full article:
Contents, 2003; 19 4: Fall
Issue includes original research on:
- Rural African-American women who use cocaine
- Family physicians' attitudes to physician-assisted suicide
- Urban-rural differences in mental and physical health conditions in nursing home population
- Identifying places at risk of not being able to support adequate health services
- Rural-urban differences in ductal carcinoma in situ
- Rural physician workforce in Florida
2003; 21 (2)
Developing an ambulance network model for Texas rural counties
Robert D Galloway, Michael J Bianchi
The Texas rural health care setting is plagued with limitations stemming from a lack of health care resources. The purpose of this article is to assist emergency medical services (EMS) planners in creating an effective and efficient ambulance network model. The article examines the existing network models already in use by rural Texas counties and presents a model for developing a new ambulance network. This article examines variables that are important to consider when developing an ambulance deployment model decentralized from a hospital. The model is based on the premise of decentralizing ambulance deployment stations away from a central depot or hospital and locating them throughout the county. The ultimate goal is to reduce response times and save lives.
The epidemiology of unintentional non-fatal injuries among children in the South Plains/Panhandle Region of Texas
Ahmed A Arif, Patti J Patterson, Tyrone F Borders, Syed M Shah
The purpose of this study was to estimate and characterize the burden of unintentional injuries among children under 16 years of age in the South Plains/Panhandle region of Texas. A total of 1,500 households were selected through a cross-sectional survey in 42 counties in the fall of 2001. Telephone interviews with parents were conducted to identify the nature and place of injury among children. The age-adjusted prevalence of parent-reported childhood injury was 15.9%. Out of 228 children injured, the majority (88%) needed medical attention. The majority of injuries occurred while the child was engaged in sports or other related recreational activity, followed by unintentional falls, and accidents at home. Compared to younger children (< 6 years), older children (11 to 16 years) were more likely to sustain injuries. A total of 35 (17.6%) children required hospital admission following their injuries. Those in the lower level socioeconomic group (as determined by the responding parents' educational status) were more likely to seek admission to the hospital following injury. In the South Plains/Panhandle region, the occurrence of unintentional injuries is a significant health problem resulting in hospitalization and loss of routine activity. Further analytical studies are needed to identify more specific risk factors that can serve as a basis for prevention efforts.
Weight gain efforts among middle school and junior high students in selected rural Texas School Districts
LuAnn Soliah, Janelle Walter, Sunni Barnes, Scott Yeang
Three rural Texas school districts were studied to determine why, when, and how middle school and junior high students (n=468) decide to gain weight. The main reason to gain weight was to overcome thinness and thus improve physical appearance. Children as young as seven-years-old were making an effort to gain weight. The dominant method used was to consume more food. Inappropriate methods and reasons were occasionally involved with the attempt to gain weight.
Australian Journal of Rural Health
2003; 11 (3)
Influences on doctors' prescribing: is geographical remoteness a factor?
Christopher Cutts, Susan E Tett
Objective: To identify factors influencing the prescribing of medicines by general practitioners in rural and remote Australia.
Design: A qualitative study using a questionnaire to determine attitudes about prescribing, specific prescribing habits and comments on prescribing in 'rural practice'.
Setting: General practice in rural and remote Queensland.
Subjects: General practitioners practising in rural and remote settings in Queensland (n = 258).
Main outcome measures: The factors perceived to influence the prescribing of medicines by medical practitioners in rural environments.
Results: A 58% response rate (n = 142) was achieved. Most respondents agreed that they prescribe differently in rural compared with city practice. The majority of respondents agreed that their prescribing was influenced by practice location, isolation of patient home location, limited diagnostic testing and increased drug monitoring. Location issues and other issues were more likely to be identified as 'influential' by the more isolated practitioners. Factors such as access to continuing medical education and specialists were confirmed as having an influence on prescribing. The prescribing of recently marketed drugs was more likely by doctors practising in less remote rural areas.
Conclusion: Practising in rural and remote locations is perceived to have an effect on prescribing. These influences need to be considered when developing quality use of medicines policies and initiatives for these locations.
Characteristics of chemotherapy practice in rural and remote area health facilities in Queensland
Alexandra McCarthy, Desley Hegney, Leisa Brown, Peter Gilbar, T. Robert Brodribb, June Swales
Objective: The overall objective of this study was to document the nature of the chemotherapy nursing practice of rural and remote area nurses in Queensland.
Design: A questionnaire survey that elicited descriptive quantitative and qualitative data.
Setting: Forty-seven rural and remote area health facilities in Queensland involved in the administration of chemotherapy.
Subjects: Sixty-seven Queensland rural and remote area nurses involved in the administration of cytotoxic drugs.
Main outcome measures: Characteristics of chemotherapy practice including context of practice, amount and type of chemotherapy administered, logistical problems, level of support from referral centres, policies and procedures, safety issues.
Results: The results indicate that the risks to nursing staff and the potential for poor patient outcomes are higher than in specialist chemotherapy facilities. This is largely due to the human and material resource constraints characteristic of rural practice. These include a lack of understanding on the part of metropolitan-based health departments and the specialist cancer centres that refer patients to rural areas of the constraints that may adversely influence patient outcomes.
Conclusions: It is essential that steps are taken to ensure that rural and remote area cancer patients have equitable access to safe and competent chemotherapy care delivered in their choice of context, and the results of this study provide guidance on ways that this can be achieved.
Towards a health career for rural and remote students: cultural and structural barriers influencing choices
Angela Durey, Beverley McNamara, Ann Larson
Objective: To promote tertiary health careers to rural and remote young people.
Design: Qualitative research using large and small group discussions and semistructured interviews.
Setting: Fifteen secondary schools in rural and remote Western Australia including five senior secondary schools and 10 district high schools.
Subjects: One hundred and twenty students from eight year 10 groups, 35 students from three year 11 groups, 54 students from five year 12 groups, 52 parents, 10 grandparents, 76 teachers and four Aboriginal and Islander Education Officers (AIEO).
Results: Students prefer information about the range of health careers to be delivered interactively. Choices to follow a health career at tertiary level were constrained by structural and cultural issues including geographical isolation, financial cost, stereotyping of health professions, insufficient information about the diversity of health careers, obligation to family, community and place and a devalued rural culture.
Conclusions: The under representation of rural and remote students in health related university courses needs to be addressed by long-term strategies taking into account both structural and cultural barriers when making career choices. Health policies should include the provision of financial support for rural and remote students and promote a broad range of health careers as challenging and rewarding life choices that offer much needed services to rural communities.
Rural sports and recreational injuries in Australia: what do we know?
Caroline Finch, Mary Mahoney, Mardie Townsend, Tsharni Zazryn
Objective: It is widely recognised that individuals residing in regional or rural areas have poorer health outcomes than those from metropolitan areas. Factors associated with these poorer health outcomes include geographical isolation, population declines, limited health care provision and higher levels of inactivity compared to urban areas. The mental, social and physical health of individuals and communities in rural areas can be improved through active participation in sport and recreation activities. Unfortunately, participation in such activities can potentially lead to injury. There is a suggestion that there is an increased risk of sports injuries in rural areas due to the lack of health professionals and coaching personnel, fewer available volunteers to organise and deliver sport, and the general attitude towards injuries in rural settings.
Results: There is very limited information about the number and types of injuries sustained during participation in sports activities in rural and regional settings. This is largely related to a lack of formal sporting structures and support mechanisms including research funding and trained personnel.
Conclusion: A range of factors need to be implemented to improve safety for sporting and recreational participants in these areas. These include improved monitoring of injury occurrence, stronger promotion of safety initiatives and wider implementation of education strategies.
Online Journal of Rural Nursing and Health Care
2003; 3(2): Winter
Rural nurse administrators: essentials for practice
Eldridge Carol R, Judkins Sharon
The rural practice setting has unique nursing and health care needs that significantly impact the role of rural nurse executives. This article describes aspects of the rural environment pertinent to rural nursing and helps identify the special competencies needed by nurses who work as managers and executives in rural settings.
Suffering it out: Meeting the needs of health care delivery in a rural area
Huttlinger Kathleen, Schaller-Ayers Jennifer, Lawson Tony, Ayers James
The health status of the people in the coal-producing counties of southwest Virginia is poor despite an apparent high provider to population threshold. This study used a qualitative approach to obtain information about accessibility to health care services and about perceptions of personal health status. Interview and focus group data revealed that the delivery of health care services is compromised by poverty and the large number of medically underinsured and uninsured individuals. Emergent themes included "suffering it out," a strong sense of community, quality time with provider and needed fixes. Another significant finding revealed the need for specialty providers. Community health nurses can provide a valuable service by making people aware of free and low cost prevention and prescription assistance programs, assist with understanding government health forms, and locating other low-cost health services for clients in their districts.
Smoking cessation practices of rural and urban health care providers
Scott Linda D, LaSala Kathleen B, Lyndaker Carolyn Z, Neil-Urban Sherry
The purpose of this descriptive research was to identify the similarities and differences of demographic characteristics, specific intervention practices, perceived barriers, and enhancement factors associated with smoking cessation interventions of rural and urban primary health care providers. A convenience sample consisted of 342 physicians, registered nurses, and advanced practice nurses with the majority of urban health care providers being younger aged physicians and advanced practice nurses compared to older, registered nurses in rural areas. Findings revealed minimal basic educational preparation of health care providers for smoking cessation interventions. Rural health care providers reported diverse, multiple practice settings with a generalist view, estimated that more of their clients smoked, and were less likely to assess clients' smoking practices and initiate smoking interventions. Consistent, strong curricula education at all health provider levels and continuing education for new and more effective strategies is essential to empower health care providers to address smoking cessation interventions consistently and effectively.
Journal Canadien de la Médecine Rural/Canadian Journal of Rural Medicine
[in French and English]
Contents, 2003; 8: (4), Automne 2003/ Fall 2003
Rural Canadian anesthesia: past, present and future
Hal Irvine, MD, FCFP presents his view of the sustainability of rural anesthesia in Canada, in the CJRM regular feature, 'Podium' [in English, no Abstract]
Utposten
[Norwegian Medical Journal for General Practice and Public Health] [in Norwegian]
Contents, 2003: 4
Salud Rural: Revista de formación y actualización en la labor diaria del médico de atención primaria
[Rural Health: the direct route of information for the primary care doctor] [in Spanish]
Contents, 2003; 20: 15