bluuebunny/crossref_metadata_2025 huggingface dataset:
Turbulence measurements from Hi absorption spectra
Authors: Roy Nirupam , Peedikakkandy Leshma , Chengalur Jayaram N.
Published: April 2008

We use the millennium Arecibo 21-cm absorption-line survey measurements to examine the issue of the non-thermal contribution to the observed Galactic H i linewidths. If we assume a simple, constant pressure model for the H i in the Galaxy, we find that the non-thermal contribution to the linewidth, vnt scales as v2nt∝lα, for vnt larger than ∼0.7 km s−1. Here, l is a derived length-scale and α ∼ 0.7 ± 0.1. This is consistent with what one would expect from a turbulent medium with a Kolmogorov scaling. Such a scaling is also predicted by theoretical models and numerical simulations of turbulence in a magnetized medium. For non-thermal linewidths narrower than ∼0.7 km s−1, this scaling breaks down, and we find that the likely reason is ambiguities arising from Gaussian decomposition of intrinsically narrow, blended lines. We use the above estimate of the non-thermal contribution to the linewidth to determine corrected H i kinetic temperature. The new limits that we obtain imply that a significantly smaller (∼40 per cent as opposed to 60 per cent) fraction of the atomic interstellar medium in our Galaxy is in the warm neutral medium phase.
A Prognosis for the Rural Hospital: Part II: Are Rural Hospitals Economically Viable?
Authors: Moscovice Ira , Rosenblatt Roger A.
Published: April 2008

This is the second of a two part series that summarizes what is known about the operation and performance of the rural hospital and discusses potential options and strategies for strengthening the viability of these institutions. In Part II, we focus on the economic viability of the rural hospital and examine external factors that influence the environment within which the rural hospital operates. We conclude that the future will remain precarious for rural hospitals and that they can hope to improve their economic viability only if they are able to determine where they fit as part of the larger health care system.
Evaluation of Medical Center Support for Rural Physicians*
Authors: Cooper James K. , Johnson Timothy P.
Published: April 2008

Professional isolation remains a problem for rural physicians. To address the problem, a university medical center established a Physician Support Office (PSO). The PSO offered rural physicians toll‐free telephone access to patient referral, patient follow‐up, library reference, and drug information services. A newsletter was also published. The service was evaluated using a quasi‐experimental design. Physicians in the experimental area felt there was improvement in several medical center services, compared to physicians in the control area. Provision of library services, referral services and a newsletter contributed significantly to the usefulness of the PSO program. Nevertheless, the PSO did not produce a significant improvement in rural physicians’overall feeling of general medical center support.
Environmental Responses in Small Rural Hospitals*
Authors: Seavey John W. , Berry David E.
Published: April 2008

Major environmental forces are placing increased pressure on community small and rural hospitals to provide access to medical care in rural communities and to survive as free standing non‐profit community institutions. This survey of chief executive officers of small and rural hospitals in two states examines their perceptions of their institution's environment and the degree to which multi‐institutional arrangements are seen as an organizational response to a changing environment. Major differences among small and rural hospitals are explored.
A Practical Approach to Medical Records in a Rural Health Care Setting*
Authors: Tatro Pam
Published: April 2008

Deciding on a system for keeping medical records in a new rural health practice, or in an established practice seeking to update an obsolete system, may be confusing because of a multitude of vendors who claim to meet every need. Special circumstances set rural health practices apart from other ambulatory care settings with regard to medical record needs. Practical considerations regarding filing systems, record content and format are offered in view of these special circumstances. Issues involving ownership of the record and access to confidential information are also explored.
Nigerian Heads of Households' Attitudes Toward Modern and Traditional Medicines*
Authors: Airhihenbuwa Collins O.
Published: April 2008

Two hundred and fifty five heads of households were surveyed in Iyekuselu district, Bendel state, Nigeria. Fifteen villages were randomly selected from the list of 107 villages that constitute the district. A total of seventeen heads of households were interviewed in each of the fifteen villages. This survey was conducted to assess the attitudes of subjects toward modern medicine and traditional medicine. The heads of households generally expressed positive attitudes toward the health services provided at the modern medicine facilities. Some of them also reported accepting traditional healing administered by native doctors as legitimate alternative health care. For the illnesses considered in this study, the majority of the respondents were willing to consider modern medicine.
Nurses' Perceptions of Inter‐ and Intra‐Professional Relationships: An Analysis of Support From Nursing and Physician Colleagues in Rural Hospitals*
Authors: Lockyer Jocelyn M. , Parboosingh I. John T.
Published: April 2008

Nurses employed in ten rural hospitals in Canada completed questionnaires designed to examine their perceptions of the strength of the professional relationship which existed among nurses and between nurses and physicians. Four questions addressed the availability of nursing education programs and the attendance of nurses and physicians at such programs. Seven questions examined the nurses’perception of physician interest in nursing education and the encouragement received from their nursing colleagues to participate in learning activities and medical management decision making. Chi square analysis was undertaken to determine whether the colleagial relationships differed by hospital or medical staff characteristics. Forty percent of the nurses felt that the majority, of physicians were supportive of continuing nursing education. Sixty‐three percent indicated their nursing colleagues encouraged them to attend educational programs. The results indicate that physician participation in nursing continuing education was greatest in communities with the fewest health resources (an acute hospital with fewer than 50 beds). In contrast, encouragement to participate in continuing nursing education was highest in settings where the hospital provided both acute and extended care services, had more patient admissions and a greater availability of educational programming.
Factors Related to Dietary Status of Limited Resource Farm Families: A Case Study*
Authors: Hertzler Ann A. , Caldwell John S. , Mark‐Teo Miew Leng
Published: April 2008

A case study approach was used to study 10 limited resource farm families to identify factors relative to the farm family situation that are associated with adequate or inadequate food habits. Dietary measures were developed and adequacy of diets was analyzed in relation to gender, women's off‐ or on‐farm employment, predominant farm activities, and cohesiveness. Traditional families, with two adults present and the women employed on the farm, had the most adequate diets and higher cohesiveness ratings. Families in transition, with women employed off the farm or headed by widowed women farmers, had the poorest diets nutritionally and tended to have lower cohesiveness ratings. The presence of a food source raised or grown for income purposes did not guarantee the use of the food for family consumption.
Residence Differences in the Health Status of Elders*
Authors: Cutler Stephen J. , Coward Raymond T.
Published: April 2008

Using data from the 1984 Supplement on Aging to the National Health Interview Survey, this study examined residential differences on a selected group of health status measures among persons 65 years of age and older (N = 11,497). Mean values on indicators of health and impairment for each of the residence categories were examined before and after adjusting for distributional differences in background and demographic characteristics which are associated with both health and residence. Three important conclusions emerged from the analysis: (1) health status does not vary with residence in a unitary fashion; (2) the relationship between residence and health status does not appear to fall along a straightforward rural‐urban continuum; and (3) there is both diversity in, and a general patterning of, the significant relationships between health and residence with the extremes of health status located in the rural categories.
Differences in Need Among the Rural and Urban Aged: Statistical Versus Practical Significance*
Authors: Leinbach Raymond M.
Published: April 2008

Needs assessment data from two states are analyzed to determine if there are differences between rural and urban older persons. Five different definitions of “rural” are utilized. A test of statistical significance is used to determine if differences exist and a measure of association is used to determine how strong the relationships are between residence and need. It is concluded that, with the exception of one rural definition within one state, there are residential differences in need. However, those differences are so small as to have limited practical significance in the public policy arena.
Use of a State‐Level Pharmaceutical Assistance Program Among Urban and Rural Elders*
Authors: Goodfellow Marianne , Tubman Jon G. , Landry Julie A , Abern Frank , Lago Dan , Smyer Michael A.
Published: April 2008

A number of state‐level pharmaceutical assistance programs have been established as a result of the growing recognition of the role of Pharmaceuticals in the long‐term care of the elderly. However, existing research does not provide a coherent expectation for patterns of use by rural and urban elderly. The data for this analysis are drawn from a larger study of the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE). PACE provides prescription medicines for elderly who meet income requirements. The research project was designed to assess the characteristics of PACE program participants and non‐participants on a wide range of issues. Chi‐square analysis and regression models were used to assess the association between rural and urban residence and access to the PACE Program. The results indicate that rural/urban status of the elderly is not a significant predictor of the use of PACE. Other traditional variables (e.g., health self‐rating and physician visits) did predict difference in the pattern of use.
Impact of Medicare's Prospective Payment System and the Farm Crisis on the Health Care of the Elderly: A Case Study*
Authors: Sharp Tessa S. , Halpert Burton P. , Breytspraak Linda M.
Published: April 2008

The spectrum of health care for the rural elderly has been negatively affected by recent changes in Medicare reimbursement policies and by the farm crisis. This case study examined the effects of these changes on the ability of rural hospitals, the aging network, and caregivers to provide adequate and continuous care to the elderly. In this case study, three gaps in services were found: a lack of programs designed to meet the needs of terminally ill patients and their families; a lack of education during the crucial transitional period between hospital discharge and home; and a lack of services and programs for the chronically‐ill older adult. More studies are needed to determine if similar service gaps will be found in other rural communities. If so, public attention should be focused on possible solutions.
Toward a Rural Health Corps Concept: Lessons from the Dominican Republic*
Authors: Ugalde Antonio , Homedes Nuria
Published: April 2008

ABSTRACT: In recent years, primary health care services have expanded rapidly in rural Latin America. However, these services are characterized in many countries of the region by inefficiency and low quality. Research on rural health services in the Dominican Republic identifies the compulsory year of rural service required of graduating medical students (known as pasantia in some countries and medicatura rural in others) as one of the main causes for these problems. Conflicting roles assigned to rural health promoters by the ministry of health and by rural residents are another contributing factor. The manner in which these characteristics of the rural health system reduce the productivity of health resources and the quality of care is discussed. The authors suggest that the organization of a rural health corps could resolve the main flaws inherent in the use of the pasantia and strengthen the work of the promoters.
Rural Health Care in Chile*
Authors: Gandolfo Juan Giaconi , Belmar Nestor Montesinos , Villalobos Adriana Schalchli
Published: April 2008

ABSTRACT: The experiences of four years of applying a specific plan for improving rural health in Chile are discussed. These rural health initiatives have resulted in expanding the delivery of services; improvements in the health infrastructure for rural care; an important increase in the quality and the number of qualified health personnel; the creation of homes for pregnant women; the construction of latrines; improvements in the quality of life of the population through literacy activities; self‐production of food; improved basic sanitation and active participation of the community in the solution of community health problems as well as those of personal well‐being. An evaluation undertaken with a representative sample of families indicated that 83% rated the performance of the rural primary health center, and its team of health care professionals, from very good to excellent. Satisfaction with specific professionals was also high, although there were variations: physician (77.6%); midwife (86.4%); nurse (92%); “auxiliar” (93.6%) and nutritionist (75%).
The Community Health Worker: Forty Years of Experience of an Integrated Primary Rural Health Care System in Brazil*
Authors: Rice‐Marquez Nancy , Baker Timothy D. , Fischer Corinha
Published: April 2008

ABSTRACT: This article presents one aspect of a highly successful, but surprisingly little known, rural health program in Brazil. Information on the selection, training, supervision, productivity, coverage, costs, and quality of care of their Visitadoras, a type of Community Health Worker, should be of utility to rural health planners and managers in other countries.
Necessary Conditions for Supporting a General Surgeon in Rural Areas*
Authors: Glenn John K. , Hicks Lanis L. , Daugird Allen J. , Lawhorne Larry W.
Published: April 2008

Loss of a general surgeon in a rural community can alter the referral patterns, the image and utilization of the local hospital, and even the market share of local primary care physicians. Prior research has not defined the necessary and/or sufficient conditions for a rural county to be able to support a local general surgeon. Based upon empirical analysis of 96 rural Missouri counties and the limited literature available on rural surgeons and physician referral rates, a first approximation of those conditions are offered. We conclude that a rural county with a hospital, a population base of more than 15,000 people, and at least 11 potential referring physicians has sufficient conditions to enable it to support a local general surgeon. Among those rural Missouri counties not meeting the above conditions but having a general surgeon in 1984, we estimate that 8 to 10 potential referring physicians appear to be the minimum necessary condition for supporting a rural general surgeon through patient referral. From those conclusions, we argue that any rural hospital currently without a surgeon should re‐examine its situation. To prepare for a competitive future, such a hospital should take every opportunity to expand the referral base necessary to support a full‐time local surgeon rather than place long‐term reliance upon itinerant general surgeons.
The Rural Hospital Project: Conceptual Background and Current Status*
Authors: Amundson Bruce A. , Rosenblatt Roger A.
Published: April 2008

Rural hospitals are confronting continuing and increasing threats to their inability. A demonstration project for the Washington‐Alaska‐Montana‐Idaho region to address the problems of the rural hospital and health system is described. The assumptions underlying the project are that the rural hospital represents the most important component of the rural health care system, and the role of the rural hospital must be defined in relation to the broad health care needs of the population it serves. However, since the elements of community health services are also interdependent, a comprehensive approach to addressing the broad array of problems which besiege rural health services has been developed. The phases of this comprehensive health services development model are described. This approach is having a substantial impact on the ability of community health care leaders to work together, identify important problems, and initiate a range of interventions, with results that are encouraging for the future of the rural hospital and health care system.
Strategies for Promoting a Viable Rural Health Care System*
Authors: Moscovice Ira
Published: April 2008

ABSTRACT: Strategies for promoting a viable rural health care system in the context of the rapidly changing rural health care environment are presented. Also included is a series of guiding principles that support rural health care. They focus on the need for cooperation rather than competition among rural communities and health providers; the need for leadership and empowerment in rural communities; the dependence of rural health on generalists; the need to transform the reimbursement system to reward rural health services; the importance of quality of care for rural providers; the challenge of providing health and social services to the aged; and the instability caused by uncertain government attention to rural concerns. Examples of current activities that exemplify the effective use of these principles with respect to rural hospitals are discussed. These include the proposed demonstration of a new health care institution called the Medical Assistance Facility, the development of rural hospital consortia, the establishment of a rural health care transition grants program, and the activities of the New York State Legislative Commission on Rural Resources.
The Impact of Obstetrical Liability on Access to Perinatal Care in the Rural United States*
Authors: Nesbitt Thomas S. , Scherger Joseph E. , Tanji Jeffrey L.
Published: April 2008

ABSTRACT: Liability issues have caused large numbers of obstetrical providers, particularly family and general practitioners, to discontinue offering perinatal care in rural areas. Losses of even small numbers of rural obstetrical providers can severely limit access to care for large geographic areas. A lack of access to local obstetrical care can result in less than adequate prenatal care and in potential delays in the diagnosis and care of acute perinatal complications. Women who live in these underserved rural communities suffer increased adverse birth outcomes, leading to significantly higher medical costs. Proposed solutions to the problem include risk management programs associated with reduced liability premiums; increased Medicaid reimbursement for obstetrical care; health department subsidies to offset insurance premiums for rural obstetrical care; and programs in predoctoral and residency training designed to identify, assess and address the health care needs of rural areas. Although some measure of success has resulted from these efforts, more systematic and comprehensive policy changes are needed to meet the challenge of this crisis.
A University Rural Teaching Practice: A Model for Collaboration in Rural Health Care*
Authors: Rosenthal Thomas C. , Bissonette Raymond , Holden David M. , Brunelle Thomas
Published: April 2008

ABSTRACT: After nearly two decades of Federal, State and local incentives, primary medical services in rural areas remain far short of target. Numerous demonstration projects supported by public and private funds have had some success but models with both broad replicability and independence of external start‐up and/or maintenance support are rare. The Department of Family Medicine at the State University of New York at Buffalo has established a novel collaborative network of public and private organizations to emplace a four‐physician rural group practice concurrently accomplishing three major goals: high quality primary and specialty medical services to two medically underserved populations; enriched training opportunities for students, residents, and fellows; and financial viability. Beyond meeting regional needs, however, the components and nature of the collaborative effort indicate reproducibility in many communities throughout the country. To emphasize exportable features we will focus on: opportunities, operational strategies, financial feasibility, training advantages, and impact.
The Effects of Area Health Education Centers on Primary Care Physician‐to‐Population Ratios from 1975 to 1985*
Authors: Hynes Kevin , Givner Nathaniel
Published: April 2008

The purpose of this study was to explore how the primary care (PC) physician‐to‐population ratio changed from 1975 to 1985 in counties that were served by an Area Health Education Center (AHEC) in contrast to those counties that were not. The investigation attempted to determine whether any observed changes in this ratio were dependent upon either degree of urbanization or contiguity to a Standard Metropolitan Statistical Area (SMSA). The data source for this study was the Area Resource File. Results indicated that: (a) irrespective of AHEC status, increased degree of urbanization across counties was associated with relatively more PC physicians in both 1975 and 1985; (b) PC physician‐to‐population ratios increased from 1975 to 1985 for all American Medical Association (AMA) county code categories, regardless of AHEC versus non‐AHEC designation; (c) AHEC counties demonstrated greater (or equivalent) absolute improvement for all AMA county code categories except for several categories which represented more urbanized counties; (d) for the least urbanized counties in the AMA code, the percentage improvement in PC physician‐to‐population ratios for AHEC counties ranged from 3 to 5 percent higher than corresponding percentage improvement in ratios for non‐AHEC counties; and (e) AHEC counties showed greater absolute and percentage improvement in PC physician‐to‐population ratios than did non‐AHEC counties for counties not contiguous to SMSAs.
Competition and Rural Primary Care Programs*
Authors: Ricketts Thomas C.
Published: April 2008

Rural primary care programs were established in areas where there was thought to be no competition for patients. However, evidence from site visits and surveys of a national sample of subsidized programs revealed a pattern of competitive responses by the clinics. In this study of 193 rural primary care programs, mail and telephone surveys produced uniform data on the organization, operation, finances, and utilization of a representative sample of clinics. The programs were found to compete in terms of: (1) price, (2) service mix, (3) staff availability, (4) structural accessibility, (5) outreach, and (6) targeting a segment of the market. The competitive strategies employed by the clinics had consequences that affected their productivity and financial stability. The strategies were related to the perceived missions of the programs, and depended heavily upon the degree of isolation of the program and the targeting of the services. The competitive strategy chosen by a particular program could not be predicted based on service area population and apparent competitors in the service area. The goals and objectives of the programs had more to do with their competitive responses than with market characteristics. Moreover, the chosen strategies may not meet the demands of those markets.
Nonfatal Farm Injuries in North Dakota: A Sociological Analysis*
Authors: Geller Jack M. , Ludtke Richard L. , Stratton Terry
Published: April 2008

The 1980s has not been a particularly prosperous decade for many farm operators. Due to shifts in the agricultural economy, many farmers have experienced farm foreclosure and rural displacement; while many more are at serious risk of losing their farms. Within the context of the agricultural crisis, this study examines the impact of economic hardship on the probability of experiencing a farm injury. Specifically, we hypothesized that farm operators who were experiencing economic distress would be more likely to experience a farm injury. Data from the North Dakota Rural Life Poll (n=450) was used to estimate the incidence of farm accidents, as well as examine the relationship between selected farm operator characteristics and the incidence of a farm accident. The data suggests that younger farm operators with higher debt‐to‐asset ratios are significantly more likely to experience a farm accident. The study goes on to examine some of the dynamics of this relationship, and implications for farm safety education are addressed.
Factors Related to Job Satisfaction and Autonomy as Correlates of Potential Job Retention for Rural Nurses*
Authors: Hanson Charlene M. , Jenkins Susan , Ryan Rebecca
Published: April 2008

ABSTRACT: This study of 167 nurses in 10 rural Georgia agencies examines the relationships among personal characteristics, factors of job satisfaction, autonomy, and job retention. The findings indicate that, contrary to expectations, personal characteristics (e.g., age, education, salary, marital status, and number of dependents) are not strong predictors of job retention in this sample. Some of the factors of job satisfaction do correlate negatively with indicators of impending job change, but the strongest relationships were those related to nursing autonomy. The study concludes that, of the variables studied, autonomy was the most effective predictor of job satisfaction and intention to remain in the current position.
Book Reviews Editor
Authors: Samuels Michael B. , Bell Nora K.
Published: April 2008

INLANDER, CHARLES B., LEVIN, LOWELL B., AND WEINER, E.D. Medicine on Trial: The Appalling Story of Medical Ineptitude and the Arrogance that Overlooks It.
Rural America in the 1980s: A Context for Rural Health Research
Authors: Coward Raymond T. , Miller Michael K. , Dwyer Jeffrey W.
Published: April 2008

The decade of the 1980s was a roller coaster ride for many rural Americans, rural health care providers, and scholars of rural life. The “rural renaissance” of the late 1970s and early 1980s was followed by the economic “farm crisis” of the mid‐1980s and, in the late 1980s, by a resurgence of interest and policy making related to small towns and rural communities. It was a tempestuous time. Perhaps such fluctuations in national attention and concern are characteristic of most 10‐year periods in history; however, the vacillations that occurred in the 1980s seemed, particularly, to have no fixed course.
The Health Status, Health Services Utilization, and Support Networks of the Rural Elderly: A Decade Review*
Authors: Dwyer Jeffrey W. , Lee Gary R. , Coward Raymond T.
Published: April 2008

ABSTRACT: Research from the 1980s on several dimensions of health and health care among the rural elderly is reviewed. Following a brief discussion of the demographic patterns and life conditions of the rural elderly, the current state of knowledge regarding health status, health services utilization, and the potential for informal and familial care of the elderly is examined. The review concentrates on studies that include comparisons between rural and urban populations and/or control for additional variables that are known to covary with residence. Such analyses permit the documentation of the effects of residential location on health indicators net of other factors. The review concludes that the rural elderly are relatively disadvantaged in terms of both health status and access to health care services, and have little if any advantage over the urban elderly in their access to informal sources of care. Following the review, an agenda for future research is identified.
America's Rural Hospitals: A Selective Review of 1980s Research
Authors: Mick Stephen S. , Morlock Laura L.
Published: April 2008

ABSTRACT: We review 1980s research on American rural hospitals within the context of a decade of increasing restrictiveness in the reimbursement and operating environments. Areas addressed include rural hospital definitions, organizational and financial performance, and strategic management activities. The latter category consists of hospital closure, diversification and vertical integration, swing‐bed conversion, sole community provider designation, horizontal integration and multihospital system affiliation, marketing, and patient retention. The review suggests several research needs, including: developing more meaningful definitions of rural hospitals, engaging in methodologically sound work on the effects of innovative programs and strategic management activities—including conversion of the facility itself—on rural hospital performance, and completing studies of the effects of rural hospital closure or conversion on the health of the communities served.
Utilizing Cooperative Extension Services to Meet Rural Health Needs*
Authors: Halpert Burton P. , Sharp Tessa S.
Published: April 2008

ABSTRACT: Professionals concerned with rural health issues sometimes overlook the possibilities that the Cooperative Extension Services (CES) hold for addressing rural health problems. Joint venturing between health care and CES professionals can help address the growing rural health care concerns associated with cost containment strategies and the federal deficit, as well as the traditional problems associated with the scarcity of health care resources in rural areas. Cooperative extension, a 75‐year‐old national, community‐based system can provide the structural and program delivery capacity to help shape health care delivery in rural areas through community organization and education. The structure and functions of the CES, brief examples of successful CES programs, and some helpful hints provide insights into the potential for successful cooperation and collaboration. This collaboration can represent a cost‐effective strategy to address problems in the changing health care climate.
Family Medicine Education and Rural Health: A Response to Present and Future Needs
Authors: Boulger James G.
Published: April 2008

ABSTRACT: The importance of family medicine in providing rural health services has been established for quite some time. The need to train physicians who select the specialty of family medicine is critical at a time when medical student interest in the primary care specialties appears to be diminishing. Renewed efforts by educational institutions and incentives at the state and federal levels will be necessary to assist in the alleviation of shortages of rural physicians. The educational program at the University of Minnesota, Duluth, School of Medicine has achieved a great deal of success in training rural family physicians. A coordinated program effort, featuring the efforts of more than 200 family physicians during the past 15 years, has led to 52.5 percent of all graduates selecting family practice and more than 41 percent choosing practice sites with a population fewer than 20,000. Elements of the program at Duluth could serve as a model for other schools desiring to increase the number of students entering family medicine and rural practice.
Hospital Choice of Medicare Beneficiaries in a Rural Market: Why Not the Closest?
Authors: Adams E. Kathleen , Wright George E.
Published: April 2008

ABSTRACT: As part of a larger study of hospital choice, the travel patterns of more than 12,000 Medicare beneficiaries residing in three overlapping rural areas were examined. During 1986 these Medicare beneficiaries were admitted to one of 53 hospitals in an area that encompassed parts of Minnesota, North Dakota, and South Dakota. Information on ZIP code of residence, closest hospital, and hospital of admission were used to analyze hospital choices of the Medicare rural elderly residing in this area. Tosummarize their travel patterns, the admitting hospital was categorized based on whether it was urban or rural, its size and whether or not it was the closest facility. Findings indicated that 60 percent of these rural Medicare beneficiaries used hospital services at their closest rural hospital, regardless of its size. However, 79 percent of those whose closest hospital was larger than 75 beds used it, while only 54 percent of those whose closest rural hospital was fewer than 75 beds obtained services there. Overall, 30 percent of those residing in this rural market area went to an urban hospital. These patterns appeared to reflect an evaluation by the physician and/or individual of the relative attractiveness of the local hospital versus alternatives available, as well as the individual's characteristics. Travel patterns varied by the beneficiary's age as well as his or her relative complexity of illness, as measured by a Disease Staging methodology. Findings have implications for the provision and financing of hospital services in rural areas.
Poverty, Primary Care and Age‐Specific Mortality*
Authors: Farmer Frank L. , Stokes C. Shannon , Fiser Robert H. , Papini Dennis P.
Published: April 2008

ABSTRACT: An important area of concern among rural health researchers and policy analysts is the social and ecological correlates of mortality levels. This research is concerned with the empirical relationship between the prevalence of poverty and the mortality experience of different age groups within the population. Poverty is viewed as a characteristic ofthe social organization of local areas and operationalized by employing several indicators, including a measure of rurality. The empirical results indicate that the magnitude of the association between the prevalence of poverty and mortality varies among different age groups. The impact of rurality, while being consistently positive, is shown to be statistically nonsignificant. The research also shows that the availability of primary care is associated with lower mortality.
Causes and Consequences of Rural Small Hospital Closures from the Perspectives of Mayors
Authors: Hart L. Gary , Pirani Michael J. , Rosenblatt Roger A.
Published: April 2008

ABSTRACT: Mayors of rural towns whose small general hospitals closed between 1980 and 1988 were surveyed. Only hospitals that were the sole hospitals in their towns and that had not reopened were included in the survey. Of the 132 hospitals meeting these criteria, 130 (98.5%) of the mayors of their communities responded to the survey.

The typical study hospital had 31 beds, with an average daily census of 12. Three fourths of the hospital closures were in the North‐Central and South census regions. Half of the hospital closures were for hospitals that were 20 miles or more from another hospital.

Mayors attributed the closure of their hospitals primarily to governmental reimbursement policies, poor hospital management and lack of physicians. To a lesser extent, they also implicated competition from other hospitals, reputation for poor quality care, lack of provider teamwork, and inadequate hospital board leadership.

Respondents reported they had little warning that their hospitals were in imminent danger of closing. Warnings of six months or less were reported by 49 percent of the mayors; only 33 percent of mayors of towns with for‐profit hospitals reported having more than six months warning.

Of the 132 hospital buildings that closed, only 38 percent were not in use in some capacity in the summer of 1989. Most were being utilized as some form of health care facility such as an ambulatory clinic, nursing home, or emergency room.

More than three fourths of the mayors felt access to medical care had deteriorated in their communities after hospital closure, with a disproportionate impact on the elderly and poor. Nearly three fourths of the mayors also perceived that the health status of the community was worse because of the hospital closure, and more than 90 percent felt it had substantially impaired the community's economy.
Rural Adolescent Alcohol Use: An Overview*
Authors: Fanner Frank L. , Kelleher Kelly J. , Rickert Vaughn I.
Published: April 2008

Use and abuse of alcohol by rural adolescents is an important problem for those who care for youth and for the future of rural communities. Alcohol use is common and associated with many of the risk factors identified in previous urban‐sampled research. However, there is considerable rural heterogenety, and the specific characteristics of rural families and communities that may predispose certain adolescents to earlier use or problem drinking are not well understood. Identification of these factors are not only critical for the treatment of affected adolescents and their families, but also for the prevention of adolescent problem drinking. While a number of authors have attempted to describe rural adolescent drinking and associated factors, these studies have been limited by sampling only school populations, small samples, use of unstandardized instruments and no long‐term follow‐up. In the same vein, no investigators have described the impact of population density, farm residence, predominant local industry, or sociocultural characteristics of rural families and communities on adolescent alcohol use and other health compromising behaviors. Thus, prospective longitudinal studies are sorely needed. Even more important, no research exists that explores the effectiveness of treatment or prevention services for rural adolescents. Communities and providers are forced to rely on models developed in urban settings that do not take into account the lack of access to other services, the shortage of trained specialists, and the limited economic resources of rural communities. A focused effort by investigators, research agencies, and local communities will be necessary for these barriers to be overcome.
Issues Surrounding the Distribution and Utilization of Nurse Nonphysician Providers in Rural America*
Authors: Conway‐Welch Colleen
Published: April 2008

The cost and quality of health care is an ever‐increasing concern. Responsible people are looking for logical solutions. One solution is the increased involvement of nurse practitioners and certified nurse midwives in the delivery of health care services to patients. This paper reviews the supply, education, and responsibilities of nurse practitioners and certified nurse midwives, government studies of the need for nonphysician providers, the cost‐effectiveness of health care delivered by nurse practitioners and certified nurse midwives, and impediments to practice.
The 1990s and Beyond: Determining the Need for Community Health and Primary Care Nurses for Rural Populations*
Authors: Hanson Charlene M.
Published: April 2008

Increased numbers of primary care and advanced practice nurses with unique generalist skills will be required to meet the accelerating physiologic and sociocultural health care needs of rural populations. Several factors have been identified that will influence the demands and position of community‐based nurses in rural practice settings during the next decade. A back‐to‐basics type of health care offered out of a growing elderly population; technological breakthroughs that make it possible for more chronically ill patients to live at home; serious substance abuse and other adolescent problems; AIDS; and high infant morbidity and mortality statistics are only some of the concerns that will demand nursing intervention. These changes speak to the need for improved nursing coordination, stronger collegial relationships, and better communication between physicians and nurses. Health care is moving in new directions to offer more efficient and technologically sophisticated care. These changes enhance the need for clinically expert educators who teach and jointly practice in programs with a rural focus. Telecommunications, and heightened computer literacy, will play a major role both in nursing education and clinical practice. The goals of kindergarten through 12th grade health promotion and disease prevention strategies in school health will be the norm and will require better prepared, and positions for, school nurses. More midwives and public health nurses will be needed to care for the growing population of sexually active adolescents who are in need of family planning and prenatal care. Underinsured and indigent populations will continue to fall within the purview of midlevel practitioners, as will providing anesthesia services in small rural hospitals. The transition of some rural hospitals into expanded primary care units (e.g., EACHs and RPCHs), and new models of case management will greatly influence nursing demands. This paper will further identify critical areas of advanced practice nursing within community settings, including new relationships with other health care providers, and will introduce strategies upon which rural health policy recommendations for the 1990s can be addressed.
Current Approaches to Shortage Area Designation*
Authors: Lee Richard C.
Published: April 2008

This paper reviews the various indicators and criteria that are in use to identify rural and urban areas with shortages of primary care physicians, dentists, psychiatrists, or nurses; areas with medically under served populations; high migrant impact areas; and areas of greatest need/shortage, leading to lists of designated shortage or underserved areas eligible for various federal and state programs; and to lists of areas with priority for resource placement. Presenting these shortage and under service criteria at a workshop dealing with adequacy was not meant to suggest an equivalency between the concepts of “shortage,”“underservice,” and “adequacy,” but the shortage and underservice criteria can be thought of as a floor on the definition of adequacy, and may contain elements of that definition. Refinements or revisions to the various criteria could probably better identify the needs in rural areas, or the kind of staffing mix needed in various types of areas, or improve priority setting among designated areas; but the existing criteria remain a good first screen to identify those areas with health services‐related needs that require further attention.
Drinking, Farm, and Camp Life: A Study of Drinking Behavior in Migrant Camps in New York State
Authors: Chi Peter S.K. , McClain Janet
Published: April 2008

This research focuses on issues of alcohol consumption among migrant farmworkers in Orange County, NY. Because drinking is a common behavioral response to erratic hard work and camp life, variation in alcohol consumption was analyzed within the context of a holistic perspective on migrant life. Although migrant farmworkers tend to drink more in the camp than in the home community, the multivariate analysis indicates that such variation is primarily affected by socialization and social support factors, not by work‐related variables. Potential strategies for modifying migrant farmworkers’drinking behavior are discussed based on the results of this study.
Farm Product Prices and Agricultural Safety: Connections and Consequences
Authors: Kelsey Timothy W.
Published: April 2008

Economic conditions in farming have been a common thread in explanations of agriculture's high rate of occupational injuries and death. If prices were higher or the farm economy were stronger, it is said, farmers could afford to be safer. However, could afford to be safer does not mean that farmers would be safer. This study examines the question of whether higher farm product prices could be expected to reduce agricultural injury rates. The critique includes a statistical model relating prices and acres per worker to non‐rollover fatal farm injuries, using national data from 1969 to 1987. Contrary to current arguments, the model shows that higher prices historically are associated with higher fatality rates, suggesting that increased prices serve as an incentive for working harder and that the state of the agricultural economy is not a good explanation for high injury rates.
Job Retention of Medical Clerical
Authors: Troutt‐Ervin Eileen D. , Morgan Frederic L.
Published: April 2008

According to the Bureau of Labor Statistics (cf. Crispell, 1990), the medical clerical field is one of the faster growing areas of employment. This paper reports on long‐term employment of trainees involved in nontraditional medical clerical programs. These programs were funded by the Job Training Partnership Act (JTPA) and filled both the needs of the local rural health care facilities and the employment needs of unskilled youths and adults. These nontraditional students of low socioeconomic background and poor work history were successfully mainstreamed into university courses and consequently obtained productive employment.

A follow‐up study was conducted of 64 individuals who completed three different, one‐year JTPA programs. The study investigated the following questions: Was the trainee currently employed? If so, was employment related to the training program, and were the quarterly salaries higher than minimum wage and previous salaries? How many different jobs were reported since training? Did the individual retain employment in a rural setting?

The JTPA programs at Southern Illinois University included some innovative yet practical components that resulted in very high program completion rates, high initial placement, and a continuing pattern of long‐term employment. These components included: emphasis on training for the most needed positions/jobs that matched university capabilities; the pursuit of higher starting salaries; informing participants of support services; training in job hunting and work readiness; using some individualized, competency‐based instruction; establishing internship arrangements with prospective employers; and careful matching of the trainee to initial placement site with consideration of personality as well as skills.
Multihospital System Affiliation as a Survival Strategy for Rural Hospitals Under the Prospective Payment System
Authors: Halpern Michael T. , Alexander Jeffrey A. , Fennell Mary L.
Published: April 2008

The introduction of Medicare's Prospective Payment System (PPS) has disproportionately increased financial pressures on rural hospitals and posed challenges to the survival of these institutions. Increasingly, rural hospitals are seeking strategies that can enhance their chances for survival in a turbulent and hostile environment. This study examined the survival effects of one such strategy, multihospital system affiliation. Specifically, we assessed: (1) whether and how different types of system affiliation in the post‐PPS era affect the likelihood of rural hospital survival; (2) whether particular structural, environmental and hospital performance characteristics moderate the effects of system affiliation on rural hospital survival; and (3) whether systematic selection by rural hospitals into multihospital systems potentially accounts for observed relationships between system affiliation and survival.

Proportional hazards analyses indicate that system affiliation with investor‐owned systems significantly reduces survival probabilities of rural hospitals. Affiliation with not‐for‐profit systems or system affiliation under contract management arrangements does not affect survival probabilities of rural hospitals.

These general findings are moderated by the effects of hospital ownership and size at the time of affiliation. Finally, study findings indicated that systematic selection by poor performing rural hospitals into investor‐owned systems has occurred in the post‐PPS era. No evidence of selection into not‐for‐profit systems was discovered.