneurology is characterised by implementing a patient/caregiver driven system designed to improve access to cost-efficient neurological care, which has potential for use in primary, secondary and tertiary levels of healthcare in rural and underserved regions of the world. We suggest involvement of healthcare stakeholders in teleneurology to address this global problem of limited access to neurological care. This model can facilitate the management of neurological diseases, impact on outcome, reduce frequency of consultations and hospitalisations, facilitate teaching of healthcare workers and promote research. 2016 BMJ Publishing Group Ltd.

Evaluation of the Program in Medical Education for the Urban Underserved (PRIME-US) at the UC Berkeley-UCSF Joint Medical Program (JMP): The First 4 Years.

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Sokal-Gutierrez, Karen; Ivey, Susan L; Garcia, Roxanna M; Azzam, Amin

2015-01-01

Medical educators, clinicians, and health policy experts widely acknowledge the need to increase the diversity of our healthcare workforce and build our capacity to care for medically underserved populations and reduce health disparities. The Program in Medical Education for the Urban Underserved (PRIME-US) is part of a family of programs across the University of California (UC) medical schools aiming to recruit and train physicians to care for underserved populations, expand the healthcare workforce to serve diverse populations, and promote health equity. PRIME-US selects medical students from diverse backgrounds who are committed to caring for underserved populations and provides a 5-year curriculum including a summer orientation, a longitudinal seminar series with community engagement and leadership-development activities, preclerkship clinical immersion in an underserved setting, a master's degree, and a capstone rotation in the final year of medical school. This is a mixed-methods evaluation of the first 4 years of the PRIME-US at the UC Berkeley-UC San Francisco Joint Medical Program (JMP). From 2006 to 2010, focus groups were conducted each year with classes of JMP PRIME-US students, for a total of 11 focus groups; major themes were identified using content analysis. In addition, 4 yearly anonymous, online surveys of all JMP students, faculty and staff were conducted and analyzed. Most PRIME-US students came from socioeconomically disadvantaged backgrounds and ethnic backgrounds underrepresented in medicine, and all were committed to caring for underserved populations. The PRIME-US students experienced many program benefits including peer support, professional role models and mentorship, and curricular enrichment activities that developed their knowledge, skills, and sustained commitment to care for underserved populations. Non-PRIME students, faculty, and staff also benefited from participating in PRIME-sponsored seminars and community-based activities

Men’s Educational Group Appointments in Rural Nicaragua

Science.gov (United States)

Campbell, Bruce B.; Gonzalez, Hugo; Campbell, McKenzie; Campbell, Kent

2016-01-01

Men’s preventive health and wellness is largely neglected in rural Nicaragua, where a machismo culture prevents men from seeking health care. To address this issue, a men’s educational group appointment model was initiated at a rural health post to increase awareness about hypertension, and to train community health leaders to measure blood pressure. Men’s hypertension workshops were conducted with patient knowledge pretesting, didactic teaching, and posttesting. Pretesting and posttesting performances were recorded, blood pressures were screened, and community leaders were trained to perform sphygmomanometry. An increase in hypertension-related knowledge was observed after every workshop and community health leaders demonstrated proficiency in sphygmomanometry. In addition, several at-risk patients were identified and follow-up care arranged. Men’s educational group appointments, shown to be effective in the United States in increasing patient knowledge and satisfaction, appear to function similarly in a resource-constrained environment and may be an effective mechanism for reaching underserved men in Nicaragua. PMID:27885146

A quantitative day in the life of a Saskatchewan rural physician.

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Harrison, Emmett; Dhillon, Paul B A

2018-01-01

Rural family physicians are often required to meet a wide variety of medical service demands that are otherwise the responsibility of specialty physicians in urban centres. However, many rural physicians enjoy the practice variety and ability to meet patients' medical needs through this wider spectrum of care. We aimed to quantify and summarize the workload and clinical disorders seen by rural family physicians in Saskatchewan relative to urban family physicians. We used Saskatchewan Ministry of Health billing data for 2015/16 to compare rural and urban care provision. The data were summarized in a graphic 1-month format to portray a typical month in the life of a rural physician in the province. In the office setting, rural family physicians saw 16.8% more cardiac presentations in adults over 65 years of age than did urban family physicians; otherwise, there were no significant differences in the top office diagnosis categories seen by the 2 groups. Differences were apparent, however, in the hospital setting: urban family physicians saw more patients presenting with pain and, reflective of centralization of obstetric delivery services, performed more deliveries than did rural physicians. There are differences in the clinical presentations seen by rural and urban family physicians, and these need to be considered by new physicians considering rural practice. Our simple visual depiction of average workload, vacation and activity levels of rural physicians can further inform medical residents on the realities of working in rural Saskatchewan as a family physician. A more complete understanding of clinical workload expectations may promote recruitment of resident physicians.

Training Psychologists for Rural Practice: Exploring Opportunities and Constraints.

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

2018-04-17

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

The Online-Counseling Debate: A View toward the Underserved

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Sanchez-Page, Delida

2005-01-01

This article responds to some important issues that Mallen, Vogel, Rochlen, and Day raise in "Online Counseling: Reviewing the Literature from a Counseling Psychology Framework." This reaction reviews the appropriateness of online counseling for underserved populations. The author provides suggestions for better serving historically undeserved…

Eating breakfast together as a family: mealtime experiences and associations with dietary intake among adolescents in rural Minnesota, USA.

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Larson, Nicole; Wang, Qi; Berge, Jerica M; Shanafelt, Amy; Nanney, Marilyn S

2016-06-01

Although existing evidence links breakfast frequency to better dietary quality, little is known specifically in regard to the benefits associated with eating breakfast together with one's family. The present study describes the prevalence and experience of having family meals at breakfast among rural families and examines associations between meal frequency and adolescent diet quality. Data were drawn from Project BreakFAST, a group-randomized trial aimed at increasing school breakfast participation in rural Minnesota high schools, USA. Linear mixed models were used to examine associations between student reports of family breakfast frequency and Healthy Eating Index 2010 (HEI-2010) scores while accounting for clustering within schools, demographics and household food security. Adolescent students from sixteen schools completed online surveys, height and weight measurements, and dietary recalls at baseline in 2012-2014. The sample included 827 adolescents (55·1 % girls) in grades 9-10 who reported eating breakfast on at most three days per school week. On average, adolescents reported eating breakfast with their family 1·3 (sd 1·9) times in the past week. Family breakfast meals occurred most frequently in the homes of adolescents who reported a race other than white (P=0·002) or Hispanic ethnicity (P=0·02). Family breakfast frequency was directly associated with adolescent involvement in preparing breakfast meals (Pfood patterns at breakfast. Additional research is needed to better inform and evaluate strategies.

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

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

2017-11-01

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

The influence of neighbors' family size preference on progression to high parity births in rural Nepal.

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Jennings, Elyse A; Barber, Jennifer S

2013-03-01

Large families can have a negative impact on the health and well-being of women, children, and their communities. Seventy-three percent of the individuals in our rural Nepalese sample report that two children is their ideal number, yet about half of the married women continue childbearing after their second child. Using longitudinal data from the Chitwan Valley Family Study, we explore the influence of women's and neighbors' family size preferences on women's progression to high parity births, comparing this influence across two cohorts. We find that neighbors' family size preferences influence women's fertility, that older cohorts of women are more influenced by their neighbors' preferences than are younger cohorts of women, and that the influence of neighbors' preferences is independent of women's own preferences. © 2013 The Population Council, Inc.

Are Mothers Really "Gatekeepers" of Children?: Rural Mothers' Perceptions of Nonresident Fathers' Involvement in Low-Income Families

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Sano, Yoshie; Richards, Leslie N.; Zvonkovic, Anisa M.

2008-01-01

Guided by symbolic interactionism, this qualitative study based on interviews with 83 rural mothers investigated mothers' perceptions of nonresident fathers' involvement in low-income families. Contrary to some fathers' claims that mothers "gatekeep" their access to children, the majority of mothers in our study wanted increased father…

The effect of economic factors on families calorie demand in rural

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hossein ebadipour

2016-11-01

The quantity of the received calories by families is one of the important debates in public and development economic context. This is an attractive subject for government officials and policy makers in different countries. In the current paper, the impacts of households' income shocks, price and food commodity subsidies on the quantity of the received amount of calories in the rural parts of Iran are studied. For this purpose, we used time series data of 1961-2011 in the vector auto-regressive (VAR model. The results indicated that the impact period of the applied shock on the quantity of paid subsidies to agricultural sector is shorter than the period of price and income shocks. Besides, the most sensitivity of calorie demand is related to the income factor. According to the research findings, we can conclude that for creating food security, we should create economic stability in the market and consider the final effect of changes in nutrition pattern when determining the policies regarding market regulation, subsidies and taxation regardless of income growth that affect rural households and will have a serious negative impact on calories.

Systemic approach in rural administration: Study of the family production unit

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Adilson R. Paz Stamberg

2015-06-01

Full Text Available This paper focuses on understanding the rationality of production management and available resources in agricultural production unit (UPA, identifying its main technical and socioeconomic characteristics in order to make a diagnosis to subsidize the rural manager in decision making.This study was part of the extension project approved in the Institutional Incentive Extension Program of the Farroupilha Federal Institute (Brazil, prioritizing as object of study a family UPA in the municipality of Santo Antônio das Missões/RS/Brazil, being conducted between October-November 2014.As methodological procedure a survey was done with qualitative and quantitative data, such as natural resources, utilized agricultural area, herd, plant, machinery and equipment, availability of labor force and yields of the various cultivation subsystems, breeding and processing. This data was organized in a spreadsheet, which identifies the adopted production system and its main technical and socioeconomic characteristics. As proposed, technical and managerial intervention in the production system, proposed strategically to enhance milk production opposed to the soybean production, considering its high contribution in relation to the value added per unit area.Key Words: Rural Administration - Production management - Systemic approach.

Is a practice-based rural research network feasible in Europe?

Science.gov (United States)

Klemenc-Ketis, Zalika; Kurpas, Donata; Tsiligianni, Ioanna; Petrazzuoli, Ferdinando; Jacquet, Jean-Pierre; Buono, Nicola; Lopez-Abuin, Jose; Lionis, Christos

2015-01-01

Research in family medicine is a well-established entity nationally and internationally, covering all aspects of primary care including remote and isolated practices. However, due to limited capacity and resources in rural family medicine, its potential is not fully exploited yet. An idea to foster European rural primary care research by establishing a practice-based research network has been recently put forward by several members of the European Rural and Isolated Practitioners Association (EURIPA) and the European General Practice Research Network (EGPRN). Two workshops on why, and how to design a practice-based research network among rural family practices in Europe were conducted at two international meetings. This paper revisits the definition of practice-based research in family medicine, reflects on the current situation in Europe regarding the research in rural family practice, and discusses a rationale for practice-based research in rural family medicine. A SWOT analysis was used as the main tool to analyse the current situation in Europe regarding the research in rural family practice at both meetings. The key messages gained from these meetings may be employed by the Wonca Working Party on research, the International Federation of Primary Care Research Network and the EGPRN that seek to introduce a practice-based research approach. The cooperation and collaboration between EURIPA and EGPRN creates a fertile ground to discuss further the prospect of a European practice-based rural family medicine research network, and to draw on the joint experience.

Family trauma through generations: incest and domestic violence in rural Sweden in the nineteenth century.

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Drugge, Ulf

2008-10-01

Two generations of a family who lived in mid-nineteenth rural Sweden are described. Domestic violence was a common feature in the first generation family. The salient feature there was undoubtedly the incestuous father-daughter relationships. The way incest appeared in Sweden about 150 years ago, the role of local authorities, and the serious consequences to those victimized is analyzed with reference to both the cultural context of that time and to modern theories of incest. Seemingly puzzling violence committed by a second generation family member is related to the domestic violence in the previous generation. Due to the extraordinary character of the incest cases and the specific church council sessions in which the incest case was treated, aspects of family life normally hidden behind curtains of conventions were made public. Reaction patterns drawn from this case indicate a patriarchal system of oppression and badly-directed considerations.

Physician assistants as servant leaders: meeting the needs of the underserved.

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Huckabee, Michael J; Wheeler, Daniel W

2011-01-01

The purpose of this study was to determine if the level of servant leader characteristics in clinically practicing physician assistants (PAs) in underserved populations differed from PAs serving in other locales. Five subscales of servant leadership: altruistic calling, emotional healing, wisdom, persuasive mapping, and organizational stewardship, were measured in a quantitative study of clinically practicing PAs using a self-rating survey and a similar survey by others rating the PA. Of 777 PAs invited, 321 completed the survey. On a scale of 1 to 5, mean PA self-ratings ranged from 3.52 (persuasive mapping) to 4.05 (wisdom). Other raters' scores paired with the self-rated PA scores were comparable in all subscales except wisdom, which was rated higher by the other raters (4.32 by other raters, 4.01 by PAs, P= .002). There was no significant difference in the measures of servant leadership reported by PAs serving the underserved compared to PAs serving in other populations. Servant leader subscales were higher for PAs compared to previous studies of other health care or community leader populations. The results found that the PA population studied had a prominent level of servant leadership characteristics that did not differ between those working with underserved and nonunderserved populations.

Breastfeeding Patterns in the Rural Community of Hilo, Hawai‘i: An Exploration of Existing Data Sets

OpenAIRE

Flood, Jeanie L

2013-01-01

Before any breastfeeding promotion effort, an understanding of the existing breastfeeding patterns is essential. Hawai‘i County is a rural, ethnically diverse, medically underserved community. The purpose of this study was to describe the breastfeeding patterns of women living in Hilo, Hawai‘i. Data from several existing national, state, and local data sets were accessed to identify and describe the breastfeeding patterns of women in this community. Available breastfeeding data about women in...

Recruiting and retaining primary care physicians in urban underserved communities: the importance of having a mission to serve.

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Odom Walker, Kara; Ryan, Gery; Ramey, Robin; Nunez, Felix L; Beltran, Robert; Splawn, Robert G; Brown, Arleen F

2010-11-01

We examined factors influencing physician practice decisions that may increase primary care supply in underserved areas. We conducted in-depth interviews with 42 primary care physicians from Los Angeles County, California, stratified by race/ethnicity (African American, Latino, and non-Latino White) and practice location (underserved vs nonunderserved area). We reviewed transcriptions and coded them into themes by using standard qualitative methods. Three major themes emerged in relation to selecting geographic- and population-based practice decisions: (1) personal motivators, (2) career motivators, and (3) clinic support. We found that subthemes describing personal motivators (e.g., personal mission and self-identity) for choosing a practice were more common in responses among physicians who worked in underserved areas than among those who did not. By contrast, physicians in nonunderserved areas were more likely to cite work hours and lifestyle as reasons for selecting their current practice location or for leaving an underserved area. Medical schools and shortage-area clinical practices may enhance strategies for recruiting primary care physicians to underserved areas by identifying key personal motivators and may promote long-term retention through work-life balance.

Individual Breast Cancer risk assessment in Underserved Populations: Integrating empirical Bioethics and Health Disparities Research

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Anderson, Emily E.; Hoskins, Kent

2013-01-01

Research suggests that individual breast cancer risk assessment may improve adherence to recommended screening and prevention guidelines, thereby decreasing morbidity and mortality. Further research on the use of risk assessment models in underserved minority populations is critical to informing national public health efforts to eliminate breast cancer disparities. However, implementing individual breast cancer risk assessment in underserved patient populations raises particular ethical issues that require further examination. After reviewing these issues, we will discuss how empirical bioethics research can be integrated with health disparities research to inform the translation of research findings. Our in-progress National Cancer Institute (NCI) funded study, How Do Underserved Minority Women Think About Breast Cancer?, conducted in the context of a larger study on individual breast cancer risk assessment, is presented as a model. PMID:23124498

Lack of Quality Primary Health Services: The Problems of the Underserved.

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Hall, Daniel A.

1978-01-01

Major political and economic forces, which affect the provision of primary health services, particularly to underserved populations, are reviewed. Technological, professional, governmental, fiscal, and societal solutions are proposed. (GC)

Rural residents' perspectives on the rural 'good death': a scoping review.

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Rainsford, Suzanne; MacLeod, Roderick D; Glasgow, Nicholas J; Wilson, Donna M; Phillips, Christine B; Wiles, Robert B

2018-05-01

The 'good death' is one objective of palliative care, with many 'good death' viewpoints and research findings reflecting the urban voice. Rural areas are distinct and need special consideration. This scoping review identified and charted current research knowledge on the 'good' rural death through the perspectives of rural residents, including rural patients with a life-limiting illness, to identify evidence and gaps in the literature for future studies. A comprehensive literature search of English language articles (no date filter applied) was conducted in 2016 (2 January to 14 February) using five library databases. Reference lists of included articles, recent issues of eight relevant journals and three grey literature databases were also hand-searched. Twenty articles (for 17 studies and one systematic review) were identified after a two-phase screening process by two reviewers, using pre-determined inclusion criteria. Data from each study were extracted and charted, analysed using a thematic analysis of the included articles' content, and with a quantitative analysis of the scoping review. These papers revealed data collected from rural patients with a life-limiting illness and family caregivers, rural healthcare providers, the wider rural community, rural community leaders and rural health administrators and policy makers. Rural locations were heterogeneous. Residents from developed and developing countries believe a 'good death' is one that is peaceful, free of pain and without suffering; however, this is subjective and priorities are based on personal, cultural, social and religious perspectives. Currently, there is insufficient data to generalise rural residents' perspectives and what it means for them to die well. Given the extreme importance of a 'good death', there is a need for further studies to elicit rural patient and family caregiver perspectives. © 2016 John Wiley & Sons Ltd.

Engaging diverse underserved communities to bridge the mammography divide

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Cully Angelia

2011-01-01

Full Text Available Abstract Background Breast cancer screening continues to be underutilized by the population in general, but is particularly underutilized by traditionally underserved minority populations. Two of the most at risk female minority groups are American Indians/Alaska Natives (AI/AN and Latinas. American Indian women have the poorest recorded 5-year cancer survival rates of any ethnic group while breast cancer is the number one cause of cancer mortality among Latina women. Breast cancer screening rates for both minority groups are near or at the lowest among all racial/ethnic groups. As with other health screening behaviors, women may intend to get a mammogram but their intentions may not result in initiation or follow through of the examination process. An accumulating body of research, however, demonstrates the efficacy of developing 'implementation intentions' that define when, where, and how a specific behavior will be performed. The formulation of intended steps in addition to addressing potential barriers to test completion can increase a person's self-efficacy, operationalize and strengthen their intention to act, and close gaps between behavioral intention and completion. To date, an evaluation of the formulation of implementation intentions for breast cancer screening has not been conducted with minority populations. Methods/Design In the proposed program, community health workers will meet with rural-dwelling Latina and American Indian women one-on-one to educate them about breast cancer and screening and guide them through a computerized and culturally tailored "implementation intentions" program, called Healthy Living Kansas - Breast Health, to promote breast cancer screening utilization. We will target Latina and AI/AN women from two distinct rural Kansas communities. Women attending community events will be invited by CHWs to participate and be randomized to either a mammography "implementation intentions" (MI2 intervention or a

Occupational Health and Sleep Issues in Underserved Populations.

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Kalliny, Medhat; McKenzie, Judith Green

2017-03-01

Sleep disorders and occupational hazards, injuries, and illnesses impact an individual's overall health. In the United States, substantial racial, ethnic, and socioeconomic disparities exist in sleep and occupational health. Primary care physicians working in underserved communities should be aware of this disparity and target these higher-risk populations for focused evaluation and intervention. Copyright © 2016 Elsevier Inc. All rights reserved.

Exercise and Sports Medicine Issues in Underserved Populations.

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Morelli, Vincent; Bedney, Daniel L; Eric Dadush, Arie

2017-03-01

Primary care providers can make a strong argument for exercise promotion in underserved communities. The benefits are vitally important in adolescent physical, cognitive, and psychological development as well as in adult disease prevention and treatment. In counseling such patients, we should take into account a patient's readiness for change and the barriers to exercise. Copyright © 2016 Elsevier Inc. All rights reserved.

Older family carers in rural areas: experiences from using caregiver support services based on Information and Communication Technology (ICT).

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Blusi, Madeleine; Asplund, Kenneth; Jong, Mats

2013-09-01

The aim of this intervention study was to illuminate the meaning of ICT-based caregiver support as experienced by older family carers living in vast rural areas, caring for a spouse at home. In order to access, the support service participants were provided with a computer and high speed Internet in their homes. Semi structured webcam-interviews were carried out with 31 family carers. A strategy for webcam interviewing was developed to ensure quality and create a comfortable interview situation for the family carers. Interviews were analysed using content analyses, resulting in the themes: Adopting new technology with help from others and Regaining social inclusion . The results indicate that ICT-based support can be valuable for older family carers in rural areas as it contributes to improve quality in daily life in a number of ways. In order to fully experience the benefits, family carers need to be frequent users of the provided support. Adequate training and encouragement from others were essential in motivating family carers to use the support service. Access to Internet and webcamera contributed to reducing loneliness and isolation, strengthening relationships with relatives living far away and enabled access to services no longer available in the area. Use of the ICT-service had a positive influence on the relationship between the older carer and adult grandchildren. It also contributed to carer competence and promote feelings of regaining independence and a societal role.

How to Guide: Aggregate under-served markets into buying pools

Energy Technology Data Exchange (ETDEWEB)

None

2000-12-26

This activity promotes new opportunities to increase energy security and lower energy costs for under-served markets. It involves market analysis and collaboration with community partners, as well as outreach activities to inform target markets and technical assistance for participants.

Analysing the relationship between family planning workers' contact and contraceptive switching in rural Bangladesh using multilevel modelling.

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Hossain, Mian B

2005-09-01

With a population of over 131 million and a fertility rate of 29.9 per 1000, population growth constitutes a primary threat to continued economic growth and development in Bangladesh. One strategy that has been used to cease further increases in fertility in Bangladesh involves using family planning outreach workers who travel throughout rural and urban areas educating women regarding contraceptive alternatives. This study uses a longitudinal database to assess the impact of family planning outreach workers' contact upon contraceptive switching and upon the risk of an unintended pregnancy. Using longitudinal data on contraceptive use from the Operations Research Project (ORP) of the International Centre for Diarrhoeal Disease Research (ICDDR,B) in Bangladesh, multiple decrement life table analysis and multilevel, discrete-time competing risk hazards models were used to estimate the cumulative probabilities of switching to an alternative form of contraceptive use after a woman engaged in a discussion with an outreach worker. After controlling for the effects of socio-demographic and economic characteristics, the analysis revealed that family planning outreach workers' contact with women significantly decreases the risk of transitioning to the non-use of contraceptives. This contact also reduces the risk of an unintended pregnancy. Family planning workers' contact with women is associated with the increased risk of a woman switching from one modern method to another modern method. The study results indicate that side-effects and other method-related reasons are the two primary reasons for contraceptive discontinuation in rural Bangladesh.

Implementing academic detailing for breast cancer screening in underserved communities

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Ashford Alfred R

2007-12-01

Full Text Available Abstract Background African American and Hispanic women, such as those living in the northern Manhattan and the South Bronx neighborhoods of New York City, are generally underserved with regard to breast cancer prevention and screening practices, even though they are more likely to die of breast cancer than are other women. Primary care physicians (PCPs are critical for the recommendation of breast cancer screening to their patients. Academic detailing is a promising strategy for improving PCP performance in recommending breast cancer screening, yet little is known about the effects of academic detailing on breast cancer screening among physicians who practice in medically underserved areas. We assessed the effectiveness of an enhanced, multi-component academic detailing intervention in increasing recommendations for breast cancer screening within a sample of community-based urban physicians. Methods Two medically underserved communities were matched and randomized to intervention and control arms. Ninety-four primary care community (i.e., not hospital based physicians in northern Manhattan were compared to 74 physicians in the South Bronx neighborhoods of the New York City metropolitan area. Intervention participants received enhanced physician-directed academic detailing, using the American Cancer Society guidelines for the early detection of breast cancer. Control group physicians received no intervention. We conducted interviews to measure primary care physicians' self-reported recommendation of mammography and Clinical Breast Examination (CBE, and whether PCPs taught women how to perform breast self examination (BSE. Results Using multivariate analyses, we found a statistically significant intervention effect on the recommendation of CBE to women patients age 40 and over; mammography and breast self examination reports increased across both arms from baseline to follow-up, according to physician self-report. At post-test, physician

SUICIDAL ATTEMPTS AMONG YOUNG RURAL INHABITANTS

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Zdzisław Brzeski

2010-06-01

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.

Early Childhood Behavioral Health Integration in Pediatric Primary Care: Serving Refugee Families in the Healthy Steps Program

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Buchholz, Melissa; Fischer, Collette; Margolis, Kate L.; Talmi, Ayelet

2016-01-01

Primary care settings are optimal environments for providing comprehensive, family-centered care to young children and their families. Primary care clinics with integrated behavioral health clinicians (BHCs) are well-positioned to build trust and create access to care for marginalized and underserved populations. Refugees from around the world are…

Intrinsic rewards experienced by a group of dentists working with underserved populations.

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Gardner, S P; Roberts-Thomson, K F; Winning, T A; Peterson, R

2014-09-01

The aim of this study was to explore, using qualitative methods, the intrinsic reasons why dentists work with underserved groups. Minority and marginalized groups of Australians suffer a greater burden of dental disease than the general population due to disparities in accessing care. Recruitment and retention of dentists to care for underserved groups is problematic due to personal, professional and structural reasons. What drives dentists to work with underserved groups is not widely known. Sixteen dentists were recruited using 'snowball' purposeful sampling. Semi-structured in-depth interviews were conducted. Thematic analysis was conducted on the transcriptions to identify themes. Five key themes emerged: (1) 'tapped on the shoulder', being personally approached or invited; (2) 'dental school experience', the challenges faced as a student; (3) 'empathic concern', the non-judgemental expressions of care toward others; (4) 'resilience', the ability to bounce back after setbacks; (5) 'intrinsic reward', the personal gain and satisfaction received. This study focuses on the intrinsic rewards which were found to be simple, unexpected, and associated with relieving pain, community engagement and making a difference. Emphasizing personal fulfilment and intrinsic reward could be useful when promoting dentistry as a career and when encouraging graduates to consider working with disadvantaged groups. © 2014 Australian Dental Association.

In search of attachment: a qualitative study of chronically ill women transitioning between family physicians in rural Ontario, Canada.

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Randall, Ellen; Crooks, Valorie A; Goldsmith, Laurie J

2012-12-23

Most Canadians receive basic health services from a family physician and these physicians are particularly critical in the management of chronic disease. Canada, however, has an endemic shortage of family physicians. Physician shortages and turnover are particularly acute in rural regions, leaving their residents at risk of needing to transition between family physicians. The knowledge base about how patients manage transitioning in a climate of scarcity remains nascent. The purpose of this study is to explore the experience of transitioning for chronically ill, rurally situated Canadian women to provide insight into if and how the system supports transitioning patients and to identify opportunities for enhancing that support. Chronically ill women managing rheumatic diseases residing in two rural counties in the province of Ontario were recruited to participate in face-to-face, semi-structured interviews. Interview transcripts were analysed thematically to identify emergent themes associated with the transitioning experience. Seventeen women participated in this study. Ten had experienced transitioning and four with long-standing family physicians anticipated doing so soon. The remaining three expressed concerns about transitioning. Thematic analysis revealed the presence of a transitioning trajectory with three phases. The detachment phase focused on activities related to the termination of a physician-patient relationship, including haphazard notification tactics and the absence of referrals to replacement physicians. For those unable to immediately find a new doctor, there was a phase of unattachment during which patients had to improvise ways to receive care from alternative providers or walk-in clinics. The final phase, attachment, was characterized by acceptance into the practice of a new family physician. Participants often found transitioning challenging, largely due to perceived gaps in support from the health care system. Barriers to a smooth transition

The perception of crime from Albanian families that come from rural areas (Case study in the city of Durres

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Marjeta Milloshi

2015-07-01

Full Text Available Crime in the family constitutes one of the major concerns of recent years in Albania. Violence in Albanian families remains unnoticed and is not declared by the majority of those affected. The worst is that there are deep rural areas where violence is accepted as normal within a family. Many studies have come to the conclusion that women who have higher education tend to be better prepared to cope with domestic disputes and solve the problems with communication, so are less likely to be victims of physical violence. The economic, cultural, emotional and social factors are sources that generate violence or crime within the family. The transition from a totalitarian to a democratic society brought not only functional changes, but also differences in their implementation. This was accompanied by misunderstandings of the individual crisis and human rights. This misunderstanding is often associated with deviant behavior or by criminal acts. Poverty, unemployment, jealousy, alcohol and drugs are some of the main reasons that cause domestic violence. Albania has long been considered a patriarchal society where men have more rights than women. This difference has led to a situation where husbands continue to see themselves as more superior, and tend to violate their women or children. In recent years poverty has even increased bringing domestic violence to alarming levels. But besides the major problem of growing violence within the family, the biggest problem is the failure of declaration, because of the mentality, shame, lack of trust in government bodies etc. This problem is even greater in rural areas, where there is a lack of police structures, while NGOs cannot cover the whole country. This study was concentrated in the city of Durres, where 600 surveys were undertaken to people of different ages. This paper is focused in the way of how domestic violence is seen by citizens of the city of Durres and those coming from rural areas.

Family effects on the rurality of GP's work location: a longitudinal panel study.

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McGrail, Matthew R; Russell, Deborah J; O'Sullivan, Belinda G

2017-10-19

Reduced opportunities for children's schooling and spouse's/partner's employment are identified internationally as key barriers to general practitioners (GPs) working rurally. This paper aims to measure longitudinal associations between the rurality of GP work location and having (i) school-aged children and (ii) a spouse/partner in the workforce. Participants included 4377 GPs responding to at least two consecutive annual surveys of the Medicine in Australia: Balancing Employment and Life (MABEL) national longitudinal study between 2008 and 2014. The main outcome, GP work location, was categorised by remoteness and population size. Five sequential binary school-age groupings were defined according to whether a GP had no children, only preschool children (aged 0-4 years), at least one primary-school child (aged 5-11 years), at least one child in secondary school (aged 12-18 years), and all children older than secondary school (aged ≥ 19). Partner in the workforce was defined by whether a GP had a partner who was either currently working or looking for work, or not. Separate generalised estimating equation models, which aggregated consecutive annual observations per GP, tested associations between work location and (i) educational stages and (ii) partner employment, after adjusting for key covariates. Male GPs with children in secondary school were significantly less likely to work rurally (inclusive of > 50 000 regional centres through to the smallest rural towns of locations were not significantly associated with the educational stage of their children. Having a partner in the workforce was not associated with work location for male GPs, whereas female GPs with a partner in the workforce were significantly less likely to work in smaller rural/remote communities (location is related to key family needs which differ according to GP gender and educational stages of children. Such non-professional factors are likely to be dynamic across the GP's lifespan and

A comparative study of factors influencing decisions on desired family size among married men and women in Bokkos, a rural local government area in Plateau state.

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Kahansim, Makshwar L; Hadejia, Idris S; Sambo, Mohammed N

2013-03-01

The total fertility rate of Nigerian women has remained high at 5.7. This is even higher for women in rural areas. Men and women in rural areas desire more children than those in urban areas. This study was aimed at describing and comparing the factors that influence family size decisions among men and women in Bokkos, a rural Local Government Area in Plateau state, Nigeria. A cross sectional descriptive comparative study was used. Data was collected using structured interviewer administered questionnaires. Seventy two percent of women and 83.6% of men who desire to have 1-4 children had at least a secondary school education. Close to seventy percent of both men and women would have fewer children if they are certain of their survival to adulthood. Over 50% of the respondents believe that the husbands should have the final say on family size decisions. Preference for male children influences decisions on family size among men and women in the study population.

Feasibility of a low-cost hearing screening in rural Indiana

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Khalid M. Khan

2017-09-01

Full Text Available Abstract Background Hearing loss remains a neglected public health issue in the rural and agricultural communities in the United States and therefore, promotion of a low-cost hearing screening may be important for these underserved populations. The major objectives of our study were to assess feasibility of a low-cost telephone-administered hearing test in rural Indiana and to identify the challenges, barriers and viable implementation strategies associated with this test. Also, we evaluated whether a focus group session could change the hearing health attitude of rural residents. Methods We recruited 126 adults from six rural Indiana counties who participated in study activities in the following order: 1 a pre-focus group demographic, knowledge and attitude survey, 2 a focus group for discussing the feasibility of a telephone-administered hearing screening, 3 a post focus group attitude survey and 4 hearing was screened using an audiometer and self-assessment scale. These activities generated both qualitative and quantitative data, which were subsequently analyzed. Results Hearing impairment was perceived as an important public health issue. Many participants expressed interests to try the low-cost National Hearing Test (NHT. However, participants recommended NHT to be facilitated by community organizations to provide access to landline phones. The focus group turned out to be an excellent awareness building activity producing significant improvement in hearing health attitudes. Comparison of self and audiometric evaluations indicated underestimation of hearing handicap in our rural study population. Conclusions The study results underscore the urgent need for an effective strategy to promote low-cost hearing screening in rural US communities.

Web usability testing with a Hispanic medically underserved population.

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Moore, Mary; Bias, Randolph G; Prentice, Katherine; Fletcher, Robin; Vaughn, Terry

2009-04-01

Skilled website developers value usability testing to assure user needs are met. When the target audience differs substantially from the developers, it becomes essential to tailor both design and evaluation methods. In this study, researchers carried out a multifaceted usability evaluation of a website (Healthy Texas) designed for Hispanic audiences with lower computer literacy and lower health literacy. METHODS INCLUDED: (1) heuristic evaluation by a usability engineer, (2) remote end-user testing using WebEx software; and (3) face-to-face testing in a community center where use of the website was likely. Researchers found standard usability testing methods needed to be modified to provide interpreters, increased flexibility for time on task, presence of a trusted intermediary such as a librarian, and accommodation for family members who accompanied participants. Participants offered recommendations for website redesign, including simplified language, engaging and relevant graphics, culturally relevant examples, and clear navigation. User-centered design is especially important when website developers are not representative of the target audience. Failure to conduct appropriate usability testing with a representative audience can substantially reduce use and value of the website. This thorough course of usability testing identified improvements that benefit all users but become crucial when trying to reach an underserved audience.

The Current Situation of Hypertension among Rural Minimal Assurance Family Participants in Liaoning (China): A Cross-Sectional Study.

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Chen, Yintao; Yu, Shasha; Chen, Shuang; Guo, Xiaofan; Li, Yuan; Li, Zhao; Sun, Yingxian

2016-12-02

In China, the prevalence of hypertension is increasing and is showing an epidemic accelerating trend. However, there is a lack of studies reporting the hypertension status of rural residents with minimum living allowances. We performed a cross-sectional study including 11,435 (5285 men and 6150 women) from the general population aged ≥35 years in the Liaoning Province of China from 2012 to 2013, of which 1258 (11.0%) participants came from minimal assurance families. Anthropometric measurements, laboratory examinations and self-reported lifestyle factor information were collected by trained personnel. Multivariate logistic regression was used to detect the association between socioeconomic status (SES) and the risk of hypertension. We found that the prevalence of hypertension was as high as 61.9% in participants from minimal assurance families and the odd ratio for hypertension was 1.32 (95% CI: 1.15-1.52). The awareness, treatment, and control rates among treated hypertensive participants did not increase with higher level of income and education. In the total sample, the lower income levels increased the risk for hypertension, but education didn't show a significant association with hypertension. Thus, there is a severe hypertension situation in the Liaoning rural population of minimal assurance families, which need more attention and prevention and control measures for hypertension.

Enhancing Maternal and Perinatal Health in Under-Served Remote Areas in Sub-Saharan Africa: A Tanzanian Model.

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Angelo S Nyamtema

Full Text Available In Tanzania, maternal mortality ratio (MMR, unmet need for emergency obstetric care and health inequities across the country are in a critical state, particularly in rural areas. This study was established to determine the feasibility and impact of decentralizing comprehensive emergency obstetric and neonatal care (CEmONC services in underserved rural areas using associate clinicians.Ten health centres (HCs were upgraded by constructing and equipping maternity blocks, operating rooms, laboratories, staff houses and installing solar panels, standby generators and water supply systems. Twenty-three assistant medical officers (advanced level associate clinicians, and forty-four nurse-midwives and clinical officers (associate clinicians were trained in CEmONC and anaesthesia respectively. CEmONC services were launched between 2009 and 2012. Monthly supportive supervision and clinical audits of adverse pregnancy outcomes were introduced in 2011 in these HCs and their respective district hospitals.After launching CEmONC services from 2009 to 2014 institutional deliveries increased in all upgraded rural HCs. Mean numbers of monthly deliveries increased by 151% and obstetric referrals decreased from 9% to 3% (p = 0.03 in HCs. A total of 43,846 deliveries and 2,890 caesarean sections (CS were performed in these HCs making the mean proportion of all births in EmONC facilities of 128% and mean population-based CS rate of 9%. There were 190 maternal deaths and 1,198 intrapartum and very early neonatal deaths (IVEND in all health facilities. Generally, health centres had statistically significantly lower maternal mortality ratios and IVEND rates than district hospitals (p < 0.00 and < 0.02 respectively. Of all deaths (maternal and IVEND 84% to 96% were considered avoidable.These findings strongly indicate that remotely located health centres in resource limited settings hold a great potential to increase accessibility to CEmONC services and to improve

Enhancing Maternal and Perinatal Health in Under-Served Remote Areas in Sub-Saharan Africa: A Tanzanian Model.

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Nyamtema, Angelo S; Mwakatundu, Nguke; Dominico, Sunday; Mohamed, Hamed; Pemba, Senga; Rumanyika, Richard; Kairuki, Clementina; Kassiga, Irene; Shayo, Allan; Issa, Omary; Nzabuhakwa, Calist; Lyimo, Chagi; van Roosmalen, Jos

2016-01-01

In Tanzania, maternal mortality ratio (MMR), unmet need for emergency obstetric care and health inequities across the country are in a critical state, particularly in rural areas. This study was established to determine the feasibility and impact of decentralizing comprehensive emergency obstetric and neonatal care (CEmONC) services in underserved rural areas using associate clinicians. Ten health centres (HCs) were upgraded by constructing and equipping maternity blocks, operating rooms, laboratories, staff houses and installing solar panels, standby generators and water supply systems. Twenty-three assistant medical officers (advanced level associate clinicians), and forty-four nurse-midwives and clinical officers (associate clinicians) were trained in CEmONC and anaesthesia respectively. CEmONC services were launched between 2009 and 2012. Monthly supportive supervision and clinical audits of adverse pregnancy outcomes were introduced in 2011 in these HCs and their respective district hospitals. After launching CEmONC services from 2009 to 2014 institutional deliveries increased in all upgraded rural HCs. Mean numbers of monthly deliveries increased by 151% and obstetric referrals decreased from 9% to 3% (p = 0.03) in HCs. A total of 43,846 deliveries and 2,890 caesarean sections (CS) were performed in these HCs making the mean proportion of all births in EmONC facilities of 128% and mean population-based CS rate of 9%. There were 190 maternal deaths and 1,198 intrapartum and very early neonatal deaths (IVEND) in all health facilities. Generally, health centres had statistically significantly lower maternal mortality ratios and IVEND rates than district hospitals (p < 0.00 and < 0.02 respectively). Of all deaths (maternal and IVEND) 84% to 96% were considered avoidable. These findings strongly indicate that remotely located health centres in resource limited settings hold a great potential to increase accessibility to CEmONC services and to improve maternal and

Diet and Obesity Issues in the Underserved.

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Mejia de Grubb, Maria C; Levine, Robert S; Zoorob, Roger J

2017-03-01

The goal of this article is to inform new directions for addressing inequalities associated with obesity by reviewing current issues about diet and obesity among socioeconomically vulnerable and underserved populations. It highlights recent interventions in selected high-risk populations, as well as gaps in the knowledge base. It identifies future directions in policy and programmatic interventions to expand the role of primary care providers, with an emphasis on those aimed at preventing obesity and promoting healthy weight. Copyright © 2016 Elsevier Inc. All rights reserved.

The Role of Parenting Practices in the Home Environment among Underserved Youth.

Science.gov (United States)

Conlon, Beth A; McGinn, Aileen P; Lounsbury, David W; Diamantis, Pamela M; Groisman-Perelstein, Adriana E; Wylie-Rosett, Judith; Isasi, Carmen R

2015-08-01

The home environment, which includes parenting practices, is an important setting in which children develop their health behaviors. We examined the role of parenting practices in the home environment among underserved youth. We examined baseline data of a family-focused pediatric obesity intervention. Parenting practices (monitoring, discipline, limit setting of soda/snacks [SS] and screen media [SM], pressure to eat, and reinforcement) and availability of fruits/vegetables (FV) and sugar-sweetened beverages (SSBs), family meals, television (TV) watching during meals, TVs in the home, owning active video games/sports equipment, and household food security were assessed in 301 parent/caregivers of overweight/obese children (ages 7-12 years; BMI≥85th percentile). Associations were evaluated using Spearman's rank correlation coefficients and logistic regression models adjusted for potential confounders. Parents/caregivers (ages 22-67 years) were largely Hispanic/Latino (74.1%), female (92.4%), and reported high levels of limit setting SS and low levels of pressure to eat. Parent age, gender, country of birth, and years living in the United States accounted for differences among several parenting practices. Adjusted logistic regression models identified several statistically significant associations, including: Monitoring was positively associated with availability FV (odds ratio [OR]=2.19; 95% confidence interval [CI], 1.25, 3.82); limit setting SS was inversely associated with availability of SSBs (OR=0.40; 95% CI, 0.21, 0.75); and limit setting SM was inversely associated with TV viewing during family meals (OR=0.51; 95% CI, 0.31, 0.85). Nearly 40% of our population was food insecure, and food insecurity was positively associated with pressure to eat (OR=1.77; 95% CI, 1.01, 3.15). Parenting practices play an important role in the home environment, and longitudinal studies are needed to examine these associations in the context of family-focused pediatric obesity

"We can see a future here": Place attachment, professional identity, and forms of capital mobilized to deliver medical education in an underserviced area.

Science.gov (United States)

Hanlon, Neil; Halseth, Greg; Snadden, David

2010-09-01

Community-integrated undergraduate medical education is becoming a more common option for students predisposed to practice in rural and small town places. One such initiative, the Northern Medical Program, has been operating since 2004 in the northern interior of British Columbia, Canada. The NMP's curriculum relies heavily on the involvement of practicing physicians in its host community, Prince George. Drawing on Bourdieu's conceptualization of capital in its different forms, the commitment of the local physician community is understood as social capital derived from cultural capital centred on a collective sense of professional identity forged by conditions of practice in an underserviced area. The findings of this study are discussed with respect to the long-term operation and success of community-integrated medical education programs. Copyright 2010 Elsevier Ltd. All rights reserved.

Paths to Work in Rural Places: Key Findings and Lessons from the Impact Evaluation of the Future Steps Rural Welfare-to-Work Program. Final Report

Science.gov (United States)

Meckstroth, Alicia; Burwick, Andrew; Ponza, Michael; Marsh, Shawn; Novak, Tim; Phillips, Shannon; Diaz-Tena, Nuria; Ng, Judy

2006-01-01

Helping low-income families in rural areas find gainful employment and achieve economic self-sufficiency is an ongoing policy concern. The Rural Welfare-to-Work Strategies demonstration is using rigorous experimental designs to build knowledge about how to help low-income families in rural areas strive toward sustained employment and…

Development and Validation of a Gender Ideology Scale for Family Planning Services in Rural China

Science.gov (United States)

Yang, Xueyan; Li, Shuzhuo; Feldman, Marcus W.

2013-01-01

The objectives of this study are to develop a scale of gender role ideology appropriate for assessing Quality of Care in family planning services for rural China. Literature review, focus-group discussions and in-depth interviews with service providers and clients from two counties in eastern and western China, as well as experts’ assessments, were used to develop a scale for family planning services. Psychometric methodologies were applied to samples of 601 service clients and 541 service providers from a survey in a district in central China to validate its internal consistency, reliability, and construct validity with realistic and strategic dimensions. This scale is found to be reliable and valid, and has prospects for application both academically and practically in the field. PMID:23573222

Differences in Health Care, Family, and Community Factors Associated with Mental, Behavioral, and Developmental Disorders Among Children Aged 2-8 Years in Rural and Urban Areas - United States, 2011-2012.

Science.gov (United States)

Robinson, Lara R; Holbrook, Joseph R; Bitsko, Rebecca H; Hartwig, Sophie A; Kaminski, Jennifer W; Ghandour, Reem M; Peacock, Georgina; Heggs, Akilah; Boyle, Coleen A

2017-03-17

Mental, behavioral, and developmental disorders (MBDDs) begin in early childhood and often affect lifelong health and well-being. Persons who live in rural areas report more health-related disparities than those in urban areas, including poorer health, more health risk behaviors, and less access to health resources. 2011-2012. The National Survey of Children's Health (NSCH) is a cross-sectional, random-digit-dial telephone survey of parents or guardians that collects information on noninstitutionalized children aged health and well-being, health care access, and family and community characteristics. Using data from the 2011-2012 NSCH, this report examines variations in health care, family, and community factors among children aged 2-8 years with and without MBDDs in rural and urban settings. Restricting the data to U.S. children aged 2-8 years with valid responses for child age and sex, each MBDD, and zip code resulted in an analytic sample of 34,535 children; MBDD diagnosis was determined by parent report and was not validated with health care providers or medical records. A higher percentage of all children in small rural and large rural areas compared with all children in urban areas had parents who reported experiencing financial difficulties (i.e., difficulties meeting basic needs such as food and housing). Children in all rural areas more often lacked amenities and lived in a neighborhood in poor condition. However, a lower percentage of children in small rural and isolated areas had parents who reported living in an unsafe neighborhood, and children in isolated areas less often lived in a neighborhood lacking social support, less often lacked a medical home, and less often had a parent with fair or poor mental health. Across rural subtypes, approximately one in six young children had a parent-reported MBDD diagnosis. A higher prevalence was found among children in small rural areas (18.6%) than in urban areas (15.2%). In urban and the majority of rural

The role of tradition in mulitigeneration rural families in Małopolska Rola tradycji w wielopokoleniowych rodzinach wiejskich w Małopolsce

Directory of Open Access Journals (Sweden)

Magdalena Kowalska

2008-06-01

Full Text Available Research was carried out in 2006 in three gminas (administrative boroughs of the Małopolska Province – Dębno, Wieliczka, and Zabierzów. 40 multigeneration rural families were selected in each gmina. Interviews were conducted with them on the basis of a questionnaire made up of three parts focused on the representatives of three genera-tions: grandparents, parents, and grandchildren. 360 people were surveyed in total. The results of the research, which are presented here, will try to provide an answer to the ques-tion of how critical a role tradition plays in the life of multigeneration rural families, and also to what extent they cherish the customs and habits which they have inherited from previous generations.

Women and family poultry production in rural Africa.

Science.gov (United States)

Gueye, E H

2000-02-01

Poultry production has existed for many generations in Africa, and almost every village household keeps chickens. The rural family poultry (RFP) are generally raised in free-range and/or backyard systems, which are traditional extensive husbandry systems. The development of an intensive poultry production has been the goal of the African government over the years. Despite efforts aiming for such goal, RFP is still very important in African countries that are both poor and net importers of food. It is a valuable asset because it can contribute significantly in alleviating poverty, securing food supply, and promoting gender equality. In view of this, interventions to improve RFP production systems should take into account the sociocultural issues, specifically gender-based aspects. It is noted that such interventions might, in addition to food security and poverty alleviation, also serve to promote gender equality. RFP development programs should be more women-friendly in order to facilitate women's participation, as RFP production in the region is generally a woman's business. Moreover, efforts to empower village women has to be envisaged cautiously as there is a serious risk of men taking over once the poultry sector becomes more profitable.

A Comparison Study of Single-Parent Families Living on Remote, Rural Islands and in Urban Settings in Japan.

Science.gov (United States)

Hiratani, Yuko; Hohashi, Naohiro

2016-06-01

Nursing interventions that aim to enhance the family environment are necessary to help single-parent families with children to improve family functioning. The cultural and social factors that are unique to Japan's remote islands should be considered to assess the influence of this unique setting on family functioning. The objectives of this study were to evaluate the family functioning of child-rearing single-parent families living in different environments and to investigate the association between family demographics and family functioning. A self-administered questionnaire, the Japanese version of the Survey of Family Environment, was used to evaluate the sufficiency of family functioning. The participants were families with children enrolled in nurseries and kindergartens who were either living in remote, rural islands or in an urban city on the mainland in Japan. Family functioning was significantly higher for single-parent families living on the islands than for those living in the city in terms of media use, participation in community activities, and the collaboration of family members in child-rearing. Family functioning of single-parent families correlated significantly with household income, the parent's gender, family members' health, and family life cycle. Single-parent families living on Japanese offshore islands maintained family functioning through mutual support and the effective use of information technology. Nevertheless, single-parent families require additional support to improve their healthcare and financial situations.

Rural school in the Tenza Valley, rural education and agroecology reflections on rural “development”

Directory of Open Access Journals (Sweden)

Mejia Alfonso Miguel Fernando

2011-08-01

Full Text Available family: ";Arial";,";sans-serif";; font-size: 10pt; mso-fareast-font-family: MinionPro-Regular; mso-fareast-language: EN-US; mso-ansi-language: EN-US; mso-bidi-language: AR-SA;" lang="EN-US">

family: ";Arial";,";sans-serif";; font-size: 10pt; mso-fareast-font-family: MinionPro-Regular; mso-ansi-language: EN-US;" lang="EN-US">The municipality of Sutatenza (Boyaca, constitutes an important reference for rural education in Colombia due to “Radio Sutatenza” (Educational Radio and the People’s Cultural Action in the mid-twentieth century. Currently, in the same town, a process called the Campesina Community School del Valle de Tenza has been brewing, under an agroecological approach, guided in its work to the cultural and productive Andean farmers, their families and their young people to cultivate in them a return the field. This article addresses this educational experience for contrasting approaches of “development” with the perceptions and visions that emerge from the rural world, without being radically different, it raises important questions for the call for and controversy of development, from the local.

The hub-and-spoke organization design revisited: a lifeline for rural hospitals.

Science.gov (United States)

Elrod, James K; Fortenberry, John L

2017-12-13

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.

Designing for Underserved Populations: Constraints and Requirements of Personal Health Record Systems

Centers for Disease Control (CDC) Podcasts

In this podcast, Dr. Thomas Horan discusses how language, literacy, and access barriers can be overcome with electronic Personal Health Record (PHR) systems to improve health among the most vulnerable, isolated, and underserved populations.

Commercial Television Exposure, Fast Food Toy Collecting, and Family Visits to Fast Food Restaurants among Families Living in Rural Communities.

Science.gov (United States)

Emond, Jennifer A; Bernhardt, Amy M; Gilbert-Diamond, Diane; Li, Zhigang; Sargent, James D

2016-01-01

To assess the associations between children's exposure to television (TV) networks that aired child-directed advertisements for children's fast food meals with the collection of fast food meal toy premiums and frequency of family visits to those restaurants. One hundred parents of children 3-7 years old were recruited from a rural pediatrics clinic during 2011; families receiving Medicaid were oversampled. Parents reported the child's TV viewing habits and family visit frequency to the fast food restaurants participating in child-directed TV marketing at the time, and their child's requests for visits to and the collecting of toy premiums from those restaurants. Logistic regression models assessed adjusted associations between a child's TV viewing with more frequent restaurant visits (≥monthly in this population). Structural equation modeling assessed if child requests or toy collecting mediated that association. Thirty-seven percent of parents reported ≥monthly visits to the select fast food restaurants. Among children, 54% requested visits to and 29% collected toys from those restaurants. Greater child commercial TV viewing was significantly associated with more frequent family visits to those fast food restaurants (aOR 2.84 for each 1-unit increase in the child's commercial TV viewing scale, P restaurants. Child desire for toy premiums may be a mediating factor. Copyright © 2016 Elsevier Inc. All rights reserved.

Commercial TV exposure, fast-food toy collecting and family visits to fast food restaurants among families living in rural communities

Science.gov (United States)

Emond, Jennifer A.; Bernhardt, Amy M.; Gilbert-Diamond, Diane; Li, Zhigang; Sargent, James D.

2015-01-01

Objective To assess the associations between children's exposure to TV networks that aired child-directed advertisements for children's fast food meals with the collection of fast food meal toy premiums and frequency of family visits to those restaurants. Study design One hundred parents of children 3–7 years old were recruited from a rural pediatrics clinic during 2011; families receiving Medicaid were oversampled. Parents reported the child's television viewing habits and family visit frequency to the fast food restaurants participating in child-directed TV marketing at the time, and their child's requests for visits to and the collecting of toy premiums from those restaurants. Logistic regression models assessed adjusted associations between a child's TV viewing with more frequent restaurant visits (≥monthly in this population). Structural equation modeling assessed if child requests or toy collecting mediated that association. Results Thirty-seven percent of parents reported ≥monthly visits to the select fast food restaurants. Among children, 54% requested visits to and 29% collected toys from those restaurants. Greater child commercial TV viewing was significantly associated with more frequent family visits to those fast food restaurants (adjusted odds ratio 2.84 for each one-unit increase in the child's commercial TV viewing scale, prestaurants. Child desire for toy premiums may be a mediating factor. PMID:26526362

Underserved Pregnant and Postpartum Women's Access and Use of Their Health Records.

Science.gov (United States)

Guo, Yuqing; Hildebrand, Janet; Rousseau, Julie; Brown, Brandon; Pimentel, Pamela; Olshansky, Ellen

The purpose of this study was to examine knowledge of and experiences with use of their electronic health record (EHR) among mostly Hispanic women during pregnancy and postpartum. Women who were in the MOMS Orange County prenatal or postpartum home visitation program completed surveys and participated in focus groups. Descriptive and content analyses were used. Twenty-six women participated. Nearly all women (24, 92.3%) knew what health records were and most (80.8%) felt that keeping their records would increase or greatly increase their confidence in caring for themselves and their families. Approximately one third reported already keeping a copy of their health records. Common barriers to accessing and understanding health records included healthcare providers' noncompliance with the Health Information Technology for Economic and Clinical Health Act, limited EHR adoption, unfriendly patient portals, complicated medical terminology, rushed appointments with healthcare providers, lack of Spanish interpreters, and lack of Spanish-speaking healthcare providers. Programs are needed to educate and support women and providers in using health records to promote health literacy, pregnancy management, and patient-provider relationships in underserved populations.

Simulation and optimization study on a solar space heating system combined with a low temperature ASHP for single family rural residential houses in Beijing

DEFF Research Database (Denmark)

Deng, Jie; Tian, Zhiyong; Fan, Jianhua

2016-01-01

A pilot project of the solar water heating system combined with a low temperature air source heat pump (ASHP) unit was established in 2014 in a detached residential house in the rural region of Beijing, in order to investigate the system application prospect for single family houses via system...... optimization design and economic analysis. The established system was comprised of the glass heat-pipe based evacuated tube solar collectors with a gross area of 18.8 m2 and an ASHP with a stated heating power of 8 kW for the space heating of a single family rural house of 81.4 m2. The dynamic thermal...... with good building insulation were undertaken to figure out the system economical efficiency in the rural regions of Beijing. The results show that the payback periods of the solar space heating system combined with the ASHP with the collector areas 15.04-22.56 m2 are 17.3-22.4 years for the established...

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

Science.gov (United States)

Mburu, Grace; George, Gavin

2017-07-31

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.

Building an argument for Internet expansion in Dwesa- an under-serviced rural community in South Africa

CSIR Research Space (South Africa)

Dlamini, S

2014-11-01

Full Text Available The purpose of this paper is to present research findings that investigate the extent of Internet usage as well as options for extending the current reach of the wireless network in Dwesa, a rural area in South Africa’s Eastern Cape Province. A mix...

Breast Cancer Outreach for Underserved Women: A Randomized Trial and Cost-Effectiveness Analysis

National Research Council Canada - National Science Library

Pasick, Rena

1999-01-01

The current study, BACCIS-II, is a randomized controlled trial of an outreach intervention model designed to increase the rate of periodic mammography and clinical breast exam among underserved women...

Motives for moving to rural, peripheral areas - work, “rural idyll” or “income transfer”

DEFF Research Database (Denmark)

Andersen, Hans Skifter; Nørgaard, Helle

2012-01-01

Much interest is given to attracting new settlement in rural, peripheral areas due to long-term population loss. The ideal type of settler is identified as families with young children. However, various studies on rural migration show that migrants are a mixed group of young, middle aged and older...... couples and individuals as well as families with children. A large part of the migrants have jobs while other are unemployed or on other types of social welfare. In a Danish context a key hypothesis is that especially welfare recipients and those outside the labor market settle in the countryside due...... to low housing prices. This article explores which groups of people move to rural, peripheral areas and why they chose to do so....

THE EFFECTS OF WORKPLACE SOCIAL SUPPORT ON WORK-FAMILY CONFLICT (CASE STUDY: RURAL WATER AND WASTEWATER COMPANY EMPLOYEES KERMANSHAH, IRAN)

OpenAIRE

Sobhani Aliasgar

2017-01-01

The main objective of the current study is to investigate the relationship between workplace social support and work-family conflict among employees who were married, living with a partner, or had at least one child or dependent living at home and worked a minimum of 20 h/week in Rural Water and Wastewater Company employees Kermanshah, Iran. The relation between workplace social support and work–family conflict (WFC) was examined using a two-dimensional measure of WFC and both global and sum...

Productive inclusion, family livestock situation of rural women of brazil without poverty program in a municipality of the rs - context a little-known reality

Directory of Open Access Journals (Sweden)

Marta Julia Marques Lopes

2018-01-01

Full Text Available The aim of this article is to describe and analyze sociodemographic characteristics of rural women working in family livestock, inserted in Brazil without Poverty Plan in Encruzilhada do Sul. This type of work is culturally defined as masculine as well, the question is how women in it operate. In Rio Grande do Sul, the southern half has in beef cattle the main productive activity which alludes to a supposed production homogeneity. This condition challenges and boost research that shows the multiplicity of experiences of livestock rural families. Thus, the motivation of this article also is based on the problem of discussion little debated on family livestock, for example, the sexual division of labor and women's participation in the activity. So it was found the presence of women in family livestock and their inclusion in the Brazil without Poverty Program. The information analyzed shows that 92.31% of ownership in the program are women, 6.59% of men and 1.10% for both. This reality leads the female role of idea in action, however it is necessary to consider other issues that contribute to other explanatory possibilities of this condition. The trajectory and the sexual division of labor "earmarking" women to the most precarious jobs, it may be a potential answer. Thus, the recognition of women's work is hindered in social practices and intra-family and sexual division of labor is reaffirmed by the notions of what is "man of affairs and women's things". The issues that emerge interrelate livestock, poverty and gender, since most of the families of the Brazil without Poverty is also included in the livestock. We question the extent to which livestock is male activity and poverty would be a "parameter" to characterize rural activities, including livestock, as female?

Compensation and Production in Family Medicine by Practice Ownership

Directory of Open Access Journals (Sweden)

Alison C. Essary

2016-02-01

Full Text Available The increasing focus on high performance, patient-centered, team-based care calls for a strategy to evaluate cost-effective primary care. The trend toward physician practice consolidation further challenges the primary care health care system. Productivity measures establish provider value and help inform decision making regarding resource allocation in this evolving health care system. In this national survey of family medicine practices, physician assistant (PA productivity, as defined by mean annual patient encounters, exceeds that of both nurse practitioners (NPs and physicians in physician-owned practices and of NPs in hospital or integrated delivery system-owned practices. Total compensation, defined as salary, bonus, incentives, and honoraria for physicians, is significantly more compared to both PAs and NPs, regardless of practice ownership or productivity. Physician assistants and NPs earn equivalent compensation, regardless of practice ownership or productivity. Not only do these data support the value and role of PAs and NPs on the primary care team but also highlight differences in patient encounters between practice settings. Rural and underserved community practices, where physician-owned practices persist, also merit further consideration. Further research is needed to inform both organizational and policy decisions for the provision of high-quality, cost-effective, and accessible primary health care.

Promising Practices: A Literature Review of Technology Use by Underserved Students

Science.gov (United States)

Zielezinski, Molly B.; Darling-Hammond, Linda

2016-01-01

How can technologies and digital learning experiences be used to support underserved, under-resourced, and underprepared students? For many years, educators, researchers, and policy makers looking for strategies to close the achievement gap and improve student learning have sought solutions involving new uses of technology, especially for students…

Verbal Autopsies in Rural Tanzania

African Journals Online (AJOL)

Maternal mortality rates in rural Tanzania are high. In preparation for the introduction of an intervention to reduce maternal deaths by distribution of misoprostol and erythromycin to women living in rural Rorya District, Mara Region, Tanzania, we conducted a limited verbal autopsy by surveying family members of women ...

Breaking Barriers to Bike Share: Insights from Residents of Traditionally Underserved Neighborhoods

Science.gov (United States)

2017-06-01

Evidence has shown that higher income and white populations are overrepresented in both access to and use of bike share. Efforts to overcome underserved communities barriers to access and use of bike share have been initiated in a number of cities...

Methods and design of a 10-week multi-component family meals intervention: a two group quasi-experimental effectiveness trial.

Science.gov (United States)

Rogers, Catherine; Anderson, Sarah E; Dollahite, Jamie S; Hill, Tisa F; Holloman, Chris; Miller, Carla K; Pratt, Keeley J; Gunther, Carolyn

2017-01-09

Given the ongoing childhood obesity public health crisis and potential protective effect of family meals, there is need for additional family meals research, specifically experimental studies with expanded health outcomes that focus on the at-risk populations in highest need of intervention. Future research, specifically intervention work, would also benefit from an expansion of the target age range to include younger children, who are laying the foundation of their eating patterns and capable of participating in family meal preparations. The purpose of this paper is to address this research gap by presenting the objectives and research methods of a 10-week multi-component family meals intervention study aimed at eliciting positive changes in child diet and weight status. This will be a group quasi-experimental trial with staggered cohort design. Data will be collected via direct measure and questionnaires at baseline, intervention completion (or waiting period for controls), and 10-weeks post-intervention. Setting will be faith-based community center. Participants will be 60 underserved families with at least 1, 4-10 year old child will be recruited and enrolled in the intervention (n = 30) or waitlist control group (n = 30). The intervention (Simple Suppers) is a 10-week family meals program designed for underserved families from racial/ethnic diverse backgrounds. The 10, 90-min program lessons will be delivered weekly over the dinner hour. Session components include: a) interactive group discussion of strategies to overcome family meal barriers, plus weekly goal setting for caregivers; b) engagement in age-appropriate food preparation activities for children; and c) group family meal for caregivers and children. Main outcome measures are change in: child diet quality; child standardized body mass index; and frequency of family meals. Regression models will be used to compare response variables results of intervention to control group, controlling for

CHARM, a gender equity and family planning intervention for men and couples in rural India: protocol for the cluster randomized controlled trial evaluation.

Science.gov (United States)

Yore, Jennifer; Dasgupta, Anindita; Ghule, Mohan; Battala, Madhusadana; Nair, Saritha; Silverman, Jay; Saggurti, Niranjan; Balaiah, Donta; Raj, Anita

2016-02-20

Globally, 41% of all pregnancies are unintended, increasing risk for unsafe abortion, miscarriage and maternal and child morbidities and mortality. One in four pregnancies in India (3.3 million pregnancies, annually) are unintended; 2/3 of these occur in the context of no modern contraceptive use. In addition, no contraceptive use until desired number and sex composition of children is achieved remains a norm in India. Research shows that globally and in India, the youngest and most newly married wives are least likely to use contraception and most likely to report husband's exclusive family planning decision-making control, suggesting that male engagement and family planning support is important for this group. Thus, the Counseling Husbands to Achieve Reproductive Health and Marital Equity (CHARM) intervention was developed in recognition of the need for more male engagement family planning models that include gender equity counseling and focus on spacing contraception use in rural India. For this study, a multi-session intervention delivered to men but inclusive of their wives was developed and evaluated as a two-armed cluster randomized controlled design study conducted across 50 mapped clusters in rural Maharashtra, India. Eligible rural young husbands and their wives (N = 1081) participated in a three session gender-equity focused family planning program delivered to the men (Sessions 1 and 2) and their wives (Session 3) by village health providers in rural India. Survey assessments were conducted at baseline and 9&18 month follow-ups with eligible men and their wives, and pregnancy tests were obtained from wives at baseline and 18-month follow-up. Additional in-depth understanding of how intervention impact occurred was assessed via in-depth interviews at 18 month follow-up with VHPs and a subsample of couples (n = 50, 2 couples per intervention cluster). Process evaluation was conducted to collect feedback from husbands, wives, and VHPs on program

Patient-family EoL communication and its predictors: Reports from caregivers of Latino patients in the rural U.S.-Mexico border region.

Science.gov (United States)

Ko, Eunjeong; Lee, Jaehoon; Ramirez, Carlos; Lopez, Denicka; Martinez, Stephanie

2017-10-26

Family caregivers play an important role in end-of-life (EoL) decision making when the patient is unable to make his/her own decisions. While communication about EoL care between patients and family is perhaps a first step toward advance care planning (ACP)/EoL decisions, not every culture puts great value on open communication about this topic. The aims of the present study were to explore EoL communication and the aspects of communication among caregivers of Latino patients in the rural United States (U.S.)-Mexico border region. This study analyzed data from a hospice needs assessment collected from 189 family caregivers of Latino patients at a home health agency in a rural U.S.-Mexico border region. Bivariate tests and logistic regression were used to address our aims. About half of the family caregivers (n = 96, 50.8%) reported to have ever engaged in EoL discussion with patients. Significant predictors of EoL discussion included life-sustaining treatment preference (odds ratio [OR] = 0.44, p EoL communication. Also, caregivers who worried that physicians might want to stop treatments (i.e., "pull the plug") too soon were less likely to do so. Conversely, caregivers who had knowledge about ADs were more likely to engage in EoL communication. EoL communication is a complex process influenced by individual, social, and cultural values and the beliefs of both the patient and his/her family. Inclusion of family caregivers in the ACP process and facilitating culturally tailored EoL communication between patients and family caregivers is important.

The Utility of Rural and Underserved Designations in Geospatial Assessments of Distance Traveled to Healthcare Services: Implications for Public Health Research and Practice

Directory of Open Access Journals (Sweden)

Matthew Lee Smith

2013-01-01

Full Text Available Health disparities research in rural populations is based on several common taxonomies identified by geography and population density. However, little is known about the implications of different rurality definitions on public health outcomes. To help illuminate the meaning of different rural designations often used in research, service delivery, or policy reports, this study will (1 review the different definitions of rurality and their purposes; (2 identify the overlap of various rural designations in an eight-county Brazos Valley region in Central Texas; (3 describe participant characteristic profiles based on distances traveled to obtain healthcare services; and (4 examine common profile characteristics associated with each designation. Data were analyzed from a random sample from 1,958 Texas adults participating in a community assessment. K-means cluster analysis was used to identify natural groupings of individuals based on distance traveled to obtain three healthcare services: medical care, dental care, and prescription medication pick-up. Significant variation in cluster representation and resident characteristics was observed by rural designation. Given widely used taxonomies for designating areas as rural (or provider shortage in health-related research, this study highlights differences that could influence research results and subsequent program and policy development based on rural designation.

The utility of rural and underserved designations in geospatial assessments of distance traveled to healthcare services: implications for public health research and practice.

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Smith, Matthew Lee; Dickerson, Justin B; Wendel, Monica L; Ahn, Sangnam; Pulczinski, Jairus C; Drake, Kelly N; Ory, Marcia G

2013-01-01

Health disparities research in rural populations is based on several common taxonomies identified by geography and population density. However, little is known about the implications of different rurality definitions on public health outcomes. To help illuminate the meaning of different rural designations often used in research, service delivery, or policy reports, this study will (1) review the different definitions of rurality and their purposes; (2) identify the overlap of various rural designations in an eight-county Brazos Valley region in Central Texas; (3) describe participant characteristic profiles based on distances traveled to obtain healthcare services; and (4) examine common profile characteristics associated with each designation. Data were analyzed from a random sample from 1,958 Texas adults participating in a community assessment. K-means cluster analysis was used to identify natural groupings of individuals based on distance traveled to obtain three healthcare services: medical care, dental care, and prescription medication pick-up. Significant variation in cluster representation and resident characteristics was observed by rural designation. Given widely used taxonomies for designating areas as rural (or provider shortage) in health-related research, this study highlights differences that could influence research results and subsequent program and policy development based on rural designation.

Factors affecting frequency of communication about family health history with family members and doctors in a medically underserved population.

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Kaphingst, Kimberly A; Goodman, Melody; Pandya, Chintan; Garg, Priyanka; Stafford, Jewel; Lachance, Christina

2012-08-01

Family history contributes to risk for many common chronic diseases. Little research has investigated patient factors affecting communication of this information. 1061 adult community health center patients were surveyed. We examined factors related to frequency of discussions about family health history (FHH) with family members and doctors. Patients who talked frequently with family members about FHH were more likely to report a family history of cancer (p =.012) and heart disease (p history of heart disease (p = .011), meet physical activity recommendations (p = .022), seek health information frequently in newspapers (p history of some diseases, those not meeting physical activity recommendations, and those who do not frequently seek health information may not have ongoing FHH discussions. Interventions are needed to encourage providers to update patients' family histories systematically and assist patients in initiating FHH conversations in order to use this information for disease prevention and control. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Physical Activity in an Underserved Population: Identifying Technology Preferences.

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Medairos, Robert; Kang, Vicky; Aboubakare, Carissa; Kramer, Matthew; Dugan, Sheila Ann

2017-01-01

This study aims to identify patterns of use and preferences related to technology platforms that could support physical activity (PA) programs in an underserved population. A 29-item questionnaire was administered at 5 health and wellness sites targeting low income communities in Chicago. Frequency tables were generated for Internet, cell phone, and social media use and preferences. Chi-squared analysis was used to evaluate differences across age and income groups. A total of 291 individuals participated and were predominantly female (69.0%). Majority reported incomes less than $30,000 (72.9%) and identified as African American/Black/Caribbean (49.3%) or Mexican/Mexican American (34.3%). Most participants regularly used smartphones (63.2%) and the Internet (75.9%). Respondents frequently used Facebook (84.8%), and less commonly used Instagram (43.6%), and Twitter (20.0%). Free Internet-based exercise programs were the most preferred method to increase PA levels (31.6%), while some respondents (21.0%) thought none of the surveyed technology applications would help. Cell phone, Internet, and social media use is common among the surveyed underserved population. Technology preferences to increase PA levels varied, with a considerable number of respondents not preferring the surveyed technology platforms. Creating educational opportunities to increase awareness may maximize the effectiveness of technology-based PA interventions.

The Influence of Family on Educational and Occupational Achievement of Adolescents in Rural Low-Income Areas: An Ecological Perspective.

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Schiamberg, Lawrence B.; Chin, Chong-Hee

Focusing on the family as a context for the development of life plans by youth, this report summarizes findings of a 14-year longitudinal study on the educational and occupational life plans and achievement of youth in rural low-income areas in six southeastern states. Specific attention is given to (1) how parental educational and occupational…

Embracing autism in Canadian rural communities.

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Hoogsteen, Lindsey; Woodgate, Roberta L

2013-06-01

The purpose of this study was to explore the lived experience of Canadian parents living in rural areas who were parenting a child with autism. A phenomenological design described by van Manen was applied to guide this study. This study took place in rural communities of Western Canada. Purposive sampling was used to recruit 26 families parenting a child with autism in rural communities. Participants ranged in age from 26 to 50 years old and lived an average of 197 kilometres away from an urban city. Parents of children with autism took part in audio-taped, in-depth interviews. A total of 26 open-ended interviews were completed over four months with an average of 83 minutes per interview. All interviews and field notes were transcribed verbatim and analyzed using van Manen's selective highlighting approach. When describing the characteristics of living rurally while parenting a child with autism, parents reported that the rural community had (i) less of everything, (ii) safety and familiarity, and (iii) a family of support. Parents believed that although there were disadvantages to living in a rural community, parents felt isolated in terms of services but not in terms of the support received by the community. The results of this study add to our knowledge of parenting experiences with attention to the rural experience and furthermore, recommendations for nurses and health care professionals were provided. © 2013 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.

Effects of dance on depression, physical function, and disability in underserved adults.

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Murrock, Carolyn J; Graor, Christine Heifner

2014-07-01

This study documented the feasibility and immediate effects of a dance intervention two times per week for 12 weeks on depression, physical function, and disability in older, underserved adults. The one-group, pretest-posttest study had a convenience sample of 40 participants recruited from a federally subsidized apartment complex located in an economically depressed, inner-city neighborhood. Depression, physical function, and disability were measured at baseline and 12 weeks. Average age was 63 years (SD = 7.9), 92% were female, and 75% were African American. At baseline, participants reported increased depression (M = 20.0, SD = 12.4), decreased physical function (M = 56.6, SD = 10.9), and increased disability limitations (M = 65.7, SD = 14.9). At posttest, paired t tests showed that the dance intervention significantly decreased depression, t = 6.11, p dance intervention may be an effective adjunct therapy to improve depression, disability, and physical function in underserved adults.

Differences in Health Care, Family, and Community Factors Associated with Mental, Behavioral, and Developmental Disorders Among Children Aged 2–8 Years in Rural and Urban Areas — United States, 2011–2012

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Holbrook, Joseph R.; Bitsko, Rebecca H.; Hartwig, Sophie A.; Kaminski, Jennifer W.; Ghandour, Reem M.; Peacock, Georgina; Heggs, Akilah; Boyle, Coleen A.

2017-01-01

Problem/Condition Mental, behavioral, and developmental disorders (MBDDs) begin in early childhood and often affect lifelong health and well-being. Persons who live in rural areas report more health-related disparities than those in urban areas, including poorer health, more health risk behaviors, and less access to health resources. Reporting Period 2011–2012. Description of System The National Survey of Children’s Health (NSCH) is a cross-sectional, random-digit–dial telephone survey of parents or guardians that collects information on noninstitutionalized children aged health and well-being, health care access, and family and community characteristics. Using data from the 2011–2012 NSCH, this report examines variations in health care, family, and community factors among children aged 2–8 years with and without MBDDs in rural and urban settings. Restricting the data to U.S. children aged 2–8 years with valid responses for child age and sex, each MBDD, and zip code resulted in an analytic sample of 34,535 children; MBDD diagnosis was determined by parent report and was not validated with health care providers or medical records. Results A higher percentage of all children in small rural and large rural areas compared with all children in urban areas had parents who reported experiencing financial difficulties (i.e., difficulties meeting basic needs such as food and housing). Children in all rural areas more often lacked amenities and lived in a neighborhood in poor condition. However, a lower percentage of children in small rural and isolated areas had parents who reported living in an unsafe neighborhood, and children in isolated areas less often lived in a neighborhood lacking social support, less often lacked a medical home, and less often had a parent with fair or poor mental health. Across rural subtypes, approximately one in six young children had a parent-reported MBDD diagnosis. A higher prevalence was found among children in small rural areas

Cardiovascular risk in minority and underserved women in Appalachian Tennessee: a descriptive study.

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Pearson, Tamera Lea

2010-04-01

The purposes of this study were to translate current knowledge regarding cardiovascular risk factors, screening, and prevention to a disparate population of women and to ascertain the cardiovascular health status and risk factors in a sample of minority and underserved Appalachian women. Demographic data were collected from a voluntary sample of women from a disparate population living in Appalachian Tennessee. A coronary risk profile recorded family health history, personal health history, and lifestyle habits affecting risk for cardiovascular disease. Physiologic measurements included body mass index, blood pressure, fasting glucose, cholesterol levels, ankle brachial index, and carotid artery stenosis. Women in Appalachia Tennessee from a disparate population have high risks for heart disease and stroke. This is a critical time to address any modifiable risk factors and aggressively treat underlying cardiovascular diseases such as hypertension and hypercholesterolemia. Nurse practitioners (NPs) often provide primary care to women who may not be aware of their cardiovascular risks or actual disease. NPs can ensure that their practice incorporates primary and secondary cardiovascular prevention through screening, individual health education, and aggressive evidence-based treatment plans for women.

Homeless Children: Addressing the Challenge in Rural Schools. ERIC Digest.

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Vissing, Yvonne M.

Despite stereotypes to the contrary, homelessness is as prevalent in rural as urban areas. This digest examines the implications of homelessness for rural children and youth and discusses possible actions by rural educators. An estimated half of the rural homeless are families with children. Compared to urban counterparts, rural homeless families…

Values transferred and cherished by mothers in the rural families in the Polish Second Republic

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ANNA JÓZEFOWICZ

2017-10-01

Full Text Available In the Polish Second Republic, so in the country rebom afiter one hundred twenty three years of captivity, the role of a woman as a woman-mother, was significantly emphasized. Press, literature, researchers have proved that safety and order in the whole country depend on safety and order in individual families. The key notion became: „from education of a mother to education of a child”. While analyzing sources such as newspapers, magazines, diaries, guidebooks, I noticed the following values for which mothers in rural families were held to be responsible: 1 ,value of work connected with obligation in farm and household, so role of mother asahousewife; 2.the value of the family as a community and the mother's role in it. Mother was the first protector, tutor, patron of a child. Mother took care of child and other members in the family, she helped them, she guaranteed the positive atmosphere at home, took care of safety in a wide context. It was significant that mother appealed in the process of socialization to common traditions and experiences; 3.value of education and social consciousness, so the role of the mother in shaping social consciousness; 4.patriotic value, so the role of the mother in shaping patriotic attitude

The Quick Peek Program: A Model for Developmental Screening within Underserved Communities

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Harris, Jill; Norton, Amy

2016-01-01

Developmental screening of young children is important in all populations, especially underserved communities with known health care disparities. The American Academy of Pediatrics created guidelines and a toolkit for pediatricians to conduct developmental surveillance and screening, yet these guidelines are not uniformly implemented within…

Gender and Rural Employment: A View from Latin America

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Ballara, Marcela

2007-01-01

The paper focuses on women employment in rural areas and its impacts in food security. The presentation includes data on rural women employment and its different labour strategies: temporary work, non agriculture rural employment and permanent rural employment. Poverty alleviation and its impact on families as well as implications in the economic…

Rural maternity care.

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

2012-10-01

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

Using Videoconferencing to Deliver Individual Therapy and Pediatric Psychology Interventions with Children and Adolescents.

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Nelson, Eve-Lynn; Patton, Susana

2016-04-01

Because of the widening access gap between need for individual and pediatric psychology services and child specialist availability, secure videoconferencing options are more needed than ever to address access challenges across underserved settings. The authors summarize real-time videoconferencing evidence to date across individual therapy with children and pediatric psychology interventions using videoconferencing. The authors summarize emerging guidelines that inform best practices for individual child therapy over videoconferencing. The authors present three case examples to illustrate best practices. The first behavioral pediatrics case summarizes evidence-based approaches in treating a rural young adolescent with attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and hearing impairment. The second pediatric psychology case describes similarities and difference between on-site and videoconferencing services in treating a rural child with toileting concerns. The third adolescent case describes treatment of an urban honors student with depression. Videoconferencing is an effective approach to improving access to individual and pediatric psychology interventions for children and adolescents. Videoconferencing approaches are well accepted by families and show promise for disseminating evidence-based treatments to underserved communities.

A Smart Partnership: Integrating Educational Technology for Underserved Children in India

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Charania, Amina; Davis, Niki

2016-01-01

This paper explores the evolution of a large multi-stakeholder partnership that has grown since 2011 to scale deep engagement with learning through technology and decrease the digital divide for thousands of underserved school children in India. Using as its basis a case study of an initiative called integrated approach to technology in education…

An early stage evaluation of the Supporting Program for Obstetric Care Underserved Areas in Korea.

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Na, Baeg Ju; Kim, Hyun Joo; Lee, Jin Yong

2014-06-01

"The Supporting Program for Obstetric Care Underserved Areas (SPOU)" provides financial aids to rural community (or district) hospitals to reopen prenatal care and delivery services for regions without obstetrics and gynecology clinics or hospitals. The purpose of this study was to evaluate the early stage effect of the SPOU program. The proportion of the number of birth through SPOU was calculated by each region. Also survey was conducted to investigate the extent of overall satisfaction, elements of dissatisfaction, and suggestions for improvement of the program; 209 subjects participated from 7 to 12 December, 2012. Overall, 20% of pregnant women in Youngdong (71 cases) and Gangjin (106 cases) used their community (or district) hospitals through the SPOU whereas Yecheon (23 cases) was 8%; their satisfaction rates were high. Short distance and easy accessibility was the main reason among women choosing community (or district) hospital whereas the reasons of not selecting the community (or district) hospital were favor of the outside hospital's facility, system, and trust in the medical staffs. The SPOU seems to be currently effective at an early stage. However, to successfully implement this program, the government should make continuous efforts to recruit highly qualified medical staffs and improve medical facility and equipment.

Workplace physical violence among hospital nurses and physicians in underserved areas in Jordan.

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AbuAlRub, Raeda Fawzi; Al Khawaldeh, Abdullah Talal

2014-07-01

To: (1) examine the incidence, frequency and contributing factors to workplace violence among nurses and physicians in underserved areas in Jordan, and (2) identify the existing policies and the management modalities to tackle workplace violence. Workplace violence is a major problem in healthcare organisations. An understanding of the nature of violence is essential to implementing successful management. A descriptive exploratory research design. The questionnaire that was developed in 2003 by the International Labor Office, the International Council of Nurses, the World Health Organization, and the Public Services International was used to collect data from a convenience sample of 521 Jordanian physicians and nurses (396 nurses, 125 physicians) who worked in hospitals located in underserved areas. Around 15% of the participants were exposed to physical violence. The factors that contributed to workplace violence were related to absence of policies, inadequate staffing and lack of communication skills. Only 16·9% of participants indicated that there were specific policies available for dealing with physical workplace violence. Strengthening security and providing training were some of the important factors indicated by participants for decreasing violence in the workplace. Workplace violence is a problem in underserved areas that needs attention from administrators. Most participants were very dissatisfied with the way the administrators dealt with the incidents. Instituting firm policies against perpetrators and developing protective violence guidelines to support healthcare staff in managing workplace violence are paramount to tackle the problem of workplace violence. © 2013 John Wiley & Sons Ltd.

Implicações do turismo no espaço rural e em estabelecimentos da agricultura familiar

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Luciano Zanetti Pessôa Candiotto

2011-10-01

Full Text Available Considering the expansion of rural tourism in the world and in Brazil and the incentive of public and private sectors to family farms open their properties to tourism, we wrote this article to presents and discuss the implications of rural tourism and to emphasize their consequences in family farms. So, we worked with brazilian and foreigners literature that analyses the spatial implications and changes of this activity and try to present our impressions about rural tourism, which may grow in rural spaces and modify its social and spatial dynamics. Keywords: tourism; rural space; social and spatial implications; family farm; family unity of production and life (UPVF.

Recruitment practices for U.S. minority and underserved populations in NRG oncology: Results of an online survey

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Elise D. Cook

2018-06-01

Full Text Available Introduction: Cancer clinical trials (CCT provide much of the evidence for clinical guidelines and standards of care. But low levels of CCT participation are well documented, especially for minorities. Methods and materials: We conducted an online survey of 556 recruitment practices across the NRG Oncology network. Survey aims were 1 to learn how sites recruit minority/underserved populations; 2 to better understand the catchment areas of the NRG institutions; and 3 to aid in planning education programs for accrual of minority/underserved populations. Results: The survey response rate was 34.9%. The most effective methods reported for recruiting minority/underserved participants were patient navigators (44.4% and translators (38.9%. All institutions reported using a mechanism for eligibility screening and 71% of institutions reported using a screening/enrollment tracking system. CCT training was required at 78.1% and cultural competency training was required at 47.5% of responding institutions. Only 19.9% of sites used community partners to assist with minority recruitment and just 37.1% of respondents reported a defined catchment area. Sites reported very little race and ethnicity data. Conclusion: This NRG Oncology online survey provides useful data for improvements in trial enrollment and training to recruit minority/underserved populations to CCT. Areas for further investigation include web-based methods for recruitment and tracking, cultural competency training, definition of catchment areas, use of patient navigators, and community partnerships. The survey results will guide recruitment training programs.

Agricultura familiar, multifuncionalidade da agricultura e ruralidade: interfaces de uma realidade complexa Family farming, multifunctionality of agriculture and rurality: interfaces of a complex reality

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Regina Aparecida Leite de Camargo

2012-09-01

Full Text Available Nas últimas décadas, assistimos à revitalização do debate em torno da agricultura familiar pela incorporação das discussões sobre as múltiplas funções da agricultura num rural que não pode mais ser visto como domínio exclusivo da atividade agrícola e dos agricultores. No contexto brasileiro, acreditamos que essa discussão deva ser permeada pela análise de como processos diferenciados de distribuição fundiária e desenvolvimento econômico e o tipo de agricultura resultante geram ruralidades específicas com características como, no caso da agricultura familiar, a manutenção de práticas sociais e de trabalho marcadas pelas relações de parentesco e vizinhança presentes numa sociedade de interconhecimento. Partindo desse princípio, este trabalho analisa a agricultura familiar de um bairro rural do município de Ouro Fino - MG, sua herança histórica e sua participação na criação de uma paisagem natural e humana que muito contribui para a atratividade da região.The last decades witnessed the revitalization of the debate around family farming with the addition of discussions regarding the multiple functions of agriculture, given the fact that rural areas are longer devoted exclusively to agricultural activities. In the Brazilian context, we believed that this debate must be permeated by analyses of how differentiated processes of land distribution and economic development, and the resulting types of agriculture, generate specific ruralities with characteristics such as, in the case of family farming, the maintenance of social and work practices marked by the relations among relatives and neighbours. It is in this light that this research analyses family agriculture in a rural area of Ouro Fino-MG, its historical heritage, and its participation in the creation of a physical and human landscape that greatly contributes to the attractiveness of the region.

Development of Sustainable Rural Tourism

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Sandra Kantar

2017-06-01

Full Text Available This paper presents a sociological view of possibilities for the development of sustainable rural tourism in Koprivnica-Krizevci county, which is located in the north-western part of Croatia. The possibilities for developing rural tourism within the concept of sustainable development have been researched through qualitative empirical research interview method. Research subjects were the owners of tourist farms, decision makers, experts and other stakeholders in the tourism development. Rural tourism represents an alternative to maritime tourism and is relatively undeveloped but important in terms of development of rural areas and family farms. This paper enables an insight into an integrated sustainability of rural tourism which consists of four dimensions: biologicalecological, economic, socio-cultural and political sustainability. In conclusion, integral sustainability in rural tourism is not achieved in all dimensions. Therefore, rural tourism could be a strategy for sustainable development for rural areas and also could be a tool for product differentiation for area that are at stagnation stage.

American Dental Association White Paper Targets Dental Care for the Underserved

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Berthold, Mark

2005-01-01

Reaffirming its leadership role toward better oral health for all Americans, the ADA has produced a white paper that also challenges policy-makers and the US to improve access to dental services. The white paper, "State and Community Models for Improving Access to Dental Care for the Underserved," was presented October 1 to the House of…

Leveraging Telehealth to Bring Volunteer Physicians Into Underserved Communities.

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Uscher-Pines, Lori; Rudin, Robert; Mehrotra, Ateev

2017-06-01

Many disadvantaged communities lack sufficient numbers of local primary care and specialty physicians. Yet tens of thousands of physicians, in particular those who are retired or semiretired, desire meaningful volunteer opportunities. Multiple programs have begun to use telehealth to bridge the gap between volunteer physicians and underserved patients. In this brief, we describe programs that are using this model and discuss the promise and pitfalls. Physician volunteers in these programs report that the work can be fulfilling and exciting, a cutting-edge yet convenient way to remain engaged and contribute. Given the projected shortfall of physicians in the United States, recruiting retired and semiretired physicians to provide care through telehealth increases the total supply of active physicians and the capacity of the existing workforce. However, programs typically use volunteers in a limited capacity because of uncertainty about the level and duration of commitment. Acknowledging this reality, most programs only use volunteer physicians for curbside consults rather than fully integrating them into longitudinal patient care. The part-time availability of volunteers may also be difficult to incorporate into the workflow of busy safety net clinics. As more physicians volunteer in a growing number of telehealth programs, the dual benefits of enriching the professional lives of volunteers and improving care for underserved communities will make further development of these programs worthwhile.

Factors associated with differential uptake of seasonal influenza immunizations among underserved communities during the 2009-2010 influenza season.

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Vlahov, David; Bond, Keosha T; Jones, Kandice C; Ompad, Danielle C

2012-04-01

Influenza vaccination coverage remains low and disparities persist. In New York City, a community-based participatory research project (Project VIVA) worked to address this issue in Harlem and the South Bronx by supplementing existing vaccination programs with non-traditional venues (i.e., community-based organizations). We conducted a 10 min survey to assess access to influenza vaccine as well as attitudes and beliefs towards influenza vaccination that could inform intervention development for subsequent seasons. Among 991 participants recruited using street intercept techniques, 63% received seasonal vaccine only, 11% seasonal and H1N1, and 26% neither; 89% reported seeing a health care provider (HCP) during the influenza season. Correlates of immunization among those with provider visits during the influenza season included being US-born, interest in getting the vaccine, concern about self or family getting influenza, an HCP's recommendation and comfort with government. Among those without an HCP visit, factors associated with immunization included being US born, married, interest in getting the vaccine, understanding influenza information, and concern about getting influenza. Factors associated with lack of interest in influenza vaccine included being born outside the US, Black and uncomfortable with government. In medically underserved areas, having access to routine medical care and understanding the medical implications of influenza play an important role in enhancing uptake of seasonal influenza vaccination. Strategies to improve vaccination rates among Blacks and foreign-born residents need to be addressed. The use of non-traditional venues to provide influenza vaccinations in underserved communities has the potential to reduce health disparities.

The Teacherage in American Rural Education.

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Maxcy, Spencer J.

1979-01-01

Traces the historical evolution of the teacherage, initially proposed as a solution to the problem of housing teachers and as a model home for the edification of rural families. Pinpoints the conceptual connection between the teacherage and the parsonage--each linking the institution to the rural community. (CAM)

Preparing Historically Underserved Students for STEM Careers: The Role of an Inquiry-based High School Science Sequence Beginning with Physics

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Bridges, Jon P.

Improving the STEM readiness of students from historically underserved groups is a moral and economic imperative requiring greater attention and effort than has been shown to date. The current literature suggests a high school science sequence beginning with physics and centered on developing conceptual understanding, using inquiry labs and modeling to allow students to explore new ideas, and addressing and correcting student misconceptions can increase student interest in and preparation for STEM careers. The purpose of this study was to determine if the science college readiness of historically underserved students can be improved by implementing an inquiry-based high school science sequence comprised of coursework in physics, chemistry, and biology for every student. The study used a retrospective cohort observational design to address the primary research question: are there differences between historically underserved students completing a Physics First science sequence and their peers completing a traditional science sequence in 1) science college-readiness test scores, 2) rates of science college-and career-readiness, and 3) interest in STEM? Small positive effects were found for all three outcomes for historically underserved students in the Physics First sequence.

Rural women's health

National Research Council Canada - National Science Library

Thurston, Wilfreda E; Leach, Belinda; Leipert, Beverly

2012-01-01

... about reduction of government funding and access to health care, and about the shortage of new volunteers to replace them when they burn out. These are a few of the stories told in the chapters of this book. This ground-breaking collection of essays identifies priority issues that must be addressed to ensure rural women's well-being, and offers innovative ideas for improvement and further research. Rural women play a critical role within their families and communities, and the health of these wome...

Digital divide and information needs for improving family support among the poor and underserved.

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Collins, Sarah A; Yoon, Sunmoo; Rockoff, Maxine L; Nocenti, David; Bakken, Suzanne

2016-03-01

Despite of its emotional benefits, communication with family members who live abroad can present a large financial burden for low-income foreign-born individuals. The aims of this study were (1) to explore the current technologies available for low-cost communication with family living abroad and (2) to assess the level of awareness and use of low-cost technologies for family communication as well as related information needs among low-income foreign-born individuals. This mixed-methods study included an environmental scan, survey, and focus groups with low-income foreign-born individuals living in East Harlem in New York City. Low-income individuals who have family members living abroad face financial stress with complicated technology choices for communication with family living abroad and they have many information needs. They would welcome interactive and convenient educational tools that (1) build skills for utilization of various technologies and (2) provide decision support to simplify choosing among the vast array of available communication options. © The Author(s) 2014.

Liability concerns and shared use of school recreational facilities in underserved communities.

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Spengler, John O; Connaughton, Daniel P; Maddock, Jason E

2011-10-01

In underserved communities, schools can provide the physical structure and facilities for informal and formal recreation as well as after-school, weekend, and summer programming. The importance of community access to schools is acknowledged by authoritative groups; however, fear of liability is believed to be a key barrier to community access. The purpose of this study was to investigate perceptions of liability risk and associated issues among school administrators in underserved communities. A national survey of school administrators in underserved communities (n=360, response rate of 21%) was conducted in 2009 and analyzed in 2010. Liability perceptions in the context of community access were assessed through descriptive statistics. The majority of respondents (82.2%) indicated concern for liability should someone be injured on school property after hours while participating in a recreational activity. Among those that did not allow community access, 91% were somewhat to very concerned about liability and 86% believed that stronger legislation was needed to better protect schools from liability for after-hours recreational use. Among those who claimed familiarity with a state law that offered them limited liability protection, nearly three fourths were nevertheless concerned about liability. Liability concerns are prevalent among this group of school administrators, particularly if they had been involved in prior litigation, and even if they indicated they were aware of laws that provide liability protection where use occurs after hours. Reducing these concerns will be important if schools are to become locations for recreational programs that promote physical activity outside of regular school hours. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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

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Wanchek, Tanya N; Rephann, Terance J

2013-01-01

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

Eliciting and utilizing rural students' funds of knowledge in the service of science learning: An action research study

Science.gov (United States)

Lloyd, Ellen M.

Several researchers have pointed out the failures of current schooling to adequately prepare students in science and called for radical reform in science education to address the problem. One dominant critique of science education is that several groups of students are not well served by current school science practices and discourses. Rural students represent one of these underserved populations. Yet, there is little in the literature that speaks specifically to reforming the science education of rural students. Utilizing action research as a methodology, this study was designed to learn more about the unique knowledge and life experiences of rural students, and how these unique knowledge, skills and interests could suggest new ways to improve science education in rural schools. Informed by this ultimate goal, I created an after school science club where the participating high school students engaged in solving a local watershed problem, while explicitly bringing to bear their unique backgrounds, local knowledge and life experiences from living in a rural area of Upstate New York. Using Funds of Knowledge as the theoretical framework, this after-school club served as the context to investigate the following research questions: (1) What science-related funds of knowledge do rural high school students have? (2) How were these funds of knowledge capitalized on to support science learning in an after-school setting?

Sources and perceptions of indoor and ambient air pollution in rural Alaska.

Science.gov (United States)

Ware, Desirae; Lewis, Johnnye; Hopkins, Scarlett; Boyer, Bert; Noonan, Curtis; Ward, Tony

2013-08-01

Even though Alaska is the largest state in the United States, much of the population resides in rural and underserved areas with documented disparities in respiratory health. This is especially true in the Yukon-Kuskokwim (southwest) and Ahtna (southcentral) Regions of Alaska. In working with community members, the goal of this study was to identify the air pollution issues (both indoors and outdoors) of concern within these two regions. Over a two-year period, 328 air quality surveys were disseminated within seven communities in rural Alaska. The surveys focused on understanding the demographics, home heating practices, indoor activities, community/outdoor activities, and air quality perceptions within each community. Results from these surveys showed that there is elevated potential for PM10/PM2.5 exposures in rural Alaska communities. Top indoor air quality concerns included mold, lack of ventilation or fresh air, and dust. Top outdoor air pollution concerns identified were open burning/smoke, road dust, and vehicle exhaust (e.g., snow machines, ATVs, etc.). These data can now be used to seek additional funding for interventions, implementing long-term, sustainable solutions to the identified problems. Further research is needed to assess exposures to PM10/PM2.5 and the associated impacts on respiratory health, particularly among susceptible populations such as young children.

Application of Handheld Tele-ECG for Health Care Delivery in Rural India

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Meenu Singh

2014-01-01

Full Text Available Telemonitoring is a medical practice that involves remotely monitoring patients who are not at the same location as the health care provider. The purpose of our study was to use handheld tele-electrocardiogram (ECG developed by Bhabha Atomic Research Center (BARC to identify heart conditions in the rural underserved population where the doctor-patient ratio is low and access to health care is difficult. The objective of our study was clinical validation of handheld tele-ECG as a screening tool for evaluation of cardiac diseases in the rural population. ECG was obtained in 450 individuals (mean age 31.49 ± 20.058 residing in the periphery of Chandigarh, India, from April 2011 to March 2013, using the handheld tele-ECG machine. The data were then transmitted to physicians in Postgraduate Institute of Medical Education and Research (PGIMER, Chandigarh, for their expert opinion. ECG was interpreted as normal in 70% individuals. Left ventricular hypertrophy (9.3% was the commonest abnormality followed closely by old myocardial infarction (5.3%. Patient satisfaction was reported to be ~95%. Thus, it can be safely concluded that tele-ECG is a portable, cost-effective, and convenient tool for diagnosis and monitoring of heart diseases and thus improves quality and accessibility, especially in rural areas.

Population dynamics and rural poverty.

Science.gov (United States)

Fong, M S

1985-01-01

An overview of the relationship between demographic factors and rural poverty in developing countries is presented. The author examines both the micro- and macro-level perspectives of this relationship and the determinants and consequences of population growth. The author notes the prospects for a rapid increase in the rural labor force and considers its implications for the agricultural production structure and the need for institutional change. Consideration is also given to the continuing demand for high fertility at the family level and the role of infant and child mortality in the poverty cycle. "The paper concludes by drawing attention to the need for developing the mechanism for reconciliation of social and individual optima with respect to family size and population growth." The need for rural development projects that take demographic factors into account is stressed as is the need for effective population programs. (summary in FRE, ITA) excerpt

HealthATM: personal health cyberinfrastructure for underserved populations.

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Botts, Nathan E; Horan, Thomas A; Thoms, Brian P

2011-05-01

There is an opportunity for personal health record (PHR) systems to play a vital role in fostering health self-management within underserved populations. If properly designed and promoted, it is possible that patients will use PHRs to become more empowered in taking an active role toward managing their health needs. This research examines the potential of a cyberinfrastructure-based PHR to encourage patient activation in health care, while also having population health implications. A multi-phased, iterative research approach was used to design and evaluate a PHR system called HealthATM, which utilizes services from a cloud computing environment. These services were integrated into an ATM-style interface aimed at providing a broad range of health consumers with the ability to manage health conditions and encourage accomplishment of health goals. Evaluation of the PHR included 115 patients who were clients of several free clinics in Los Angeles County. The majority of patients perceived ease of use (74%) and confidence (73%) in using the HealthATM system, and thought they would like to use it frequently (73%). Patients also indicated a belief in being responsible for their own health. However, fewer felt as though they were able to maintain necessary life changes to improve their health. Findings from the field tests suggest that PHRs can be a beneficial health management tool for underserved populations. In order for these types of tools to be effective within safety-net communities, they must be technically accessible and provide meaningful opportunities to increase patient engagement in their health care. Copyright © 2011. Published by Elsevier Inc.

Disseminating relevant health information to underserved audiences: implications of the Digital Divide Pilot Projects.

Science.gov (United States)

Kreps, Gary L

2005-10-01

This paper examines the influence of the digital divide on disparities in health outcomes for vulnerable populations, identifying implications for medical and public libraries. The paper describes the results of the Digital Divide Pilot Projects demonstration research programs funded by the National Cancer Institute to test new strategies for disseminating relevant health information to underserved and at-risk audiences. The Digital Divide Pilot Projects field-tested innovative systemic strategies for helping underserved populations access and utilize relevant health information to make informed health-related decisions about seeking appropriate health care and support, resisting avoidable and significant health risks, and promoting their own health. The paper builds on the Digital Divide Pilot Projects by identifying implications for developing health communication strategies that libraries can adopt to provide digital health information to vulnerable populations.

The Impact of Family Setting and Local Opportunities on Leaving Home and Migration Destinations of Rural Youths, The Netherlands 1860-1940

NARCIS (Netherlands)

Mönkediek, Bastian; Kok, Jan; Mandemakers, Kees

2016-01-01

In this article we aim to study how Dutch children’s individual destinies result from the complex interplay of family setting and local conditions in a rural environment. We focus on their final move from the parental home, and we will analyse not only timing and incidence of leaving, but also the

[How to carry out work on family planning after adopting production responsibility systems in rural areas].

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Xiao, S H

1982-05-29

After the Third Meeting of the Eleventh People's Congress, the entire responsibility for agricultural production was transferred to a lower level. Peasants in various areas have adopted the so called production responsibility system, and the phenomenon of an increased population rate has also appeared in some areas. In this article, the author discusses how to solve these problems created by the new situation. The 1st step is try to control population growth through socialist propaganda education, administrative measures, economic incentives and punishments, and family planning work. The 2nd step is to popularize the practice of having only 1 child per household in the rural areas. The 2nd and 3rd child in each family should be controlled and prohibited. This policy formulated by the Central Government should be carried out thoroughly. Families which follow the policy and have only 1 child should be encouraged with economic rewards, and those families which have 2 or more children should be punished economically. The 3rd step is to establish a national work team to be in charge of family planning and birth control. There should be an ideological unity among the nation's leadership. Party members and cadres should establish themselves as good examples for the people so that the population control work may become successful.

Methods and design of a 10-week multi-component family meals intervention: a two group quasi-experimental effectiveness trial

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Catherine Rogers

2017-01-01

Full Text Available Abstract Background Given the ongoing childhood obesity public health crisis and potential protective effect of family meals, there is need for additional family meals research, specifically experimental studies with expanded health outcomes that focus on the at-risk populations in highest need of intervention. Future research, specifically intervention work, would also benefit from an expansion of the target age range to include younger children, who are laying the foundation of their eating patterns and capable of participating in family meal preparations. The purpose of this paper is to address this research gap by presenting the objectives and research methods of a 10-week multi-component family meals intervention study aimed at eliciting positive changes in child diet and weight status. Methods This will be a group quasi-experimental trial with staggered cohort design. Data will be collected via direct measure and questionnaires at baseline, intervention completion (or waiting period for controls, and 10-weeks post-intervention. Setting will be faith-based community center. Participants will be 60 underserved families with at least 1, 4–10 year old child will be recruited and enrolled in the intervention (n = 30 or waitlist control group (n = 30. The intervention (Simple Suppers is a 10-week family meals program designed for underserved families from racial/ethnic diverse backgrounds. The 10, 90-min program lessons will be delivered weekly over the dinner hour. Session components include: a interactive group discussion of strategies to overcome family meal barriers, plus weekly goal setting for caregivers; b engagement in age-appropriate food preparation activities for children; and c group family meal for caregivers and children. Main outcome measures are change in: child diet quality; child standardized body mass index; and frequency of family meals. Regression models will be used to compare response variables results of

Integrated model of primary and secondary eye care for underserved rural areas: The L V Prasad Eye Institute experience

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Gullapalli N Rao

2012-01-01

Full Text Available Blindness is a major global public health problem and recent estimates from World Health Organization (WHO showed that in India there were 62 million visually impaired, of whom 8 million are blind. The Andhra Pradesh Eye Disease Study (APEDS provided a comprehensive estimate for prevalence and causes of blindness for the state of Andhra Pradesh (AP. It also highlighted that uptake of services was also an issue, predominantly among lower socio-economic groups, women, and rural populations. On the basis of this analysis, L V Prasad Eye Institute (LVPEI developed a pyramidal model of eye care delivery. This article describes the LVPEI eye care delivery model. The article discusses infrastructure development, human resource development, and service delivery (including prevention and promotion in the context of primary and secondary care service delivery in rural areas. The article also alludes to opportunities for research at these levels of service delivery and the amenability of the evidence generated at these levels of the LVPEI eye health pyramid for advocacy and policy planning. In addition, management issues related to the sustainability of service delivery in rural areas are discussed. The article highlights the key factors required for the success of the LVPEI rural service delivery model and discusses challenges that need to be overcome to replicate the model. The article concludes by noting the potential to convert these challenges into opportunities by integrating certain aspects of the existing healthcare system into the model. Examples include screening of diabetes and diabetic retinopathy in order to promote higher community participation. The results of such integration can serve as evidence for advocacy and policy.

Health problems and the health care provider choices: A comparative study of urban and rural households in Egypt

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Salma B. Galal

2014-06-01

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.

The emergence of the work class "family farmer" as individuals with rights in the path of the Brazilian rural syndicalism A emergência dos "agricultores familiares" como sujeitos de direitos na trajetória do sindicalismo rural brasileiro

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Everton Lazzaretti Picolotto

2009-01-01

Full Text Available The process of the family farmers' recognition as individuals with rights demonstrates having their first roots, in spite of being recent, if compared to the history of the Brazilian rural syndicalism, still in the constitution of the labor-syndical legislation in 1930. Therefore, seeking to explore that process the present paper has as objective to analyze the family farmers' emergence as individuals of rights in the contemporary Brazilian society, analyzing the processes of formation of the rural syndicalism and the expansion of the labor law for the rural workers as a form of accomplishment of a "regulated citizenship" until the decade of 1970; the urge to the official syndicalism, the structuring of a "new syndicalism" and the new social actors' appearance in the field, which made possible the enlargement of the citizenship spaces in the period of re-democratization in Brazil; the "crisis" of the new syndicalism, the creation of new syndical structures "apart" of the official structure (syndicalism of the family agriculture and the emergency of the "family farmers" as subject of rights in the recent periodO processo de reconhecimento dos agricultores familiares como sujeitos de direitos apesar de ser recente quando pensado a partir da trajetória do sindicalismo rural brasileiro demonstra ter suas primeiras raízes ainda na constituição da legislação trabalhista-sindical dos anos de 1930. Visando explorar esse processo o artigo tem por objetivo analisar a emergência dos agricultores familiares como sujeitos de direitos na sociedade brasileira contemporânea. Analisa-se os processos de formação do sindicalismo rural e de expansão da legislação trabalhista para os trabalhadores rurais como forma de realização de uma "cidadania regulada" até a década de 1970; o questionamento do sindicalismo oficial, a estruturação de um "novo sindicalismo" e a emergência de novos atores sociais no campo, que possibilitaram a ampliação dos

A social work study on family patterns and street children

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Mohammad Reza Iravani

2014-06-01

Full Text Available This paper presents a social work study on relationship between various family characteristics and street children in rural area as well as city of Esfahan, Iran. The proposed study selects a sample of 150 street children, 75 from city and 75 from rural area, and using some statistical tests verifies the effects of three factors including family income, place of residency and family size on street children. The results indicate that the city residence had more street children than rural residence did. In addition, there was a meaningful difference between the number of street children in low-income families and high-income families. Finally, the survey results indicate that big size families more likely suffered from street children than low size families did.

Area-level risk factors for adverse birth outcomes: trends in urban and rural settings.

Science.gov (United States)

Kent, Shia T; McClure, Leslie A; Zaitchik, Ben F; Gohlke, Julia M

2013-06-10

Significant and persistent racial and income disparities in birth outcomes exist in the US. The analyses in this manuscript examine whether adverse birth outcome time trends and associations between area-level variables and adverse birth outcomes differ by urban-rural status. Alabama births records were merged with ZIP code-level census measures of race, poverty, and rurality. B-splines were used to determine long-term preterm birth (PTB) and low birth weight (LBW) trends by rurality. Logistic regression models were used to examine differences in the relationships between ZIP code-level percent poverty or percent African-American with either PTB or LBW. Interactions with rurality were examined. Population dense areas had higher adverse birth outcome rates compared to other regions. For LBW, the disparity between population dense and other regions increased during the 1991-2005 time period, and the magnitude of the disparity was maintained through 2010. Overall PTB and LBW rates have decreased since 2006, except within isolated rural regions. The addition of individual-level socioeconomic or race risk factors greatly attenuated these geographical disparities, but isolated rural regions maintained increased odds of adverse birth outcomes. ZIP code-level percent poverty and percent African American both had significant relationships with adverse birth outcomes. Poverty associations remained significant in the most population-dense regions when models were adjusted for individual-level risk factors. Population dense urban areas have heightened rates of adverse birth outcomes. High-poverty African American areas have higher odds of adverse birth outcomes in urban versus rural regions. These results suggest there are urban-specific social or environmental factors increasing risk for adverse birth outcomes in underserved communities. On the other hand, trends in PTBs and LBWs suggest interventions that have decreased adverse birth outcomes elsewhere may not be reaching

Genital Ulcers and Sexual Transmitted Disease in Rural Nigeria ...

African Journals Online (AJOL)

Casual sex was a dominant behavioural pattern. The phenomenon of denial was encountered in females. STDs are not uncommon in rural Nigeria. Integration of Sexual health in rural health, family health, and school health is urgently needed. Key Words: Genital ulcers, STDs, Rural Nigeria Jnl of Medical Investigation and ...

Educational Outcomes across the Generational and Gender Divide: The Rural Family Habitus of Pakistani Families Living in Poverty

Science.gov (United States)

Arnot, Madeleine; Naveed, Arif

2014-01-01

Education for all as a global agenda has particular repercussions for those living in rural poverty. By adopting a Bourdieusian framework to analyse interview data collected from fathers, mothers, sons and daughters in 10 rural Punjabi households, we expose the intersections of education, gender, poverty and rurality. The concept of a "rural…

"The Kids Still Come First": Creating Family Stability during Partnership Instability in Rural, Low-Income Families

Science.gov (United States)

Sano, Yoshie; Manoogian, Margaret M.; Ontai, Lenna L.

2012-01-01

This qualitative study examined the nature of partnerships among 28 rural low-income mothers who experienced partnership transitions across three waves of annual interviews. Guided by "lens of uncertainty" and "boundary ambiguity theory," the authors specifically explored (a) how low-income mothers in rural communities experience partnership…

A controlled community-based trial to promote smoke-free policy in rural communities.

Science.gov (United States)

Hahn, Ellen J; Rayens, Mary Kay; Adkins, Sarah; Begley, Kathy; York, Nancy

2015-01-01

Rural, tobacco-growing areas are disproportionately affected by tobacco use, secondhand smoke, and weak tobacco control policies. The purpose was to test the effects of a stage-specific, tailored policy-focused intervention on readiness for smoke-free policy, and policy outcomes in rural underserved communities. A controlled community-based trial including 37 rural counties. Data were collected annually with community advocates (n = 330) and elected officials (n = 158) in 19 intervention counties and 18 comparison counties over 5 years (average response rate = 68%). Intervention communities received policy development strategies from community advisors tailored to their stage of readiness and designed to build capacity, build demand, and translate and disseminate science. Policy outcomes were tracked over 5 years. Communities receiving the stage-specific, tailored intervention had higher overall community readiness scores and better policy outcomes than the comparison counties, controlling for county-level smoking rate, population size, and education. Nearly one-third of the intervention counties adopted smoke-free laws covering restaurants, bars, and all workplaces compared to none of the comparison counties. The stage-specific, tailored policy-focused intervention acted as a value-added resource to local smoke-free campaigns by promoting readiness for policy, as well as actual policy change in rural communities. Although actual policy change and percent covered by the policies were modest, these areas need additional resources and efforts to build capacity, build demand, and translate and disseminate science in order to accelerate smoke-free policy change and reduce the enormous toll from tobacco in these high-risk communities. © 2014 National Rural Health Association.

Disseminating relevant health information to underserved audiences: implications of the Digital Divide Pilot Projects*

Science.gov (United States)

Kreps, Gary L.

2005-01-01

Objective: This paper examines the influence of the digital divide on disparities in health outcomes for vulnerable populations, identifying implications for medical and public libraries. Method: The paper describes the results of the Digital Divide Pilot Projects demonstration research programs funded by the National Cancer Institute to test new strategies for disseminating relevant health information to underserved and at-risk audiences. Results: The Digital Divide Pilot Projects field-tested innovative systemic strategies for helping underserved populations access and utilize relevant health information to make informed health-related decisions about seeking appropriate health care and support, resisting avoidable and significant health risks, and promoting their own health. Implications: The paper builds on the Digital Divide Pilot Projects by identifying implications for developing health communication strategies that libraries can adopt to provide digital health information to vulnerable populations. PMID:16239960

Habitus of social security in the lifestyles of rural families: the case of the São Miguel do Anta and Piranga municipalities in Zona da Mata Mineira, Brazil

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Vanessa Aparecida Moreira de Barros

Full Text Available ABSTRACT: The universalization of the right to social security for rural producers and rural workers is a recent victory for Brazilian society. The implementation of this benefit began in the early 1990s. This article aimed to analyze the effects of rural social security on the lifestyle of families with retirees. The research was conducted in two small municipalities with agricultural economies from Zona da Mata Mineira region. The research used cross-sectional data collection procedures by applying a survey with open and closed-ended questions about consumption and living. The research sample was representative of the study population, comprising 117 rural elderly people, 64 from Piranga City and 53 from São Miguel do Anta City. Data obtained were categorized, analyzed and tested using Statistical Package for Social Sciences (SPSS software. The survey results highlighted routine behavior and a predisposition to act based on a long term planning system, supported by the certainty of receiving the pension. Planned and long-term investments became a reality, including home improvement projects and acquisition of durable goods. Concerns about immediate family maintenance gave way to a perspective based on future planning.

Utilisation of family planning techniques among women: an ...

African Journals Online (AJOL)

Utilisation of family planning by women will promote sustainable development and general wellbeing of women at the rural community. The study assessed utilization of family planning techniques among women in the rural area of Lagos state. Sixty respondents were randomly selected for the study. Structured interview ...

With Educational Benefits for All: Campus Inclusion through Learning Communities Designed for Underserved Student Populations

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Fink, John E.; Hummel, Mary L.

2015-01-01

This chapter explores the practices of learning communities designed for specific, underserved student populations, highlighting on-campus examples and culminating with a synthesized list of core practices from these "inclusive" learning communities.

Weight status as a moderator of the relationship between motivation, emotional social support, and physical activity in underserved adolescents.

Science.gov (United States)

St George, Sara M; Wilson, Dawn K; Lawman, Hannah G; Van Horn, M Lee

2013-05-01

This study examined weight status as a moderator of the relationship between motivation (controlled, autonomous, regulatory), emotional social support (parents, peers) and moderate-to-vigorous physical activity (MVPA) in underserved adolescents (ethnic minority, low-income). Participants from the Active by Choice Today Trial (n = 1,416; 54% girls, 73% African American, 52% overweight/obese) completed baseline measures, including height and weight, psychosocial surveys, and 7-day accelerometry estimates. Weight status was defined by body mass index z-score (zBMI). Weight status moderated the effects of controlled, autonomous, and regulatory motivation on MVPA, such that these variables were more strongly associated with MVPA in adolescents with lower versus higher zBMI scores. A better understanding of why motivation is not related to MVPA in underserved youth with a higher weight status is needed. Future pediatric obesity treatment in underserved youth may need to move beyond motivation into environmental factors associated with long-term behavior change.

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

Science.gov (United States)

Congdon, J G; Magilvy, J K

2001-01-01

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

Impact of an in-built monitoring system on family planning performance in rural Bangladesh

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Ashraf Ali

2007-06-01

Full Text Available Abstract Background During 1982–1992, the Maternal and Child Health Family Planning (MCH-FP Extension Project (Rural of International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B, in partnership with the Ministry of Health and Family Welfare (MoHFW of the Government of Bangladesh (GoB, implemented a series of interventions in Sirajganj Sadar sub-district of Sirajganj district. These interventions were aimed at improving the planning mechanisms and for reviewing the problem-solving processes to build an effective monitoring system of the interventions at the local level of the overall system of the MOHFW, GoB. Methods The interventions included development and testing of innovative solutions in service-delivery, provision of door-step injectables, and strengthening of the management information system (MIS. The impact of an in-built monitoring system on the overall performance was assessed during the period from June 1995 to December 1996, after the withdrawal of the interventions in 1992. Results The results of the assessment showed that Family Welfare Assistants (FWAs increased household-visits within the last two months, and there was a higher use of service-delivery points even after the withdrawal of the interventions. The results of the cluster surveys, conducted in 1996, showed that the selected indicators of health and family-planning services were higher than those reported by the Bangladesh Demographic and Health Survey (BDHS 1996–1997. During June 1995-December, 1996, the contraceptive prevalence rate (CPR increased by 13 percentage points (i.e. from 40% to 53%. Compared to the national CPR (49%, this increase was statistically significant (p Conclusion The in-built monitoring systems, including effective MIS, accompanied by rapid assessments and review of performance by the programme managers, have potentials to improve family planning performance in low-performing areas.

Participation and innovation, the keys to rural development: The case of rural Medellin

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Rodríguez Adolfo Hernandez

2011-08-01

Full Text Available

family: ";Arial";,";sans-serif";; font-size: 10pt; mso-fareast-font-family: MinionPro-Regular; mso-ansi-language: EN-US;" lang="EN-US">The challenge of rural development in the Municipality of Medellin has to do with a political decision to assess processes based on participation and innovation in rural communities. The authorities have the opportunity to establish a territory in order to guarantee stability and consolidation of the populations considering their many activities when the districts are threatened by rampant urban sprawl. The opportunity exists to rebuild civil society in the territory based on cultural identity and to build new spaces without exclusion.

Structural Quality and Utilization of Outpatient Curative Care Under Family Medicine Scheme in Rural Area of Mazandaran– Iran

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Samad Rouhani

2013-09-01

Full Text Available Background & purpose: Since 2005, a reform known as Rural Insurance and Family Medicine Scheme has introduced to primary health care network in Iran in rural areas and small towns. The content of the reform implies a substantial change in those aspects of health centers that mainly could be categorized as structural quality. Although, this is the requirement of all health care providers, they are not identical in those items. In this article, we have tried to report the relation between structural quality of health centers and utilization of curative care in Mazandran province. Materials & Methods: This was a cross-sectional study conducted in 2013. Secondary and routinely collected data was used to answer the research questions. The source of original data was provincial health authority’s data set. A check list containing pre-identified variables was used to extract the data. Using SPSS software package, regression analysis was run to measure the role of different independent variable on dependent variable. Results: There were 215 rural health centers affiliated to 16 cities or small towns that the reform has taken place. The outreach area population of these health centers was 1ˏ330ˏ212 of which 834ˏ189 (62.71% were covered by rural insurance solely. Health centers are not identical in terms of the characteristics of health centers and their utilization. Among the variables with significant impact on the utilization of outpatient care, except for number of physician in each health centre and existence of state owned pharmacy that were found in some health centers, the rest of variables had significant positive impact on the demand for physician visit. Conclusion: Structural quality has significant impact on the utilization of curative care of primary healthcare units at rural area in Iran. The reform seems well targeted the quality improvement and utilization of effective primary health care.

A qualitative study of medical students in a rural track: views on eventual rural practice.

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Roseamelia, Carrie; Greenwald, James L; Bush, Tiffany; Pratte, Morgan; Wilcox, Jessica; Morley, Christopher P

2014-04-01

Rural tracks (RTs) exist within medical schools across the United States. These programs often target those students from rural areas and those with primary care career interests, given that these factors are robust predictors of eventual rural practice. However, only 26% to 64% of graduates from RTs enter eventual rural practice. We conducted a qualitative, exploratory study of medical students enrolled in one school's RT, examining their interests in rural training, specialization, and eventual rural practice, via open coding of transcripts from focus groups and in-depth individual interviews, leading to identification of emerging themes. A total of 16 out of 54 eligible first- and second-year preclinical medical students participated in focus group sessions, and a total of seven out of 17 eligible third- and fourth-year medical students participated in individual interviews. Analyses revealed the recognition of a "Rural Identity," typical characteristics, and the importance of "Program Fit" and "Intentions for Practice" that trended toward family medicine specialization and rural practice. However, nuances within the comments reveal incomplete commitment to rural practice. In many cases, student preference for rural practice was driven largely by a disinterest in urban practice. Students with rural and primary care practice interests are often not perfectly committed to rural practice. However, RTs may provide a haven for such students within medical school.

Income related inequality and influencing factors: a study for the incidence of catastrophic health expenditure in rural China.

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Gu, Hai; Kou, Yun; Yan, Zhiwen; Ding, Yilei; Shieh, Jusheng; Sun, Jun; Cui, Nan; Wang, Qianjing; You, Hua

2017-09-20

Catastrophic health expenditure (CHE) puts a heavy disease burden on patients' families, aggravating income-related inequality. In an attempt to reduce the financial risks of rural families incurring CHE, China began the New Rural Cooperative Medical System (NCMS) on a trial basis in 2003 and has raised the reimbursement rates continuously since then. Based on statistical data about rural families in sample area of Jiangsu province, this study measures the incidence of CHE, analyzes socioeconomic inequality related to CHE, and explores the influences of the NCMS on the incidence of CHE. Statistical data were acquired from two surveys about rural health care, one conducted in 2009 and one conducted in 2010. In 2009, 1424 rural families were analyzed; in 2010, 1796 rural families were analyzed. An index of CHE is created to enable the evaluation of the associated financial risks. The concentration index and concentration curve are used to measure the income-related inequality involved in CHE. Multiple logistic regression is utilized to explore the factors that influence the incidence of CHE. The incidence of CHE decreased from 13.62% in 2009 to 7.74% in 2010. The concentration index of CHE was changed from -0.298 (2009) to -0.323 (2010). Compared with rural families in which all members were covered by the NCMS, rural families in which some members were not covered by the NCMS had a lower incidence of CHE: The odds ratio is 0.65 with a 95% confidence interval of 0.43 to 1.00. For rural families in which all members were covered by the NCMS, the increase in reimbursement rates is correlated to the decline in the incidence of CHE if other influencing factors were controlled: The odds ratio is 0.48 with a 95% confidence interval of 0.36 to 0.64. Between 2009 and 2010, the incidence rate of CHE in the sampled area decreased sharply, CHE was more concentrated among least wealthy and inequality increased during study period. As of 2010, the poorest rural families still had

The impact of family transitions on child fostering in rural Malawi.

Science.gov (United States)

Grant, Monica J; Yeatman, Sara

2014-02-01

Despite the frequency of divorce and remarriage across much of sub-Saharan Africa, little is known about what these events mean for the living arrangements of children. We use longitudinal data from rural Malawi to examine the effects of family transitions on the prevalence and incidence of child fostering, or children residing apart from their living parents. We find that between 7 % and 15 % of children aged 3-14 are out-fostered over the two-year intersurvey period. Although divorce appears to be a significant driver of child fostering in the cross-sectional analysis, it is not significantly associated with the incidence of out-fostering. In contrast, maternal remarriage has both a lagged and an immediate effect on the incidence of out-fostering. Furthermore, the likelihood of out-fostering is even higher among children whose mother remarried and had a new child during the intersurvey period. Using longitudinal data collected from living mothers rather than from children's current foster homes offers new insights into the reasons children are sent to live with others besides their parents.

Complementary and alternative medicine use by visitors to rural Japanese family medicine clinics: results from the international complementary and alternative medicine survey.

Science.gov (United States)

Shumer, Gregory; Warber, Sara; Motohara, Satoko; Yajima, Ayaka; Plegue, Melissa; Bialko, Matthew; Iida, Tomoko; Sano, Kiyoshi; Amenomori, Masaki; Tsuda, Tsukasa; Fetters, Michael D

2014-09-25

There is growing interest in the use of complementary and alternative medicine (CAM) throughout the world, however previous research done in Japan has focused primarily on CAM use in major cities. The purpose of this study was to develop and distribute a Japanese version of the International Complementary and Alternative Medicine Questionnaire (I-CAM-Q) to assess the use of CAM among people who visit rural Japanese family medicine clinics. Using a Japanese version of the International Complementary and Alternative Medicine Questionnaire (I-CAM-Q), a cross-sectional survey was conducted in three rural family medicine clinics. All patients and those accompanying patients who met inclusion criteria were eligible to participate. Data were entered into SPSS Statistics and analyzed for use by age, gender, and location. Of the 519 respondents who participated in the project, 415 participants reported CAM use in the past 12 months (80.0%). When prayer is excluded, the prevalence of CAM use drops to 77.3% in the past year, or 403 respondents. The most common forms of CAM used by respondents were pain relief pads (n = 170, 32.8%), herbal medicines/supplements (n = 167, 32.2%), and massage by self or family (n = 166, 32.0%). Female respondents, individuals with higher levels of education, and those with poorer overall health status were more likely to use CAM than respondents without these characteristics. Only 22.8% of CAM therapies used were reported to physicians by survey participants. These data indicate that CAM use in rural Japan is common. The results are consistent with previous studies that show that Japanese individuals are more interested in forms of CAM such as pain relief pads and massage, than in mind-body forms of CAM like relaxation and meditation. Due to the high utilization of certain CAM practices, and given that most CAM users do not disclose their CAM use to their doctors, we conclude that physicians in rural Japan would benefit by asking about CAM use

Family networks and income hiding

NARCIS (Netherlands)

Beekman, Gonne; Gatto, Marcel; Nillesen, Eleonora

2015-01-01

This study investigates the relationship between family network density and income hiding in rural Liberia. We link people's behaviour in a modified lottery experiment and a time preference game to detailed information about their family networks. We find that individuals with a dense family

Increasing access to health workers in underserved areas: a conceptual framework for measuring results

NARCIS (Netherlands)

Huicho, L.; Dieleman, M.; Campbell, J.; Codjia, L.; Balabanova, D.; Dussault, G.; Dolea, C.

2010-01-01

Many countries have developed strategies to attract and retain qualified health workers in underserved areas, but there is only scarce and weak evidence on their successes or failures. It is difficult to compare lessons and measure results from the few evaluations that are available. Evaluation

Increasing access to health workers in underserved areas : a conceptual framework for measuring results

NARCIS (Netherlands)

Huicho, Luis; Dieleman, Marjolein; Campbell, James; Codjia, Laurence; Balabanova, Dina; Dussault, Gilles; Dolea, Carmen

Many countries have developed strategies to attract and retain qualified health workers in underserved areas, but there is only scarce and weak evidence on their successes or failures. It is difficult to compare lessons and measure results from the few evaluations that are available. Evaluation

Household and familial resemblance in risk factors for type 2 diabetes and related cardiometabolic diseases in rural Uganda

DEFF Research Database (Denmark)

Nielsen, Jannie; Bahendeka, Silver K.; Whyte, Susan R.

2017-01-01

prevention and screening, we investigated the resemblance of T2D risk factors at household level and by type of familial dyadic relationship in a rural Ugandan community. Methods: This cross-sectional household-based study included 437 individuals ≥13 years of age from 90 rural households in south......-western Uganda. Resemblance in glycosylated haemoglobin (HbA1c), anthropometry, blood pressure, fitness status and sitting time were analysed using a general mixed model with random effects (by household or dyad) to calculate household intraclass correlation coefficients (ICCs) and dyadic regression coefficients...... (ICC=0.24), HbA1c (ICC=0.18) and systolic blood pressure (ICC=0.11). Regarding dyadic resemblance, the highest standardised regression coefficient was seen in fitness status for spouses (0.54, 95% CI 0.32 to 0.76), parent–offspring (0.41, 95% CI 0.28 0.54) and siblings (0.41, 95% CI 0.25 to 0...

Enrolling Minority and Underserved Populations in Cancer Clinical Research.

Science.gov (United States)

Wallington, Sherrie F; Dash, Chiranjeev; Sheppard, Vanessa B; Goode, Tawara D; Oppong, Bridget A; Dodson, Everett E; Hamilton, Rhonda N; Adams-Campbell, Lucile L

2016-01-01

Research suggests that community involvement is integral to solving public health problems, including involvement in clinical trials-a gold standard. Significant racial/ethnic disparities exist in the accrual of participants for clinical trials. Location and cultural aspects of clinical trials influence recruitment and accrual to clinical trials. It is increasingly necessary to be aware of defining characteristics, such as location and culture of the populations from which research participants are enrolled. Little research has examined the effect of location and cultural competency in adapting clinical trial research for minority and underserved communities on accrual for clinical trials. Utilizing embedded community academic sites, the authors applied cultural competency frameworks to adapt clinical trial research in order to increase minority participation in nontherapeutic cancer clinical trials. This strategy resulted in successful accrual of participants to new clinical research trials, specifically targeting participation from minority and underserved communities in metropolitan Washington, DC. From 2012 to 2014, a total of 559 participants enrolled across six nontherapeutic clinical trials, representing a 62% increase in the enrollment of blacks in clinical research. Embedding cancer prevention programs and research in the community was shown to be yet another important strategy in the arsenal of approaches that can potentially enhance clinical research enrollment and capacity. The analyses showed that the capacity to acquire cultural knowledge about patients-their physical locales, cultural values, and environments in which they live-is essential to recruiting culturally and ethnically diverse population samples. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Urban-rural differences in excess mortality among high-poverty populations: evidence from the Harlem Household Survey and the Pitt County, North Carolina Study of African American Health.

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Geronimus, Arline T; Colen, Cynthia G; Shochet, Tara; Ingber, Lori Barer; James, Sherman A

2006-08-01

Black youth residing in high-poverty areas have dramatically lower probabilities of surviving to age 65 if they are urban than if they are rural. Chronic disease deaths contribute heavily. We begin to probe the reasons using the Harlem Household Survey (HHS) and the Pitt County, North Carolina Study of African American Health (PCS). We compare HHS and PCS respondents on chronic disease rates, health behaviors, social support, employment, indicators of health care access, and health insurance. Chronic disease profiles do not favor Pitt County. Smoking uptake is similar across samples, but PCS respondents are more likely to quit. Indicators of access to health care and private health insurance are more favorable in Pitt County. Findings suggest rural mortality is averted through secondary or tertiary prevention, not primary. Macroeconomic and health system changes of the past 20 years may have left poor urban Blacks as medically underserved as poor rural Blacks.

Effect of Health Literacy on Decision-Making Preferences among Medically Underserved Patients.

Science.gov (United States)

Seo, Joann; Goodman, Melody S; Politi, Mary; Blanchard, Melvin; Kaphingst, Kimberly A

2016-05-01

Participation in the decision-making process and health literacy may both affect health outcomes; data on how these factors are related among diverse groups are limited. This study examined the relationship between health literacy and decision-making preferences in a medically underserved population. We analyzed a sample of 576 primary care patients. Multivariable logistic regression was used to examine the independent association of health literacy (measured by the Rapid Estimate of Adult Literacy in Medicine-Revised) and patients' decision-making preferences (physician directed or patient involved), controlling for age, race/ethnicity, and gender. We tested whether having a regular doctor modified this association. Adequate health literacy (odds ratio [OR] = 1.7;P= 0.009) was significantly associated with preferring patient-involved decision making, controlling for age, race/ethnicity, and gender. Having a regular doctor did not modify this relationship. Males were significantly less likely to prefer patient-involved decision making (OR = 0.65;P= 0.024). Findings suggest health literacy affects decision-making preferences in medically underserved patients. More research is needed on how factors, such as patient knowledge or confidence, may influence decision-making preferences, particularly for those with limited health literacy. © The Author(s) 2016.

Family and Community: (Re)Telling Our Own Story

Science.gov (United States)

Byrne, Anne; O'Mahony, Deirdre

2012-01-01

In this article, the authors explore the consequences of an American 1930s classic anthropological study for a contemporary rural community in the west of Ireland. The contribution of family, kin, and community relations to sustaining a rural way of life was the primary focus of Arensberg and Kimball's study of Irish farm families published as…

Factors Associated With Medical School Graduates' Intention to Work With Underserved Populations: Policy Implications for Advancing Workforce Diversity.

Science.gov (United States)

Garcia, Andrea N; Kuo, Tony; Arangua, Lisa; Pérez-Stable, Eliseo J

2018-01-01

Given projected U.S. physician shortages across all specialties that will likely impact underserved areas disproportionately, the authors sought to explore factors most correlated with medical school graduates' intention to work with underserved populations (IWUP). Data from the 2010-2012 Association of American Medical Colleges Medical School Graduation Questionnaire (n = 40,846) were analyzed. Variables (demographics, career preference, debt burden, intention to enter loan forgiveness programs) were examined using chi-square tests and logistic regression models. Respondents included 49.5% (20,228/40,846) women, 16.6% (6,771/40,837) underrepresented minorities (URMs), and 32.4% (13,034/37,342) with primary care intent. The median educational debt was $160,000. Respondents who were women (adjusted odds ratio [aOR] 1.59, 95% confidence interval [CI] 1.49, 1.70), URMs (aOR 2.50, 95% CI 2.30, 2.72), intended to enter loan forgiveness programs (aOR 2.44, 95% CI 2.26, 2.63), intended to practice primary care (aOR 1.65, 95% CI 1.54, 1.76), and intended to emphasize nonclinical careers (aOR 1.23, 95% CI 1.11, 1.37) had greater odds of reporting IWUP. Among those who chose specialties and careers with a nonclinical emphasis, and among those with greater burdens of educational and consumer debt, URMs were nearly twice as likely as other minorities and whites to report IWUP. Findings suggest physician characteristics that may be associated with filling workforce gaps in underserved areas. Restructuring financial incentive programs to support physician leaders and specialists with characteristics associated with IWUP may complement similar policies in primary care and could have key impacts on health equity in underserved areas.

Parent behavior and child weight status among a diverse group of underserved rural families

Science.gov (United States)

The purpose of this study was threefold: to investigate the association between three parenting behaviors (parenting style, feeding style, and feeding practices); to evaluate whether these behaviors were associated with child weight; and to determine whether style (parenting and feeding) moderated t...

Single-Parent Families in Rural Communities

Science.gov (United States)

Lewis, Ken

1978-01-01

Presenting national statistics on single-parent families, this article illustrates the need for serious study of this phenomenon, suggesting that changing divorce laws, increased single-parent adoptions, and an increase in the number of supportive services for single-parent families are contingencies having significant bearing upon the…

Recognition and Analysis of the Effective Social Dimensions on the Tendency of Rural Youths to Addiction in Rural Areas of Isfahan City

Directory of Open Access Journals (Sweden)

Ahmad Hajarian

2013-04-01

Full Text Available Objective: The object of this study was the identification of effective factors and the prevalence of drug use among rural youths. Method: The study was a scientific-comparative research. The sample was 450 rural youths from the city of Isfahan. The related questionnaires were collected in 15 villages of Isfahan city. Findings: Results showed that between family factors and consumption rate, family rift and family dependency and father's occupational status were effective ones. Also, among the social and emotional factors anomaly, tendency to religious issues and friendship with those addicted to drugs have been effective in getting addiated of rural youths. Among personal factors, the increase of education level can act as an effective factor. Conclusion: the results showed that between tnndency to religious factors and consumption rate there is a negative meaning. Similarly, there is a positive meaning among unemployment, stablishing friendship with addicted, being close to urban places and addiction to drugs.

An intergenerational study of perceptions of changes in active free play among families from rural areas of Western Canada.

Science.gov (United States)

Holt, Nicholas L; Neely, Kacey C; Spence, John C; Carson, Valerie; Pynn, Shannon R; Boyd, Kassi A; Ingstrup, Meghan; Robinson, Zac

2016-08-19

Children's engagement in active free play has declined across recent generations. Therefore, the purpose of this study was to examine perceptions of intergenerational changes in active free play among families from rural areas. We addressed two research questions: (1) How has active free play changed across three generations? (2) What suggestions do participants have for reviving active free play? Data were collected via 49 individual interviews with members of 16 families (15 grandparents, 16 parents, and 18 children) residing in rural areas/small towns in the Province of Alberta (Canada). Interview recordings were transcribed verbatim and subjected to thematic analysis guided by an ecological framework of active free play. Factors that depicted the changing nature of active free play were coded in the themes of less imagination/more technology, safety concerns, surveillance, other children to play with, purposeful physical activity, play spaces/organized activities, and the good parenting ideal. Suggestions for reviving active free play were coded in the themes of enhance facilities to keep kids entertained, provide more opportunities for supervised play, create more community events, and decrease use of technology. These results reinforce the need to consider multiple levels of social ecology in the study of active free play, and highlight the importance of community-based initiatives to revive active free play in ways that are consistent with contemporary notions of good parenting.

Recall and Effectiveness of Messages Promoting Smoke-Free Policies in Rural Communities

Science.gov (United States)

Butler, Karen M.; Wiggins, Amanda T.; Kostygina, Ganna; Langley, Ronald E.; Hahn, Ellen J.

2016-01-01

Abstract Introduction: Low-cost media campaigns increase demand for smoke-free policies in underserved rural areas. The study examined the impact of loss- and gain-framed smoke-free print ads on recall and perceived effectiveness in rural communities, controlling for personal characteristics. Methods: Following 6- to 9-month print media campaigns in three rural counties, recall and perceived effectiveness of loss-framed (ie, targeting dangers of secondhand smoke [SHS]) and gain-framed (ie, highlighting positive aspects of smoke-free air) ads were assessed using random-digit-dial phone surveys. Respondents were asked if they remembered each ad, whether they liked it, whether they were prompted to contact a smoke-free coalition, whether the ad made them think, and whether it prompted emotion. Mixed modeling assessed whether personal factors predicted ad recall or perceived effectiveness. Results: Loss-framed ads were less likely to be recalled but more likely to prompt emotion. For ads of both frame types, females reported greater recall and perceived effectiveness than males. Those with less education reported higher perceived effectiveness of the ads but lower recall. Nonsmokers were more likely than smokers to perceive the ads as effective. Knowledge of SHS risk and support for smoke-free workplaces were positively associated with recall and effectiveness. Conclusions: Ad recall and perceived effectiveness were associated with framing and demographic and personal characteristics. Smoke-free efforts in rural areas may be bolstered by continuing to promote benefits of smoke-free workplace policies and educate on SHS risks. Rural areas may need to provide a combination of ad types and framing strategies to appeal to a wide audience. Implications: Rural communities are disproportionately affected by SHS and less likely to be protected by smoke-free policies. This study adds evidence-based guidance for tailoring rural smoke-free media campaigns using different framing

Saúde de famílias do Movimento dos Trabalhadores Sem Terra e de bóias-frias, Brasil, 2005 Salud de familias del Movimiento de Trabajadores Sin Tierra y de trabajadores rurales "jornaleros", Brasil, 2005 Health of families from the Landless Workers' Movement and temporary rural workers, Brazil, 2005

Directory of Open Access Journals (Sweden)

Fernando Ferreira Carneiro

2008-08-01

del Movimiento de los Trabajadores Rurales Sin Tierra, el hecho de ser del Movimiento y estar organizado mejora sus perspectivas de salud, en comparación a los "jornaleros". Los resultados de la modernización conservadora en el campo brasileño ha empeorado las condiciones de vida de los trabajadores rurales "jornaleros" generando una superexplotación del trabajo humano, mientras que la Reforma Agraria ha hecho posible una mejor calidad de vida y salud para las familias, cuando comparadas en las áreas estudiadas.OBJECTIVE: To assess the health conditions of families from the Landless Rural Workers' Movement and temporary rural workers. METHODS: The research involved a comparative study of three populations: a settlement and a camp linked to the Rural Workers' Movement, and the families of temporary rural workers in a city of Southeast Brazil, in 2005. Information relating to sociodemographic characteristics and families were collected by means of questionnaires that were put to 202 families. In addition, structured observation and group discussions were used. A discriminative factor analysis was carried out to confirm differences between the communities. RESULTS: The three communities scored an average of 89%, which implies that they are distinct groups and supports the hypothesis that there are real differences between them when it come to health and lifestyle conditions. There was a high rate of food insecurity (39.5% among temporary rural workers, almost double that of families who were camping and four times greater than those living on settlements. Temporary rural workers' salaries were low and fluctuate, meaning that they were more exposed to pesticides than the families living on settlements or in camps. A striking characteristic of families living on the settlement was that they all practiced animal rearing, unlike the families of temporary rural workers, practically none of whom were able to do so in the city. The perceptions of most families who were

A Tobacco Cessation Intervention with Rural, Medically Underserved, Blue-collar Employees: A Quasiexperimental Study

Directory of Open Access Journals (Sweden)

Telisa Stewart

2016-12-01

Conclusion: Participants at the intervention worksite increased their knowledge regarding the dangers of tobacco use and secondhand smoke exposure. Among current tobacco users, the intervention appeared to increase family rules regarding secondhand smoke exposure in their homes and vehicles.

Designing for Underserved Populations: Constraints and Requirements of Personal Health Record Systems

Centers for Disease Control (CDC) Podcasts

2009-02-11

In this podcast, Dr. Thomas Horan discusses how language, literacy, and access barriers can be overcome with electronic Personal Health Record (PHR) systems to improve health among the most vulnerable, isolated, and underserved populations.  Created: 2/11/2009 by Coordinating Center for Health Information Service (CCHIS), Healthy Healthcare Settings Goal Team, Office of Strategy and Innovation.   Date Released: 9/2/2009.

Health Seeking Behavior and Family Planning Services Accessibility in Indonesia

Directory of Open Access Journals (Sweden)

Niniek Lely Pratiwi

2014-11-01

Full Text Available Background: The MDG target to increase maternal health will be achieved when 50% of maternal deaths can be prevented through improvment the coverage of K1, K4, to make sure that midwife stay in the village improve the delivery by health workers in health facilities, increase coverage long-term contraceptive methods participant as well as family and community empowerment in health. Methods: This study is a further analysis of Riskesdas in 2010 to assess how big the accessibility of services in family planning in Indonesia. Results: Women of 3–4 children in rural greater and prevalence (27.1% compared to women who live in urban areas (25.0%. The main reason of not using contraception mostly because they want to have children 27.0% in urban, 28.2% rural whereas, the second reason is the fear of side effects 23.1% in urban, 16.5% rural. There is 10% of respondent did not use contraceptives, because they did not need it. Health seeking behavior of pregnant women with family planning work status has a significant relationship (prevalence ratio 1.073. The jobless mothers has better access to family planning services compared to working mother. Conclusions: Accessibility of family planning services is inadequate, because not all rural ‘Poskesdes’ equipped with infrastructure and family planning devices, a lack of knowledge of family planning in rural areas. Health seeking behavior of family planning services is mostly to the midwives, the scond is to community health centers and than polindes, ‘poskesdes’ as the ranks third.

Rural and urban differences in the commission of animal cruelty.

Science.gov (United States)

Tallichet, Suzanne E; Hensley, Christopher

2005-12-01

Despite the recent surge in society's interest in human violence, relatively few studies have been conducted examining the closely related phenomenon of animal cruelty. Although several researchers have begun to identify some of the correlates of animal cruelty, few have attempted to understand how differences in the backgrounds of rural and urban residents have led to their abuse of animals. Using survey data from 261 inmates, the authors investigate how demographic, familial differences and species type have contributed to the frequency of acts of animal cruelty. In general, early exposure to animal abuse is a strong predictor of the subsequent behavior. However, rural inmates learned to be cruel by watching family members exclusively, whereas urban inmates learned from family members and friends. Moreover, urban inmates chose dogs, cats, and wild animals as their target animals; however, rural inmates chose only cats.

Unmet Needs of Family Planning Among Women: A Cross-Sectional Study in a Rural Area of Kanchipuram District, Tamil Nadu, South India.

Science.gov (United States)

Vishnu Prasad, R; Venkatachalam, J; Singh, Zile

2016-10-01

Global contraceptive usage was 63.3 % in 2010 which was 9 % more than that in 1990. NFHS-III 2005-2006 revealed that the contraceptive prevalence rate was 56 % while in the past decade it was 48 %. In India, female sterilization is the most commonly preferred method of contraception accounting for 76 %, while in Tamil Nadu it was 90 %. Thus, this study aims at measuring the prevalence of unmet needs of family planning and its determinants in a rural area of Kancheepuram district, Tamil Nadu. The study was carried out as a community-based cross-sectional study in Chunambed panchayat, a rural area in Kanchipuram District, Tamil Nadu, India, among 505 women of age group 15-49 years. Cluster random sampling was done to select the households to include in the study. In every household, all the available and eligible women were explained about the study and recruited after obtaining informed consent. Chi-square test was applied for finding the difference in proportion, and p value <0.05 was considered statistically significant. The prevalence of unmet need for family planning in our study population was nearly 31 %; it was even more for younger age groups and for the women whose family size was less. 51.7 % of the participants were currently using a contraceptive measure and very few of their partners used contraception. Government health facilities were the major source of contraceptive service and majority of our participants were well aware about the various contraceptive methods. Unmet needs of family planning were high in our study population, and the knowledge about the contraceptive use and family planning was found to be fairly adequate.

Effect of Active Videogames on Underserved Children's Classroom Behaviors, Effort, and Fitness.

Science.gov (United States)

Gao, Zan; Lee, Jung Eun; Pope, Zachary; Zhang, Dachao

2016-09-30

The purpose of this study was to examine the effect of active videogames (AVGs) on underserved minority children's on-task classroom behavior, academic effort, and fitness. A one group pre- and posttest repeated measures design was used. In Fall 2013, 95 fourth grade children (57 boys, 38 girls; 96% of minority) from three classes at an underserved urban elementary school participated in teacher-supervised AVG activities (e.g., Wii Sports, Xbox Just Dance). Specifically, students participated in a 50-minute weekly AVG program at school for 6 weeks. Children's academic effort was evaluated by classroom teachers using a validated scale that assessed activity, attention, conduct, and social/emotional behavior. Moreover, children's classroom behavior was observed immediately before and after each AVG session by trained researchers. Finally, cardiovascular fitness was also measured. A paired t-test was used to assess teacher-rated student effort, while one-way (gender) analysis of variance (ANOVA) with repeated measures was performed to analyze children's on-task classroom behavior. There was a significant effect on children's effort between the first (mean = 3.24, SD = 0.75) and last week (mean = 3.41, SD = 0.73) assessments, t = 2.42, P = 0.02. In addition, there was a significant effect on classroom behavior, F = 33.103, P < 0.01. In detail, children scored significantly higher on on-task behavior during the post-AVG observation (mean = 81.4, SD = 12.3) than seen during the pre-AVG observation (mean = 69.8, SD = 14.9). However, no main effect was indicated for gender, F = 0.39, P = 0.54. No significant improvement in cardiovascular fitness was observed, although slight improvements were seen. Offering an AVG program at school could improve underserved minority children's classroom on-task behavior and academic effort. Future studies may include a control group to further confirm the effectiveness of AVG

Feasibility of a rural palliative supportive service.

Science.gov (United States)

Pesut, B; Hooper, B P; Robinson, C A; Bottorff, J L; Sawatzky, R; Dalhuisen, M

2015-01-01

Healthcare models for the delivery of palliative care to rural populations encounter common challenges: service gaps, the cost of the service in relation to the population, sustainability, and difficulty in demonstrating improvements in outcomes. Although it is widely agreed that a community capacity-building approach to rural palliative care is essential, how that approach can be achieved, evaluated and sustained remains in question. The purpose of this community-based research project is to test the feasibility and identify potential outcomes of implementing a rural palliative supportive service (RPaSS) for older adults living with life-limiting chronic illness and their family caregiver in the community. This paper reports on the feasibility aspects of the study. RPaSS is being conducted in two co-located rural communities with populations of approximately 10 000 and no specialized palliative services. Participants living with life-limiting chronic illness and their family caregivers are visited bi-weekly in the home by a nurse coordinator who facilitates symptom management, teaching, referrals, psychosocial and spiritual support, advance care planning, community support for practical tasks, and telephone-based support for individuals who must commute outside of the rural community for care. Mixed-method collection strategies are used to collect data on visit patterns; healthcare utilization; family caregiver needs; and participant needs, functional performance and quality of life. A community-based advisory committee worked with the investigative team over a 1-year period to plan RPaSS, negotiating the best fit between research methods and the needs of the community. Recruitment took longer than anticipated with service capacity being reached at 8 months. Estimated service capacity of one nurse coordinator, based on bi-weekly visits, is 25 participants and their family caregivers. A total of 393 in-person visits and 53 telephone visits were conducted between

The long-term demographic role of community-based family planning in rural Bangladesh.

Science.gov (United States)

Phillips, J F; Hossain, M B; Arends-Kuenning, M

1996-01-01

Experimental studies demonstrating the effectiveness of nonclinical distribution of contraceptives are typically conducted in settings where contraceptive use is low and unmet need is extensive. Determining the long-term role of active outreach programs after initial demand is met represents an increasingly important policy issue in Asia, where contraceptive prevalence is high and fixed service points are conveniently available. This article examines the long-term rationale for household family planning in Bangladesh-where growing use of contraceptives, rapid fertility decline, and normative change in reproductive preferences are in progress, bringing into question the rationale for large-scale deployment of paid outreach workers. Longitudinal data are analyzed that record outreach encounters and contraceptive use dynamics in a large rural population. Findings demonstrate that outreach has a continuing impact on program effectiveness, even after a decade of household visitation. The policy implications of this finding are reviewed.

Screening and Follow-Up Monitoring for Substance Use in Primary Care: An Exploration of Rural-Urban Variations.

Science.gov (United States)

Chan, Ya-Fen; Lu, Shou-En; Howe, Bill; Tieben, Hendrik; Hoeft, Theresa; Unützer, Jürgen

2016-02-01

Rates of substance use in rural areas are close to those of urban areas. While recent efforts have emphasized integrated care as a promising model for addressing workforce shortages in providing behavioral health services to those living in medically underserved regions, little is known on how substance use problems are addressed in rural primary care settings. To examine rural-urban variations in screening and monitoring primary care- based patients for substance use problems in a state-wide mental health integration program. This was an observational study using patient registry. The study included adult enrollees (n = 15,843) with a mental disorder from 133 participating community health clinics. We measured whether a standardized substance use instrument was used to screen patients at treatment entry and to monitor symptoms at follow-up visits. While on average 73.6 % of patients were screened for substance use, follow-up on substance use problems after initial screening was low (41.4 %); clinics in small/isolated rural settings appeared to be the lowest (13.6 %). Patients who were treated for a mental disorder or substance abuse in the past and who showed greater psychiatric complexities were more likely to receive a screening, whereas patients of small, isolated rural clinics and those traveling longer distances to the care facility were least likely to receive follow-up monitoring for their substance use problems. Despite the prevalent substance misuse among patients with mental disorders, opportunities to screen this high-risk population for substance use and provide a timely follow-up for those identified as at risk remained overlooked in both rural and urban areas. Rural residents continue to bear a disproportionate burden of substance use problems, with rural-urban disparities found to be most salient in providing the continuum of services for patients with substance use problems in primary care.

African leaders' views on critical human resource issues for the implementation of family medicine in Africa.

Science.gov (United States)

Moosa, Shabir; Downing, Raymond; Essuman, Akye; Pentz, Stephen; Reid, Stephen; Mash, Robert

2014-01-17

The World Health Organisation has advocated for comprehensive primary care teams, which include family physicians. However, despite (or because of) severe doctor shortages in Africa, there is insufficient clarity on the role of the family physician in the primary health care team. Instead there is a trend towards task shifting without thought for teamwork, which runs the risk of dangerous oversimplification. It is not clear how African leaders understand the challenges of implementing family medicine, especially in human resource terms. This study, therefore, sought to explore the views of academic and government leaders on critical human resource issues for implementation of family medicine in Africa. In this qualitative study, key academic and government leaders were purposively selected from sixteen African countries. In-depth interviews were conducted using an interview guide. All interviews were audio-recorded, transcribed and thematically analysed. There were 27 interviews conducted with 16 government and 11 academic leaders in nine Sub-Saharan African countries: Botswana, Democratic Republic of Congo, Ghana, Kenya, Malawi, Nigeria, Rwanda, South Africa and Uganda. Respondents spoke about: educating doctors in family medicine suited to Africa, including procedural skills and holistic care, to address the difficulty of recruiting and retaining doctors in rural and underserved areas; planning for primary health care teams, including family physicians; new supervisory models in primary health care; and general human resource management issues. Important milestones in African health care fail to specifically address the human resource issues of integrated primary health care teamwork that includes family physicians. Leaders interviewed in this study, however, proposed organising the district health system with a strong embrace of family medicine in Africa, especially with regard to providing clinical leadership in team-based primary health care. Whilst these

Meeting Increasing Demands for Rural General Surgeons.

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Mccarthy, Mary C; Bowers, Howard E; Campbell, Damon M; Parikh, Priti P; Woods, Randy J

2015-12-01

Dynamic assessment of the effective surgical workforce recommends 27,300 general surgeons in 2030; 2,525 more than are presently being trained. Rural shortages are already critical and there has been insufficient preparation for this need. A literature review of the factors influencing the choice of rural practice was performed. A systematic search was conducted of PubMed and the Web of Science to identify applicable studies in rural practice, surgical training, and rural general surgery. These articles were reviewed to identify the pertinent reports. The articles chosen for review are directed to four main objectives: 1) description of the challenges of rural practice, 2) factors associated with the choice of rural practice, 3) interventions to increase interest and preparation for rural practice, and 4) present successful rural surgical practice models. There is limited research on the factors influencing surgeons in the selection of rural surgery. The family practice literature suggests that physicians are primed for rural living through early experience, with reinforcement during medical school and residency, and retained through community involvement, and personal and professional satisfaction. However, more research into the factors drawing surgeons specifically to rural surgery, and keeping them in the community, is needed.

A Practical Risk Stratification Approach for Implementing a Primary Care Chronic Disease Management Program in an Underserved Community.

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Xu, Junjun; Williams-Livingston, Arletha; Gaglioti, Anne; McAllister, Calvin; Rust, George

2018-01-01

The use of value metrics is often dependent on payer-initiated health care management incentives. There is a need for practices to define and manage their own patient panels regardless of payer to participate effectively in population health management. A key step is to define a panel of primary care patients with high comorbidity profiles. Our sample included all patients seen in an urban academic family medicine clinic over a two-year period. The simplified risk stratification was built using internal electronic health record and billing system data based on ICD-9 codes. There were 347 patients classified as high-risk out of the 5,364 patient panel. Average age was 59 years (SD 15). Hypertension (90%), hyperlipidemia (62%), and depression (55%) were the most common conditions among high-risk patients. Simplified risk stratification provides a feasible option for our team to understand and respond to the nuances of population health in our underserved community.

Knowledge, attitude and practice of family planning methods among the rural females of Bagbahara block Mahasamund district in Chhattishgarh State, India

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Mohammad Jawed Quereishi

2017-01-01

Full Text Available Background If many women in Chhattisgarh are not using family planning, it is not due to a lack of knowledge. Knowledge of contraception is nearly universal; 98 percent of currently married women know at least one modern family planning method. Women are most familiar with female sterilization (97 percent, followed by male sterilization (86 percent, the pill (68 percent, the condom (55 percent, and the IUD (40 percent. About two out of every five women (43 percent have knowledge of at least one traditional method. Yet only 45 percent of married women in Chhattisgarh are currently using some method of contraception, about the same as in Madhya Pradesh (44 percent but less than the national average (48 percent. Contraceptive prevalence in Chhattisgarh is considerably higher in urban areas (59 percent than in rural areas (42 percent. Objectives To assess the knowledge, attitude and practice of family planning methods, and factors that could affect their use, among the rural females of reproductive age group (15-49 years. Methods A total of 326 females of reproductive age group (15-49years from the rural areas of Bagbahara block of Mahasamund district in Chhattisgarh state were selected randomly and interviewed with the help of semi-structured interview schedule, which consists of demographic data, questions related to knowledge, attitude and practice of different contraceptive methods and factors affecting the use of these methods. Results Most of the respondents (79% were aware of at least one contraceptive method. The most common source of information on contraception was Health staffs (46%, followed by ASHA (Mitanin workers (42.5%, media (7.5% and relatives/friends (4%. Knowledge of non-contraceptive benefits of family planning methods was claimed by only 19% of the respondents, while knowledge about various adverse effects was reported by 32% of the respondents. About 62% of respondents showed favourable attitude towards family planning methods

Life Satisfaction among Young Adults from Rural Families.

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Wilson, Stephan M.; Peterson, Gary W.

1988-01-01

Examined possible predictors of life satisfaction among 322 low-income young adults from rural Appalachia. Both objective and subjective conditions of life were predictors of life satisfaction: financial resources, self-esteem, and proximity to childhood home were positive predictors; frustrations about limited job opportunities and community size…

Rural exposure during medical education and student preference for future practice location - a case of Botswana.

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Arscott-Mills, Tonya; Kebaabetswe, Poloko; Tawana, Gothusang; Mbuka, Deogratias O; Makgabana-Dintwa, Orabile; Sebina, Kagiso; Kebaetse, Masego; Mokgatlhe, Lucky; Nkomazana, Oathokwa

2016-06-10

Botswana's medical school graduated its first class in 2014. Given the importance of attracting doctors to rural areas the school incorporated rural exposure throughout its curriculum. This study explored the impact of rural training on students' attitudes towards rural practice. The University of Botswana family medicine rural training sites, Maun and Mahalapye. The study used a mixed-methods design. After rural family medicine rotations, third- and fifth-year students were invited to complete a questionnaire and semi-structured interview. Data were analysed using descriptive statistics and thematic analysis. The thirty-six participants' age averaged 23 years and 48.6% were male. Thirtythree desired urban practice in a public institution or university. Rural training did not influence preferred future practice location. Most desired specialty training outside Botswana but planned to practice in Botswana. Professional stagnation, isolation, poorly functioning health facilities, dysfunctional referral systems, and perceived lack of learning opportunities were barriers to rural practice. Lack of recreation and poor infrastructure were personal barriers. Many appreciated the diversity of practice and supportive staff seen in rural practice. Several considered monetary compensation as an enticement for rural practice. Only those with a rural background perceived proximity to family as an incentive to rural practice. The majority of those interviewed plan to practice in urban Botswana, however, they did identify factors that, if addressed, may increase rural practice in the future. Establishing systems to facilitate professional development, strengthening specialists support, and deploying doctors near their home towns are strategies that may improve retention of doctors in rural areas.Keyords: rural health, student perceptions.

"Doing Gender," Ensuring Survival: Mexican Migration and Economic Crisis in the Rural Mountain West

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Schmalzbauer, Leah

2011-01-01

This article draws on ethnographic research to explore the impacts of the current economic crisis on Mexican migrant families in rural Montana. It looks specifically at the ways rural families negotiate gender roles and expectations as they devise survival strategies in response to major economic shifts. My analysis suggests that traditional…

Impact of Patient Empathy Modeling on Pharmacy Students Caring for the Underserved

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Chen, Judy T.; LaLopa, Joseph

2008-01-01

Objective To determine the impact of the Patient Empathy Modeling pedagogy on students' empathy towards caring for the underserved during an advanced pharmacy practice experience (APPE). Design Pharmacy students completing an APPE at 2 primary care clinics participated in a Patient Empathy Modeling assignment for 10 days. Each student “became the patient,” simulating the life of an actual patient with multiple chronic diseases who was coping with an economic, cultural, or communication barrier to optimal healthcare. Students completed the Jefferson Scale of Physician Empathy (JSPE) before and after completing the assignment, and wrote daily journal entries and a reflection paper. Assessment Twenty-six students completed the PEM exercises from 2005-2006. Scores on the JSPE improved. Students' comments in journals and reflection papers revealed 3 major themes: greater appreciation of the difficulty patients have with adherence to medication and treatment regimens, increased empathy for patients from different backgrounds and patients with medical and psychosocial challenges, and improved ability to apply the lessons learned in the course to their patient care roles. Conclusion A Patient Empathy Modeling assignment improved pharmacy students' empathy toward underserved populations. Integrating the assignment within an APPE allowed students to immediately begin applying the knowledge and insight gained from the exercise. PMID:18483606

Income-generating projects in rural communities: from theory to ...

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Income-generating projects in rural communities: from theory to practice - a personal report. ISSN 0378-5254 Journal of Family Ecology and .... mine aspects of household resources management by women in one of the rural settlements ..... an administrative course presented by the support organisation to help them run the ...

Bush Tracks: Journeys in the Development of Rural Pedagogies

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McConaghy, Cathryn; Lloyd, Linley; Hardy, Joy; Jenkins, Kathy

2006-01-01

The academic and social achievements of students in rural schools are very uneven and often absenteeism and suspension rates are high. Factors such as globalisation, economic restructuring, unemployment, youth suicide and family trauma, drought and environmental change (see Bourke & Lockie 2001) also impact on rural schooling and add further…

An intergenerational study of perceptions of changes in active free play among families from rural areas of Western Canada

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Nicholas L. Holt

2016-08-01

Full Text Available Abstract Background Children’s engagement in active free play has declined across recent generations. Therefore, the purpose of this study was to examine perceptions of intergenerational changes in active free play among families from rural areas. We addressed two research questions: (1 How has active free play changed across three generations? (2 What suggestions do participants have for reviving active free play? Methods Data were collected via 49 individual interviews with members of 16 families (15 grandparents, 16 parents, and 18 children residing in rural areas/small towns in the Province of Alberta (Canada. Interview recordings were transcribed verbatim and subjected to thematic analysis guided by an ecological framework of active free play. Results Factors that depicted the changing nature of active free play were coded in the themes of less imagination/more technology, safety concerns, surveillance, other children to play with, purposeful physical activity, play spaces/organized activities, and the good parenting ideal. Suggestions for reviving active free play were coded in the themes of enhance facilities to keep kids entertained, provide more opportunities for supervised play, create more community events, and decrease use of technology. Conclusions These results reinforce the need to consider multiple levels of social ecology in the study of active free play, and highlight the importance of community-based initiatives to revive active free play in ways that are consistent with contemporary notions of good parenting.

Inclusive Early Childhood Development: Ensuring the Rights and Well-Being of Infants and Toddlers with Disabilities and Their Families

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Wertlieb, Donald

2018-01-01

The science and practice of early childhood development now stands ready to address the needs and ensure the rights of infants and young children with disabilities and their families, among the most underserved and marginalized in all regions of the world. Synergies in global policies such as the "United Nations Convention on the Rights of…

Marriage and Suicide among Chinese Rural Young Women

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Zhang, Jie

2010-01-01

Suicides by young females in rural China contribute substantially to the high rate of suicide and the total number of suicides in China. Given the traditional familial structure that remains largely intact in rural China, this research focuses on whether being married is a risk or protective factor for suicide by young women. I examined 168 rural…

HIV risk and prevention among men who have sex with men in rural South Africa.

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Maleke, Kabelo; Makhakhe, Nosipho; Peters, Remco Ph; Jobson, Geoffrey; De Swardt, Glenn; Daniels, Joseph; Lane, Timothy; McIntyre, James A; Imrie, John; Struthers, Helen

2017-03-01

Rural South African men who have sex with men (MSM) are likely to be underserved in terms of access to relevant healthcare and HIV prevention services. While research in urban and peri-urban MSM populations has identified a range of factors affecting HIV risk in South African MSM, very little research is available that examines HIV risk and prevention in rural MSM populations. This exploratory study begins to address this lack by assessing perceptions of HIV risk among MSM in rural Limpopo province. Using thematic analysis of interview and discussion data, two overarching global themes that encapsulated participants' understandings of HIV risk and the HIV risk environment in their communities were developed. In the first theme, "community experience and the rural social environment", factors affecting HIV risk within the broad risk environment were discussed. These included perceptions of traditional value systems and communities as homophobic; jealousy and competition between MSM; and the role of social media as a means of meeting other MSM. The second global theme, "HIV/AIDS knowledge, risk and experience", focused on factors more immediately affecting HIV transmission risk. These included: high levels of knowledge of heterosexual HIV risk, but limited knowledge of MSM-specific risk; inconsistent condom and lubricant use; difficulties in negotiating condom and lubricant use due to uneven power dynamics in relationships; competition for sexual partners; multiple concurrent sexual partnerships; and transactional sex. These exploratory results suggest that rural South African MSM, like their urban and peri-urban counterparts, are at high risk of contracting HIV, and that there is a need for more in-depth research into the interactions between the rural context and the specific HIV risk knowledge and behaviours that affect HIV risk in this population.

Oral Health Inequalities between Rural and Urban Populations of the African and Middle East Region.

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Ogunbodede, E O; Kida, I A; Madjapa, H S; Amedari, M; Ehizele, A; Mutave, R; Sodipo, B; Temilola, S; Okoye, L

2015-07-01

Although there have been major improvements in oral health, with remarkable advances in the prevention and management of oral diseases, globally, inequalities persist between urban and rural communities. These inequalities exist in the distribution of oral health services, accessibility, utilization, treatment outcomes, oral health knowledge and practices, health insurance coverage, oral health-related quality of life, and prevalence of oral diseases, among others. People living in rural areas are likely to be poorer, be less health literate, have more caries, have fewer teeth, have no health insurance coverage, and have less money to spend on dental care than persons living in urban areas. Rural areas are often associated with lower education levels, which in turn have been found to be related to lower levels of health literacy and poor use of health care services. These factors have an impact on oral health care, service delivery, and research. Hence, unmet dental care remains one of the most urgent health care needs in these communities. We highlight some of the conceptual issues relating to urban-rural inequalities in oral health, especially in the African and Middle East Region (AMER). Actions to reduce oral health inequalities and ameliorate rural-urban disparity are necessary both within the health sector and the wider policy environment. Recommended actions include population-specific oral health promotion programs, measures aimed at increasing access to oral health services in rural areas, integration of oral health into existing primary health care services, and support for research aimed at informing policy on the social determinants of health. Concerted efforts must be made by all stakeholders (governments, health care workforce, organizations, and communities) to reduce disparities and improve oral health outcomes in underserved populations. © International & American Associations for Dental Research 2015.

Rural Trends in Diagnosis and Services for Autism Spectrum Disorder

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Ligia Antezana

2017-04-01

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.

The Role Of Rural Women In Crop And Poultry Production In Cross ...

African Journals Online (AJOL)

This paper examines the roles of rural women in crops and poultry production in rural areas in Cross River State, and their contribution to food production and preservation. The paper also revealed that rural women participate in food production and bearing responsibility for food marketing and distribution, family health, ...

Women in natural resource collection: Experience from rural Jharkhand in India

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Ghosh, Bhola Nath; De, Utpal Kumar

2015-02-01

Women living in rural areas are closely associated with the natural environment. Poor families are mostly dependent on natural resources for their survival activities viz. grazing of cattle, collection of water for drinking and cooking purposes and collection of fuel wood. In the poor families due to the compulsion of earning, adult males mostly go for outside activities and sometimes female members of the family also join them. The aforementioned natural resource collection activities are considered to be inferior, less remunerative and hence suitable for the women or young kids to perform. Thus, they are found to be more close to the nature than men and this very close relationship makes them perfect managers of the eco-system in their vicinity. The life of rural women is so much intertwined with the environment that they can't even think of her survival without it. However, there might be significant inter-household differences in the distribution of such activities between male and female members of the families, depending upon their socio-economic characteristics, cultural and religious beliefs and attitude towards women and children. The involvement of women in such activities is also found to be more in the tribal dominated societies. This paper tried to examine the extent to which women in rural Jharkhand are involved in such natural resource collection and management activities. Also, we tried to unearth various economic and cultural reasons and their impact on the involvement of women in such activities across various social and economic groups. The analysis of primary data collected from the rural areas of tribal dominated Jharkhand reveals that income, occupation and status of the families have significant inverse link with the involvement of women and also of girl children at the cost of their educational prospects. Religious and cultural beliefs also enter in the determination of extent of involvement of women and children in the rural society. It is

Knowledge of communicable and noncommunicable diseases among Karen ethnic high school students in rural Thasongyang, the far northwest of Thailand.

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Lorga, Thaworn; Aung, Myo Nyein; Naunboonruang, Prissana; Junlapeeya, Piyatida; Payaprom, Apiradee

2013-01-01

The double burden of communicable and noncommunicable diseases (NCD) is an increasing trend in low- and-middle income developing countries. Rural and minority populations are underserved and likely to be affected severely by these burdens. Knowledge among young people could provide immunity to such diseases within a community in the long term. In this study we aimed to assess the knowledge of several highly prevalent NCDs (diabetes, hypertension, and chronic obstructive pulmonary disease [COPD]) and several highly incident communicable diseases (malaria and diarrheal diseases) among Karen high school students in a rural district in far northwest of Thailand. The aim of the study is to explore information for devising life-course health education that will be strategically based in schools. A cross-sectional survey approved by the ethics committee of Boromarajonani College of Nursing Nakhon Lampang (BCNLP), Lampang, Thailand was conducted in Thasongyang, Tak province, from September 2011 to January 2012. Questionnaires for assessing knowledge regarding diabetes, hypertension, COPD, malaria, and diarrheal diseases were delivered to all 457 Karen high school students attending Thasongyang high school. A total of 371 students returned the questionnaires. Experts' validation and split-half reliability assessment was applied to the instrument. Students' main sources of health information were their teachers (62%), health care workers (60%), television (59%), and parents (54%). Familial risk factors of diabetes and hypertension were not known to more than two thirds of the students. Except obesity and physical inactivity, lifestyle-related risk factors were also not known to the students. Though living in a malaria-endemic area, many of the Karen students had poor knowledge about preventive behaviors. Half of the students could not give a correct answer about the malaria and hygienic practice, which might normally be traditionally relayed messages. Health education and

Using Social Cognitive Theory to Predict Physical Activity and Fitness in Underserved Middle School Children

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Martin, Jeffrey J.; McCaughtry, Nate; Flory, Sara; Murphy, Anne; Wisdom, Kimberlydawn

2011-01-01

Few researchers have used social cognitive theory and environment-based constructs to predict physical activity (PA) and fitness in underserved middle-school children. Hence, we evaluated social cognitive variables and perceptions of the school environment to predict PA and fitness in middle school children (N = 506, ages 10-14 years). Using…

Dementia diagnosis and post-diagnostic support in Scottish rural communities: experiences of people with dementia and their families.

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Innes, Anthea; Szymczynska, Paulina; Stark, Cameron

2014-03-01

This paper explores the reported difficulties and satisfactions with diagnostic processes and post-diagnostic support offered to people with dementia and their families living in the largest remote and rural region in Scotland. A consultation with 18 participants, six people with dementia and 12 family members, was held using semi-structured interviews between September and November 2010. Three points in the diagnostic process were explored: events and experiences pre-diagnosis; the experience of the diagnostic process; and post-diagnostic support. Experiences of people with dementia and their carers varied at all three points in the diagnostic process. Participant experiences in this study suggest greater efforts are required to meet Government diagnosis targets and that post-diagnostic support needs to be developed and monitored to ensure that once a diagnosis is given people are well-supported. Without post-diagnostic provision Government targets for diagnosis are just that, quota targets, rather than a means to improve service experiences.

Motivation for Math in Rural Schools: Student and Teacher Perspectives

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Hardre, Patricia L.

2011-01-01

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…

Effects of racial and ethnic group and health literacy on responses to genomic risk information in a medically underserved population.

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Kaphingst, Kimberly A; Stafford, Jewel D; McGowan, Lucy D'Agostino; Seo, Joann; Lachance, Christina R; Goodman, Melody S

2015-02-01

Few studies have examined how individuals respond to genomic risk information for common, chronic diseases. This randomized study examined differences in responses by type of genomic information (genetic test/family history) and disease condition (diabetes/heart disease), and by race/ethnicity in a medically underserved population. 1,057 English-speaking adults completed a survey containing 1 of 4 vignettes (2-by-2 randomized design). Differences in dependent variables (i.e., interest in receiving genomic assessment, discussing with doctor or family, changing health habits) by experimental condition and race/ethnicity were examined using chi-squared tests and multivariable regression analysis. No significant differences were found in dependent variables by type of genomic information or disease condition. In multivariable models, Hispanics were more interested in receiving a genomic assessment than Whites (OR = 1.93; p literacy had greater interest than those with adequate health literacy. Blacks (OR = 1.78; p = .001) and Hispanics (OR = 1.85; p = .001) had greater interest in discussing information with family than Whites. Non-Hispanic Blacks (OR = 1.45; p = .04) had greater interest in discussing genomic information with a doctor than Whites. Blacks (β = -0.41; p literacy was negatively associated with number of health habits participants intended to change. Findings suggest that race/ethnicity may affect responses to genomic risk information. Additional research could examine how cognitive representations of this information differ across racial/ethnic groups. Health literacy is also critical to consider in developing approaches to communicating genomic information.

Recall and Effectiveness of Messages Promoting Smoke-Free Policies in Rural Communities.

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Rayens, Mary Kay; Butler, Karen M; Wiggins, Amanda T; Kostygina, Ganna; Langley, Ronald E; Hahn, Ellen J

2016-05-01

Low-cost media campaigns increase demand for smoke-free policies in underserved rural areas. The study examined the impact of loss- and gain-framed smoke-free print ads on recall and perceived effectiveness in rural communities, controlling for personal characteristics. Following 6- to 9-month print media campaigns in three rural counties, recall and perceived effectiveness of loss-framed (ie, targeting dangers of secondhand smoke [SHS]) and gain-framed (ie, highlighting positive aspects of smoke-free air) ads were assessed using random-digit-dial phone surveys. Respondents were asked if they remembered each ad, whether they liked it, whether they were prompted to contact a smoke-free coalition, whether the ad made them think, and whether it prompted emotion. Mixed modeling assessed whether personal factors predicted ad recall or perceived effectiveness. Loss-framed ads were less likely to be recalled but more likely to prompt emotion. For ads of both frame types, females reported greater recall and perceived effectiveness than males. Those with less education reported higher perceived effectiveness of the ads but lower recall. Nonsmokers were more likely than smokers to perceive the ads as effective. Knowledge of SHS risk and support for smoke-free workplaces were positively associated with recall and effectiveness. Ad recall and perceived effectiveness were associated with framing and demographic and personal characteristics. Smoke-free efforts in rural areas may be bolstered by continuing to promote benefits of smoke-free workplace policies and educate on SHS risks. Rural areas may need to provide a combination of ad types and framing strategies to appeal to a wide audience. Rural communities are disproportionately affected by SHS and less likely to be protected by smoke-free policies. This study adds evidence-based guidance for tailoring rural smoke-free media campaigns using different framing: gain-framed messages (ie, benefits of smoke-free environments) to

The quality assessment of family physician service in rural regions, Northeast of Iran in 2012.

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Vafaee-Najar, Ali; Nejatzadegan, Zohreh; Pourtaleb, Arefeh; Kaffashi, Shahnaz; Vejdani, Marjan; Molavi-Taleghani, Yasamin; Ebrahimipour, Hosein

2014-04-01

Following the implementation of family physician plan in rural areas, the quantity of provided services has been increased, but what leads on the next topic is the improvement in expected quality of service, as well. The present study aims at determining the gap between patients' expectation and perception from the quality of services provided by family physicians during the spring and summer of 2012. This was a cross-sectional study in which 480 patients who referred to family physician centers were selected with clustering and simple randomized method. Data were collected through SERVQUAL standard questionnaire and were analyzed with descriptive statistics, using statistical T-test, Kruskal-Wallis, and Wilcoxon signed-rank tests by SPSS 16 at a significance level of 0.05. The difference between the mean scores of expectation and perception was about -0.93, which is considered as statistically significant difference (P≤ 0.05). Also, the differences in five dimensions of quality were as follows: tangible -1.10, reliability -0.87, responsiveness -1.06, assurance -0.83, and empathy -0.82. Findings showed that there was a significant difference between expectation and perception in five concepts of the provided services (P≤ 0.05). There was a gap between the ideal situation and the current situation of family physician quality of services. Our suggestion is maintaining a strong focus on patients, creating a medical practice that would exceed patients' expectations, providing high-quality healthcare services, and realizing the continuous improvement of all processes. In both tangible and responsive, the gap was greater than the other dimensions. It is recommended that more attention should be paid to the physical appearance of the health center environment and the availability of staff and employees.

Evaluation of a patient navigation program to promote colorectal cancer screening in rural Georgia, USA.

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Honeycutt, Sally; Green, Rhonda; Ballard, Denise; Hermstad, April; Brueder, Alex; Haardörfer, Regine; Yam, Jennifer; Arriola, Kimberly J

2013-08-15

Colorectal cancer (CRC) is a leading cause of cancer death in the United States. Early detection through recommended screening has been shown to have favorable treatment outcomes, yet screening rates among the medically underserved and uninsured are low, particularly for rural and minority populations. This study evaluated the effectiveness of a patient navigation program that addresses individual and systemic barriers to CRC screening for patients at rural, federally qualified community health centers. This quasi-experimental evaluation compared low-income patients at average risk for CRC (n = 809) from 4 intervention clinics and 9 comparison clinics. We abstracted medical chart data on patient demographics, CRC history and risk factors, and CRC screening referrals and examinations. Outcomes of interest were colonoscopy referral and examination during the study period and being compliant with recommended screening guidelines at the end of the study period. We conducted multilevel logistic analyses to evaluate the program's effectiveness. Patients at intervention clinics were significantly more likely than patients at comparison clinics to undergo colonoscopy screening (35% versus 7%, odds ratio = 7.9, P screening test (43% versus 11%, odds ratio = 5.9, P Screening Program, can be an effective approach to ensure that lifesaving, preventive health screenings are provided to low-income adults in a rural setting. Copyright © 2013 American Cancer Society.

Empowering Promotores de Salud as partners in cancer education and research in rural southwest Kansas.

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Cupertino, Ana Paula; Saint-Elin, Mercedes; de Los Rios, Johana Bravo; Engelman, Kimberly K; Greiner, K Allen; Ellerbeck, Edward F; Nápoles, Anna M

2015-01-01

To describe community-based participatory processes used to develop promotore training on cancer research, and to assess the feasibility of training promotores from rural communities to disseminate cancer research information. Prospective, cohort design. Rural communities in the state of Kansas. 34 Spanish-speaking promotores attended an information session; 27 enrolled and 22 completed training. With input from a community advisory board, the authors developed a leadership and cancer curriculum and trained Spanish-speaking promotores to disseminate information on cancer research. Promotores completed pretraining and post-training surveys in Spanish to assess demographic characteristics and changes in knowledge of cancer, cancer treatment and cancer research studies, and intent to participate in cancer research. Cancer knowledge, awareness of cancer clinical trials, interest in participating in cancer clinical research studies. Compared to pretraining, after training, promotores were more likely to correctly define cancer, identify biopsies, describe cancer stages, and report ever having heard of cancer research studies. Completion rates of the training and willingness to participate in cancer research were high, supporting the feasibility of training promotores to deliver community-based education to promote cancer research participation. Nursing professionals and researchers can collaborate with promotores to disseminate cancer education and research among underserved rural Latino communities in Kansas and elsewhere. Members of these communities appear willing and interested in improving their knowledge of cancer and cancer clinical trials.

The effect of rural development policy on domestic violence

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Ćejvanović Ferhat

2015-01-01

Full Text Available Rural development policy deals with achieving goals for rural areas and a wide range of socio-economic activities are included within it. This work intends to connect rural development policies with the occurrence of domestic violence in rural areas. The area of research is the territory of Tuzla Canton, which is, by definition of OECD (less than 150 habitants/km2, a predominantly rural area. Domestic violence is a wide spread form of violence and a discrimination against women. Domestic violence includes all forms of violence occurring in the family, expanding the possibilities that perpetrators of violence and victims of violence may even be persons who do not live in the family but are related to family members, e.g. former partners, relatives, etc. Research results show that victims of domestic violence are in 90% of the cases women (wives, mothers, daughters, sisters, etc. and that domestic violence is constantly increasing each following year. All forms of violence over women come stem from a principal discrimination towards women which results in coerce or use of force. For that reason, violence over women is a manifestation of a fundamentally unequal position of women and men, and it represents a form of discrimination against women. This paper uses data acquired from Federal Office of Statistics of Federation of Bosnia and Herzegovina and statistical data from the Ministry of Internal Affairs of Tuzla Canton. On the basis of the gathered data, we employed the descriptive method, the method of analysis and synthesis, as well as the comparative method of analysis. The hypothesis of this paper was the assumption that 'women in rural areas are more frequently victims of domestic violence than women living in urban areas'.

Medical School Outcomes, Primary Care Specialty Choice, and Practice in Medically Underserved Areas by Physician Alumni of MEDPREP, a Postbaccalaureate Premedical Program for Underrepresented and Disadvantaged Students.

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Metz, Anneke M

2017-01-01

Minorities continue to be underrepresented as physicians in medicine, and the United States currently has a number of medically underserved communities. MEDPREP, a postbaccalaureate medical school preparatory program for socioeconomically disadvantaged or underrepresented in medicine students, has a stated mission to increase the numbers of physicians from minority or disadvantaged backgrounds and physicians working with underserved populations. This study aims to determine how MEDPREP enhances U.S. physician diversity and practice within underserved communities. MEDPREP recruits disadvantaged and underrepresented in medicine students to complete a 2-year academic enhancement program that includes science coursework, standardized test preparation, study/time management training, and emphasis on professional development. Five hundred twenty-five disadvantaged or underrepresented students over 15 years completed MEDPREP and were tracked through entry into medical practice. MEDPREP accepts up to 36 students per year, with two thirds coming from the Midwest region and another 20% from nearby states in the South. Students complete science, test preparation, academic enhancement, and professionalism coursework taught predominantly by MEDPREP faculty on the Southern Illinois University Carbondale campus. Students apply broadly to medical schools in the region and nation but are also offered direct entry into our School of Medicine upon meeting articulation program requirements. Seventy-nine percent of students completing MEDPREP became practicing physicians. Fifty-eight percent attended public medical schools, and 62% attended medical schools in the Midwest. Fifty-three percent of program alumni chose primary care specialties compared to 34% of U.S. physicians, and MEDPREP alumni were 2.7 times more likely to work in medically underserved areas than physicians nationally. MEDPREP increases the number of disadvantaged and underrepresented students entering and graduating

Rural Math Excel Partnership (RMEP) Project Final Performance Report

Science.gov (United States)

Harmon, Hobart; Tate, Veronica; Stevens, Jennifer; Wilborn, Sandy; Adams, Sue

2018-01-01

The goal of the Rural Math Excel Partnership (RMEP) project, a development project funded by the U.S. Department of Education Investing in Innovation (i3) grant program, was to develop a model of shared responsibility among families, teachers, and communities in rural areas as collective support for student success in and preparation for advanced…

From pipelines to pathways: the Memorial experience in educating doctors for rural generalist practice.

Science.gov (United States)

Rourke, James; Asghari, Shabnam; Hurley, Oliver; Ravalia, Mohamed; Jong, Michael; Parsons, Wanda; Duggan, Norah; Stringer, Katherine; O'Keefe, Danielle; Moffatt, Scott; Graham, Wendy; Sturge Sparkes, Carolyn; Hippe, Janelle; Harris Walsh, Kristin; McKay, Donald; Samarasena, Asoka

2018-03-01

This report describes the community context, concept and mission of The Faculty of Medicine at Memorial University of Newfoundland (Memorial), Canada, and its 'pathways to rural practice' approach, which includes influences at the pre-medical school, medical school experience, postgraduate residency training, and physician practice levels. Memorial's pathways to practice helped Memorial to fulfill its social accountability mandate to populate the province with highly skilled rural generalist practitioners. Programs/interventions/initiatives: The 'pathways to rural practice' include initiatives in four stages: (1) before admission to medical school; (2) during undergraduate medical training (medical degree (MD) program); (3) during postgraduate vocational residency training; and (4) after postgraduate vocational residency training. Memorial's Learners & Locations (L&L) database tracks students through these stages. The Aboriginal initiative - the MedQuest program and the admissions process that considers geographic or minority representation in terms of those selecting candidates and the candidates themselves - occurs before the student is admitted. Once a student starts Memorial's MD program, the student has ample opportunities to have rural-based experiences through pre-clerkship and clerkship, of which some take place exclusively outside of St. John's tertiary hospitals. Memorial's postgraduate (PG) Family Medicine (FM) residency (vocational) training program allows for deeper community integration and longer periods of training within the same community, which increases the likelihood of a physician choosing rural family medicine. After postgraduate training, rural physicians were given many opportunities for professional development as well as faculty development opportunities. Each of the programs and initiatives were assessed through geospatial rurality analysis of administrative data collected upon entry into and during the MD program and PG training (L

No gynecologist in town: the gynecological care of women in rural Taiwan

Directory of Open Access Journals (Sweden)

Lai LJ

2015-07-01

Full Text Available Li-Jung Lai,1 Chia-Lin Chou,2 H Irene Su,3 Tzeng-Ji Chen,1,4 Li-Fang Chou,5 Yueh-Ching Chou,2,6,7 Shinn-Jang Hwang,1,8 Hann-Chin Yu9,10 1Department of Family Medicine, 2Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan; 3Department of Reproductive Medicine, University of California, San Diego, CA, USA; 4Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, 5Department of Public Finance, National Chengchi University, 6Department and Institute of Pharmacology, National Yang-Ming University, 7College of Pharmacy, Taipei Medical University, 8Department of Family Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 9Taipei Veterans General Hospital Hsinchu Branch, Hsinchu County, Taiwan; 10Department of Healthcare Management, Yuanpei University, Hsinchu, Taiwan Background: A shortage of gynecologists exists in many countries. Even within an affluent country, gynecological clinics might not be evenly distributed. The purpose of the study was to investigate the disparity in gynecological care between adult women living in towns with and without gynecologists in Taiwan.Methods: Data sources were the cohort datasets of the National Health Insurance Research Database, with claims data of 1 million beneficiaries in 2010. A woman’s residency was operationally inferred from the locations where she had most frequently visited physicians’ clinics or local community hospitals within the year.Results: In Taiwan, 145 (39.4% of 368 towns had no practicing gynecologist. Of 382,167 women with health care use in the datasets, 21,794 (5.7% lived in towns without a gynecologist. The overwhelming majority of these towns lay in sparsely populated, rural areas. During the year, 132,702 women (34.7% had sought medical help for gynecological diseases and 113,698 (29.8% had visited gynecologists for gynecological diseases. Women in towns without a gynecologist were less

Analysis of context factors in compulsory and incentive strategies for improving attraction and retention of health workers in rural and remote areas: a systematic review.

Science.gov (United States)

Liu, Xiaoyun; Dou, Lixia; Zhang, Huan; Sun, Yang; Yuan, Beibei

2015-07-21

Current literature systematically reports that interventions to attract and retain health workers in underserved areas need to be context specific but rarely defines what that means. In this systematic review, we try to summarize and analyse context factors influencing the implementation of interventions to attract and retain rural health workers. We searched online databases, relevant websites and reference lists of selected literature to identify studies on compulsory rural service programmes and financial incentives. Forty studies were selected. Information regarding context factors at macro, meso and micro levels was extracted and synthesized. Macro-level context factors include political, economic and social factors. Meso-level factors include health system factors such as maldistribution of health workers, growing private sector, decentralization and health financing. Micro-level factors refer to the policy implementation process including funding sources, administrative agency, legislation process, monitoring and evaluation. Macro-, meso- and micro-level context factors can play different roles in agenda setting, policy formulation and implementation of health interventions to attract and retain rural health workers. These factors should be systematically considered in the different stages of policy process and evaluation.

Family physicians' attitude and interest toward participation in urban family physician program and related factors

Directory of Open Access Journals (Sweden)

Masoumeh Sadeghi

2016-01-01

Full Text Available Introduction: Every family physician has a key role in achieving the goals of the family physician program (FPP. Low satisfaction of physicians in certain areas of Iran and their low maintenance level in the program is quite challenging. The aims of the present study were; (1 to assess the attitude of rural/rural-urban family physicians about FPP and (2 to investigate their interest toward participation in urban FPP and (3 to explore the influencing factors. Methods: This cross-sectional study was performed on 137 family physicians who were working in rural/rural-urban FPP in Mashhad University of Medical Sciences (Iran. A self-designed valid and reliable questionnaire including demographic data and thirty questions on the participants' attitudes toward the FPP in Likert scale were used. Data were analyzed by multiple logistic regression models using SPSS software. Results: 49.3% of physicians were interested in continuing their cooperation in the urban-FPP. The mean total attitude score was 62.18 out of 100. The highest agreement and positive attitude of physicians were related to achievements of the program goals dimension. Multiple analyses showed that gender (odds ratio [OR] =5.5; male vs. female and employment status (OR = 16.7 and 10.9 for permanent employment and by contract compared to legal obligation, respectively were significantly associated with physicians' willingness toward participation in the urban-FPP. Conclusion: About half of the studied physicians were interested toward participation in the urban-FPP; Male physicians more than females and permanent employees more than others were willing and interested to participate in the urban-FPP.

Rural and urban married Asian immigrants in Taiwan: determinants of their physical and mental health.

Science.gov (United States)

Chen, Walter; Shiao, Wen-Been; Lin, Blossom Yen-Ju; Lin, Cheng-Chieh

2013-12-01

Different geographical areas with unique social cultures or societies might influence immigrant health. This study examines whether health inequities and different social factors exist regarding the health of rural and urban married Asian immigrants. A survey was conducted on 419 rural and 582 urban married Asian immigrants in Taiwan in 2009. Whereas the descriptive results indicate a worse mental health status between rural and urban married Asian immigrants, rural married immigrants were as mentally healthy as urban ones when considering different social variables. An analysis of regional stratification found different social-determinant patterns on rural and urban married immigrants. Whereas social support is key for rural immigrant physical and mental health, acculturation (i.e., language proficiency), socioeconomics (i.e., working status), and family structure (the number of family members and children living in the family) are key to the mental health of urban married immigrants in addition to social support. This study verifies the key roles of social determinants on the subjective health of married Asian immigrants. Area-differential patterns on immigrant health might act as a reference for national authorities to (re)focus their attention toward more area-specific approaches for married Asian immigrants.

The Jones Family's Culture of Literacy

Science.gov (United States)

Johnson, Amy Suzanne

2010-01-01

This article considers the uses of literacy within the Jones family (all names are pseudonyms), an African American family who lives in the rural South of the United States. Drawing on life history data with three women in the Jones family--Harriet Jones (grandmother), Sally Harris (mother), and Lola Harris (granddaughter)--the author traces how…

Social Problems Of Aged In A Rural Population

Directory of Open Access Journals (Sweden)

Singh Charan

1995-01-01

Full Text Available Research Question: What are the social problems of aged persons in a rural population? Objectives: i To study social problems of aged. ii To identify measures to eliminate them. Study design: Cross- sectional. Setting: Rural areas of Machhra Rural Health & Training Centre attached with Deptt. of SPM, Medical College, Meerut. Participants: Population above 60 years of age. Sample Size: 1000 households from 5 villages, which had 464 participants. Study Variables: Chi- square test. Results: In all, 259 (55.8% aged persons were engaged in productive work while 205 (44.2% were not doing any productive work. Of 376 aged persons living in joint families, 207 (55% were being respected, 71(18.9% were indifferently treated and 98 (26.1% were being neglected by family members. Recommendations: It is a strong case for proper planning to improve the lot of old age population especially for their social problems at the earliest.

Do Mothers in Rural China Practice Gender Equality in Educational Aspirations for Their Children?

Science.gov (United States)

Zhang, Yuping; Kao, Grace; Hannum, Emily

2007-01-01

In this article, the authors focus on a poor rural area in northwestern China and investigates whether the gender attitudes of mothers can be linked to their plans for educating their own children in the future. Using recent longitudinal data from the Gansu Survey of Children and Families (GSCF), a survey of rural 9-12-year-old children, families,…

7 CFR 2003.10 - Rural Development State Offices.

Science.gov (United States)

2010-01-01

... (CONTINUED) ADMINISTRATIVE REGULATIONS ORGANIZATION Functional Organization of the Rural Development Mission... oversight and leadership on major program functions. Major program functions include: Single Family and...

Pop Up/Drill Down: A Traveling Exhibit Designed to Reach Underserved Communities through Art and Geosciences

Science.gov (United States)

Kurtz, N.

2017-12-01

Scientists observe the world around them in an attempt to understand it. Artists observe the world around them in an attempt to create a reflection or response to the environment. It is critical for the two fields to work together in order to engage and inform the general population. The Consortium for Ocean Leadership, the International Ocean Discovery Program and a series of collaborators are designing a traveling exhibit that will inspire underserved communities in the excitement of exploration, the process of science, and the people and tools required to get there. The project aims to learn more about how to increase access to and awareness of ocean/earth science by bringing a pop-up style museum exhibit to local libraries and public events. As an artist with a science and education background and the graphic designer for this exhibit, this author will highlight the ways this project utilizes art and design to educate underserved populations in ocean and geosciences.

Family Size and Rural Poverty -in the Kwahu South District in Ghana ...

African Journals Online (AJOL)

Rural Poverty is one of the greatest social problems confronting the world today. The problem is more pronounced in the developing countries. Ghana is no exception to this global problem of rural poverty. Ghana as a nation has adopted a lot of measures to address poverty. From the early 1980's to 2002, the country has ...

International Comparisons in Underserved Health: Issues, Policies, Needs and Projections.

Science.gov (United States)

Hutchinson, Paul; Morelli, Vincent

2017-03-01

Health care globally has made great strides; for example, there are lower rates of infant and maternal mortality. Increased incomes have led to lower rates of diseases accompanying poverty and hunger. There has been a shift away from the infectious diseases so deadly in developing nations toward first-world conditions. This article presents health care statistics across age groups and geographic areas to help the primary care physician understand these changes. There is a special focus on underserved populations. New technologies in health and health care spending internationally are addressed, emphasizing universal health care. The article concludes with recommendations for the future. Copyright © 2016 Elsevier Inc. All rights reserved.

Improving cardiovascular health of underserved populations in the community with Life's Simple 7.

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Murphy, Marcia Pencak; Coke, Lola; Staffileno, Beth A; Robinson, Janis D; Tillotson, Robin

2015-11-01

The purpose of this nurse practitioner (NP) led initiative was to improve the cardiovascular health of two underserved populations in the community using the American Heart Association (AHA) Life's Simple 7 and My Life Check (MLC) tools. Two inner city community sites were targeted: (a) a senior center servicing African American (AA) older adults, and (b) a residential facility servicing homeless women. Preprogram health data (blood pressure, cholesterol, blood glucose levels, body mass index, and health behaviors) were collected to calculate MLC scores. Postprogram health data were obtained on participants with the lowest MLC scores who completed the program. Eight older adults completed the program with a 37.1% increase in average MLC score (6.2 vs. 8.5). Ten women completed the program with a 9.3% decrease in average MLC score (4.3 vs. 3.9). Favorable benefits were observed in the AA older adults. In contrast, similar benefits were not observed in the women, which may be because of a constellation of social, environmental, biological, and mental health factors. NPs are prepared to target community-based settings to address the health of underserved populations. Engaging key stakeholders in the planning and implementation is essential for success. ©2015 American Association of Nurse Practitioners.

Examining e-Health literacy and the digital divide in an underserved population in Hawai'i.

Science.gov (United States)

Connolly, Kathleen Kihmm; Crosby, Martha E

2014-02-01

Seeking health information is one of the leading uses for the Internet and World Wide Web (WWW). Research has found the amount one benefits from e-Health information (health information from electronic sources) is directly related to the level of e-Health literacy. e-Health literacy is defined as "the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem." In order to gain a further understanding of the effects and use of technology, the digital divide, and the relationship between technology utilization and health outcomes, focus group interviews were conducted with participants diagnosed with diabetes and currently residing in a Medically Underserved Area. Overall, 25 volunteers participated in the four focus group meetings. Based on the focus group discussions, a general low e-Health literacy rate was identified. This was demonstrated by the lack of access to the Internet and the skills needed to retrieve health information. Of the 25 participants, 64% reported having Internet access at some level, but, only one reported going on the Internet every day. When the barriers to using the Internet were discussed, many participants expressed a lack of knowledge in how to retrieve information. Results of this study further show that having access to technology is not necessarily associated with usage. This dynamic is evolving into a new form of digital divide, gap in information retrieval and usage, versus gap in access. This is the first known study to examine e-Health literacy in an underserved population in Hawai'i. With the proliferation of information and communication technology and the transformation of information retrieval to be mobile and "on demand", a multi-pronged communication and education strategy is needed to explore how technology can improve e-Health literacy and health outcomes among underserved populations.

Examining e-Health Literacy and the Digital Divide in an Underserved Population in Hawai‘i

Science.gov (United States)

Crosby, Martha E

2014-01-01

Seeking health information is one of the leading uses for the Internet and World Wide Web (WWW). Research has found the amount one benefits from e-Health information (health information from electronic sources) is directly related to the level of e-Health literacy. e-Health literacy is defined as “the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem.” In order to gain a further understanding of the effects and use of technology, the digital divide, and the relationship between technology utilization and health outcomes, focus group interviews were conducted with participants diagnosed with diabetes and currently residing in a Medically Underserved Area. Overall, 25 volunteers participated in the four focus group meetings. Based on the focus group discussions, a general low e-Health literacy rate was identified. This was demonstrated by the lack of access to the Internet and the skills needed to retrieve health information. Of the 25 participants, 64% reported having Internet access at some level, but, only one reported going on the Internet every day. When the barriers to using the Internet were discussed, many participants expressed a lack of knowledge in how to retrieve information. Results of this study further show that having access to technology is not necessarily associated with usage. This dynamic is evolving into a new form of digital divide, gap in information retrieval and usage, versus gap in access. This is the first known study to examine e-Health literacy in an underserved population in Hawai‘i. With the proliferation of information and communication technology and the transformation of information retrieval to be mobile and “on demand”, a multi-pronged communication and education strategy is needed to explore how technology can improve e-Health literacy and health outcomes among underserved populations. PMID:24567867

Evaluating tablet computers as a survey tool in rural communities.

Science.gov (United States)

Newell, Steve M; Logan, Henrietta L; Guo, Yi; Marks, John G; Shepperd, James A

2015-01-01

Although tablet computers offer advantages in data collection over traditional paper-and-pencil methods, little research has examined whether the 2 formats yield similar responses, especially with underserved populations. We compared the 2 survey formats and tested whether participants' responses to common health questionnaires or perceptions of usability differed by survey format. We also tested whether we could replicate established paper-and-pencil findings via tablet computer. We recruited a sample of low-income community members living in the rural southern United States. Participants were 170 residents (black = 49%; white = 36%; other races and missing data = 15%) drawn from 2 counties meeting Florida's state statutory definition of rural with 100 persons or fewer per square mile. We randomly assigned participants to complete scales (Center for Epidemiologic Studies Depression Inventory and Regulatory Focus Questionnaire) along with survey format usability ratings via paper-and-pencil or tablet computer. All participants rated a series of previously validated posters using a tablet computer. Finally, participants completed comparisons of the survey formats and reported survey format preferences. Participants preferred using the tablet computer and showed no significant differences between formats in mean responses, scale reliabilities, or in participants' usability ratings. Overall, participants reported similar scales responses and usability ratings between formats. However, participants reported both preferring and enjoying responding via tablet computer more. Collectively, these findings are among the first data to show that tablet computers represent a suitable substitute among an underrepresented rural sample for paper-and-pencil methodology in survey research. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

Rural Health, Center of Excellence for Remote and Medically Under-Served Areas (CERMUSA). Addendum

Science.gov (United States)

2010-07-01

Plaque *c. Pulpitis or an abscess d. Gingivitis 4. Pulp necrosis can be defined as: a. A viral infection in the gums *b. Death of the pulp...families. Available data indicate higher incidences of breast and prostate cancer affecting U.S. military versus the general population (Zhu et al...Meyerowitz, B. E., et al. (2006). Fatigue in long-term breast carcinoma survivors: A longitudinal investigation. Cancer, 106(4), 751-758. Courneya, K

Nigerian Journal of Family Practice: Submissions

African Journals Online (AJOL)

Coverage of NJFP includes: Family medicine; Primary health care; District health; Rural health; Health promotion Prevention of disease and disability ;Community oriented primary care ;Education and training of professionals and health workers in primary health care and family medicine; Medical informatics and ...

Treating Rural Pediatric Obesity through Telemedicine: Baseline Data from a Randomized Controlled Trial

OpenAIRE

Gallagher, Katherine Steiger; Davis, Ann McGrath; Malone, Brett; Landrum, Yasuko; Black, William

2011-01-01

Objective To describe baseline characteristics of participants in a pediatric obesity intervention tailored specifically to rural families delivered via telemedicine. Methods Randomized-control trial comparing a family-based behavioral intervention to a usual care condition. Participants Fifty-eight first through fifth graders and their parents from the rural Midwest. Measures Demographic, body mass index (BMI), Actigraph activity monitor information, 24-h dietary recalls, Child Behavior Chec...

Collaboration Among Institutions to Bring Geospatial Technology to an Underserved Rural Region

Science.gov (United States)

Johnson, T.

2012-12-01

The University of Maine at Machias and Washington County Community College, the two smallest and most remote public institutions in Maine, provide important education and workforce development services in a rural and economically-challenged region. Through an innovative collaboration supported by the National Science Foundation, the two institutions have developed geospatial technology (GST) programs designed to meet the specific workforce needs of the region, affording students with the opportunity to pursue degrees, certificates and minors. Prior to this effort, neither school had the resources to maintain a GST laboratory or to offer courses consistently. The region had almost no GST capacity with which to manage critical environmental resources and grapple with economic, public safety, and public health challenges. Several statewide studies had shown a growing need for more GST technicians and training for incumbent workers. The new programs are designed to produce a small number of specialist technicians with associate's degrees and a large number of ancillary users with significant GST expertise from courses, certificates or minors. Course content is shaped by workforce research in Maine and elsewhere, and all courses are offered in either blended, online or short-term intensive formats to provide access to incumbent workers and extend the geographic reach of the programs. Through the university's Geographic Information Systems (GIS) Service Center, students from both institutions engage in real-world projects, and are linked with employers via internships. This has the added plus of providing low-cost and no-cost GIS services to area clients, generating demand. Many of these projects and internships lead to work for graduates, even through the economic downturn. By creating courses that serve multiple audiences, each contributing a small number to the total enrollment, the programs constitute a sustainable model that serves the growing needs of the region

Libyan intuitive for rural electrification

International Nuclear Information System (INIS)

Ibrahim, I. M. Saleh; Kreama, N. M.; Khalat, M. A.

2006-01-01

One of the obstacles in rural electrification is choosing the type of the electric source which best fits rural areas technically, socially, and economically. Renewable sources can be used to electrify rural areas. Rural electrification in Libya by photovoltaic systems in a national program which is devoted to electrify isolated villages, as part of this program the installation of 300 systems was started at the beginning of the year 2003 with a total power of 400 K Wp, the sizes of stand alone systems are 1.8 K Wp, 1.2 K Wp, 0.75 K Wp, and 0.15 K Wp, beside a hybrid system of diesel and PV. The systems was designed to supply different family needs a total of 5000 inhabitants will benefit from this project. In this paper we will introduce the rural photovoltaic electrification in Libya program, company the performance of three different PV sizes through the first two years of working. The systems performing well and with performance ratio much more than the deigned, very little power failure was reported, and there are social and technical issues to be addressed before, and after the installation of the PV system.(Author)

Practices Caring For The Underserved Are Less Likely To Adopt Medicare's Annual Wellness Visit.

Science.gov (United States)

Ganguli, Ishani; Souza, Jeffrey; McWilliams, J Michael; Mehrotra, Ateev

2018-02-01

In 2011 Medicare introduced the annual wellness visit to help address the health risks of aging adults. The visit also offers primary care practices an opportunity to generate revenue, and may allow practices in accountable care organizations to attract healthier patients while stabilizing patient-practitioner assignments. However, uptake of the visit has been uneven. Using national Medicare data for the period 2008-15, we assessed practices' ability and motivation to adopt the visit. In 2015, 51.2 percent of practices provided no annual wellness visits (nonadopters), while 23.1 percent provided visits to at least a quarter of their eligible beneficiaries (adopters). Adopters replaced problem-based visits with annual wellness visits and saw increases in primary care revenue. Compared to nonadopters, adopters had more stable patient assignment and a slightly healthier patient mix. At the same time, visit rates were lower among practices caring for underserved populations (for example, racial minorities and those dually enrolled in Medicaid), potentially worsening disparities. Policy makers should consider ways to encourage uptake of the visit or other mechanisms to promote preventive care in underserved populations and the practices that serve them.

Cancer screening promotion among medically underserved Asian American women: integration of research and practice.

Science.gov (United States)

Yu, Mei-yu; Seetoo, Amy D; Hong, Oi Saeng; Song, Lixin; Raizade, Rekha; Weller, Adelwisa L Agas

2002-01-01

Mammography and Pap smear tests are known to be effective early detection measures for breast and cervical cancers, respectively, but Asian Americans are reluctant to make visits for routine preventive care. Quantitative and qualitative research conducted by the Healthy Asian Americans Project (HAAP) between 1996 and 1999 indicated that Asian residents in southeastern Michigan, like the general Asian population in the US, underutilized early cancer screening programs due to cultural, psychosocial, linguistic, and economic barriers. This article reports how the HAAP's research findings guided the Michigan Breast and Cervical Cancer Control Program (BCCCP) promotion (conducted from 2000 to 2001 among medically underserved Asian women residing in southeastern Michigan), and how evaluation of the HAAP's BCCCP promotion will direct future research and health promotion programs. The article presents strategies used to improve access to cancer screening programs for diverse Asian sub-groups as well as outcomes of the 2-year HAAP's BCCCP promotion among the target population. Discussion regarding lessons and experiences gained from integration of research and practice has implications on design and implementation of the cancer screening promotion for the rapidly increasing Asian American population as well as other medically underserved minority populations in the US.

The Need and Use the Rural ICT Services in Iranian Rural Areas

Directory of Open Access Journals (Sweden)

Amir Mozafar Amini

2015-11-01

Full Text Available Nowadays, Internet access and use of information resources in all human societies are experiencing a rising trend, and different communities are used each with multiple infrastructures due to the benefits of ICT. The present study was based on applied research. In this research, a hybrid approach involving quantitative methods (survey and qualitative (observation, interviews was used. Statistical population of this study consists of two parts, the first part responsible for rural ICT offices, with a population of 125 people using Cochran Formula 80 subjects were selected as first sample, and the second part of the rural of first sample villages with a population of 84,836 people using Cochran formula and randomized-comparative method were studied as second sample. The questionnaire was subjected to reliability testing by using data collection in the pilot study with Cronbach’s Alpha value 0.73 to 0.95 for all variables. SPSS statistical software was used to analysis the data. The results of the study indicate that the overall performance of the agencies providing services to the rural was lower-middle in the offices in banking services has received first place, and the final ranking in the provision of health services. The results of study showed that rural employment, level education and family size effect on the rate of rural ICT offices.

Recent abuse from in-laws and associations with adverse experiences during the crisis among rural Ivorian women: extended families as part of the ecological model.

Science.gov (United States)

Falb, Kathryn L; Annan, Jeannie; Hossain, Mazeda; Topolska, Monika; Kpebo, Denise; Gupta, Jhumka

2013-01-01

Violence against women in the aftermath of conflict represents a growing area of concern. However, little is known about violence perpetrated by a woman's in-laws and how these experiences may be related to adverse experiences during a crisis. Therefore, guided by the ecological model, the objectives of the following analysis were to (1) document adverse experiences during the crisis among rural Ivorian women and (2) investigate the association between such experiences and abuse perpetrated by partners' extended families, among a sample of women residing in rural Côte d'Ivoire. Utilising data from a baseline survey conducted in 2010, we generated descriptive statistics and used generalised estimating equations to assess the relationships of interest. Women whose family was victimised during the crisis had 1.7 times the odds of reporting past-year in-law abuse compared to those women whose families did not experience such adversity (95% CI: 1.1-2.4), and women who experienced a personal form of adversity had twice the odds of reporting past-year in-law abuse compared to women who did not report victimisation (95% CI: 1.2-3.2). Being forced to flee was not statistically associated with in-law abuse. Findings underscore the importance of addressing in-law abuse in order to promote women's health in post-conflict settings.

The impacts of rapid demographic transition on family structure and income inequality in Brazil, 1981-2011.

Science.gov (United States)

Maia, Alexandre Gori; Sakamoto, Camila Strobl

2016-11-01

This study analysed the impact of changing family structure on income distribution. Specifically, it analysed how changes in the proportions of different categories of family in the population contributed to increases in the income of the richest and poorest social strata in Brazil, and the consequent impacts on income inequality. Rural and urban families were compared in order to understand how these dynamics had different impacts on more developed (urban) and less developed (rural) areas. The results emphasize how changes observed in family structure are more pronounced among the richest families, contributing to an increase in (i) the income of the richest families and (ii) income inequality between the richest and poorest families, as well as between urban and rural areas.

Assessing Differences in the Availability of Opioid Addiction Therapy Options: Rural Versus Urban and American Indian Reservation Versus Nonreservation.

Science.gov (United States)

Hirchak, Katherine A; Murphy, Sean M

2017-01-01

Opioid misuse is a large public health problem in the United States. Residents of rural areas and American Indian (AI) reservation/trust lands represent traditionally underserved populations with regard to substance-use disorder therapy. Assess differences in the number of opioid agonist therapy (OAT) facilities and physicians with Drug Addiction Treatment Act (DATA) waivers for rural versus urban, and AI reservation/trust land versus non-AI reservation/trust land areas in Washington State. The unit of analysis was the ZIP code. The dependent variables were the number of OAT facilities and DATA-waivered physicians in a region per 10,000 residents aged 18-64 in a ZIP code. A region was defined as a ZIP code and its contiguous ZIP codes. The independent variables were binary measures of whether a ZIP code was classified as rural versus urban, or AI reservation/trust land versus non-AI reservation/trust land. Zero-inflated negative binomial regressions with robust standard errors were estimated. The number of OAT clinics in a region per 10,000 ZIP-code residents was significantly lower in rural versus urban areas (P = .002). This did not differ significantly between AI reservation/trust land and non-AI reservation/trust land areas (P = .79). DATA-waivered physicians in a region per 10,000 ZIP-code residents was not significantly different between rural and urban (P = .08), or AI reservation/trust land versus non-AI reservation/trust land areas (P = .21). It appears that the potential for Washington State residents of rural and AI reservation areas to receive OAT is similar to that of residents outside of those areas; however, difficulties in accessing therapy may remain, highlighting the importance of expanding health care insurance and providing support for DATA-waivered physicians. © 2016 National Rural Health Association.

Patterns of life events preceding the suicide in rural young Chinese: a case control study.

Science.gov (United States)

Zhang, Jie; Ma, Zhenyu

2012-10-01

Previous studies on the Chinese suicide found some life events prior to the suicide different from those in the West, but there is a lack of summary of the Chinese life event patterns to better understand the effects of the social structure on Chinese suicide. We tried to identify the life events that precede the Chinese rural youth suicides and compare them with what are found in the West, so as to find the patterns that are particularly true in the Chinese culture contexts. Suicide cases were investigated with a psychological autopsy study in rural China, and local community living controls were also interviewed with the same protocol. We collapsed 64 negative life events into six categories: (1) Marriage/Love, (2) Family/Home, (3) Work/Business, (4) Health/Hospital, (5) Law/Legal, (6) Friend/Relationship. About 92.3% of the suicides studied had experienced at least one type of negative life events. The three most common negative life events categories in the past one year were Family/Home (60.7%), Health/Hospital (53.8%) and Marriage/Love (51.3%) in the rural young suicide victims. Among the negative life events, those related to family relations, love affairs, and marital issues were most likely to precede a suicide of rural suicides in China, and it is especially true of rural young women. Family is an important social institution in rural China for suicide prevention efforts. Copyright © 2012 Elsevier B.V. All rights reserved.

Constraints to Gender Participation in Rural Community ...

African Journals Online (AJOL)

User

who reside in the rural areas as family units (Agricultural Extension Society of Nigeria ... cooperatives, individuals through private initiatives, corporate bodies as well as ..... from similar cultural background have many things in common.

Assessment of the nutrition and physical activity education needs of low-income, rural mothers: can technology play a role?

Science.gov (United States)

Atkinson, Nancy L; Billing, Amy S; Desmond, Sharon M; Gold, Robert S; Tournas-Hardt, Amy

2007-08-01

The purpose of this study was to examine the perceptions of low-income, rural mothers regarding their need for nutrition and physical activity education and the role of technology in addressing those needs. Quantitative and qualitative research was combined to examine the nature and scope of the issues faced by this target population. Women who were currently receiving food stamps and had children in nursery school to eighth grade were recruited through a state database to participate in a telephone survey (N = 146) and focus groups (N = 56). Low-income, rural mothers were aware of and practiced many health behaviors related to nutrition and physical activity, but they faced additional barriers due to their income level, rural place of residence, and having children. They reported controlling the fat content in the food they cooked and integrating fruits and vegetables but showed less interest in increasing fiber consumption. They reported knowing little about physical activity recommendations, and their reported activity patterns were likely inflated because of seeing housework and child care as exercise. To stretch their food budget, the majority reported practicing typical shopping and budgeting skills, and many reported skills particularly useful in rural areas: hunting, fishing, and canning. Over two-thirds of the survey respondents reported computer access and previous Internet use, and most of those not yet online intended to use the Internet in the future. Those working in rural communities need to consider technology as a way to reach traditionally underserved populations like low-income mothers.

Modelling a sustainability yardstick in modern energisation of rural sub-Saharan Africa

International Nuclear Information System (INIS)

Sebitosi, A.B.; Pillay, P.

2007-01-01

The bulk of rural Africa (as well as much of the third world) remains un-electrified and is underserved or poorly served by any other form of modern energy infrastructure. In case of a deep sub-Sahara African country like Kenya it is often dismissively argued that lack of finance and appropriate technology are the obvious causes. This argument would however not hold when applied to the more technologically advanced South Africa where a whopping 50% of rural households still suffer a similar fate. The common perception is that in the presence of modern technology the desired social change process will automatically commence. Unfortunately (and possibly due to pressure from donors) typical post project reports from the third world often contain deliberate commissions or omissions that essentially belie the grim reality on the ground. What seems to lack is a well-defined yardstick or standard check-off list as to the essential attributes of a sustainable energy dissemination project. Problems in modern society are now largely tackled using a wide range of software applications. However even with all the well-tested skills in computer coding endless consumer complaints abound. 'Usability Engineering' is an example a state-of-the-art scientific tool that has been extensively used in recent times by the software design industry to tackle such problems as enhancement of the human/computer interface. This paper proposes that these modern scientific tools could be adopted to create a yardstick and break the intangible technological barrier to African rural modernization to better the lot of our communities

The potential migration effect of rural hospital closures

DEFF Research Database (Denmark)

Sørensen, Jens Fyhn Lykke

2008-01-01

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...

Maternal-child health fellowship: maintaining the rigor of family medicine obstetrics.

Science.gov (United States)

Magee, Susanna R; Radlinski, Heidi; Nothnagle, Melissa

2015-01-01

The United States has a growing shortage of maternity care providers. Family medicine maternity care fellowships can address this growing problem by training family physicians to manage high-risk pregnancies and perform cesarean deliveries. This paper describes the impact of one such program-the Maternal Child Health (MCH) Fellowship through the Department of Family Medicine at Brown University and the careers of its graduates over 20 years (1991--2011). Fellowship graduates were mailed a survey regarding their training, current practice and teaching roles, and career satisfaction. Seventeen of 23 fellows (74%) responded to the survey. The majority of our fellowship graduates provide maternity care. Half of our respondents are primary surgeons in cesarean sections, and the majority of these work in community hospitals. Nearly all of our graduates maintain academic appointments and teach actively in their respective departments of family medicine. Our maternal child health fellowship provides family physicians with the opportunity to develop advanced skills needed to provide maternity care for underserved communities and teaching skills to train the next generation of maternal child health care providers.

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

Science.gov (United States)

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

2017-01-01

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.

Rural Hospital Employment of Physicians and Use of Cesareans and Nonindicated Labor Induction.

Science.gov (United States)

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

2018-02-01

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.

RURAL DEVELOPMENT: MORE THAN SINGLE AGRICULTURAL DEVELOPMENT DESARROLLO RURAL: MÁS QUE DESARROLLO AGRÍCOLA

Directory of Open Access Journals (Sweden)

Pachón Ariza Fabio Alberto

2007-11-01

Full Text Available Rural development as the notion of development has been strongly influenced by the idea of economic growth. Conversely, the rural development road has been focus on agricultural modernization of production systems, intensive use of chemical inputs to increase levels and technology transfer. The actual rural reality has conducted to a revaluation of what rural means and therefore its development. In these sense has grown the importance of rural related activities linked to the diversification and generating of extra revenues for rural families. This could be one of the cases behind this change in perceptions on previous rural development, giving more importance to other aspects such as cultural diversity, community participation, decision taking, decentralization processes, cultural values, and in consequence hot associate rural development with agricultural development.El desarrollo rural al igual que el sólo desarrollo, ha estado fuertemente influenciado por la idea que lo liga con el crecimiento económico. Concebido de esta forma, la manera como se ha intentado alcanzar desarrollo rural ha sido por medio de la modernización de los sistemas de producción agropecuaria, del uso indiscriminado de insumos químicos para aumentar los niveles productivos y de transferencia de tecnología. La realidad que se vive en el sector rural ha hecho que se evolucione hacia una revaloración de lo que significa lo rural y, de esta manera, también su desarrollo. Por este camino han tomado más importancia actividades conexas a lo productivo agropecuario y también la diversificación de las formas de generación de ingresos para las familias rurales. Ésta podría ser una de las causas para que también cambie la percepción que existía sobre el desarrollo rural y se brinde más importancia a otros aspectos como la aceptación de la diversidad, la participación de la comunidad en la toma de decisiones, la descentralización de la administración, el

Family welfare programme calls for an integrated approach.

Science.gov (United States)

Singh, P N

3 phases can be identified in India's family planning program in the 4 decades since the country achieved its independence: a stage designed to improve the infrastructure of family planning; a phase of integration of different health and family welfare services; and an attempt of community involvement and universal coverage. At this time there is a widespread infrastructure and a growing awareness of family planning services. The birthrate has declined from 41.2/1000 in the 1960s to 33.3/1000 in the 1980s; the mortality rate declined from 27.4 to 14.2. The current facilities of family welfare services are inadequate, particularly in rural areas. The present provision of auxiliary nurse midwives (ANMS) at the rate of 1/5000 can cover effectively only 1/3 of eligible couples. Further, in rural areas, communication and motivational efforts are lacking as well as easy availability of personnel and medical supplies. Finally, about 40% of the rural population lives below the poverty line and have not reached the economic threshold which is essential for adoption of the small family norm. The primary issue is to deal with the problem of social development. The emphasis needs to be on an integrated and package approach to economic progress and social transformation coupled with the family planning program. The best way to bring about the needed socioeconomic change is to provide educational and gainful employment opportunities.

Challenges and opportunities in building a sustainable rural primary care workforce in alignment with the Affordable Care Act: the WWAMI program as a case study.

Science.gov (United States)

Allen, Suzanne M; Ballweg, Ruth A; Cosgrove, Ellen M; Engle, Kellie A; Robinson, Lawrence R; Rosenblatt, Roger A; Skillman, Susan M; Wenrich, Marjorie D

2013-12-01

The authors examine the potential impact of the Patient Protection and Affordable Care Act (ACA) on a large medical education program in the Northwest United States that builds the primary care workforce for its largely rural region. The 42-year-old Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) program, hosted by the University of Washington School of Medicine, is one of the nation's most successful models for rural health training. The program has expanded training and retention of primary care health professionals for the region through medical school education, graduate medical education, a physician assistant training program, and support for practicing health professionals.The ACA and resulting accountable care organizations (ACOs) present potential challenges for rural settings and health training programs like WWAMI that focus on building the health workforce for rural and underserved populations. As more Americans acquire health coverage, more health professionals will be needed, especially in primary care. Rural locations may face increased competition for these professionals. Medical schools are expanding their positions to meet the need, but limits on graduate medical education expansion may result in a bottleneck, with insufficient residency positions for graduating students. The development of ACOs may further challenge building a rural workforce by limiting training opportunities for health professionals because of competing demands and concerns about cost, efficiency, and safety associated with training. Medical education programs like WWAMI will need to increase efforts to train primary care physicians and increase their advocacy for student programs and additional graduate medical education for rural constituents.

Rural women's perspectives of maternity services in the Midland Region of New Zealand.

Science.gov (United States)

Gibbons, Veronique; Lancaster, Gytha; Gosman, Kim; Lawrenson, Ross

2016-09-01

INTRODUCTION Rural women face many challenges with regards to maternity services. Many rural primary birthing facilities in New Zealand have closed. The Lead Maternity Carer (LMC) model of maternity care, introduced in 1990, has moved provision of rural maternity care from doctors to independent midwifery services. Shortages of rural midwives in the Midland region led to rural maternity care being seen as a vulnerable service. AIM To understand the views and experiences of rural women concerning maternity care, to inform the future design and provision of rural maternity services. METHODS Participants were drawn from areas purposively selected to represent the five District Health Boards comprising the Midland health region. A demographic questionnaire, focus groups and individual interviews explored rural women's perspectives of antenatal care provision. These were analysed thematically. RESULTS Sixty-two women were recruited. Key themes emerging from focus groups and interviews included: access to services, the importance of safety and quality of care, the need for appropriate information at different stages, and the role of partners, family and friends in the birthing journey. While most women were happy with access to services, quality of care, provision of information, and the role of family in their care, for some women, this experience could be enhanced. CONCLUSION Midwives are the frontline service for women seeking antenatal services. Support for rural midwives and for local birthing units is needed to ensure rural women receive services equal to that of their urban counterparts.

Relationships between family physicians’ referral for palliative radiotherapy, knowledge of indications for radiotherapy, and prior training: a survey of rural and urban family physicians

Directory of Open Access Journals (Sweden)

Olson Robert A

2012-05-01

Full Text Available Abstract Background The primary objective of this research was to assess the relationship between FPs’ knowledge of palliative radiotherapy (RT and referral for palliative RT. Methods 1001 surveys were sent to FPs who work in urban, suburban, and rural practices. Respondents were tested on their knowledge of palliative radiotherapy effectiveness and asked to report their self-assessed knowledge. Results The response rate was 33%. FPs mean score testing their knowledge of palliative radiotherapy effectiveness was 68% (SD = 26%. The majority of FPs correctly identified that painful bone metastases (91%, airway obstruction (77%, painful local disease (85%, brain metastases (76% and spinal cord compression (79% can be effectively treated with RT, though few were aware that hemoptysis (42% and hematuria (31% can be effectively treated. There was a linear relationship between increasing involvement in palliative care and both self-assessed (p  Conclusions Self-assessed and tested knowledge of palliative RT is positively associated with referral for palliative RT. Since palliative RT is underutilized, further research is needed to assess whether family physician educational interventions improve palliative RT referrals. The current study suggests that studies could target family physicians already in practice, with educational interventions focusing on hemostatic and other less commonly known indications for palliative RT.

Rural electric power infrastructure and infantile work; Infraestrutura energetica rural e incidencia de trabalho infantil

Energy Technology Data Exchange (ETDEWEB)

Schmid, Aloisio Leoni [Parana Univ., Curitiba, PR (Brazil). Dept. de Arquitetura]. E-mail: alschmid@uol.com.br

2000-07-01

Based both on the data available at the IBGE (Brazilian Geographic and Statistical Institute) Worldwide Web site from the Censo Agropecuario de 1996 and on the premise, that human energy is one of the most important energy sources in rural areas, the existence of a correlation of infant work and electric energy infrastructure in Brazilian rural properties was investigated. The verification was conducted first by Municipality, and second by product. Analysis covered agriculture, poultry and extractive practices. As a result, first part led to no correlation at all. However, the second part suggested a correlation to exist between share of rural workers under 14 and share of rural properties not having access to electric energy services. This correlation refers to the share of workers being both under 14 and belonging to the owner's family, corroborating the indication, in the literature, of infant work being a familiar tradition in the Brazilian countryside. Finally, the advance of the investigations with an approach more specific to region and character of economic activity is recommended. (author)

The role of motivation in understanding social contextual influences on physical activity in underserved adolescents in the ACT Trial: a cross-sectional study.

Science.gov (United States)

Lawman, Hannah G; Wilson, Dawn K; Van Horn, M Lee; Zarrett, Nicole

2012-12-01

Previous research has shown that social contextual factors are important in understanding physical activity (PA) behavior, although little is known about how these factors may relate to PA, especially in underserved adolescents (low income, minorities). This study examined how motivation may differentially mediate the relationship of two social contextual variables (i.e., peer and parent social support) and moderate-to-vigorous PA (MVPA). Baseline data (n = 1421 sixth graders, 54% female, 72% African American) from the Active by Choice Today (ACT) trial in underserved adolescents were analyzed. Motivation was examined as a mediator of the relationships between peer social support, parent social support, and MVPA (measured by 7-day accelerometer estimates). Motivation and peer but not parent support were significantly related to MVPA overall. Significant mediation effects were found indicating motivation partially mediated the relation between peer social support and MVPA and to a lesser degree parent support and MVPA. These findings provide support for the importance of social contextual influences, especially peer social support, on underserved adolescents' PA and motivation for PA.

Food as pharma: marketing nutraceuticals to India's rural poor.

Science.gov (United States)

Street, Alice

2015-05-27

This commentary sketches out the politics of the expansion of affordable, fast-moving nutraceutical products into rural India, with a focus on fortified foods and beverages. It examines the relationships between industry, government and humanitarian organisations that are being forged alongside the development of markets for nutraceuticals; the production of evidence and the harnessing of science to support nutraceutical companies' claims; the ways in which nutraceuticals are being marketed and distributed in rural areas; and the concepts of health and well-being that are being promulgated through those marketing campaigns. Lastly, it asks what kinds of impact fast-moving nutraceuticals are likely to have on the lives of India's rural poor. It concludes by questioning how smooth a transition to nutraceutical consumption Big Food marketing strategies can really facilitate and how readily low-income families seeking to feed their families and safeguard health will actually adopt concepts of wellness and internalise micro-nutrient associated risks.

The impact of socially-accountable, community-engaged medical education on graduates in the Central Philippines: Implications for the global rural medical workforce.

Science.gov (United States)

Siega-Sur, J L; Woolley, T; Ross, S J; Reeve, C; Neusy, A-J

2017-10-01

Developing and retaining a high quality medical workforce, especially within low-resource countries has been a world-wide challenge exacerbated by a lack of medical schools, the maldistribution of doctors towards urban practice, health system inequities, and training doctors in tertiary centers rather than in rural communities. To describe the impact of socially-accountable health professional education on graduates; specifically: their motivation towards community-based service, preparation for addressing local priority health issues, career choices, and practice location. Cross-sectional survey of graduates from two medical schools in the Philippines: the University of Manila-School of Health Sciences (SHS-Palo) and a medical school with a more conventional curriculum. SHS-Palo graduates had significantly (p < 0.05) more positive attitudes to community service. SHS-Palo graduates were also more likely to work in rural and remote areas (p < 0.001) either at district or provincial hospitals (p = 0.032) or in rural government health services (p < 0.001) as Municipal or Public Health Officers (p < 0.001). Graduates also stayed longer in both their first medical position (p = 0.028) and their current position (p < 0.001). SHS-Palo medical graduates fulfilled a key aim of their socially-accountable institution to develop a health professional workforce willing and able, and have a commitment to work in underserved rural communties.

What do beginning students, in a rurally focused medical course, think about rural practice?

Science.gov (United States)

Young, Louise; Lindsay, Daniel B; Ray, Robin A

2016-12-07

Medical schools may select students for their attitudes towards rural medical practice, yet the rural-urban disparity in availability of medical practitioners and services has not diminished in recent times despite government initiatives and increasing numbers being trained for a career in medicine. One medical school, with a focus on rural and remote medicine, aims to select students with positive perceptions for rural medical practice. A research project collected data on the perceptions of these medical students in the first week of their medical studies. Students completed a low stakes essay on the life and work of a rural doctor. Initially, this formed part of a literacy assessment to determine any students requiring remediation. All students were asked if they would consent to their essay being reviewed for a research project. Data was obtained from those students who consented and handed their essays in for review. The 103 student essays underwent thematic analysis and sentences were coded into three main themes of rural lifestyle, doctor role and rural practice. Second level themes were further elicited and results were quantified according to whether they were positive or negative. Positive themes included rural lifestyle, doctor role, views of doctor, impact on community, broader work and skills knowledge, and better relationships with community and patients. Negative themes included doctor's health, pressure on doctor, family problems, greater workload, privacy and confidentiality issues, cultural issues, isolation, limited resources and financial impacts. Quantitisation of this data was used to transform essay sentences into a numerical form which allowed statistical analysis and comparison of perceptions using Z tests. No significant differences on the number of positive and negative responses for rural lifestyle and rural practice were found. The rural doctor role had a significantly more positive than negative views. Significant differences were

Patterns of Life Events Preceding the Suicide in Rural Young Chinese: A Case Control Study1

Science.gov (United States)

Zhang, Jie; Ma, Zhenyu

2012-01-01

Background Previous studies on the Chinese suicide found some life events prior to the suicide different from those in the West, but there is a lack of summary of the Chinese life event patterns to better understand the effects of the social structure on Chinese suicide. Aim We tried to identify the life events that precede the Chinese rural youth suicides and compare them with what found in the West, so as to find the patterns that are particularly true in the Chinese culture contexts. Methods Suicide cases were investigated with a psychological autopsy study in rural China, and local community living controls were also interviewed with the same protocol. Results We collapsed 64 negative life events into six categories: (1) Marriage/Love, (2) Family/Home, (3) Work/Business, (4) Health/Hospital, (5) Law/Legal, (6) Friend/Relationship. About 92.3% of the suicides studied had experienced at least one type of negative life events. The three most common negative life events categories in the past one year were Family/Home (60.7%), Health/Hospital (53.8%) and Marriage/Love (51.3%) in the rural young suicide victims. Conclusions Among the negative life events, those related to family relations, love affairs, and marital issues were most likely to precede a suicide of rural suicides in China, and it is especially true of rural young women. Family is an important social institution in rural China for suicide prevention efforts. PMID:22595373

Comparison of Migrants in Two Rural and an Urban Area of Central Brazil.

Science.gov (United States)

Wilkening, E. A.

The goal of this study was to compare the migration and adaptation of settlers in urban areas with settlers in rural areas of Brazil. A sample of 1,255 families, divided into an urban group, a near-urban rural group, and a rural group were interviewed. The migration patterns of the groups were discussed and factors related to migration were…

the Avian Park Service Learning Centre story

African Journals Online (AJOL)

The Ukwanda Centre for Rural Health (UCRH) opened in 2001, followed 10 years later by the establishment of the Ukwanda Rural Clinical School in one of the rural health districts of the Western Cape. This paper relates the journey of the Faculty with the underserviced community of Avian Park through the provision of ...

A qualitative survey of poverty in the rural areas around Giyani township

OpenAIRE

2012-01-01

M.Ed. Poverty is a serious concern all over the world. This phenomenon hinders development, particularly in rural areas where the majority of families are living below the poverty line. In many rural communities the RDP programme did not reach the majority of people. The study is aimed at finding out the extent, perceived causes and consequences of poverty in Homu A and Homu C near Giyani. The families regarded as the more impoverished in the two villages were selected as participants of t...

Developing a Parent-Centered Obesity Prevention Program for 4-H Families: Implications for Extension Family Programming

Science.gov (United States)

Benke, Carrie J.; Bailey, Sandra J.; Martz, Jill; Paul, Lynn; Lynch, Wesley; Eldridge, Galen

2013-01-01

Planning youth and family programming in the 21st century is daunting given family members' busy schedules. This is even more challenging when planning programs in rural areas, where there are vast distances between communities. This article discusses a research and educational outreach project that uses best practices in program development…

The Complex Decision-Making Processes of Rural Emerging Adults: Counseling beyond Dualism

Science.gov (United States)

San Antonio, Donna M.

2016-01-01

Rural adolescents approach the transition out of high school with individual concerns about making an emotionally or financially expensive "mistake," family concerns about young people leaving home, and national and local concerns about declining rural economies and out-migration. The literature concerning this topic considers factors…

The Impact of Desired Family Size Upon Family Planning Practices in Rural East Pakistan

Science.gov (United States)

Mosena, Patricia Wimberley

1971-01-01

Results indicated that women whose desired family size is equal to or less than their actual family size have significantly greater frequencies practicing family planning than women whose desired size exceeds their actual size. (Author)

Leisure Today--Family Cohesion Through Leisure and Recreation.

Science.gov (United States)

Smith, S. Harold, Ed.; And Others

1984-01-01

Family relationships can be strengthened through recreation and leisure activities. Articles dealing with leisure research, values, computers, recreation in rural areas, and youth sports are offered for those interested in facilitating the development of strong families. (DF)

OB fellowship outcomes 1992-2010: where do they go, who stops delivering, and why?

Science.gov (United States)

Rodney, W MacMillan; Martinez, Conchita; Collins, Millard; Laurence, Greg; Pean, Carl; Stallings, Joe

2010-01-01

This study describes characteristics and the evolution of the careers of graduates from a 1-year post-residency fellowship program whose primary objectives included clinical skills in Cesarean section. Besides obstetrical practice, rural service and attainment of faculty appointment were used as surrogate measures of fulfilling an underserved need for family medicine obstetrics. For 18 years, the authors maintained contact with all 80 physicians completing 1-year fellowships in family medicine obstetrics in Memphis and Nashville. The founding chair of these programs surveyed each physician and maintained a network of contacts to study outcomes such as graduation, service location, hospital privileges, retention, and career changes. The study tracked 100% of the sample and documented high rates of fellowship completion (74/80 [93%]), Cesarean privileges (71/74 [96%]), and service in a rural community for at least 2 years (47/74 [64%]). The fellowship was also associated with participation as faculty (36/74 [46%]). This paper produces the first and longest-term data describing attrition over time and examines the reasons why fellowship-trained family physicians stop doing maternity care. It is the only series with a 100% response rate and provides longitudinal data on the outcomes of these fellowship programs. Attrition was highest at rural sites. Workforce planners and fellowship designers might benefit from these considerations.

Self-care self-efficacy, religious participation and depression as predictors of poststroke self-care among underserved ethnic minorities

Directory of Open Access Journals (Sweden)

Suzanne M. Robertson

2013-04-01

Full Text Available Underserved ethnic minorities have multiple chronic disease risk factors, including tobacco, alcohol and substance use, which contribute to increased incidence of stroke. Self-efficacy (self-care self-efficacy, religious participation and depression may directly and indirectly influence engagement in post stroke self-care behaviors. The primary aim of the present study was to investigate the effects of self-care self-efficacy, religious participation and depression, on tobacco, alcohol and substance use in a sample of largely ethnic minority, underserved stroke survivors (n=52. Participants previously recruited for a culturally tailored secondary stroke prevention self-care intervention were included. The treatment group received three stroke self-care sessions. The usual care group completed assessments only. Both groups were included in these analyses. Main outcome measures included tobacco, alcohol and substance use. Self-care self-efficacy, religious participation and depression were also assessed. Logistic regression analyses, using self-efficacy, religious practice and depression as the referents, were used to predict binary outcomes of tobacco, alcohol and substance use at 4-weeks post-stroke. Higher depression and self-care self-efficacy were associated with reduced odds of smoking and substance use. Greater participation in religious activities was associated with lower odds of alcohol use. We can conclude that incorporating depression treatment and techniques to increase self-care self-efficacy, and encouraging religious participation may help to improve stroke self-care behaviors for underserved and low socioeconomic status individuals. Results are discussed in the context of stroke self-management.