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Rehabil Nurs 2003; 28: 57-63Outcomes of cardiac rehabilitation participants and nonparticipants in a rural area
Yates BC, Braklow-Whitton JL, Agrawal S
University of Nebraska Medical Center, Omaha, NE, USA. bcyates@unmc.edu
Nationally, only 11%-20% of cardiac patients, on average, enroll in cardiac rehabilitation programs after their cardiac events. The purpose of this study was to examine: (a) differences in functional health outcomes, clinical risk factor outcomes, and lifestyle behaviors between patients who participated in cardiac rehabilitation (CR) and those who did not during the first year after their cardiac event; and (b) to examine predictors of and reasons for CR participation and non-participation in a Midwestern, rural clinical population. Green's health education framework guided the study. A cross-sectional, comparative design was used to mail surveys to 538 cardiac patients who were hospitalized over a 1-year period at a regional medical center; 255 surveys were returned, and the final sample numbered 222. Of these, 154 (69%) attended CR. Compared to non-participants (n = 68), participants reported significantly higher levels of functioning on 7 of the 8 subscales of the Medical Outcome Study Short Form-36 (SF-36). In relation to clinical risk factor outcomes, participants had a significantly lower body mass index than non-participants. Patients who attended CR reported that they had switched to low-fat foods, started an exercise program, lost weight, lowered stress, lowered blood pressure, and reduced blood cholesterol at significantly higher rates than non-participants. Patients were more likely to participate in CR if their physician explained its benefits, if they were told about it during their hospitalization, and if they lived close to a CR program. Patients with coronary heart disease need to be referred to CR for improved physical and psychosocial functioning and successful risk factor modification.
J Public Health Med 2003; 25: 19-21
Is the National Service Framework standard for thrombolytic therapy achievable in a rural area?
Harney AM, McClean R, Rawles J, Stewart D
Stream Street Surgery, 40 Stream Street, Downpatrick BT30 6DE
The National Service Framework (NSF) for coronary heart disease requires that patients with acute myocardial infarction should start thrombolytic therapy within 60 min of the patient making contact with the National Health Service. In an audit of 700 patients with suspected acute myocardial infarction, patients' first contact was most commonly with a general practitioner (GP) (505/700; 72 per cent), who attended on 88 per cent (446/505) of occasions when they were called. In 93 per cent (255/284) of cases where both GP and an ambulance attended, the GP arrived first, by 25 min (median). In the final audit period, median call-to-thrombolysis time was 90 min (26 per cent < or = 60). We conclude that with existing physical and personnel resources in this semi-rural area of Northern Ireland, the NSF standard for thrombolytic treatment is unlikely to be met in a majority of cases unless GPs adopt prehospital thrombolysis
Mo Med 2003; 100: 94-7
A comparison of rural and urban anticoagulation management of atrial fibrillation in a southwest Missouri health system
Hover AR, Rogers JT, Hunt C
St. John's Physicians & Clinics, St. John's Regional Health System, Department of Quality Resources, Springfield, Missouri, USA
The purpose of this study is to determine if an opportunity exists to improve anticoagulation therapy for non-hospitalized, chronic atrial fibrillation patients cared for by St. John's Health System physicians. Clinical chart review consisted of 200 patients in both the urban and rural practice groups. Urban practices were found to have 95 percent of the cases receiving warfarin, 95 percent confidence interval (90-100). Rural practices were found to have 97 percent of the cases anticoagulated, 95 percent confidence interval (88-99).
J Korean Med Sci 2003; 18: 248-54
Positive trends of public attitudes toward epilepsy after public education campaign among rural Korean residents
Kim MK, Kim IK, Kim BC, Cho KH, Kim SJ, Moon JD
Department of Neurology, Medical Research Institute, Chonnam National University Medical School, Gwangju, Korea. mkkim20@hotmail.com
To assess trends of public attitudes toward epilepsy in Korea, two surveys were performed in the same village using a common questionnaire before and after the schedule of public education on epilepsy. Cross-sectional studies were conducted by means of a door-to-door interview, in which all residents over 19 yr of age living in the survey area were targeted. Vehicles for the educational campaign took the form of lectures and small group discussions. The understanding of epilepsy among Korean respondents appeared to be not only based more on supernatural or superstitious thinking, but was also less comparable to that of other studies. The attitudes toward epilepsy also were far more negative in Korean rural areas than in other countries. The false belief that "epilepsy can not be treated" was the factor that contributed most to negative attitudes. Although a positive trend was obvious not only in understanding the cause of epilepsy but also in attitudes toward epilepsy, the majority of respondents still remain unchanged in their misunderstanding of and negative attitudes toward epilepsy. To ameliorate the social stigma against epilepsy in Korea, continuous and repetitive educational efforts as well as the sympathy of the lay societies regarding epilepsy would be needed.
J Neurol Sci 2003; 209: 65-8
The functional status of people with epilepsy in rural sub-Saharan Africa
Birbeck GL, Kalichi EM
Michigan State University, 138 Service Rd, A217, 48824-1313, East Lansing, MI, USA
PURPOSE: Little data is available regarding the impact of epilepsy on the functional status of people with epilepsy (PWE) in developing countries. In sub-Saharan Africa, limited medical services and social stigmatization subject PWE to substantial physical, psychological and social deprivation. To better delineate the overall burden and distribution of epilepsy-associated disability in sub-Saharan Africa, we assessed the functional status of PWE in a rural, population-based sample and made comparisons to published reports from urban Zimbabwe.
METHODS: A population-based survey of PWE with epilepsy in rural Zambia utilizing WHO questionnaires.
RESULTS: Among 86 PWE in 3 rural Zambian communities, 67% participated in the interviews. Only 62% of PWE were receiving treatment. Five to seven percent of rural PWE reported problems with basic hygiene and 9-14% were unable to fulfill work demands, attend social events or enjoy leisure activities. In contrast, 95% of urban PWE denied any problems with social functioning, work performance or relationships. Compared to the urban population, rural PWE had a greater seizure burden (2.3/month vs. 1/month, p=0.007) and reported more difficulties with activities of daily living, including problem solving (70% vs. 54%, p=0.02), speed of thinking (70% vs. 59%, p=0.02) and relationships with co-workers (68% vs. 26%, p CONCLUSIONS: A significant proportion of PWE in rural sub-Saharan Africa report problems fulfilling both social and professional functions. These results also suggest that rural PWE may have poorer functional status than their urban counterparts.
Lancet 2003; 361: (9364) 1186-7
Treatment and control of arterial hypertension in a rural community in Ecuador
Anselmi M, Avanzini F, Moreira JM, Montalvo G, Armani D, Prandi R, Marquez M, Caicedo C, Colombo F, Tognoni G
Centro de Epidemiologia Comunitaria y Medicina Tropical, Esmeraldas, Ecuador avanzini@marionegri.it
Cardiovascular diseases are widespread in developing countries, but little is known about cardiovascular risk profiles in rural communities. To assess the importance of arterial hypertension in a rural district of Ecuador, we screened 4284 of the 8876 adults who lived in the area. 1542 (36%) individuals had hypertension, only four (0.3%) of whom were well controlled by treatment. We monitored all deaths for 2.5 years, and noted that cardiovascular diseases were the primary cause of death in the adult population. Furthermore, of the individuals who died of a cardiovascular disease, four out of five had a history of hypertension. Our findings indicate that in this rural area of Ecuador the high prevalence of uncontrolled hypertension is a major cause of total mortality.
J Med Assoc Thai 2003; 86: 46-51
Compliance with treatment of adult epileptics in a rural district of Thailand
Asawavichienjinda T, Sitthi-Amorn C, Tanyanont W
Unit of Neurology, Department of Medicine, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima 30000, Thailand
BACKGROUND: Epilepsy, a disease when seizures can occur from antiepileptic drug withdrawal, requires regular drug taking. Non-compliance, therefore, is a major factor contributing to sub-optimal control of the seizures.
PURPOSE: To determine the factors associated with noncompliance in epileptics in rural Thailand.
METHOD: All epileptics, registered in the Pak Thong Chai District and their caregivers were invited to be interviewed and examined by a neurologist in their village.
RESULTS: Of a total of 93 epileptics registered, 83 with their caregivers were interviewed and examined by the neurologist (T.A.) and of those 72 were adults. Of the 72 adult epileptics, 41 (56.9%) were 100 per cent compliant and factors found to be significantly associated with compliance were gender, household income and patient's health insurance (p-value < 0.05). The major reasons for non-compliance were misunderstanding (48.4%), forgetfulness (16.1%) and economic problem (12.9%). CONCLUSION: To improve patient-compliance, the real factors for non-compliance, which are unique to patients in a specific area, need to be identified.
Trop Med Int Health 2003; 8: 336-41
Factors influencing the care-seeking behaviour of chest symptomatics: a community-based study involving rural and urban population in Tamil Nadu, South India
Sudha G, Nirupa C, Rajasakthivel M, Sivasusbramanian S, Sundaram V, Bhatt S, Subramaniam K, Thiruvalluvan E, Mathew R, Renu G, Santha T
Tuberculosis Research Centre, Indian Council of Medical Research, Chennai, India
Our aim was to identify the factors that influence the care-seeking behaviour of chest symptomatics in urban and rural areas in South India. We conducted in-depth interviews with 649 participants: 80% of 310 urban residents and 63% of 339 rural people had sought care (P < 0.01), 93% within 1 month of onset of symptoms. Private health care facilities were the first and preferred point of contact for 57% of urban and 48% of rural participants; the major reasons were proximity to residence and their perception that good-quality care would be available there. Symptomatics who did not seek care attributed their inaction to insufficient severity of symptoms (51%), unaffordability (46%) and lack of time due to work pressures (25%). Socio-economic factors such as literacy and family income significantly influenced care-seeking behaviour. Our results indicate that most chest symptomatics seek care promptly; their initial response is to go to the nearest private health care facility, shifting to another if they are dissatisfied. Fifty per cent of the participants who did not seek care felt that their symptoms were not severe.