Urban Counterparts (urban + counterpart)

Distribution by Scientific Domains

Selected Abstracts

Treating the aged in rural communities: the application of cognitive-behavioral therapy for depression

Martha R. Crowther
Abstract Many rural communities are experiencing an increase in their older adult population. Older adults who live in rural areas typically have fewer resources and poorer mental and physical health status than do their urban counterparts. Depression is the most prevalent mental health problem among older adults, and 80% of the cases are treatable. Unfortunately, for many rural elders, depressive disorders are widely under-recognized and often untreated or undertreated. Psychotherapy is illustrated with the case of a 65-year-old rural married man whose presenting complaint was depressive symptoms after a myocardial infarction and loss of ability to work. The case illustrates that respect for rural elderly clients' deeply held beliefs about gender and therapy, coupled with an understanding of their limited resources, can be combined with psychoeducational and therapeutic interventions to offer new options. © 2010 Wiley Periodicals, Inc. J Clin Psychol: In Session 66:1,11, 2010. [source]

Sociodemographic and Health Profiles of the Oldest Old In China

Zeng Yi
Unique data from a 1998 healthy longevity baseline survey provide demographic, socio-economic, and health characteristics of the oldest old, aged 80,105, in China. This subpopu-lation is growing rapidly and is likely to need extensive social and health services. A large majority of Chinese oldest old live with their children and rely mainly on children for financial support and care. Most Chinese oldest old had no or very little education. Ability to function independently in daily living declines rapidly and self-rated health declines moderately across the oldest old ages. As compared to their urban counterparts, the rural oldest old have far less pension support, are significantly less educated, and are more likely to be widowed and to rely on children for support. Apart from higher rates of survival, the female oldest old in China are far more disadvantaged than the male oldest old. [source]

Impact of Rural Residence on Survival of Male Veterans Affairs Patients After Age 65

Todd A. MacKenzie PhD
Abstract Objectives: More than 1 in 5 Veterans Affairs (VA) users lives in a rural setting. Rural veterans face different barriers to health care than their urban counterparts, but their risk of death relative to their urban counterparts is unknown. The objective of our study was to compare survival between rural and urban VA users. Methods: We linked the Large Health Survey of Veteran Enrollees conducted in 1999 to the Veterans Administration vital status registry. We used time-to-event regression models controlling for patient race, education, ZIP-code median income, and marital and smoking status. Findings: Of the 372,463 male veterans of age 65 or greater, 80,931 lived in rural settings. Age-adjusted mortality was 5.9% higher (95% CI, 4.5%-7.2%) in rural residents compared to urban residents. After adjusting for age, education, and ZIP-code median income, rural residents had 3.0% lower mortality (95% CI, 1.5%-4.4%). Compared to urban and suburban VA users, rural VA users' mortality at age 65 was 12% lower, but this advantage gradually diminished by age 75. Conclusion: Mortality after the age of 65 for male VA users is higher in rural dwellers than in urban dwellers. However, among veterans of the same socioeconomic characteristics, rural-dwelling veterans have up to 15% better mortality than urban-dwelling veterans until the age of 75. [source]

Do Older Rural and Urban Veterans Experience Different Rates of Unplanned Readmission to VA and Non-VA Hospitals?

William B. Weeks MD
ABSTRACT:,Context: Unplanned readmission within 30 days of discharge is an indicator of hospital quality. Purpose: We wanted to determine whether older rural veterans who were enrolled in the VA had different rates of unplanned readmission to VA or non-VA hospitals than their urban counterparts. Methods: We used the combined VA/Medicare dataset to examine 3,513,912 hospital admissions for older veterans that occurred in VA or non-VA hospitals between 1997 and 2004. We calculated 30-day readmission rates and odds ratios for rural and urban veterans, and we performed a logistic regression analysis to determine whether living in a rural setting or initially using the VA for hospitalization were independent risk factors for unplanned 30-day readmission, after adjusting for age, sex, length of stay of the index admission, and morbidity. Findings: Overall, rural veterans had slightly higher 30-day readmission rates than their urban counterparts (17.96% vs 17.86%; OR 1.006, 95% CI: 1.0004, 1.013). For both rural- and urban-dwelling veterans, readmission after using a VA hospital was more common than after using a non-VA hospital (20.7% vs 16.8% for rural veterans, 21.2% vs 16.1% for urban veterans). After adjusting for other variables, readmission was more likely for rural veterans and following admission to a VA hospital. Conclusions: Our findings suggest that VA should consider using the unplanned readmission rate as a performance metric, using the non-VA experience of veterans as a performance benchmark, and helping rural veterans select higher performing non-VA hospitals. [source]

Urban-Rural Differences in Motivation to Control Prejudice Toward People With HIV/AIDS: The Impact of Perceived Identifiability in the Community

Janice Yanushka Bunn PhD
ABSTRACT:,Context:HIV/AIDS is occurring with increasing frequency in rural areas of the United States, and people living with HIV/AIDS in rural communities report higher levels of perceived stigma than their more urban counterparts. The extent to which stigmatized individuals perceive stigma could be influenced, in part, by prevailing community attitudes. Differences between rural and more metropolitan community members' attitudes toward people with HIV/AIDS, however, have rarely been examined. Purpose: This study investigated motivation to control prejudice toward people with HIV/AIDS among non-infected residents of metropolitan, micropolitan, and rural areas of rural New England. Methods: A total of 2,444 individuals were identified through a random digit dialing sampling scheme, and completed a telephone interview to determine attitudes and concerns about a variety of health issues. Internal or external motivation to control prejudice was examined using a general linear mixed model approach, with independent variables including age, gender, community size, and perceived indentifiability within one's community. Findings: Results showed that community size, by itself, was not related to motivation to control prejudice. However, there was a significant interaction between community size and community residents' perceptions about the extent to which people in their communities know who they are. Conclusion: Our results indicate that residents of rural areas, in general, may not show a higher level of bias toward people with HIV/AIDS. The interaction between community size and perceived identifiability, however, suggests that motivation to control prejudice, and potentially the subsequent expression of that prejudice, is more complex than originally thought. [source]

Medicare Hospital Charges in the Last Year of Life: Distribution by Quarter for Rural and Urban Nursing Home Decedents With Cognitive Impairment

Charles E. Gessert MD
ABSTRACT:,Background:Medicare beneficiaries incur 27%-30% of lifetime charges in the last year of life; most charges occur in the last quarter. Factors associated with high end-of-life Medicare charges include less advanced age, non-white race, absence of advance directive, and urban residence. Methods: We analyzed Medicare hospital charges in the last year of life for nursing home residents with severe cognitive impairment, focusing on rural,urban differences. The study population consisted of 3,703 nursing home residents (1,882 rural, 1,821 urban) in Minnesota and Texas who died in 2000-2001. Data on Medicare hospital charges were obtained from 1998-2001 Centers for Medicare and Medicaid Services MedPAR files. Results: During the last year of life, unadjusted charges averaged $12,448 for rural subjects; $31,780 for urban. The charges were distributed across the last 4 quarters similarly for the 2 populations, with 15%-20% of charges incurred in each of the first 3 quarters, and 47% (rural) and 52% (urban) in the last quarter. At the individual level, a higher percentage of hospital charges were incurred in the last 90 days by urban than by rural residents (P < .001). A larger proportion of urban (43%) than rural (37%) residents were hospitalized in the final quarter. The charges for hospitalized residents (N = 1,994) were distributed similarly to those of the entire study population. Discussion: Medicare hospital charges during the last year of life were lower for rural nursing home residents with cognitive impairment than for their urban counterparts. Charges tend to be more concentrated in the last 90 days of life for urban residents. [source]

Rural,Urban Differences in Primary Care Physicians' Practice Patterns, Characteristics, and Incomes

William B. Weeks MD
ABSTRACT:,Context:Low salaries and difficult work conditions are perceived as a major barrier to the recruitment of primary care physicians to rural settings. Purpose: To examine rural,urban differences in physician work effort, physician characteristics, and practice characteristics, and to determine whether, after adjusting for any observed differences, rural primary care physicians' incomes were lower than those of urban primary care physicians. Methods: Using survey data from actively practicing office-based general practitioners (1,157), family physicians (1,378), general internists (2,811), or pediatricians (1,752) who responded to the American Medical Association's annual survey of physicians between 1992 and 2002, we used linear regression modeling to determine the association between practicing in a rural (nonmetropolitan) or urban (standard metropolitan statistical area) setting and physicians' annual incomes after controlling for specialty, work effort, provider characteristics, and practice characteristics. Findings: Rural primary care physicians' unadjusted annual incomes were similar to their urban counterparts, but they tended to work longer hours, complete more patient visits, and have a much greater proportion of Medicaid patients. After adjusting for work effort, physician characteristics, and practice characteristics, primary care physicians who practiced in rural settings made $9,585 (5%) less than their urban counterparts (95% confidence intervals: ,$14,569, ,$4,602, P < .001). In particular, rural practicing general internists and pediatricians experienced lower incomes than did their urban counterparts. Conclusions: Addressing rural physicians' lower incomes, longer work hours, and greater dependence on Medicaid reimbursement may improve the ability to ensure that an adequate supply of primary care physicians practice in rural settings. [source]

Alcohol and Drug Use in Rural Colonias and Adjacent Urban Areas of the Texas Border

Richard T. Spence PhD
ABSTRACT:,Context: Little is known about substance use and treatment utilization in rural communities of the United States/Mexico border. Purpose: To compare substance use and need and desire for treatment in rural colonias and urban areas of the border. Methods: Interviews were conducted in 2002-2003 with a random sample of adults living in the lower Rio Grande Valley of Texas, adjacent to the Mexican border. The present analysis compares responses from 400 residents of rural colonias to those of 395 residents of cities and towns in the same geographic region. Findings: While the prevalence of drug use and drug-related problems was similar in both areas, binge drinking and alcohol dependence were higher in rural colonias than in urban areas and remained so after taking demographic and neighborhood variables into account. An increase in illicit drug use and substance-related problems in rural but not urban areas was seen when comparing results from this study with those of a previous survey conducted in 1996. The percentage of adults in potential need of treatment and the percentage motivated to seek it were similar in both urban and rural areas. However, colonia residents were more likely than their urban counterparts to be recent immigrants and to have lower incomes and educational attainment, factors that can increase the barriers they face in getting needed services. Conclusions: Rural areas are "catching up" with urban areas in problematic substance use. Given the potential barriers to accessing treatment services in rural areas, efforts should be focused on reaching those residents. [source]

Medicare-Certified Home Health Care: Urban-Rural Differences in Utilization

Lacey Hartman MPP
ABSTRACT:,Context:Availability of Medicare-certified home health care (HHC) to rural elders can prevent more expensive institutional care. To date, utilization of HHC by rural elders has not been studied in detail.Purpose:To examine urban-rural differences in Medicare HHC utilization.Methods:The 2002 100% Medicare HHC claims and denominator files were used to estimate use of HHC and to make urban-rural comparisons on the basis of utilization levels within ZIP codes.Findings:Overall, the proportion of Medicare beneficiaries living in areas with little HHC utilization is relatively low. Rural elders, however, are more likely than their urban counterparts to live in such areas. Less than 1% of urban beneficiaries live in ZIP codes with no or low use of HHC, but over 17% of the most rural beneficiaries live in such areas.Conclusions:Continued monitoring of rural HHC utilization and access is important, especially as Medicare seeks to evaluate the effectiveness of payment increases to rural home health agencies. [source]

The State of Diabetes Care Provided to Medicare Beneficiaries Living in Rural America

Joseph P. Weingarten Jr PhD
ABSTRACT:,Context: Diabetes poses a growing health burden in the United States, but much of the research to date has been at the state and local level. Purpose: To present a national profile of diabetes care provided to Medicare beneficiaries living in urban, semirural, and rural communities. Methods: Medicare beneficiaries with diabetes aged 18-75 were identified from Part A and Part B claims data from 1999 to 2001. A composite of 3 diabetes care indicators was assessed (annual hemoglobin A1c test, biennial lipid profile, and biennial eye examination). Findings: Over 77% had a hemoglobin A1c test, 74% a lipid profile, and 69% an eye examination. Patterns of care were considerably different across the urban-rural continuum at the state, Census division, and regional levels. States in the northern and eastern portions of the country had higher indicator rates for rural than for urban residents. States in the South had much lower rates for rural residents than their urban counterparts. Despite these within-state differences, across-state comparisons found that several states tended to have low indicator rates in every level of the urban-rural continuum. A common feature of these states was the relatively high concentration of nonwhite beneficiaries. For example, southern states had much higher concentrations of nonwhite beneficiaries relative to other areas in the country and demonstrated low rates in every level of the urban-rural continuum. Conclusions: Urban-rural quality of care differences may be a function not just of geography but also of the presence of a large nonwhite population. [source]

Family Decision-Making for Nursing Home Residents With Dementia: Rural-Urban Differences

Charles E. Gessert MD
ABSTRACT:,Context: Research has demonstrated substantial differences between end-of-life care in rural and urban settings. As the end of life approaches, rural elders are less likely to be hospitalized, to be placed in an intensive care unit, or to have a feeding tube, compared to their urban counterparts. These differences cannot be fully explained by rural-urban differences in access to medical services. Purpose: To describe and understand rural-urban differences in attitudes toward death and in end-of-life decision making. Methods: Eight focus groups were convened in rural and urban Minnesota nursing homes. The 38 focus group participants were family members of nursing home residents with severe cognitive impairment. Findings: Most rural focus group participants voiced unqualified acceptance of death and placed few conditions on death, beyond their hope that it would be quick and peaceful. Urban respondents presented a wider range of attitudes toward death, from unambiguous acceptance of immediate death to evident discomfort with welcoming death under any circumstances. These rural-urban differences had practical implications. Rural respondents were much less likely to endorse interventions that would impede death, compared to their urban counterparts. Conclusions: Rural respondents tended to express confidence in natural forces; death was seen as neutral or beneficent. Resistance to the approach of death was more characteristic of urban respondents, some of whom insisted upon aggressive medical care in advanced dementia. [source]

A National Study of Obesity Prevalence and Trends by Type of Rural County

J. Elizabeth Jackson MA
ABSTRACT: Context: Obesity is epidemic in the United States, but information on this trend by type of rural locale is limited. Purpose: To estimate the prevalence of and recent trends in obesity among US adults residing in rural locations. Methods: Analysis of data from the Behavioral Risk Factor Surveillance System (BRFSS) for the years 1994,1996 (n = 342,055) and 2000,2001 (n = 385,384). The main outcome measure was obesity (body mass index [BMI] ,30), as determined by calculating BMI from respondents' self-reported height and weight. Results: In 2000,2001, the prevalence of obesity was 23.0% (95% confidence interval [CI] 22.6%-23.4%) for rural adults and 20.5% (95% CI 20.2%-20.7%) for their urban counterparts, representing increases of 4.8% (95% CI 4.2%-5.3%) and 5.5% (95% CI 5.1%-5.9%), respectively, since 1994,1996. The highest obesity prevalence occurred in rural counties in Louisiana, Mississippi, and Texas; obesity prevalence increased for rural residents in all states but Florida over the study period. African Americans had the highest obesity prevalence of any group, up to 31.4% (95% CI 29.1%-33.6) in rural counties adjacent to urban counties. The largest difference in obesity prevalence between those with a college education compared with those without a high school diploma occurred in urban areas (18.4% [95% CI 17.9%-18.9%] vs 23.5% [95% CI 22.5%-24.5%], respectively); the smallest difference occurred in small, remote rural counties (20.3% [95% CI 18.7%-21.9%] versus 22.3% [95% CI 20.7%-24.0%], respectively). Conclusions: The prevalence of obesity is higher in rural counties than in urban counties; obesity affects some residents of rural counties disproportionately. [source]

Rural Nebraska Elementary School Educators Teach Nutrition Concepts

H. Darlene Pohlman Ph.D.
The purpose of this study was to determine if diferences exist in the teaching of nutrition to students in grades one to four in rural (less than 10,000 population); midsized (10,000 to 99,999); and urban (100,000 or more) counties in Nebrash. Surveys me sent to one-fifty of educators teaching grades une to four (n=1,232); the response rate was 37.7%. Sixty eight percent of the teachers responded that the teaching of nutrition was of very high or high priority in the elementary curriculum. Nutrition was taught as part of a nutrition/health unit as well as being integrated into other subject areas. The resources the teachers used me not different by county population size. Significant diferences (p >.05) were observed among county groups as to the frequency of teaching the recommended intakes of grain products, vegetables, fruits, dairy, and meats, with urban teachers teaching these concepts least often. The majority of the teachers rarely, if ever, taught serving sizes and which food groups are in combination foods, with no diferences among county groups. The formal training that the respondents had in nutrition was not different among groups. A larger percentage of teachers in rural and midsized community groups taught food selection concepts me consistently or frequently than did their urban counterparts. [source]

Joint replacement surgeries among medicare beneficiaries in rural compared with urban areas

Mark L. Francis
Objective People in rural areas live farther away from hospitals than do people in urban areas. Thus, there is concern that people living in rural areas may be less willing or able to undergo elective surgical procedures. This study was undertaken to determine whether Medicare beneficiaries in rural areas were less likely to have elective total knee or hip replacement surgeries compared with their urban counterparts. Methods We performed a cross-sectional study of Medicare beneficiaries, controlling for age, sex, race/ethnicity, and economic status. Beneficiaries were assigned to rural versus urban areas based on their zip code of residence and the 10-point Rural-Urban Commuting Area designation. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. Results Compared with urban beneficiaries, rural beneficiaries were 27% more likely to have total knee or hip replacement surgeries (OR 1.27 [95% CI 1.26,1.28]). After adjusting for age, sex, race/ethnicity, median household income, average house value, mean poverty ratio, and state of residence, rural beneficiaries were still 14% more likely to have total joint replacement surgeries (OR 1.14 [95% CI 1.13,1.16]). Differential use of surgery before and after receiving Medicare eligibility did not explain the findings. While significant sex, racial, and ethnic disparities were present in both rural and urban areas, for the most part these disparities were ameliorated rather than accentuated in rural areas. Conclusion Contrary to expectations, our findings indicate that Medicare beneficiaries living in rural areas are more likely to undergo total knee or hip replacement surgeries. [source]

The urban and rural divide for women giving birth in NSW, 1990,1997

Christine L. Roberts
ABSTRACT OBJECTIVE: To examine trends in the pregnancy profile and outcomes of urban and rural women. METHODS: Data were obtained from the NSW Midwives Data Collection on births in NSW, 1990,1997. Associations between place of residence (urban/rural) and maternal factors and pregnancy outcomes were examined, including changes over time. RESULTS: From 1990 to 1997 there were 685,631 confinements in NSW and these mothers resided as follows: 76% metropolitan, 5% large rural centres, 8% small rural centres, 11% other rural areas and 1% remote areas. Rural mothers were more likely to be teenagers, multiparous, without a married or de facto partner, public patients and smokers. Births in rural areas declined, particularly among women aged 20,34 years. Infants born to mothers in remote communities were at increased odds of stillbirth and tow Apgar scores (all women) and small,for,gestational,age (SGA) (Indigenous women only). CONCLUSIONS: The profile of pregnant women in rural NSW is different from their urban counterparts and is consistent with relative socioeconomic disadvantage and possibly suboptimal maternity services in some areas. While increased risk of SGA is associated with environmental factors such as smoking and nutrition, the reasons for increased risk of stillbirth are unclear. Although there does not appear to be an increased risk of preterm birth for rural women this may be masked by transfer of high,risk pregnancies interstate. IMPLICATIONS: Maternity services need to be available and accessible to all rural women with targeting of interventions known to reduce low birthweight and perinatal death. [source]

Four years after graduation: Occupational therapists' work destinations and perceptions of preparedness for practice

Dione Brockwell
Abstract Objective:,The present study sought to identify the work destinations of graduates and ascertain their perceived preparedness for practice from a regional occupational therapy program, which had been specifically developed to support the health requirements of northern Australians by having an emphasis on rural practice. Design:,Self-report questionnaires and semistructured in-depth telephone interviews. Participants:,Graduates (n = 15) from the first cohort of occupational therapists from James Cook University, Queensland. Main outcome measure:,The study enabled comparisons to be made between rural and urban based occupational therapists, while the semistructured interviews provided a deeper understanding of participants' experiences regarding their preparation for practice. Results:,Demographic differences were noted between occupational therapists working in rural and urban settings. Rural therapists were predominantly younger and had worked in slightly more positions than their urban counterparts. The study also offered some insights into the value that therapists placed on the subjects taught during their undergraduate occupational therapy training, and had highlighted the differences in perceptions between therapists with rural experience and those with urban experience regarding the subjects that best prepared them for practice. Generally, rural therapists reported that all subjects included in the curriculum had equipped them well for practice. Conclusions:,Findings suggest the need to undertake further research to determine the actual nature of rural practice, the personal characteristics of rural graduates and the experiences of students while on rural clinical placements. [source]

High-tech rural clinics and hospitals in Japan: a comparison to the Japanese average

Masatoshi Matsumoto
Abstract Context:,Japanese medical facilities are noted for being heavily equipped with high-tech equipment compared to other industrialised countries. Rural facilities are anecdotally said to be better equipped than facilities in other areas due to egalitarian health resource diffusion policies by public sectors whose goal is to secure fair access to modern medical technologies among the entire population. Objectives:,To show the technology status of rural practice and compare it to the national level. Design:,Nationwide postal survey. Setting, Subjects & Interventions:,Questionnaires were sent to the directors of 1362 public hospitals and clinics (of the 1723 municipalities defined as ,rural' by four national laws). Information was collected about the technologies they possessed. The data were compared with figures from a national census of all hospitals and clinics. Results:,A total of 766 facilities responded (an effective response rate of 56%). Rural facilities showed higher possession rates in most comparable technologies than the national level. It is noted that almost all rural hospitals had gastroscopes and colonoscopes and their possession rates of bronchoscopes and dialysis equipment were twice as high as the national level. The discrepancy in possession rates between rural and national was even more remarkable in clinics than in hospitals. Rural clinics owned twice as many abdominal ultrasonographs, and three times as many gastroscopes, colonoscopes, defibrillators and computed tomography scanners as the national level. Conclusions:,Rural facilities are equipped with more technology than urban ones. Government-led, tax based, technology diffusion in the entire country seems to have attained its goal. What is already known on this subject:,As a general tendency in both developing and developed countries, rural medical facilities are technologically less equipped than their urban counterparts. What does this paper add?:,In Japan, rural medical facilities are technologically better equipped than urban facilities. [source]

Re-thinking local autonomy: Perceptions from four rural municipalities

Benoy Jacob
This article looks at how this agenda might affect smaller rural municipalities, since the assumption seems to be that one can simply re-size and re-shape policy prescriptions from urban and suburban contexts to fit rural areas. Drawing on the lessons learned from an eight-year project titled "Understanding the New Rural Economy: Options and Choices," the authors argue that autonomy is only valuable in relation to a locality's capacity to take advantage of new powers and that rural capacities are very different from those of their urban counterparts. The authors present a conceptual framework in which capacity is a dynamic and multidimensional entity of which autonomy is a necessary, though not sufficient, condition. This framework is then employed to explore four rural Canadian municipalities. This study is the first to consider traditional administrative reforms in a rural context. Employing a case-study methodology, the authors found four dimensions of capacity that may support changes to local autonomy: strategic planning, citizen participation and support, expertise, and access to revenues. Sommaire : Dirigé par les plus grandes municipalités urbaines, le programme actuel des réformes municipales au Canada met une emphase considérable sur la question de l'autonomie locale. Le présent article porte sur la manière dont ce programme pourrait avoir une incidence sur les plus petites municipalités rurales, étant donné que l'hypothèse semble être qu'il est tout simplement possible de redimensionner et refondre les prescriptions de politiques de contextes urbains et suburbains pour qu'elles s'adaptent aux régions rurales. Tirant des enseignements d'un projet sur huit ans intitulé"Comprendre la nouvelle économie rurale : options et choix" (NER), l'article prétend que l'autonomie est seulement intéressante en ce qui concerne la capacité d'une localitéà tirer parti de nouveaux pouvoirs et que les capacités rurales sont très différentes des capacités urbaines. Les auteurs présentent un cadre conceptuel où la capacité est une entité dynamique et multi-dimensionnelle dont l'autonomie est une condition nécessaire mais pas suffisante. Ce cadre est alors employé pour étudier à fond quatre municipalités rurales canadiennes. L'article est la première étude à envisager les réformes administratives traditionnelles dans un contexte rural. Ayant recours à une méthodologie d'études de cas, les auteurs ont trouvé quatre dimensions de capacité qui peuvent soutenir des changements pour l'autonomie locale : la planification stratégique, la participation et le soutien des citoyens, l'expertise et l'accès aux revenus. [source]