AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 5 2002
Ruth Cox
ABSTRACT: The aim of this paper is to demonstrate the utility of Goal Attainment Scaling (GAS) as an effective, multidisciplinary measure of client outcomes for rural and remote health services. Goal Attainment Scaling was adopted by the Spinal Outreach Team (SPOT) as a client-focussed evaluation tool, as it is sensitive to the individual nature of clients' presenting issues and the multidisciplinary focus of the team. It enables individualised goals to be set on a five-point scale. Goal Attainment Scaling was introduced to the SPOT service after a pilot trial established guidelines for its effective implementation. An ongoing review process ensures that goal scaling remains realistic and relevant. Service outcomes can be effectively summarised using a frequency distribution of GAS scores. One of the important benefits of GAS is its facilitation of collaborative goal setting between clinician and client. Goal Attainment Scaling is recommended to rural and remote multidisciplinary health services because of its ability to summarise outcomes from heterogeneous service activities. [source]

DEVELOPMENT OF ORAL HEALTH TRAINING FOR RURAL AND REMOTE ABORIGINAL HEALTH WORKERS

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 3 2001
Tom Pacza
Abstract: Research data exists that highlight the discrepancy between the medical/dental status experienced by Aboriginal people compared with that of their non-Aboriginal counterparts. This, coupled with a health system that Aboriginal people often find alienating and difficult to access, further exacerbates the many health problems they face. Poor oral health and hygiene is an issue often overlooked that can significantly impact on a person's quality of life. In areas where Aboriginal people find access to health services difficult, the implementation of culturally acceptable forms of primary health care confers significant benefits. The Aboriginal community has seen that the employment and training of Aboriginal health workers (AHW), particularly in rural and remote regions, is significantly beneficial in improving general health. In the present study, an oral health training program was developed and trialed. This training program was tailored to the needs of rural and remote AHWs. The primary objective was to institute a culturally appropriate basic preventative oral health delivery program at a community level. It is envisaged that through this dental training program, AHWs will be encouraged to implement long-term preventive measures at a local level to improve community dental health. They will also be encouraged to pursue other oral health-care delivery programs. Additionally, it is considered that this project will serve to strengthen a trust-based relationship between Aboriginal people and the health-care profession. [source]

AN ASSESSMENT OF FUNDING TO SUPPORT RURAL AND REMOTE HEALTH RESEARCH IN AUSTRALIA

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 5 2000
Carla Patterson
ABSTRACT: A. systematic search was undertaken to ascertain the nature, source and extent of funding awarded to research projects that were directed specifically at aspects of rural health over the past decade. Comment is also made on the challenge of obtaining such information directly from databases. The sources investigated were the conventional research funding bodies, hospital trusts and foundations, university funding schemes and government sources. The results of these searches revealed a crude average of 3 million dollars per year from conventional research funding with the remaining sources adding a similar amount in total. Analysis of the data using a framework modified from the Strategic Review of Health and Medical Research in Australia shows that funding is concentrated in the health services and public health areas with a preponderance of funding being directed towards the description of conditions and interventions. Significant levels of funding have been directed towards the National Health Priority Areas. [source]

Whither Peasants in Siberia?: Agricultural Reform, Subsistence, and Being Rural

CULTURE, AGRICULTURE, FOOD & ENVIRONMENT, Issue 1 2003
Katherine R. Metzo
First page of article [source]

Gender, Traditional Authority, and the Politics of Rural Reform in South Africa

DEVELOPMENT AND CHANGE, Issue 4 2002
Haripriya Rangan
The new South African Constitution, together with later policies and legislation, affirm a commitment to gender rights that is incompatible with the formal recognition afforded to unelected traditional authorities. This contradiction is particularly evident in the case of land reform in many rural areas, where women's right of access to land is denied through the practice of customary law. This article illustrates the ways in which these constitutional contradictions play out with particular intensity in the ,former homelands' through the example of a conflict over land use in Buffelspruit, Mpumalanga province. There, a number of women who had been granted informal access to communal land for the purposes of subsistence cultivation had their rights revoked by the traditional authority. Despite desperate protests, they continue to be marginalized in terms of access to land, while their male counterparts appropriate communal land for commercial farming and cattle grazing. Drawing on this protest, we argue that current South African practice in relation to the pressing issue of gender equity in land reform represents a politics of accommodation and evasion that tends to reinforce gender biases in rural development, and in so doing, undermines the prospects for genuinely radical transformation of the instituted geographies and institutionalized practices bequeathed by the apartheid regime. [source]

From Urban to Rural: Lessons for Microfinance from Argentina

DEVELOPMENT POLICY REVIEW, Issue 3 2001
Mark Schreiner
The recent success of microfinance for the urban self-employed contrasts with decades of failure on the part of public development banks for small farmers. This article describes the ways in which rural microfinance organisations have tried to adapt the lessons of urban microfinance to manage the risks and control the costs of the supply of financial services in rural areas. It then asks whether the lessons of urban microfinance are likely to apply in the poorest rural areas of Argentina. The article concludes that microfinance is unlikely to improve access to small loans and small deposits for many of the rural poor in Argentina; distances are too great, farmers too specialised, and wages too high. Improved access depends not on targeting loans by government decree but on strengthening institutions that support financial markets. [source]

A low incidence of Type 1 diabetes between 1977 and 2001 in south-eastern Sweden in areas with high population density and which are more deprived

DIABETIC MEDICINE, Issue 3 2008
B.-M. Holmqvist
Abstract Aims To explore how socioeconomic factors and population density may contribute to the geographical variation of incidence of Type 1 diabetes in children in south-eastern Sweden. Method All children diagnosed with Type 1 diabetes in south-eastern Sweden during 1977,2001 were defined geographically to their place of residence and were allocated x and y coordinates in the national grid. The population at risk and socioeconomic data were aggregated in 82 000 200-m squares and geocoded likewise. A socioeconomic index was calculated using a signed ,2 method. Rural,urban gradients were defined by overlay analysis in a geographic information system. Results The incidence during the past 25 years has been rising steadily, particularly in the last 6 years. The incidence was highest in areas with a high proportion of small families, of families with a high family income and better education, and this was found both at the time of diagnosis and at the time of birth. In the rural,urban analysis, the lowest incidence was found in the urban area with > 20 000 inhabitants, where there was also a higher frequency of deprivation. Conclusions Our findings indicate that geographical variations in incidence rates of Type 1 diabetes in children are associated with socioeconomic factors and population density, although other contributing factors remain to be explained. [source]

Financial Exclusion in Rural and Remote New South Wales, Australia: a Geography of Bank Branch Rationalisation, 1981,98

GEOGRAPHICAL RESEARCH, Issue 2 2000
N.M. Argent
The provision of financial services in rural Australia is a significant public policy issue, reflected in the high level of media and political interest in the recent spate of branch closures. There are, however, many aspects of the current debate regarding the delivery of financial services to rural communities that are, at best, less than ideal and, at worst, erroneous. Using telephone directories for New South Wales, non-metropolitan bank branch listings for the period 1981 to 1998 were collated. A recategorisation of these data according to the Rural, Remote and Metropolitan Areas classification reveals, amidst a spatial realignment of financial service provision, that rural and remote New South Wales have been disproportionately affected by a relatively recent and concerted withdrawal of services. The research demonstrates that corporate-level responses to increased competition within the financial system are significantly more important in deciding rural access to banking services than local and regional population trends. Indeed, two-thirds of rural localities that have lost branches had experienced healthy population growth during the study period. In the wake of the post-deregulation reconfiguration of the bank branch network, the socio-economic marginalisation of rural communities is being compounded, a process of ,financial exclusion' recognised in other parts of the developed world. [source]

Information and Communications Technologies in Rural Society: Being Rural in a Digital Age , Edited by Grete Rusten and Sarah Skerratt

GROWTH AND CHANGE, Issue 4 2008
Sharon C. Cobb
First page of article [source]

Improving transfer of mental health care for rural and remote consumers in South Australia

HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 2 2009
Judy Taylor BA Dip Soc Wk MSW PhD
Abstract In Australia, it is commonplace for tertiary mental health care to be provided in large regional centres or metropolitan cities. Rural and remote consumers must be transferred long distances, and this inevitably results in difficulties with the integration of their care between primary and tertiary settings. Because of the need to address these issues, and improve the transfer process, a research project was commissioned by a national government department to be conducted in South Australia. The aim of the project was to document the experiences of mental health consumers travelling from the country to the city for acute care and to make policy recommendations to improve transitions of care. Six purposively sampled case studies were conducted collecting data through semistructured interviews with consumers, country professional and occupational groups and tertiary providers. Data were analysed to produce themes for consumers, and country and tertiary mental healthcare providers. The study found that consumers saw transfer to the city for mental health care as beneficial in spite of the challenges of being transferred over long distances, while being very unwell, and of being separated from family and friends. Country care providers noted that the disjointed nature of the mental health system caused problems with key aspects of transfer of care including transport and information flow, and achieving integration between the primary and tertiary settings. Improving transfer of care involves overcoming the systemic barriers to integration and moving to a primary care-led model of care. The distance consultation and liaison model provided by the Rural and Remote Mental Health Services, the major tertiary provider of services for country consumers, uses a primary care-led approach and was highly regarded by research participants. Extending the use of this model to other primary mental healthcare providers and tertiary facilities will improve transfer of care. [source]

The Diverse Housing Needs of Rural to Urban Migrants and Policy Responses in China: Insights from a Survey in Fuzhou

IDS BULLETIN, Issue 4 2010
Liyue Lin
Based on a survey of rural-urban migrants and subsequent in-depth interviews in Fuzhou, the capital city of Fujian Province in China, this article first provides a brief review of migrants' housing conditions, and assesses the current approaches in meeting their housing needs and security. We then examine migrants' housing needs in the context of their mobility and their diversified migration flows, demonstrating that migrants have different housing needs from local urban residents, and among themselves. The article also explores the policy implications of this analysis, and makes policy recommendations, focusing mainly on redefining the roles of the state and the necessity of making policies to meet the diversified needs of rural,urban migrants in the provision of housing and housing security. [source]

Rural and agri-tourism as a tool for reorganising rural areas in old and new member states,,,a comparison study of Ireland and Poland

INTERNATIONAL JOURNAL OF TOURISM RESEARCH, Issue 2 2005
Cecilia Hegarty
Abstract Both assessment of the physical, economic and social impacts of enlargement and monitoring the implementation of policy directives are vital to future European Union operation. This paper investigates tourism development within relatively underdeveloped regions within Ireland and Poland, and it suggests implications for tourism operations. Comparison is made between product and service offerings in both regions. Strong similarities exist between the profiles of operators, operator motivations differ, and business diversification depends on regional resources and dependency on tourism markets. The level of diversification ultimately determines rural tourism development. The value of using Ireland as a reference model for Polish development and critical issues for tourism advisors and policy makers are discussed. Copyright © 2005 John Wiley & Sons, Ltd. [source]

The effect of introducing pipelines into irrigation water distribution systems on the farm economy: a case study in the Southern Governorates Rural Development Project, Republic of Yemen,

IRRIGATION AND DRAINAGE, Issue 1 2001
Rozgar Baban
le Yémen; eau souterraine; irrigation; tuyaux Abstract The Southern Governorates Rural Development Project (SGRDP) is a comprehensive participatory rural development project covering three of the five southern Governorates of the Republic of Yemen, namely Hadramaut, Abyan and Lahij. Its objective is to alleviate poverty in rural areas of these three Governorates. A major component of the project is to develop virgin lands for agriculture and allocate each 5 feddan (FD) plot to those farmers who do not own land (1 FD=4200 m2). As the annual rainfall in the project area is less than 100 mm and since landlords and other farmers already own lands suitable for agriculture in the major wadis, the only source of irrigation water in the newly developed land is the groundwater (GW). The SGRDP is aware of the scarcity of water resources in the country, particularly in the project area; it therefore makes every possible effort to optimize the use of GW for irrigation by practical means. One way of reducing GW used for irrigation is by replacing major canals in the farms by buried pipelines. This method has been tried in small-scale individual farms outside the project area and it proved that farmers could adapt to the system without difficulty. Sprinkler and drip irrigation systems have been tried in many previous agricultural development projects in the country but with no apparent success, as far as the farmers' adoption of the method is concerned. Thus, the project, as the first stage to reduce the use of GW for irrigation in the newly developed areas, planned to eliminate, initially, the conveyance losses by replacing the open canals by buried PVC pipes. In this paper, it is attempted to show that the use of buried pipes in small scale irrigation schemes is financially feasible, even if the indirect and non-tangible environmental benefits are not considered. This paper deals only with special GW schemes recommended for the project area; however, the outcome could be generalized and applied elsewhere in the country. Copyright © 2001 John Wiley & Sons Ltd. Le Projet de Développement Rural des Gouvernorats du Sud (SGRDP) est un ensemble de projet de développement rural participatif de trois des cinq Gouvernorats de la République de Yémen à savoir Hadramaut, Abyan et Lahij. Son objectif est d'atténuer la pauvreté dans les régions rurales de ces Gouvernorats. L'une des principales activités de ce projet concerne le développement des terres incultes pour l'agriculture. Ce développement passe par l'allocation de parcelles de 5 FD à chaque agriculteur sans terre. Comme la pluviosité annuelle dans cette région est inférieure à 100 mm et que les propriétaires et les autres fermiers disposent déjà des terres aptes à l'agriculture dans les WADIS importants, l'eau souterraine est la seule source d'eau pour l'irrigation des terres nouvellement développées. Compte tenu de la rareté des ressources en eau, particulièrement dans la région du projet, le SGRDP s'efforce d'optimiser l'utilisation de l'eau souterraine (ES) pour l'irrigation en adoptant des moyens pratiques. L'un des moyens de réduire l'ES utilisée en irrigation consiste à remplacer les principaux canaux des fleuves par des tuyaux enterrés. Cette méthode a été utilisée à titre d'essai dans des exploitations individuelles de petite taille en dehors de la région du projet, et il s'est avéré que les agriculteurs peuvent s'adapter à ce système sans difficultés. Les systèmes d'irrigation par aspersion et goutte à goutte ont été essayés dans de nombreux anciens projets de développement agricoles du pays, mais sans succès apparent quant à l'adoption de cette méthode par les fermiers. Ainsi, le projet, en tant que première stade de réduction de l'ES pour l'irrigation dans les régions nouvellement développées, a proposé d'éliminer au début les pertes par transport en remplaçant les canaux ouverts par des tuyaux PVC enterrés. Ce rapport essaie de montrer que l'utilisation des tuyaux enterrés dans les projets d'irrigation de petite taille, est faisable du point de vue économique même en faisant abstraction des avantages indirects et non tangibles provenant de l'environnement. Le rapport traite seulement des projets spéciaux de l'ES recommandés pour la région du projet. Cependant, les résultats peuvent être généralisés et appliqués aux autres régions du pays. Copyright © 2001 John Wiley & Sons Ltd. [source]

From Village Artisans to Industrial Clusters: Agendas and Policy Gaps in Indian Rural Industrialization

JOURNAL OF AGRARIAN CHANGE, Issue 1 2001
Ashwani Saith
This paper offers a broad strategic assessment of the experience of rural industrialization in India. It does so from a policy perspective with the aim eventually of highlighting speci?c outstanding policy issues. Rural and small-scale industrialization (RSSI) has held a special place in Indian development thinking and policy formulation from the outset. This privileged position, however, does not derive from a universal consensus with regard to the rationale and policy framework applicable to this sub-sector.However, such has been the symbolic power and populist appeal of RSSI that it has retained its special status within diverse strategic and ideological frameworks. But how has the sub-sector performed? Is the infant industry still in need of paternalistic protection at the age of ?fty? Are there any credible indications of a strategic break with longstanding policy frameworks inherited from the past? Can any crucial policy gaps be identi ?ed? How well does rural small-scale industry satisfy the extensive developmental claims made by its proponents? These are the general questions addressed. [source]

Pneumonia and Influenza Hospitalizations in Elderly People with Dementia

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2009
Elena N. Naumova PhD
OBJECTIVES: To compare the demographic and geographic patterns of pneumonia and influenza (P&I) hospitalizations in older adults with dementia with those of the U.S. population and to examine the relationship between healthcare accessibility and P&I. DESIGN: Observational study using historical medical claims from the Centers for Medicare and Medicaid Services (CMS) and CMS records supplemented with information derived from other large national sources. SETTING: Retrospective analysis of medical records uniformly collected over a 5-year period with comprehensive national coverage. PARTICIPANTS: A study population representative of more than 95% of all people aged 65 and older residing in the continental United States. MEASUREMENTS: Six million two hundred seventy-seven thousand six hundred eighty-four records of P&I between 1998 and 2002 were abstracted, and county-specific outcomes for hospitalization rates of P&I, mean length of hospital stay, and percentage of deaths occurring in a hospital setting were estimated. Associations with county-specific elderly population density, percentage of nursing home residents, median household income per capita, and rurality index were assessed. RESULTS: Rural and poor counties had the highest rate of P&I and percentage of influenza. Patients with dementia had a lower frequency of influenza diagnosis, a shorter length of hospital stay, and 1.5 times as high a rate of death as the national average. CONCLUSION: The results suggest strong disparities in healthcare practices in rural locations and vulnerable populations; infrastructure, proximity, and access to healthcare are significant predictors of influenza morbidity and mortality. These findings have important implications for influenza vaccination, testing, and treatment policies and practices targeting the growing fraction of patients with cognitive impairment. [source]

Epidemiology of hepatitis B virus infection in the Asia,Pacific region

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 2000
Chien-Jen Chen
There is a wide variation of hepatitis B virus (HBV) infection in the Asia,Pacific region. The prevalence of chronic HBV infection is lowest (< 1%) in North America, Australia and New Zealand, 2,4% in Japan, 5,18% in China and highest (15,20%) in Taiwan as well as several other countries in South East Asia. Perinatal transmission is common in HBV-hyperendemic areas. Geographical clusters of horizontal HBV infection have been reported in both high- and low-risk countries. Common sources of infection, including iatrogenic and sexual transmission, have been implicated. Migrant studies indicate the importance of childhood environments in the determination of HBV infection. Rural,urban and ethnic differences in the prevalence of HBV infection have also been reported. There has been a decrease in the prevalence of HBV infection after mass HBV vaccination programmes in some Asia, Pacific countries, which may be due to the intervention of possible transmission routes through the use of disposable syringes and needles, screening of HBV infection markers in blood banks, and prevention of high-risk tattooing, acupuncture, ear-piercing and sexual contact. A striking decrease in the incidence of HBV infection and hepatocellular carcinoma has been observed among children in Taiwan and other areas where mass vaccination programmes have been implemented. [source]

Rural and Urban Disparities in Caries Prevalence in Children with Unmet Dental Needs: The New England Children's Amalgam Trial

JOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 1 2008
Nancy Nairi Maserejian ScD
Abstract Objectives: To compare the prevalence of caries between rural and urban children with unmet dental health needs who participated in the New England Children's Amalgam Trial. Methods: Baseline tooth and surface caries were clinically assessed in children from rural Maine (n = 243) and urban Boston (n = 291), who were aged 6 to 10 years, with two or more posterior carious teeth and no previous amalgam restorations. Statistical analyses used negative binomial models for primary dentition caries and zero-inflated models for permanent dentition caries. Results: Urban children had a higher mean number of carious primary surfaces (8.5 versus 7.4) and teeth (4.5 versus 3.9) than rural children. The difference remained statistically significant after adjusting for sociodemographic factors and toothbrushing frequency. In permanent dentition, urban children were approximately three times as likely to have any carious surfaces or teeth. However, rural/urban dwelling was not statistically significant in the linear analysis of caries prevalence among children with any permanent dentition caries. Covariates that were statistically significant in all models were age and number of teeth. Toothbrushing frequency was also important for permanent teeth. Conclusions: Within this population of New England children with unmet oral health needs, significant differences were apparent between rural and urban children in the extent of untreated dental decay. Results indicate that families who agree to participate in programs offering reduced cost or free dental care may present with varying amounts of dental need based on geographic location. [source]

Implementation of a Coordinated School Health Program in a Rural, Low-Income Community

JOURNAL OF SCHOOL HEALTH, Issue 9 2007
BSHRM, Lisa Cornwell RN
ABSTRACT Background:, Coordinated school health programs (CSHPs) bring together educational and community resources in the school environment. This method is particularly important in rural areas like Kansas, where resources and trained health professionals are in short supply. Rural Stafford County, Kansas, struggles with health professional shortages and a low-income, high-need population. Methods:, In 2001, Stafford County's Unified School District 349 began a multiyear CSHP development process, which required adaptations for implementation in a rural area. First, a CSHP team was formed of community and administrative stakeholders as well as school system representatives. Next, the CSHP team assessed school district demographics so the program framework could be targeted to health needs. During a yearlong planning phase, the CSHP team determined 4 priority areas for program development, as limited staff and funds precluded developing programs in all 8 traditional CSHP areas. Program activities were tailored to the population demographics and available resources. Results:, Program outcomes were supported by School Health Index (SHI) data. Of the 8 CSHP focus areas, the SHI found high scores in 3 of the Stafford CSHP's priority areas: Health Services; Psychological, Counseling, and Social Services; and Physical Education. The fourth Stafford CSHP priority area, Nutrition Services, scored similarly to the less prioritized areas. Conclusions:, The process by which the Stafford school district modified and implemented CSHP methods can serve as a model for CSHPs in other rural, high-need areas. [source]

Prevalence and Degree of Childhood and Adolescent Overweight in Rural, Urban, and Suburban Georgia

JOURNAL OF SCHOOL HEALTH, Issue 4 2006
Richard D. Lewis
The aim of this study was to determine the prevalence of OW and EOW in school-aged youths from 4 regions of Georgia. A 2-stage cluster sampling procedure was performed in 2002, with participation of 4th-, 8th- and 11th-grade students (N = 3114). Measured height and weight were used to determine body mass index (BMI) for age percentiles and data were weighted to estimate population prevalence of OW. A logistic regression model determined predictors of OW. The overall estimate of OW prevalence was 20.2% and highest in males (22.0%), non-Hispanic blacks (21.8%), "other races" (32.4%), and students residing in rural growth (23.7%) and rural decline (23.0%) areas. Overweight prevalence was similar among grades. The overall estimated EOW was 4.3 and highest in males (4.7), other races (5.6), non-Hispanic blacks (5.2), and students from rural growth (5.4) and rural decline (5.0) areas. Sex, race, location, and economic tier were significant predictors (= 0.02) of OW. The prevalence and severity of OW was higher in youths residing in Georgia than nationally. School health professionals, community leaders, and parents should provide support for updated school policies aimed at providing BMI surveillance and a school environment that encourages physical activity and healthy nutrition practices. (J Sch Health. 2006;76(4):126-132) [source]

Structured assessment using multiple patient scenarios by videoconference in rural settings

MEDICAL EDUCATION, Issue 5 2008
Tim J Wilkinson
Context, The assessment blueprint of the Australian College of Rural and Remote Medicine postgraduate curriculum highlighted a need to assess clinical reasoning. We describe the development, reliability, feasibility, validity and educational impact of an 8-station assessment tool, StAMPS (structured assessment using multiple patient scenarios), conducted by videoconference. Methods, StAMPS asks each candidate to be examined at each of 8 stations on issues relating to patient diagnosis or management. Each candidate remains located in a rural site but is examined in turn by 8 examiners who are located at a central site. Examiners were rotated through the candidates by either walking between videoconference rooms or by connecting and disconnecting the links. Reliability was evaluated using generalisability theory. Validity and educational impact were evaluated with qualitative interviews. Results, Fourteen candidates were assessed on 82 scenarios with a reliability of G = 0.76. There was a reasonable correlation with level of candidate expertise (, = 0.57). The videoconference links were acceptable to candidates and examiners but the walking rotation system was more reliable. Qualitative comments confirmed relevance and acceptability of the assessment tool and suggest it is likely to have a desirable educational impact. Conclusions, StAMPS not only reflects the content of rural and remote practice but also reflects the process of that work in that it is delivered from a distance and assesses resourcefulness and flexibility in thinking. The reliability and feasibility of this type of assessment has implications for people running any distance-based course, but the assessment could also be used in a face-to-face setting. [source]

The Effect of Income Distribution on the Ability of Growth to Reduce Poverty: Evidence from Rural and Urban African Economies

AMERICAN JOURNAL OF ECONOMICS AND SOCIOLOGY, Issue 3 2010
Augustin Kwasi Fosu
The present study examines the extent to which income distribution affects the ability of economic growth to reduce poverty, based on 1990s data for a sample of rural and urban sectors of African economies. Using the basic-needs approach, an analysis-of-covariance model is derived and estimated, with the headcount, gap, and squared gap poverty ratios serving as the respective dependent variables, and the Gini coefficient and PPP-adjusted incomes as explanatory variables. The study finds that the responsiveness of poverty to income growth is a decreasing function of inequality, albeit at varying rates for the three poverty measures: lowest for the headcount, followed by the gap and fastest for the squared gap. The ranges for the income elasticity in the sample are estimated at: 0.02,0.68, 0.11,1.05, and 0.10,1.35, respectively, for these poverty measures. Furthermore while, on average, the responsiveness of poverty to income growth appears to be the same between the rural and urban sectors, there are substantial sectoral differences across countries. The results suggest the need for country-specific emphases on growth relative to inequality. [source]

Mortality and Revascularization Following Admission for Acute Myocardial Infarction: Implication for Rural Veterans

THE JOURNAL OF RURAL HEALTH, Issue 4 2010
Thad E. Abrams MD
Abstract Introduction: Annually, over 3,000 rural veterans are admitted to Veterans Health Administration (VA) hospitals for acute myocardial infarction (AMI), yet no studies of AMI have utilized the VA rural definition. Methods: This retrospective cohort study identified 15,870 patients admitted for AMI to all VA hospitals. Rural residence was identified by either Rural-Urban Commuting Area (RUCA) codes or the VA Urban/Rural/Highly Rural (URH) system. Endpoints of mortality and coronary revascularization were adjusted using administrative laboratory and clinical variables. Results: URH codes identified 184 (1%) veterans as highly rural, 6,046 (39%) as rural, and 9,378 (60%) as urban; RUCA codes identified 1,350 (9%) veterans from an isolated town, 3,505 (22%) from a small or large town, and 10,345 (65%) from urban areas. Adjusted mortality analyses demonstrated similar risk of mortality for rural veterans using either URH or RUCA systems. Hazards of revascularization using the URH classification demonstrated no difference for rural (HR, 0.96; 95% CI, 0.94-1.00) and highly rural veterans (HR, 1.13; 0.96-1.31) relative to urban veterans. In contrast, rural (relative to urban) veterans designated by the RUCA system had lower rates of revascularization; this was true for veterans from small or large towns (HR, 0.89; 0.83-0.95) as well as veterans from isolated towns (HR, 0.86; 0.78-0.93). Conclusion: Rural veterans admitted for AMI care have a similar risk of 30-day mortality but the adjusted hazard for receipt of revascularization for rural veterans was dependent upon the rural classification system utilized. These findings suggest potentially lower rates of revascularization for rural veterans. [source]

The Vermont Model for Rural HIV Care Delivery: Eleven Years of Outcome Data Comparing Urban and Rural Clinics

THE JOURNAL OF RURAL HEALTH, Issue 2 2010
Christopher Grace MD
Abstract Context: Provision of human immunodeficiency virus (HIV) care in rural areas has encountered unique barriers. Purpose: To compare medical outcomes of care provided at 3 HIV specialty clinics in rural Vermont with that provided at an urban HIV specialty clinic. Methods: This was a retrospective cohort study. Findings: Over an 11-year period 363 new patients received care, including 223 in the urban clinic and 140 in the rural clinics. Patients in the 2 cohorts were demographically similar and had similar initial CD4 counts and viral loads. There was no difference between the urban and rural clinic patients receiving Pneumocystis carinii prophylaxis (83.5% vs 86%, P= .38) or antiretroviral therapy (96.8% vs 97.5%, P= .79). Both rural and urban cohorts had similar decreases in median viral load from 1996 to 2006 (3,876 copies/mL to <50 copies/mL vs 8,331 copies/mL to <50 copies/mL) and change in percent of patients suppressed to <400 copies/mL (21.4%-69.3% vs 16%-71.4%, P= .11). Rural and urban cohorts had similar increases in median CD4 counts (275/mm3 -350/mm3 vs 182 cells/mm3 -379/mm3). A repeated measures regression analysis showed that neither fall in viral load (P= .91) nor rise in CD4 count (P= .64) were associated with urban versus rural site of care. Survival times, using a Cox proportional hazards model, were similar for urban and rural patients (hazard ratio for urban = 0.80 [95% CI, 0.39-1.61; P= .53]). Conclusions: This urban outreach model provides similar quality of care to persons receiving care in rural areas of Vermont as compared to those receiving care in the urban center. [source]

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

THE JOURNAL OF RURAL HEALTH, Issue 1 2009
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]

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

THE JOURNAL OF RURAL HEALTH, Issue 2 2008
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

THE JOURNAL OF RURAL HEALTH, Issue 2 2008
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]

Home Health Care Agency Staffing Patterns Before and After the Balanced Budget Act of 1997, by Rural and Urban Location

THE JOURNAL OF RURAL HEALTH, Issue 1 2008
William J. McAuley PhD
ABSTRACT:,Context:The Balanced Budget Act (BBA) of 1997 and other recent policies have led to reduced Medicare funding for home health agencies (HHAs) and visits per beneficiary. Purpose: We examine the staffing characteristics of stable Medicare-certified HHAs across rural and urban counties from 1996 to 2002, a period encompassing the changes associated with the BBA and related policies. Methods: Data were drawn from Medicare Provider of Service files and the Area Resource File. The unit of analysis was the 3,126 counties in the United States, grouped into 5 categories: metropolitan, nonmetropolitan adjacent, and 3 nonmetropolitan nonadjacent groups identified by largest town size. Only relatively stable HHAs were included. We generated summary HHA staff statistics for each county group and year. Findings: All staff categories, other than therapists, declined from 1997 to 2002 across the metropolitan and nonmetropolitan county groupings. There were substantial population-adjusted decreases in stable HHA-based home health aides in all counties, including remote counties. Conclusions: The limited presence of stable HHA staff in certain nonmetropolitan county types has been exacerbated since implementation of the BBA, especially in the most rural counties. The loss of aides in more rural counties may limit the availability of home-based long-term care in these locations, where the need for long-term care is considerable. Future research should examine the degree to which the presence of HHA staff influences actual access and whether other paid and unpaid sources of care substitute for Medicare home health care in counties with limited supplies of HHA staff. [source]

Modeling the Mental Health Workforce in Washington State: Using State Licensing Data to Examine Provider Supply in Rural and Urban Areas

THE JOURNAL OF RURAL HEALTH, Issue 1 2006
Laura-Mae Baldwin MD
ABSTRACT:,Context: Ensuring an adequate mental health provider supply in rural and urban areas requires accessible methods of identifying provider types, practice locations, and practice productivity. Purpose: To identify mental health shortage areas using existing licensing and survey data. Methods: The 1998-1999 Washington State Department of Health files on credentialed health professionals linked with results of a licensure renewal survey, 1990 US Census data, and the results of the 1990-1992 National Comorbidity Survey were used to calculate supply and requirements for mental health services in 2 types of geographic units in Washington state,61 rural and urban core health service areas and 13 larger mental health regions. Both the number of 9 types of mental health professionals and their full-time equivalents (FTEs) per 100,000 population measured supply in the health service areas and mental health regions. Findings: Notable shortages of mental health providers existed throughout the state, especially in rural areas. Urban areas had 3 times the psychiatrist FTEs per 100,000 and more than 1.5 times the nonpsychiatrist mental health provider FTEs per 100,000 as rural areas. More than 80% of rural health service areas had at least 10% fewer psychiatrist FTEs and nonpsychiatrist mental health provider FTEs than the state ratio (10.4 FTEs per 100,000 and 306.5 FTEs per 100,000, respectively). Ten of the 13 mental health regions were more than 10% below the state ratio of psychiatrist FTEs per 100,000. Conclusions: States gathering a minimum database at licensure renewal can identify area-specific mental health care shortages for use in program planning. [source]

High School Census Tract Information Predicts Practice in Rural and Minority Communities

THE JOURNAL OF RURAL HEALTH, Issue 3 2005
Susan Hughes MS
ABSTRACT: Purpose: Identify census-derived characteristics of residency graduates' high school communities that predict practice in rural, medically underserved, and high minority-population settings. Methods: Cohort study of 214 graduates of the University of California, San Francisco-Fresno Family Practice Residency Program (UCSF-Fresno) from its establishment in 1970 through 2000. Rural-urban commuting area code; education, racial, and ethnic distribution; median income; population; and federal designation as a medically underserved area were collected for census tracts of each graduate's (1) high school address and (2) practice location. Findings: Twenty-one percent of graduates practice in rural areas, 28% practice in areas with high proportions of minority population (high minority areas), and 35% practice in federally designated medically underserved areas. Graduation from high school in a rural census tract was associated with rural practice (P <.01). Of those practicing in a rural site, 32% graduated from a rural high school, as compared with 11% of nonrural practitioners. Graduation from high school in a census tract with a higher proportion of minorities was associated with practice in a proportionally high minority community (P =.01). For those practicing in a high-minority setting, the median minority percentage of the high school census tract was 31%, compared with 16% for people not practicing in a high minority area. No characteristics of the high school census tract were predictive of practice in a medically underserved area. Conclusion: Census data from the residency graduate's high school predicted rural practice and practice in a proportionally high minority community, but not in a federally designated medically underserved area. [source]