bluuebunny/crossref_metadata_2025 huggingface dataset:
Auditory stimulation affects apparent motion1
Authors: ICHIKAWA MAKOTO , MASAKURA YUKO
Published: June 2006

Abstract: In two experiments, we investigated how the number of auditory stimuli affected the apparent motion induced by visual stimuli. The multiple visual stimuli that induced the apparent motion on the front parallel plane, or in the depth dimension in terms of the binocular disparity cue, were accompanied by multiple auditory stimuli. Observers reported the number of visual stimuli (Experiments 1 and 2) and the displacement of the apparent motion that was defined by the distance between the first and last visual stimuli (Experiment 2). When the number of auditory stimuli was more/less than that of the visual stimuli, observers tended to perceive more/less visual stimuli and a larger/smaller displacement than when the numbers of the auditory and visual stimuli were the same, regardless of the dimension of motion. These results suggest that auditory stimulation may modify the visual processing of motion by modulating the spatiotemporal resolution and extent of the displacement.
Resource availability and habitat use by mantled howling monkeys in a Nicaraguan coffee plantation: can agroforests serve as core habitat for a forest mammal?
Authors: Williams‐Guillén K. , McCann C. , Martínez Sánchez J. C. , Koontz F.
Published: June 2006

Although shade coffee plantations are potentially valuable habitats for wildlife conservation, little information exists on the extent to which they provide resident wildlife populations with resources necessary for survival and reproduction. A 14‐month study of the ecology of mantled howling monkeysAlouatta palliataliving in a Nicaraguan shade coffee plantation was therefore conducted. Trees were surveyed at randomly located enumeration points in the coffee plantation and monitored for phenophase production to characterize resource availability. Day‐long focal animal follows were used to characterize the ranging and habitat preferences of the howlers. The study site had a diverse canopy, with over 60 tree species providing shade for coffee cultivation; high tree diversity ensured year‐round availability of the howlers' preferred foods. Howlers did not avoid feeding or ranging in areas of shade coffee cultivation. However, when foraging in coffee they favored large shade trees for feeding and were less likely to use areas of shade coffee with small trees and fewer arboreal pathways. Results suggest, in conjunction with controls on hunting and protection of nearby forests, that shade coffee can serve as alternate wildlife habitat and corridors between forest fragments for howling monkeys and possibly other forest mammals. Specific management recommendations to improve the conservation value of shade coffee for primates are made and the potential role of coffee plantations in primate conservation at a regional scale are discussed.
Estimating population density from indirect sign: track counts and the Formozov–Malyshev–Pereleshin formula
Authors: Stephens P. A. , Zaumyslova O. Yu. , Miquelle D. G. , Myslenkov A. I. , Hayward G. D.
Published: June 2006

For many purposes it is often desirable to estimate animal population densities over large areas. Where total counts are not possible and sightings are relatively rare, a range of methods exists to estimate densities from indirect sign. Such methods are frequently unreliable and usually require independent calibration or confirmation. We present an analytical method for estimating population density from track counts. The method, widely known in the Russian Federation but not in the English language scientific literature, requires counts of tracks of known age, together with estimates of animal daily travel distances. We use simulations to verify the theoretical basis of the approach and to indicate potential precision that may be achieved. We illustrate application of the approach using a large data set on ungulate track counts in the Russian Far East. We suggest that under most circumstances, nonparametric bootstrapping will be the most appropriate method for deriving estimates of confidence intervals about density estimates. As with other approaches to estimating density from indirect sign, the method that we discuss is vulnerable to violations of an array of underlying assumptions. However, it is easily applied and could represent an important method by which the relationship between indices of abundance and absolute density can be understood.
EEG Source Imaging in Pediatric Epilepsy Surgery: A New Perspective in Presurgical Workup
Authors: Sperli Francesca , Spinelli Laurent , Seeck Margitta , Kurian Mary , Michel Christoph M. , Lantz Göran
Published: June 2006

Summary:  Purpose: Epilepsy is a relatively frequent disease in children, with considerable impact on cognitive and social life. Successful epilepsy surgery depends on unambiguous focus identification and requires a comprehensive presurgical workup, including several neuroimaging techniques [magnetic resonance imaging, positron emission tomography (PET), and single‐photon emission computed tomography (SPECT)]. These may be difficult to apply in younger or developmentally delayed children or both, requiring sedation, and hence, a significant workforce. Modern electric source imaging (ESI) provides accurate epileptic source‐localization information in most patients, with minimal patient discomfort or need for cooperation. The purpose of the present study was to determine the usefulness of ESI in pediatric EEG recordings performed with routine electrode arrays.

Methods: Preoperative EEGs recorded from 19 to 29 scalp electrodes were reviewed, and interictal epileptiform activity was analyzed by using a linear source‐imaging procedure (depth‐weighted minimum norm) in combination with statistical parametric mapping.

Results: In 27 (90%) of 30 patients, the ESI correctly localized the epileptogenic region. These numbers compare favorably with the results from other imaging techniques in the same patients (PET, 82%; ictal SPECT, 70%). In extratemporal epilepsy, ESI was correct in all cases, and in temporal lobe epilepsy, in 10 of 13 cases. In two temporal lobe patients showing less‐accurate ESI results, 128‐electrode data could be analyzed, and in both cases, the 128‐electrode ESI was correct.

Conclusions: ESI with standard clinical EEG recordings provides excellent localizing information in pediatric patients, in particular in extratemporal lobe epilepsy. The lower yield in temporal lobe epilepsy seems to be due to undersampling of basal temporal areas with routine scalp recordings.
fMRI Lateralization of Expressive Language in Children with Cerebral Lesions
Authors: Anderson Dianne P. , Harvey A. Simon , Saling Michael M. , Anderson Vicki , Kean Michael , Abbott David F. , Wellard R. Mark , Jackson Graeme D.
Published: June 2006

Summary:  Purpose: Lateralization of language function is crucial to the planning of surgery in children with frontal or temporal lobe lesions. We examined the utility of functional magnetic resonance imaging (fMRI) as a determinant of lateralization of expressive language in children with cerebral lesions.

Methods: fMRI language lateralization was attempted in 35 children (29 with epilepsy) aged 8–18 years with frontal or temporal lobe lesions (28 left hemisphere, five right hemisphere, two bilateral). Axial and coronal fMRI scans through the frontal and temporal lobes were acquired at 1.5 Tesla by using a block‐design, covert word‐generation paradigm. Activation maps were lateralized by blinded visual inspection and quantitative asymmetry indices (hemispheric and inferior frontal regions of interest, at p < 0.001 uncorrected and p < 0.05 Bonferroni corrected).

Results: Thirty children showed significant activation in the inferior frontal gyrus. Lateralization by visual inspection was left in 21, right in six, and bilateral in three, and concordant with hemispheric and inferior frontal quantitative lateralization in 93% of cases. Developmental tumors and dysplasias involving the inferior left frontal lobe had activation overlying or abutting the lesion in five of six cases. fMRI language lateralization was corroborated in six children by frontal cortex stimulation or intracarotid amytal testing and indirectly supported by aphasiology in a further six cases. In two children, fMRI language lateralization was bilateral, and corroborative methods of language lateralization were left. Neither lesion lateralization, patient handedness, nor developmental versus acquired nature of the lesion was associated with language lateralization. Involvement of the left inferior or middle frontal gyri increased the likelihood of atypical language lateralization.

Conclusions: fMRI lateralizes language in children with cerebral lesions, although caution is needed in interpretation of individual results.
Assessment of Pneumonia in Older Adults: Effect of Functional Status
Authors: Mody Lona , Sun Rongjun , Bradley Suzanne F.
Published: June 2006

OBJECTIVES: Evaluate the effect of preadmission functional status on severity of pneumonia, length of hospital stay (LOS), and all‐cause 30‐day and 1‐year mortality of adults aged 60 and older and to understand the effect of pneumonia on short‐term functional impairment.

DESIGN: Prospective cohort study.

SETTING: University hospital.

PARTICIPANTS: One hundred twelve patients with radiograph‐proven pneumonia (mean age 74.6) were enrolled.

MEASUREMENTS: Functional status and comorbidities were assessed using the Functional Autonomy Measurement System (SMAF) and Charlson Comorbidity Index. Clinical information was used to calculate the Pneumonia Prognostic Index (PPI).

RESULTS: Eighty‐four (75%) patients were functionally independent (FI) before admission, with a SMAF score of 40 or lower. Dementia and aspiration history were higher in the group that was functionally dependent (FD) before admission (P<.001). The FI group had less‐severe pneumonia per the PPI and shorter mean LOS±standard deviation (5.62±0.51 days) than the FD group (11.42±2.58, P<.004). The FI group had lower 1‐year mortality (19/65, 23%) than the FD group (14/28, 50%), and the difference remained significant after adjusting for Charlson Index and severity of illness (P=.009). All patients lost function after admission, with loss being more pronounced in the FI group (mean change 19.24±12.9 vs 4.72±6.55, P<.001).

CONCLUSION: Older adults who were FI before admission were more likely to present with less‐severe pneumonia and have a shorter LOS. In addition, further loss of function was common in these patients. Assessment of function before and during hospitalization should be an integral part of clinical evaluation in all older adults with pneumonia.
Does Social Activity Influence the Accuracy of Subjective Memory Deficit? Findings from a British Community Survey
Authors: Trouton Alex , Stewart Robert , Prince Martin
Published: June 2006

OBJECTIVES: To investigate the association between subjective memory deficit (SMD) and cognitive impairment in a community population and modification of this association by level of social activity.

DESIGN: Cross‐sectional survey.

SETTING: A defined geographic catchment area in north London, England.

PARTICIPANTS: Six hundred fifty‐four residents aged 65 and older.

MEASURMENTS: SMD and cognitive impairment were derived from the relevant sections of the short Comprehensive Assessment and Referral Evaluation instrument, and social activity was derived from the Social Support Deficit Scale. Potential confounding factors taken into account included depression and level of functioning.

RESULTS: Twenty‐nine percent of the sample reported SMD, which was associated with objective impairment (odds ratio (OR)=3.4, 95% confidence interval (CI)=2.1–5.8). This association was stronger in participants with higher social activity (OR=6.1, 95% CI=2.9–13.0) than in those who were more isolated (OR=1.8, 95% CI=0.8–3.8). The interaction with social activity remained significant after adjustment for potential confounding factors (P=.03).

CONCLUSION: A person's social environment influences the accuracy of SMD. This may reflect the level of cognitive demands encountered in daily life or the extent to which others notice cognitive impairment.
Differential distribution of antibodies to different viruses in young animals in the free‐ranging rhesus macaques of Cayo Santiago
Authors: Sariol C.A. , González‐Martínez J. , Arana T. , Gascot S. , Suárez E. , Maldonado E. , Gerald M.S. , Rodríguez M. , Kraiselburd E.N.
Published: June 2006

Background  The breeding colony of free‐ranging rhesus macaques was established in 1938 in Cayo Santiago (CS) with animals collected in northern India. The seroprevalence to cercopithecine herpesvirus type 1 (B virus) and simian retroviruses has been studied previously.

Results  This is the first report on the seropositivity to different viruses using samples collected shortly after removing animals (n = 245) from CS. All samples were negative for measles, simian immunodeficiency virus and simian type D retroviruses. The overall prevalence of antibodies was around 50% for simian T‐lymphotropic virus I (STLV‐I). For B virus, the prevalence was 38%.

Conclusions  Data obtained showed marked differences in the antibody distribution to B virus and STLV‐I within the free‐ranging colony of rhesus macaques. Implication of these data for the Specific Pathogen Free program at the Caribbean Primate Research Center are also discussed.
Immunohistochemical detection of MT1‐MMP, RECK, and EMMPRIN in ameloblastic tumors
Authors: Kumamoto H. , Ooya K.
Published: June 2006

Background:  To evaluate the roles of matrix‐degrading proteinase regulators in progression of odontogenic tumors, expression of membrane‐bound matrix metalloproteinase (MMP) MT1‐MMP, MMP inhibitor RECK and MMP inducer EMMPRIN was analyzed in ameloblastic tumors as well as in tooth germs.

Methods:  Tissue specimens of 11 tooth germs, 40 ameloblastomas, and five malignant ameloblastic tumors were examined immunohistochemically with the use of antibodies against MT1‐MMP, RECK, and EMMPRIN.

Results:  Immunohistochemical reactivity for MT1‐MMP, RECK and EMMPRIN was detected predominantly in odontogenic epithelial cells near the basement membrane in tooth germs and benign and malignant ameloblastic tumors. The level of immunoreactivity for MT1‐MMP was slightly higher in benign and malignant ameloblastic tumors than in tooth germs. RECK expression was lower in ameloblastomas than in tooth germs. Follicular ameloblastomas showed significantly lower expression of RECK than plexiform ameloblastomas, and immunoreactivity for RECK in acanthomatous ameloblastomas was slightly lower than that in other cellular variants.

Conclusion:  Expression of MT1‐MMP, RECK and EMMPRIN in tooth germs and ameloblastic tumors suggests that these normal and neoplastic epithelial components control MMP‐dependent extracellular matrix (ECM) degradation during tooth development and tumor progression via epithelial‐mesenchymal interactions.
Expression of tumor‐associated antigen RCAS1 and its possible involvement in immune evasion in oral squamous cell carcinoma
Authors: Toyoshima T. , Nakamura S. , Kumamaru W. , Kawamura E. , Ishibashi H. , Hayashida J‐N. , Moriyama M. , Ohyama Y. , Sasaki M. , Shirasuna K.
Published: June 2006

Background:  RCAS1 (receptor‐binding cancer antigen expressed on SiSo cells) is known to induce apoptosis in its receptor‐positive cells. The authors investigated RCAS1 expression in oral squamous cell carcinoma (SCC) and its association with the apoptosis of tumor‐infiltrating lymphocytes (TILs).

Methods:  In 130 patients with oral SCC, the expression of RCAS1 in tumor cells was immunohistochemically examined and the apoptosis of TILs was examined by Terminal Deoxynucleotidyltransferase‐mediated dUTP Nick End Labeling (TUNEL) staining.

Results:  RCAS1 was detected both on the cytoplasm and the membrane of tumor cells in 41 of 130 cases (31.5%). Focusing on the expression at the invasive front interacting with host immune cells, RCAS1 was detected in 22 of 130 cases (16.9%). The percentage of TUNEL‐positive TILs in cases with RCAS1‐positive SCCs was significantly higher than in cases with RCAS1‐negative SCCs (P < 0.0001).

Conclusions:  RCAS1 can be expressed on oral SCC cells and may be involved in the tumor escape from the host immune system by inducing the apoptosis of TILs.
The role for ‘reminders’ in dental traumatology: 3. The minimum data set that should be recorded for each type of dento‐alveolar trauma – a review of existing evidence
Authors: Day Peter F. , Duggal Monty S.
Published: June 2006

Abstract –  The aim of this study was to establish the prognostic factors recorded at the time of diagnosis or initial treatment that affect pulp and periodontal healing and tooth survival. A search strategy and quality assessment method was established to review the literature. The significant factors identified are listed for each type of dento‐alveolar injury. These factors identified are the gold standard against which quality assessments of dento‐alveolar trauma records can be compared and all new computer or paper‐based methods for recording any type of dento‐alveolar trauma should aim to record this minimum information.
Genetic Diversity of Soybean and the Establishment of a Core Collection Focused on Resistance to Soybean Cyst Nematode
Authors: Ma Yan‐Song , Wang Wen‐Hui , Wang Li‐Xia , Ma Feng‐Ming , Wang Pei‐Wu , Chang Ru‐Zhen , Qiu Li‐Juan
Published: June 2006

Soybean cyst nematode (SCN; Heterodera glycines) is one of the most important pests affecting soybean production. The best method of control of SCN is through the development of resistant cultivars. However, limited progress has been made in soybean breeding in China because most modern cultivars have no resistance to SCN. The distribution and phenotype of 432 immune or highly resistant Chinese accessions were surveyed and a primary core collection was selected as a representative sample for further analyses. Using evenly distributed simple sequence repeat markers, five selection methods were applied to the primary core collection and the optimal method was chosen to establish a core collection, which consisted of 28 accessions. These encompassed 70.8% of the allelic variation present in the overall resistant collection. The 28 accessions differed from the reference resistant accessions at the genomic level, indicating that Chinese resistant accessions are distinct from known resistant accessions. This applied core collection provides a rational framework for undertaking diversity surveys, using genetic variation for the investigation of complex traits and for the discovery of novel traits.

(Managing editor: Li‐Hui)
Comparison of Classical Models for Evaluating the Heat Requirements of Olive (Olea europeae L.) in Portugal
Authors: Ribeiro Helena , Cunha Mário , Abreu Ilda
Published: June 2006

The aim of the present study was to compare the accuracy and reproducibility of six statistical models for the calculation of olive (Olea europeae L.) heat requirements to trigger the onset of flowering in three Portuguese regions: Reguengos de Monsaraz, Valença do Douro, and Braga. Other aims were to ascertain the date on which the heat‐accumulation period started and the threshold temperatures above which the development of reproductive structures starts in olives. The starting and peak dates for the regional O. europeae flowering season were estimated by monitoring airborne pollen from 1998 to 2004 using “Cour” type samplers. The threshold temperature values calculated for the three regions were very similar (9.0 °C for Valença do Douro, 9.2 °C for Reguengos de Monsaraz, and 9.7 °C for Braga). The accumulated daily mean temperature model had less interannual and inter‐regional variation, showing best predictive results for 2004, with absolute differences between the observed and predicted dates of 4 d in Reguengos de Monsaraz and 2 d in Valença do Douro and Braga for the onset of flowering date and of 2 d in Reguengos de Monsaraz, 7 d in Valença do Douro, and 4 d in Braga for peak flowering dates. This model was the most accurate, reproducible, and operational to calculate heat requirements for olives to flower, with an average mean temperature accumulation of 1 446 °C in Reguengos, 1 642 °C in Valença do Douro, and 1 703 °C in Braga to reach the onset of flowering. The best initial date for this accumulation was 1 January.

(Managing editor: Wei Wang)
Rural‐Urban Differences in the Social Climate Surrounding Environmental Tobacco Smoke: A Report From the 2002 Social Climate Survey of Tobacco Control
Authors: McMillen Robert , Breen Julie , Cosby Arthur G.
Published: June 2006

ABSTRACT: Context: Although previous research has found smoking rates to be higher among residents of rural areas, few studies have investigated rural‐urban differences in exposure to environmental tobacco smoke (ETS). Objective: This study contrasted the social climate surrounding ETS among Americans who resided in 5 levels of county urbanization. Design: Data were collected via telephone interviews administered to a representative sample of 3,009 civilian, noninstitutionalized adults over age 18 in the United States. Households were selected using random digit dialing procedures. Findings: Compared to residents of urban counties, rural residents reported fewer restrictions on smoking in the presence of children and lower incidences of smoking bans in households, family automobiles, work areas, convenience stores, fast‐food restaurants, and restaurants. Interestingly, when rural‐urban variations in knowledge and attitudes about ETS were examined, the magnitude of rural‐urban differences was smaller or nonexistent for these indicators. Moreover, logistic regression models indicated that none of these rural‐urban differences in knowledge and attitudes persisted after statistically controlling for region, smoking status, gender, race, age, and education factors. This suggests that the observed rural‐urban differences in ETS bans could not be explained adequately by rural‐urban differences in knowledge and attitudes about the dangers of ETS. Conclusions: The policy implications of this research point to a greater need in rural America for programs focusing on the restriction and elimination of ETS. They also suggest that programs focusing only on influencing the levels of ETS knowledge and attitudes among the general population may not be adequate in producing the desired change.
The Role of International Medical Graduates in America's Small Rural Critical Access Hospitals
Authors: Hagopian Amy , Thompson Matthew J. , Kaltenbach Emily , Hart L. Gary
Published: June 2006

ABSTRACT: Context: Critical access hospitals (CAHs) are a federal Medicare category for isolated rural facilities with 15 or fewer acute care beds that receive cost‐based reimbursement from Medicare. Purpose: This study examines the role of foreign‐born international medical graduates (IMGs) in the staffing of CAHs. Methods: Chief executive officers (CEOs) of CAH facilities answered a telephone survey on their use of IMGs and the characteristics of those IMGs in winter 2002 (388 responded, for a 96% response rate). This descriptive report presents roles and characteristics of IMGs in CAH facilities and the opinions of the CEOs about these practitioners. Findings: Overall, 1 (24%) in 4 admitting physicians in CAHs are graduates of non‐US medical schools (compared with 23% of physicians nationally), although the rates are higher for CAHs in persistent poverty counties, CAHs that report recruitment problems, and CAHs with smaller medical staffs. Hospitals east of the Mississippi River are more heavily reliant on IMGs than hospitals in the west. Most IMGs are internists (59%) and most (61%) come from India, the Philippines, or Pakistan. Hospital administrators rate the clinical skills of their IMGs highly and their interpersonal skills only slightly lower. Almost half of CAH administrators said their communities recruited their first IMGs during or after 1994, the year of pro‐IMG legislative changes. Conclusion: IMG physicians play a significant and possibly growing role in staffing CAHs.
Factors Associated With Health‐Related Quality of Life Among an Older Population in a Largely Rural Western Region
Authors: Borders Tyrone F. , Aday Lu Ann , Xu Ke Tom
Published: June 2006

ABSTRACT: Context: As elderly people become a larger proportion of the rural population, it is important to identify those at risk for poor health. Predictors of health‐related quality of life can be useful in designing interventions. Purpose: One objective of the present study was to profile the health‐related quality of life of community‐dwelling, elderly people in a southwestern region of the United States. A related objective was to identify the principal factors associated with health‐related quality of life, thereby identifying population subgroups in greatest need of health or social services. Methods: A telephone survey of approximately 5,000 individuals 65 years and older collected data on need for assistance with activities of daily living, physical and mental health‐related quality of life, and worry about health status measures. A modified version of the Behavioral Model was used to more clearly distinguish the different groups at risk for poor health. Findings: Those groups of community‐dwelling, elderly people in the poorest health were older than 75 years, had less than a high school education, were retired or unemployed, and had low household income. No differences were found by urban, rural, and frontier residence. Conclusions: To maintain the physical, social, and psychological health of older people residing in rural and urban areas, social services, medical care, and supportive services are needed, particularly among the most socially and economically disadvantaged.
Views on Exercise and Physical Activity Among Rural‐Dwelling Senior Citizens
Authors: Aronson Robert E. , Oman Roy F.
Published: June 2006

ABSTRACT: Context: This study was conducted with senior citizens in the 2 rural communities of Ada and Lindsay, Oklahoma. These communities are both predominantly white, with the largest minority population being American Indian. Both communities are more than 60 miles from a metropolitan area and have a history of farming and ranching. Purpose: The purpose of this study was to explore contextual factors related to physical activity among senior citizens living in rural communities. Methods: Two focus groups were conducted. The groups were conducted in mixed‐sex sessions and were audiotaped and transcribed verbatim for the purpose of analysis. Findings: Themes from the focus groups included the following: (1) the types of daily activities engaged in by seniors; (2) the meaning and connotation of the words exercise and physical activity, with physical activity connoting for some the negative imagery of physical labor; and (3) the availability and suitability of settings for physical activity. For seniors living in rural settings in Oklahoma, the lack of indoor facilities and the sometimes extreme climatic conditions serve as significant barriers to physical activity. Conclusion: This study suggests that programs seeking to encourage physical activity among seniors in rural areas could benefit from an assessment of resources and settings for physical activity and the avoidance of language that may have negative connotations for this population.
Quality of Care for Acute Myocardial Infarction in Rural and Urban US Hospitals
Authors: Baldwin Laura‐Mae , MacLehose Richard F. , Hart L. Gary , Beaver Shelli K. , Every Nathan , Chan Leighton
Published: June 2006

ABSTRACT: Context: Acute myocardial infarction (AMI) is a common and important cause of admission to US rural hospitals, as transport of patients with AMI to urban settings can result in unacceptable delays in care. Purpose: To examine the quality of care for patients with AMI in rural hospitals with differing degrees of remoteness from urban centers. Methods: This cohort study used data from the Cooperative Cardiovascular Project (CCP), including 4,085 acute care hospitals (408 remote small rural, 893 small rural, 619 large rural, and 2,165 urban) with 135,759 direct admissions of Medicare beneficiaries ages 65 and older for a confirmed AMI between February 1994 and July 1995. Outcomes included use of aspirin, reperfusion, heparin, and intravenous nitroglycerin during hospitalization; use of beta‐blockers, aspirin, and angiotensin‐converting enzyme (ACE) inhibitors at discharge; avoidance of calcium channel blockers at discharge; and 30‐day mortality. Findings: Substantial proportions of Medicare beneficiaries in both urban and rural hospitals did not receive the recommended treatments for AMI. Medicare patients in rural hospitals were less likely than urban hospitals' patients to receive aspirin, intravenous nitroglycerin, heparin, and either thrombolytics or percutaneous transluminal coronary angioplasty. Only ACE inhibitors at discharge was used more for patients in rural hospitals than urban hospitals. Medicare patients in rural hospitals had higher adjusted 30‐day post‐AMI death rates from all causes than those in urban hospitals (odds ratio for large rural 1.14 [1.10 to 1.18], small rural 1.24 [1.20 to 1.29], remote small rural 1.32 [1.23 to 1.41]). Conclusions: Efforts are needed to help hospital medical staffs in both rural and urban areas develop systems to ensure that patients receive recommended treatments for AMI.
Colorectal Cancer Screening Practices Among Men and Women in Rural and Nonrural Areas of the United States, 1999
Authors: Coughlin Steven S. , Thompson Trevor D.
Published: June 2006

ABSTRACT: Background: Previous studies have suggested that men and women in rural areas are less likely than those in urban areas to receive routine cancer screening. Methods: We examined the colorectal cancer screening practices of men (n = 23,565) and women (n = 37,847) aged ≥50 years living in rural areas and other areas of the United States using data from the 1999 Behavioral Risk Factor Surveillance System (BRFSS). Geographic areas of residence were classified as rural areas and small towns, suburban areas and small metropolitan areas, and larger metropolitan areas using US Department of Agriculture (USDA) urban/rural continuum codes. Results: The estimated median response rate across states was 55.2%. Approximately 16.2% (95% confidence interval [CI] = 15.3% to 17.2%) of persons aged ≥50 years who resided in rural areas had received a fecal occult blood test in the past year, compared with 22.0% of those living in the larger metropolitan areas (95% CI = 21.4% to 22.7%). About 28.2% (95% CI = 27.1% to 29.4%) of those who resided in rural areas had received a sigmoidoscopy or colonoscopy in the past 5 years, compared with 35.2% of those in the larger metropolitan areas (95% CI = 34.5% to 36.0%). Conclusions: These results underscore the need for continued efforts to increase colorectal cancer screening in the United States. Special efforts may be required to increase screening in rural areas.
Urban/Rural Differences in Decision Making and the Use of Advance Directives Among Nursing Home Residents at Admission
Authors: Buchanan Robert J. , Bolin Jane , Wang Suojin , Zhu Li , Kim MyungSuk
Published: June 2006

ABSTRACT: Context: Advance directives promote patient autonomy and encourage greater awareness of final care options while reducing physician and family uncertainty regarding patient preferences. Purpose: To investigate differences in decision making authority and the use of advance directives among nursing home residents admitted from urban and rural areas. Methods: A total of 551,208 admission assessments in the Minimum Data Set were analyzed for all residents admitted to a nursing facility in 2001. Using the Rural Urban Commuting Areas (RUCA) methodology and ZIP code of primary residence before admission, these residents were classified into 4 urban/rural areas. Findings: Residents from rural areas were significantly more likely to have executed a durable power of attorney for health care or for financial decisions than residents admitted from the other areas, with the largest differences observed between residents admitted from urban and rural areas. Almost 6 residents in 10 from urban areas had no advance directives in place at admission compared with only 4 residents in 10 admitted from rural areas. Conclusions: Health providers and social workers in both rural and urban areas should advise patients about the value of advance directives.
Obesity and Physical Inactivity in Rural America
Authors: Patterson Paul Daniel , Moore Charity G. , Probst Janice C. , Shinogle Judith Ann
Published: June 2006

ABSTRACT: Context and Purpose: Obesity and physical inactivity are common in the United States, but few studies examine this issue within rural populations. The present study uses nationally representative data to study obesity and physical inactivity in rural populations. Methods: Data came from the 1998 National Health Interview Survey Sample Adult and Adult Prevention Module. Self‐reported height and weight were used to calculate body mass index. Physical inactivity was defined using self‐reported leisure‐time physical activity. Analyses included descriptive statistics, x2 tests, and logistic regression. Findings: Obesity was more common among rural (20.4%, 95% CI 19.2%–21.6%) than urban adults (17.8%, 95% CI 17.2%–18.4%). Rural residents of every racial/ethnic group were at higher risk of obesity than urban whites, other factors held equal. Other predictors of obesity included being male, age 25–74, lacking a high school diploma, having physical limitations, fair to poor health, and a history of smoking. Proportionately more rural adults were physically inactive than their urban peers (62.8% versus 59.3%). Among rural residents, minorities were not significantly more likely to be inactive than whites. Males and younger adults were less likely to be inactive. Rural adults who were from the Midwest and South, had less than a high school education, had fair to poor health, and currently smoked were more likely to be inactive compared to their respective referent group. Conclusions: The high prevalence of obesity and inactive lifestyles among rural populations call for research into effective rural interventions.
Access to Health Care Among Latinos of Mexican Descent in Colonias in Two Texas Counties
Authors: Ortiz Larry , Arizmendi Lydia , Cornelius Llewellyn J.
Published: June 2006

ABSTRACT: Context: Critical to resolving the problem of health disparities among Latinos is examining the needs within ethnic subpopulations. This paper focused on the unique challenges encountered by one ethnic subpopulation—Latinos of Mexican descent living in colonias. Findings reaffirm the importance of looking within ethnic subpopulations to understand the complexities of health disparities. Purpose: This paper reports on data collected measuring access to health care among Latinos of Mexican descent living in several colonias in two southern Texas counties. Method: Observations are based on data gathered from a nonprobability sample obtained through a face to face questionnaire focusing on health care access. Persons living in two Texas counties near the US border were included in this sample, and demographic data were compared to county, state and national statistics to examine the comparability of the sample to similar populations. Findings: Findings from this snowball sample, N=271, suggested lower rates of health insurance coverage compared to the Latino population nationwide, decreased patterns of preventive screenings for blood pressure, diabetes, cholesterol, cancers (ie, breast, cervical, and prostate), and regular access to health care in Mexico by slightly more than half the sample. Conclusions: Seeking care in Mexico may be a viable solution for many indigent people of Mexican descent living in close geographic proximity to the border because it surmounts the political, cultural, linguistic, or economic barriers to health care services in the United States. Nonetheless, there are longer term questions regarding quality of care and health and wellness for this group of people.
A Program to Improve Access to Health Care Among Mexican Immigrants in Rural Colorado
Authors: de Jesus Diaz‐Perez Maria , Farley Tillman , Cabanis Clara Martin
Published: June 2006

ABSTRACT: Context: Migration to the United States from Mexico is increasing every year. Mexican immigrants tend to be poor, uninsured, monolingual Spanish speakers without adequate access to appropriate medical care. As a further barrier, many are also undocumented. Purpose: This article describes a program developed to improve access to health care among Mexican immigrants in northern Colorado. Methods: The program was implemented by a migrant/community health center in rural northern Colorado based on findings from an in‐depth health needs survey of the target population. The program consists of community outreach services vertically integrated into the main medical clinics, which comprise Salud Family Health Centers. A mobile unit went to nontraditional areas identified by community workers as gathering places for Mexican immigrants. Services provided included preventive health care (screening for diabetes, hypertension, mental health problems, dental problems, and HIV); education; and primary care for acute problems. Patients were referred to a health care home for ongoing care. Results: In the first 6 months, 1,553 Mexican immigrants were seen on the mobile unit. Hypertension and psychosocial problems were the most common problems in this population. Thirty‐five percent of patients who received consultation in the mobile unit have visited any of the clinics for follow‐up within the following year. Conclusions: A community‐based mobile outreach program targeted toward Mexican immigrants can be effective in uncovering medical and mental illness and in directing patients to a health care home. This is an important first step in eliminating health disparities among this population.
Quality Improvement Strategies and Best Practices in Critical Access Hospitals
Authors: Casey Michelle M. , Moscovice Ira
Published: June 2006

ABSTRACT: Context: Critical access hospitals (CAHs) face many challenges in implementing quality improvement (QI) initiatives, which include limited resources, low volume of patients, small staffs, and inadequate information technology. A primary goal of the Medicare Rural Hospital Flexibility Program is to improve the quality of care provided by CAHs. Purpose: This article describes key quality improvement initiatives for a national sample of CAHs that are actively involved in implementing quality‐related initiatives in collaboration with support hospitals and statewide organizations. Methods: Researchers conducted a national telephone survey of 72 CAHs and 2 in‐depth case studies of CAHs. Findings: The survey and case studies demonstrate that many CAHs are successfully implementing QI activities, including patient safety initiatives, improvements in overall QI processes and peer review processes, and implementation of QI projects focused on treatment of 1 or more specific diseases. The CAHs are involved with multiple external organizations in these activities. The administrators of the 2 case study CAHs have made QI a priority for their hospitals; ensured that resources are available for QI activities; and worked with their support hospitals, statewide organizations, and other CAHs to develop and implement rural‐relevant QI initiatives. Conclusions: Cost‐based Medicare reimbursement has been a key factor in the ability of CAHs to fund additional staff, staff training, and equipment to improve patient care. The commitment of hospital leaders and key staff is a crucial factor in moving QI initiatives forward in CAHs.
Translating Research Into Practice: Voluntary Reporting of Medication Errors in Critical Access Hospitals
Authors: Jones Katherine J. , Cochran Gary , Hicks Rodney W. , Mueller Keith J.
Published: June 2006

ABSTRACT: Context: Low service volume, insufficient information technology, and limited human resources are barriers to learning about and correcting system failures in small rural hospitals. Purpose: This paper describes the implementation of and initial findings from a voluntary medication error reporting program developed by the Nebraska Center for Rural Health Research (NCRHR) to overcome these barriers in 6 Nebraska critical access hospitals (CAHs). Methods: Participating Nebraska CAHs mailed copies of medication error reports to the NCRHR monthly for entry into a database. Quarterly summaries enabled each CAH to compare its reports by severity, type, phase of the medication use process, contributing factors, and causes to those of its peers and MEDMARXSM, a national medication error reporting program. Workshops emphasized learning from the reported errors by identifying system sources of variation in medication use and initiating change to achieve best practices. Findings: Similar to MEDMARX, 99% of medication errors reported by 6 Nebraska CAHs were not harmful, reported errors most often originated in the administration phase, and the most common error type was omission. The CAHs reported significantly smaller proportions of “near miss” errors and errors originating in the prescribing phase than in MEDMARX. Conclusions: By collaborating with CAHs, an academic medical center, and a national reporting program, the NCRHR is translating the Institute of Medicine's recommendation for voluntary error reporting into practices that allow CAHs to learn about and improve their medication use systems. However, limited presence of pharmacists in CAHs is a barrier to implementing double checks and learning from system failures in the medication use system.
Comparative Performance Data for Critical Access Hospitals
Authors: Pink George H. , Slifkin Rebecca T. , Coburn Andrew F. , Gale John A.
Published: June 2006

ABSTRACT: Context: Among small rural hospitals, there is a growing recognition of the need to measure and report on the use of resources and the safety and quality of the services provided. Dashboards, clinical value compasses, and balanced scorecards are approaches to performance measurement that have been adopted by many health care organizations. However, there exists very little comparative performance data specific for critical access hospitals. Purpose: To identify how comparative performance data for critical access hospitals (CPD‐CAH) might facilitate performance and quality improvement, to assess the potential benefits and drawbacks of such data, and to identify some of the critical issues in the development and implementation of CPD‐CAH. Methods: Assessment of discussions by participants at a rural hospital performance improvement summit and authors' analyses. Findings: CPD‐CAH potentially could improve quality of care and patient outcomes, provide comparative data and benchmarks, inform policy development, facilitate collaboration, and enhance community relations. However, CPD‐CAH could also impose an unaffordable cost, produce poor information, require complex coordination, induce a negative public reaction, and result in perverse hospital behavior. Development and implementation of CPD‐CAH would require including stakeholders' assessment of its desirability and feasibility, setting objectives, establishing guiding principles, developing a method, collecting and analyzing data, and disseminating results. Conclusions: CPD‐CAH could significantly advance CAH performance and quality improvement. However, development and implementation would be a complicated exercise requiring academic expertise and practitioner consultation. The potential value of CPD‐CAH should be carefully weighed against its potential cost.
Commercial Insurance vs Community‐based Health Plans: Time for a Policy Option With Clinical Emphasis to Address the Cost Spiral
Authors: Amundson Bruce
Published: June 2006

ABSTRACT: The nation continues its ceaseless struggle with the spiraling cost of health care. Previous efforts (regulation, competition, voluntary action) have included almost every strategy except clinical. Insurers have largely failed in their cost‐containment efforts. There is a strong emerging body of literature that demonstrates the relationship between various clinical strategies and reductions in utilization and costs. This article describes the organization of health services, including integration of delivery and financing systems, at the community level as a model that effectively addresses the critical structural flaws that have frustrated control of costs. Community‐based health plans (CHPs) have been developed and have demonstrated viability. The key elements of CHPs are a legal organizational structure, a full provider network, advanced care‐management systems, and the ability to assume financial risk. Common misconceptions regarding obstacles to CHP development are the complexity of the undertaking, difficulty assuming the insurance function, and insured pools that are too small to be viable. The characteristics of successful CHPs and 2 case studies are described, including the types of advanced care‐management systems that have resulted in strong financial performance. The demonstrated ability of CHPs to establish financial viability with small numbers of enrollees challenges the common assumption that there is a fixed relationship between health plan enrollment size and financial performance. Organizing the health system at the community/regional level provides an attractive alternative model in the health‐reformdebate. There is an opportunity for clinical systems and state and federal leaders to support the development of community‐based integrated delivery and financing system models that, among other advantages, have significant potential to modulate the pernicious cost spiral.
Rural Implications of Medicare's Post‐Acute‐Care Transfer Payment Policy
Authors: Schoenman Julie A. , Mueller Curt D.
Published: June 2006

ABSTRACT: Context: Under the Medicare post‐acute‐care (PAC) transfer policy, acute‐care hospitals are reimbursed under a per‐diem formula whenever beneficiaries are discharged from selected diagnosis‐related groups (DRGs) to a skilled nursing facility, home health care, or a prospective payment system (PPS)‐excluded facility. Total per‐diem payments are below the full DRG payment only when the patient's length of stay (LOS) is short relative to the geometric mean LOS for the DRG; otherwise, the full DRG payment is received. This policy originally applied to 10 DRGs beginning in fiscal year 1999 and was expanded to additional DRGs in FY2004. The Secretary may include other DRGs and types of PAC settings in future expansions. Purpose: This article examines how the initial policy change affected rural and urban hospitals and investigates the likely impact of the FY2004 expansion and other possible future expansions. Methods: The authors used 1998–2001 Medicare Provider Analysis and Review (MEDPAR) data to investigate changes in hospital discharge patterns after the original policy was implemented, compute the change in Medicare revenue resulting from the payment change, and simulate the expected revenue reductions under expansions to additional DRGs and swing‐bed discharges. Findings: Neither rural nor urban hospitals appear to have made a sustained change in their discharge behavior so as to limit their exposure to the transfer policy. Financial impacts from the initial policy were similar in relative terms for both types of hospitals and would be expected to be fairly similar for an expansion to additional DRGs. On average, including swing‐bed discharges in the transfer policy would have a very small financial impact on small rural hospitals; only hospitals that make extensive use of swing beds after a short inpatient stay might expect large declines in total Medicare revenue. Conclusion: Rural hospitals are not disproportionately harmed by the PAC transfer policy. An expanded policy may even benefit rural hospitals by recognizing their lower use of post‐acute‐care and readjusting DRG weights so that they are paid more appropriately when providing the full course of inpatient care.