bluuebunny/crossref_metadata_2025 huggingface dataset:
Barriers to the Retention of Registered and Licensed Practical Nurses in Small Rural Hospitals
Authors: Szigeti Elvira , Laxdal Sharon , Eberhardt Bruce J.
Published: April 2008

ABSTRACT: The availability of nursing resources is one of the most critical issues facing health care organizations in the country. The study investigated the potential factors that relate to the desire of registered nurses (RNs) and licensed practical nurses (LPNs) to continue practicing in rural hospitals of North Dakota. All RNs and LPNs who worked in North Dakota hospitals with fewer than 100 beds (490 hospitals) were mailed survey questionnaires. Approximately eight weeks later, responses were received from 291 respondents for an overall return rate of 59 percent. Correlational analyses were used to examine the subjects' responses. A moderate relationship was found among the work‐related variables. Overall job satisfaction and performance constraints were the only variables to make significant contributions to the prediction of turnover intention for both RNs and LPNs. Overall job satisfaction accounted for the largest percentage of the variance (R2=0.42 and R2=0.44) for RNs and LPNs, respectively. Satisfaction with promotion was the only work‐related variable to make a significant contribution to the prediction of turnover intention for RNs (R2=0.23). Performance constraints, role ambiguity, and shift worked were the only work‐related variables contributing to the prediction of turnover for LPNs. These results are discussed in terms of their implications for the management of RNs and LPNs in rural hospitals. Clinical ladders for promotions, the identification of potential performance constraints, and supervisory training are suggested as target areas in which rural hospitals might focus attention for managing turnover in RNs and LPNs.
Results of an Educational Intervention to Improve the Health Knowledge, Attitudes and Self‐Reported Behaviors of Swine Confinement Workers
Authors: Gjerde Craig , Ferguson Kristi , Mutel Connie , Donham Kelley , Merchant James
Published: April 2008

ABSTRACT: Swine confinement workers participated in an educational intervention designed to improve knowledge, attitudes, and behaviors related to respiratory disease. The desired changes were (1) improvement in knowledge about recommended gas and dust levels in buildings and benefits of using properly fitted masks; (2) improvement of attitudes about wearing dust masks, taking safety precautions, and inspecting the ventilation and heating systems; and (3) improvement in behaviors such as regular inspection of buildings and wearing an appropriate dust mask or respirator. The health risks of failing to practice these behaviors include chronic bronchitis, occupational asthma, organic dust toxic syndrome, chronic sinusitis, and even death from acute toxicity related to hydrogen sulfide.

An intervention group and a nonintervention group of swine confinement workers were assessed at the beginning of the project and one year later to determine changes brought about by an educational intervention. During that year, swine producers in the intervention group were mailed a series of six educational home‐study modules and reference materials on confinement topics.

Analysis of covariance and categorical repeated measures analysis were used to determine changes over time in the percentage of people who answered correctly in each group. Significant changes in knowledge scores, attitude scores, and reported behavior scores all favored the intervention group. The 14 statistically significant changes in knowledge items were related to dust mask use, manure pit safety, liquid manure agitation, building gas and dust norms, and recommended gas levels. The four attitudinal items that improved significantly concerned the importance of regular cleaning and upkeep, improving health and safety, knowing ways to keep buildings safer, and recognizing the benefits of wearing a dust mask. The four items about self‐reported behavior changes included inspecting and servicing of building heaters, measuring building gases, and wearing a mask while working.

Thus, important changes in the intervention group occurred in all three targeted areas—knowledge, attitudes, and behaviors. The results lead to three conclusions: the educational materials were effective; swine producers are educable through a low‐cost intervention; and educational intervention acan improve many factors related to the safety and health of confinement workers.
Rural Populations and Rural Physicians: Estimates of Critical Mass Ratios, by Specialty*
Authors: Hicks Lanis L. , Glenn John K.
Published: April 2008

As physicians and other providers of health care services see their traditional markets erode, an increasingly important element of any provider location decision is the determination of a population base or “critical mass” that can professionally and financially support a given set of health care services. While the size of a local population is not the sole determinant of success, ultimately an adequate population base to support a given spectrum of services must be defined, and providers increasingly need tools for evaluating opportunities in the new economic market. This is especially true in rural areas. An earlier supply and demand model for estimating the critical mass of population needed to support a physician in any one of 25 specialties and subspecialties in urban and suburban areas is adapted to the rural market. The assumptions inherent in the earlier model are examined and the issue of “critical mass” is examined from a rural health care perspective in this paper.
Self‐Care and Illness Response Behaviors in a Frontier Area
Authors: Bartlome Jeffrey A. , Bartlome Patricia , Bradham Douglas D.
Published: April 2008

Self‐care and illness response to a recent medical event were examined based on a mailed questionnaire to a random sample of 416 adults in a frontier area in north‐central Idaho. A total of 494 questionnaires were returned (45% response rate), and 78 were eliminated. Self‐care behaviors were classified as: (1) waiting to see what would happen, (2) purchasing or taking a nonprescription medication, (3) taking a prescription medication that was on hand, (4) taking both a prescription and a nonprescription medication, (5) contacting a physician, and (6) going to a hospital. These six variables were classified into three intervention constructs of no intervention (waiting), informal intervention (self‐medicating), and formal intervention (contacting a health care professional).

Fifty‐six percent of the respondents reported self‐medicating behaviors. Correlation analysis indicated that initial self‐care and illness response behaviors in this frontier area were generally appropriate. Three multiple discriminant models were tested to differentiate those people who waited, self‐medicated, and contacted formal providers from those who did not. A significant model could not discriminate between those who waited and those who did not. Models for self‐medicating and contacting formal providers correctly classified cases 60 to 70 percent of the time. The analyses indicate that self‐medicating was more likely to be reported by younger individuals, by those who lived further from the hospital, who perceived their health status to be better, who reported less satisfaction with community health care services, and that the self‐medicating was appropriate. Those respondents most likely to contact the physician reported a lower perceived health status, a higher level of appropriateness of seeking formal health care services, a perceived physician shortage as a serious community problem, greater use of a number of prescription medications in the previous two weeks, and reported living in the community longer than those who did not. The implications of these findings are discussed.
A Comparison of Financial Performance, Organizational Characteristics and Management Strategy Among Rural and Urban Nursing Facilities
Authors: Smith Howard L. , Piland Neill F. , Fisher Nancy
Published: April 2008

Despite efforts to deinstitutionalize long‐term care, it is estimated that 43 percent of the elderly will use a nursing facility at some point. Whether sufficient nursing facility services will be available to rural elderly is debatable due to cutbacks in governmental expenditures and recent financial losses among nursing facilities. This paper explores the challenges confronting rural nursing facilities in maintaining their viability and strategies that might be considered to improve their longevity. A comparative analysis of 18 urban and 34 rural nursing facilities in New Mexico is used in identifying promising strategic adaptations available to rural facilities. Among other considerations, rural facilities should strive to enhance revenue streams, implement strict cost control measures, emphasize broader promotional tactics, and diversify services commensurate with the constraints of the communities and populations served.
Accidental Occupational Farm Fatalities in North Carolina: 1984 to 1988
Authors: Bernhardt Judy Hayes , Langley Ricky L.
Published: April 2008

Development of interventions to prevent accidental occupational fatalities requires the prior identification of those at risk and the circumstances surrounding the injuries. A survey of unintentional farm fatalities was conducted using medical examiner reports (RIME) and death certificates (MECD) to identify deaths due to agricultural occupational injuries in North Carolina from 1984 through 1988. Of 393 cases, 123 met the criteria “farmer” listed as occupation on the RIME/MECD and/or “victim” in a rural area performing a farming task when injured. A second aim of this study was to use an existing data base to achieve maximum accuracy in identifying true cases of work‐related farm fatalities.

A fatality rate of 41/100,000 agricultural workers was found; the National Institutes of Occupational Safety and Health's National Traumatic Occupational Fatality study criteria would have identified only 57 percent of these. Victims were characterized as middle age (53 years), white (76%), male (100%), full‐time farmers (65%). Injury occurred during harvest season on Monday or Tuesday (47%) between 2 and 6 p.m. (54%). Death was pronounced at the scene (74%), with probable cause listed as tractor (62%). Injury location and land elevation were also related, with the mountain region having twice the fatality rate as the coastal plains region.
AIDS and Drug Abuse in Rural America
Authors: Steel Elizabeth , Haverkos Harry W.
Published: April 2008

This paper reviews the nature and extent of drug abuse‐related HIV disease services in the rural United States. Issues concerning the delivery of HIV disease and substance abuse health care services in rural settings are outlined and discussed.
Entrance and Exit of Obstetrics Providers in Rural Alabama
Authors: Bronstein Janet M.
Published: April 2008

In Alabama between 1985 and 1989, a total of 94 physicians outside of the four largest cities in the state dropped the obstetrics portion of their practices or left practice in their communities altogether. During the same period 82 physicians entered obstetrics pratice in this area. The study presented here used survey and archival data to compare pratice characteristics of generalists and specialists in rural and town counties who made different decisions about providing obstetrics care. More generalists left and more specialists entered practice both in town and in rural counties. Rural counties lost more obstetrics providers becasue more generalists provided the obstetrics care in these areas. Across both speciality and county categories, physicians in group practice who accepted Medicaid and had local access to larger numbers of patients were more likely to remain or begin new obstetric practices. During this period, some obstetrics specialists moved into rural communities that had previously supported only generalist physicians.

These findings suggest that the options for organizing successful obstetrics practices have narrowed, putting solo and generalist physicians who operate small‐scale obstetrics practices at a disadvantage. These physicians also face competition from obstetrics specialists who are beginning to enter practice in the rural areas of the state.

Designing policies that effectively improve geographic access to care requires a realistic understanding of the practice constraints faced by obstetrics providers. For example, as centralized specialist group practices serve residents from surrounding rural areas, programs that facilitate linkages, such as satellite clinics and use of mid‐level practitioners, can be promoted. The challenge for policy‐makers and advocates is to understand and take advantage of changes in the organization of obstetrics practice to improve the availability and the quality of obstetrics care in rural America.
Suicide Rates in Colorado from 1980 to 1989: Metropolitan, Nonmetropolitan, and Farm Comparisons
Authors: Stallones Lorann , Cook Magdalena
Published: April 2008

Suicide rates among farm populations have been reported to be higher than among other populations. Overall economic stressors and exposure to hazardous work conditions have been reported to be associated with the increased rates of suicide. The purpose of this paper is to examine the pattern of suicide among white men in Colorado, contrasting the rates of on‐farm suicides with those of other nonmetropolitan and metropolitan residents. The analysis indicated a high suicide rate in Colorado compared to white males in the United States; however, the farm suicide rate was similar to the U.S. rate. On‐farm suicide rates in Colorado were lower than suicide rates for the metropolitan and nonmetropolitan males. Prior to targeting all farm populations as at high risk for suicide, more work needs to be done assessing actual risk and considering potential differences in agricultural populations across the country.
The Economic Cost of Farm Tractor Rollover Deaths in New York
Authors: Kelsey Timothy W.
Published: April 2008

Farm tractor rollovers account for one quarter of all fatal farm injuries, but their economic impact has not been studied previously. This study surveyed surviving family members of people killed between 1985 and 1987 in New York farm tractor rollovers and found the average expected income lost by each death was $243,615 (response rate=46%, N=12). Fatal farm tractor rollovers may cost New York more than $2 million a year in lost income. Nonfarmers account for 33 percent of these rollover deaths. These nonfarmers were not on a farm and were not doing farm work at the time of the fatal injury. Policy responses to the dangers of farm tractors should consider the risks to nonfarmers and should be cognizant of the costs that could be averted.
Physician Staffing of Small Rural Hospital Emergency Departments: Rapid Change and Escalating Cost
Authors: Williamson Harold A. , Rosenblatt Roger A. , Hart L. Gary
Published: April 2008

We surveyed all 37 rural Washington state hospitals with fewer than 100 beds to determine how rural emergency departments are staffed by physicians and to estimate rural hospital payments for emergency department physician services. Only five hospital emergency departments (14%) were still covered by the traditional rotation of local practitioners and billed on a fee‐for‐service basis. Ten hospitals (27%) paid local private practitioners to provide emergency department coverage. Twelve other hospitals (32%) hired visiting emergency department physicians to cover only weekends or evenings. The remaining 10 rural emergency departments (27%) were staffed entirely by external contract physicians. Thus, 86 percent of rural hospitals contracted for emergency department coverage, and 59 percent obtained some or all of this service from nonlocal physicians. Most of the 32 hospitals with some form of contracted services have changed to this emergency department coverage in the last few years. The cost of these services is high, particularly for the smallest hospitals that have fewer than eight emergency department visits per day and pay physician wages of nearly $100 per patient visit. Emergency staffing responsibility has shifted from local practitioners to the hospital administrators because of rural physician scarcity and a desire to improve quality and convenience. The cost of these changes may further undermine the economic viability of the smaller rural hospitals.
A Descriptive Analysis of Health Insurance Coverage Among Farm Families in Minnesota
Authors: Kralewski John E. , Liu Yuanli , Shapiro Janet
Published: April 2008

This paper reports the findings of a study of health insurance coverage and access to health services among farm families in Minnesota. The study included 1,482 families actively engaged in farming during 1989. While less than 10 percent of the population were uninsured during this period, the majority had limited coverage with high deductible and coinsurance provisions. Moreover, they were paying an estimated 15 to 20 percent more for their plans than a similar plan would have cost in the Minneapolis‐St. Paul, MN, area. With the exception of cost, satisfaction with health services was found to be very high, and there were few indications of access problems.
Book Reviews
Authors: Glover S.
Published: April 2008

Management Principles for Health Care Professionals Joan Gratto Liebler, Ruth Ellen Levine, and Jeffrey Rothman. 2nd ed. Gaithersburg, MD: Aspen Publishers, Inc., 1992.
Job Satisfaction and Retention of Rural Community Health Nurses in North Dakota
Authors: Dunkin Jeri , Juhl Nyla , Stratton Terry , Geller Jack , Ludtke Richard
Published: April 2008

A correlation between job satisfaction and employment longevity has been demonstrated by a number of researchers. However, the measurable aspects of job satisfaction only partially explain an individual's tenure at a particular job. Information about the relationship between job satisfaction and retention of community health nurses in a rural state was provided by 258 community health nurses in North Dakota who responded to a mailed questionnaire. Job satisfaction assessment included measures of autonomy, task requirements, salary, benefits, rewards, professional status, organizational climate, and interpersonal interactions. Job satisfaction was analyzed by taking into account the individual importance of each component. While the majority (61%) of the responding nurses indicated that they expected to stay in their current jobs for a period of five years or more, they were dissatisfied with various aspects of their jobs. The greatest factor influencing the nurses’choice of current position was job availability, followed by preferences for the particular health care agencies or communities. These findings indicate that retention of rural nurses should focus on strategies that go beyond improving job satisfaction.
Nursing Supply and Characteristics in the Nonmetropolitan Areas of the United States: Findings from the 1988 National Sample Survey of Registered Nurses
Authors: Movassaghi Hormoz , Kindig David A. , Juhl Nyla , Geller Jack M.
Published: April 2008

This study examines the supply and selected characteristics of nurses working in nonmetropolitan areas of the United States using the most recent data reported in the third national sample survey of registered nurses in 1988. Nursing supply is analyzed in terms of the ratio of registered nurses per 100,000 people for three standard nonmetropolitan census county size classifications and nine regional groupings of states. Seven dimensions relating to the educational background and current professional characteristics of registered nurses are studied. Findings indicate a notable difference in the ratio of nurses per population across county size and regions of the country. In terms of characteristics selected for this study, the educational background, salary gap, and time spent in various activities differentiate nurses in rural areas from those working in urban counties. Results of this study should be particularly relevant because a variety of educational, financial, and other incentives are being considered to address what is perceived to be a crisis in rural nursing availability.
The Relationship of Rural Clinical Rotations to Where Registered Nurses Practice
Authors: Gordon Hene T. , Denton Denise
Published: April 2008

An objective of exposing health profession students to rural clinical experiences was to overcome problems of geographic maldistribution of health personnel. Nevertheless, little can be said about the impact of rural training rotations on the supply of health personnel in rural areas or on students’decisions about where to practice. To assess the relationship between rural clinical rotations and practice locales, surveys were administered to all applicants taking registered nurse exams in Arizona in July 1990, February 1991, and July 1991.

The students most likely to be working in rural locations were rural high school graduates with rural clinical experience during nursing school. Students who were urban high school graduates with rural clinical experience were only slightly less likely to locate in rural areas. Rural and urban high school graduates with no rural clinical experience were far less likely to choose rural practice. Rural rotations were associated with rural job selection only if students attended rural educational programs.
Meeting the Health Care Needs of Rural Elderly: Client Satisfaction with a University‐Sponsored Nursing Center
Authors: Giltinan Janice M. , Murray Karen T.
Published: April 2008

Responding to health care needs of the elderly has presented great challenges for health care professionals. These problems are compounded in rural communities by physical and social isolation, increased poverty, and lack of transportation. An innovative approach to meeting health needs of rural elderly is through nursing centers. Through an emphasis on health promotion and maintenance of optimal level of functioning, these primary health care facilities can foster independence and self‐care for this targeted population. In addition, nursing centers serve as clinical sites for student learning experiences and settings for nursing research.

This article focuses on a nursing center established at Edinboro University of Pennsylvania (EUP), which tailors its services to the elderly living in Edinboro. Results of a client satisfaction survey, based on the Risser Patient Satisfaction Instrument, are described in addition to patterns of nursing center usage, general categories of care, teaching interventions, referrals, counseling, and frequency of visits. Findings from the survey indicated a general high client satisfaction level with nursing care received at the center. Discussion also includes plans to expand services to elderly in the community through home visits.
Reaching Children of the Uninsured and Underinsured in Two Rural Wisconsin Counties: Findings from a Pilot Project
Authors: Clarridge Brian R. , RN Beverly J. Larson , Newman Kathleen M.
Published: April 2008

Abstract: Debates about the accessibility, costs, and coverages of health care for the population at large have recently accelerated. This paper addresses some of the demographic, health, and fiscal ramifications of creating a preventive health care bridge to children in uninsured and underinsured families in two rural Wisconsin counties.

The study findings revealed that the initial health status of children making a preventive health visit under a minimal copayment plan was noticeably worse than the status of those who had the free Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program available to them on a more or less continual basis. Upon their first visit, the children who did not have access to a free EPSDT program had a greater number of medical and dental health problems and fewer preventive dental care visits than their EPSDT contemporaries. Beyond a greater number of problems, however, we found no noticeable differences between the two groups in the types of health problems present (i.e. the clinical distribution of the problems was similar across the two groups). This paper also contrasts referral completion rates and rates of diagnostic confirmation of identified problems between the two groups. Finally, we provide estimates of the cost of coverage for each unprotected child.
Rural Students' Exposure to Risk from Automobile Travel When the Driver is Under the Influence of Alcohol or Drugs
Authors: Banahan Benjamin F. , McCaffrey David J.
Published: April 2008

Abstract: Teenage students are exposed to exceptionally high levels of risk from automobile accidents when (1) they drive under the influence of alcohol or drugs, (2) they are a passenger in a car when the driver is under the influence, or (3) they encounter another vehicle on the road driven by a person under the influence. This study examines the prevalence of risk from the first two of these situations among 6,938 rural junior and senior high school students in 11 Mississippi school districts. Data were collected through the Student Alcohol and Drug Use Survey System operated by the University of Mississippi. The percentage of students who had driven under the influence during the 30 days previous to the study ranged from 4.6 percent in the 7th grade to 26.5 percent in the 12th grade. The percentage of students who rode as passengers when the driver was under the influence ranged from 35.2 percent in the 7th grade to a high of 49.2 percent in the 10th grade. More than one third of 7th grade students and more than one half of the high school students had been at risk as a driver or passenger during the 30 days previous to the study. More male students than female students had driven under the influence or been at risk to DUI overall. Whites were more likely than blacks to report DUI behavior. Overall, 12.1 percent of the students indicated they had been in an automobile accident during the last year when the driver was under the influence of alcohol or drugs. Male students were more likely than female students to have been in an alcohol‐related accident. During the month previous to the test, 21.6 percent of the students indicated they had served as the designated driver. Males were more likely than females to have been a designated driver.
Health Insurance Coverage in U.S. Urban and Rural Areas
Authors: Frenzen Paul D.
Published: April 2008

Abstract: This study examines the health insurance coverage of the nonelderly population in U.S. urban and rural areas in 1989, using data from the March 1990 Current Population Survey conducted by the Bureau of the Census. Access to coverage was assessed by classifying all persons by family employment status and income. Rural residents had less access to coverage than urban residents but were only slightly less likely to be insured. In comparison to urban residents, fewer rural residents obtained coverage through employment, and more purchased private coverage outside the work place. The differences in coverage by family employment status and income were generally much greater than the differences by place of residence.
Research Reviews
Authors: Farmer Frank L
Published: April 2008

This section of The Journal of Rural Health is intended to assist readers in the efforts to keep current with the research literature relevant to rural health. In monitoring the journals from neighboring disciplines, we attempt to alert readers to new research and scholarly debate. The scope of this section is, for the most part, limited to publications from the United States. Inclusion of a publication does not represent an endorsement of the research or the validity of the conclusions reported. As research reviews editor, I invite comments on this section.
Research Reviews
Authors: Farmer Frank L.
Published: April 2008

This section of The Journal of Rural Health is intended to assist readers in their efforts to keep current with the research literature relevant to rural health. In monitoring the journals from neighboring disciplines, we attempt to alert readers to new research and scholarly debate. The scope of this section is, for the most part, limited to publications from the United States. Inclusion of a publication does not represent an endorsement of the research or the validity of the conclusions reported.
Differences in the Use of Health Services by Metropolitan and Nonmetropolitan Elderly
Authors: Himes Christine L. , Rutrough Thyne S.
Published: April 2008

This study examined the importance of place of residence on the elderly's use of health services through Andersen's framework of health service utilization. The study found that nonmetropolitan elderly, both farm and nonfarm, make fewer physician visits than their metropolitan counterparts. This difference is not explained by differences in their predisposing or need characteristics. No residential differences were found in the number of short‐term hospital stays or in the number of days of bed disability. No evidence was found that nonmetropolitan elderly substitute days of bed disability for physician care or for hospital stays. Also, little residential variation was found in the effect of predisposing, enabling, and need factors on physician use. The most likely explanation for the observed differences in physician use is the shortage of physicians in nonmetropolitan areas. However, without the ability to attach contextual information to national data on health status and service use, the relative importance of access to services cannot be adequately addressed.
Local Factors Affecting the Tendency to Bypass Local Hospitals for Inpatient Mental Health Care: An Exploratory Analysis
Authors: Goldsteen Raymond L. , Falcone David J. , Broyles Robert W. , Goldsteen Karen , Reilly Bernard J.
Published: April 2008

Using the records of 2,171 rural residents of Illinois who received inpatient treatment for mental illness or substance abuse, this paper examines factors that influence the tendency to seek service from a distant rather than a local hospital. Results indicate that the age and insurance coverage of the individual, the per capita income of the community area, surrogates for the service orientation of the local hospital and the proximity of the patient's residence to an urban center are significant influences. With the exceptions of drug abuse requiring detoxification or other symptomatic treatment, drug abuse accompanied by comorbidity and psychosocial disorders, psychosis, and childhood disorders, the primary diagnosis of the individual failed to have a significant effect on the propensity to bypass local sources of inpatient treatment.
Birth Outcomes to Rural Illinois Residents: Is There a Crisis?
Authors: Rock Steven M. , Straub LaVonne A.
Published: April 2008

In recent years, the supply of obstetric services in rural areas has been a concern. At the same time, the demand for such services has been affected by the reduction in population and economic base. This article explores the extent of these trends in Illinois and whether they have led to a deterioration in amount of prenatal care and birth outcomes. Using birth certificate and infant death data for residents of rural Illinois counties in 1983 and 1988, prenatal care and birth outcomes for each year are compared within rural areas and to the rest of the state, as well as between the two time periods. Although rural residents began prenatal care later, they obtained similar qualities of care as their urban counterparts. The data revealed no adverse impact on birth outcomes of residing in increasingly rural areas, nor was there a deterioration during the time period. An attempt was made to identify rural counties that lost providers and/ or facilities and those that gained them. Although such a classification scheme is subjective, similar results ensued. While indirect costs such as time and effort to obtain care may have increased, at 1988 levels of care availability there was no crisis in Illinois.
Health and Well‐Being of Childbearing Women in Rural and Urban Contexts
Authors: Walker Lorraine O. , Walker Misha L. , Walker Mary E.
Published: April 2008

As part of the national focus on women's health issues, it is important to identify those health‐related characteristics of rural women that distinguish them from women living in urban settings. The aim of this study was to compare rural and urban childbearing women on socioeconomic characteristics, perceived stress, health‐related practices, illness symptoms, parenting confidence, and body weight. One hundred sixty‐five midwestern women responded to a health survey sent to them six months after childbirth. Rural women were younger and less educationally and economically advantaged compared to urban women. Before adjusting for these differences, rural women were less self‐actualized, more interpersonally isolated, and reported less healthy nutrition than urban women. These differences disappeared when socioeconomic differences were adjusted. Rural and urban mothers did not differ in most other areas, including perceived stress, parenting confidence, and body weight. Compared to national norms, the perceived stress levels of both rural and urban mothers were significantly higher than a probability sample of U.S. women. Findings support the role of socioeconomic factors as contributing to risk of poor health promotion among rural childbearing women.
Rural Primary Care Program Survival: An Analysis of Financial Variables
Authors: Shi Leiyu , Samuels Michael E. , Konrad Thomas R. , Porter Carol Q. , Stoskopf Carleen H. , Richter Donna L.
Published: April 2008

This study examines the effect of financial characteristics of rural primary care programs on the probability of their continuing as federally funded entities. A randomly selected national cohort of rural primary care programs (n=162) was used to compare financial measures of programs that were continuing and those that were noncontinuing. Financial data were obtained from 1978‐1987 Bureau Common Reporting Requirements (BCRR) forms submitted to the Bureau of Health Care Delivery and Assistance of the Department of Health and Human Services as part of the requirement to receive federal grant support for the programs. The results emphasize the importance of both outside funding and increased level of self‐sufficiency in the continuation of rural primary care programs. Noncontinuing programs often suffer from both a lack of self‐sufficiency and a lack of outside funding, mostly from federal sources. To a lesser extent, the number of patients also affects the program's chance of continuation. From a policy perspective, government intervention is both necessary and likely if rural primary care programs are to succeed and fulfill their mission of providing primary care for the medically underserved who are primarily poor, uninsured, and unable to pay.
The Development of a State‐level Health Manpower Database Using an Employer‐based Survey: A Pilot Project
Authors: Bamberg Richard , Malvey Donna , Wainright Major Charles , Fottler Myron D. , Joiner Charles L.
Published: April 2008

State health care reform may provide a better approach to meeting the health care needs of rural communities than does federal reform because the planning is closer to the needs of local communities. However, state health reform requires a health manpower database (along with other data) that includes all health occupations and such databases are often nonexistent. This study reports on one element of such a database–a survey of a wide range of rural health care employers covering the full range of health occupations in Alabama. Information on current and future employment of the most significant health occupations is reported here. It was found that the greatest numbers of new health personnel employees needed in the future were, in descending order, nursing assistants, registered nurses, licensed practical nurses, radiological technicians, specialist physicians, nurse practitioners, physical therapists, primary care physicians, and respiratory care therapists. While an employer survey has limitations and should be supplemented by data on community needs and health status indicators, it does provide useful information for planning educational programs to prepare health personnel.
Decomposing Area of Residence Differences in Multiple Regression Studies: The Relative Contributions of Independent Variables and Model Coefficients
Authors: Vogel W. Bruce , Dwyer Jeffrey W. , Barton Amy J.
Published: April 2008

When rural/urban differences are found in health status or health care use, it is often desirable to identify those factors (such as age, social structure, income, etc.) that influence such differences. To this end, researchers often test rural/urban differences in age, social structure, income, etc., for statistical significance. Also, researchers commonly perform multivariate analyses (such as multiple regressions) to examine rural‐urban differences in the influence of various independent variables on the dependent variable of interest. Frequently, researchers discover: (1) statistically significant rural/urban differences in the independent variables (such as age, social structure, income, etc.) and (2) statistically significant rural/urban differences in the effects of these independent variables (i.e., statistically significant rural/urban differences in regression coefficients). The analysis typically stops here, without addressing the relative contributions of(1) and (2) to the rural/urban differences in the dependent variable.

This paper argues that the relative contributions of(1) and (2) have important implications for the way policy‐makers address rural health problems. This paper presents a method for assessing the relative contributions of differences in the independent variables and differences in regression coefficients to observed differences in the dependent variable, and illustrates the application of the method by analyzing rural/urban differences in the risk of institutionalization (Dwyer, Barton, & Vogel, 1994).
Lessons from the Essential Access Community Hospital Program for Rural Health Network Development
Authors: Campion Daniel M. , Dickey Donald F.
Published: April 2008

Abstract: The Essential Access Community Hospital (EACH) Program is testing a concept for limited‐service hospitals established under Medicare called the Rural Primary Care Hospital (RPCH). The program uses cost‐based reimbursement and relaxed regulatory requirements to help low‐volume rural hospitals shift emphasis from acute care to primary care and emergency services. RPCHs must form “horizontal” networks with larger hospitals and may form “vertical” arrangements with ambulatory service providers and practitioners. A small number of rural hospitals have converted to the RPCH status since the program entered the implementation stage in late 1993. It is unclear how many other hospitals will convert given uncertainty regarding the financial impact of RPCH conversion and concerns with certain requirements. The program illustrates how payment policies can provide incentives for network development and reflects the importance of physician involvement and technical assistance in developing limited‐service hospitals. In addition, it appears that EACH/RPCH networks that form under the program may serve as building blocks for broader networks, as the seven states involved in the program look to develop rural health networks that go beyond the EACH/RPCH model.
Rural Health Networks in Florida
Authors: Duncan R. Paul , Klepper Brian R. , Krumerman Caren J. , Kuhn Sandra L.
Published: April 2008

Abstract: This article describes the development of rural health networks in Florida, which has adopted formal policies to support these networks. First, the history and content of the relevant legislation are described. The current networks are identified and their development to date summarized. Finally, a detailed case study is employed to outline the steps taken to establish one network.
The Relationship of Farm Residency Status to Demographic and Service Characteristics of Agricultural Injury Victims in Central Wisconsin
Authors: Stueland Dean , Mickel Steven H. , Cleveland David A. , Rothfusz Ron R. , Zoch Tom , Jr. Peter Stamas
Published: April 2008

Abstract: This study performed a surveillance of a defined population in central Wisconsin during a two‐year period that included six months of follow‐up. The study included those who worked and lived on farms and those who only worked on farms. The injury rate for farm residents was 3.15 injuries per 100 persons per year. However, 195 of the 510 injuries (38.2%) involved persons who were not farm residents. For nonfarm residents, 88.7 percent of the victims were male, whereas for farm residents 79 percent of the victims were male. More than one half of the farm residents who were injured were the owners and an additional 21 percent were juvenile children. Of those aged 18 to 29 years, 51.3 percent were nonfarm resident victims and 15.2 percent were farm resident victims. Of nonfarm residents, 41.1 percent were married; of farm residents, 65.3 percent were married. More than one half of all injured nonfarm residents were seen within two hours of injury while one quarter of the injured farm residents were seen more than 24 hours after the injury. Only 4 percent of the injured farm residents were self‐insured, but 15 percent of the nonfarm residents were self‐insured. However, the time of injury, actual injuries, diagnoses rendered, and services received were similar for injured farm residents and injured nonfarm residents. Effective attempts to intervene on agricultural injuries will need to consider different risk factors for injuries for nonfarm residents as compared to farm residents.
A Logit Analysis of the Likelihood of Leaving Rural Settings for Registered Nurses
Authors: Pan Shihua , Dunkin Jeri , Muus Kyle J. , Harris T. Robert , Geller Jack M.
Published: April 2008

Abstract: This study examined the net effects of individual and community factors on the likelihood of registered nurses leaving current jobs using a logit analysis. Based on data from a survey of 2,509 rural nurses, four separate models were estimated and compared: one for nurses in rural settings as a whole and the other three for nurses in hospitals, skilled nursing facilities, and community/public health agencies.

Results of the general model indicated that nurses' marital status, age, position, income, job satisfaction, and satisfaction with the community were significant determinants of the likelihood of leaving current jobs. Job satisfaction was the most significant factor, followed by satisfaction with the community. Findings from the models for three different employment settings were similar to those of the general model. However, the significance of factors and their strength of effect on nurses' decisions to leave or stay in their current jobs differed across the three types of facilities.

Based on these findings rural nursing administrators and policy‐makers should give priority to retention strategies that focus on improving the job environment. The development of different strategies for different groups of nurses (i.e., by age or marital status) and different types of facilities should increase the benefit/cost ratio. In addition, programs that involve rural health care agencies in community and economic development should be further explored as an avenue to increased nurse retention in rural areas.
The Process and Outcomes of Care for Major Depression in Rural Family Practice Settings
Authors: Rost Kathryn , Williams Carla , Wherry Jeff , Jr. G. Richard Smith
Published: April 2008

Abstract: Although primary care physicians provide the majority of care for rural residents with major depression, little is known about the quality of the care they provide. The aim of this study was to characterize the process and outcomes of care for rural patients with major depression, and to examine the relationship between the process and outcomes of care in this population. Six hundred and thirty‐one patients in 21 primary care practices in small towns were screened; 47 patients (7.4% of patients screened) meeting DSM‐III‐R criteria for current major depression were recruited into the study, and 38 (81.0% of patients recruited) were followed an average of five months later using the Depression Outcomes Module (Rost, Smith, Burnam, & Burns, 1992). While 24 (63.1%) of the 38 depressed subjects received a prescription for one or more antidepressants between the index visit and follow‐up, only 11 (28.9%) received pharmacologic treatment in concordance with the new Agency for Health Care Policy and Research (AHCPR) guidelines; 26 (68.4%) of 38 depressed patients continued to meet criteria for major depression at five months. Those who received pharmacologic treatment concordant with AHCPR guidelines showed more improvement at follow‐up. The findings suggest that outcomes for major depression may be worse in rural family practice settings than in urban settings. The study also demonstrates that AHCPR guidelines define effective treatment for major depression in the study sample. The Depression Outcomes Module appears to be a reliable and valid instrument for monitoring the outcomes of care for major depression in family practice settings.
Inequities in Health Care and Survival After Injury Among Pedestrians: Explaining the Urban/Rural Differential
Authors: Miles‐Doan Rebecca , Kelly Susan
Published: April 2008

Abstract: This study investigated whether rural/urban differences in injury mortality and morbidity are primarily due to medical care maldistribution or to other factors such as sociodemographic or environmental characteristics that are highly correlated with location. To separate incidence from case‐fatality rates, the study analyzed the determinants of survival rather than cause‐specific mortality rates. Using information from Florida traffic crash reports for 1988 through 1990, the study focused on Florida pedestrians hit by motor vehicles. It explores the effect of individual‐level demographic characteristics, crash‐level indicators of impact severity, and county‐level measures of socioeconomic and medical care resources, on the odds a pedestrian survived an injury. Logistic regression analyses reveal the importance of both road environment and percent of the county that is rural. However, these analyses are not able to isolate the influence of medical care from the level of urbanization. Although the percent rural was statistically significant, indicators of the mechanical energy involved in producing the injury, posted speed, and a dark road environment were substantively more important determinants of survival.
Interactions with Colleagues and Their Effects on the Satisfaction of Rural Primary Care Physicians
Authors: Ramsbottom‐Lucier Mary T. , Caudill Timothy S. , Johnson Mitzi M.S. , Rich Eugene C.
Published: April 2008

Abstract: Physician work satisfaction is related to several aspects of practice organization, including work group or colleagues, job content, work hours, and future opportunities. Practice location is an important determinant of practice organization and personal life satisfaction. This study compared the professional satisfaction of physicians in rural and urban settings to determine how practice setting, practice type, work hours, and interactions with colleagues influenced satisfaction. Surveys focusing on professional satisfaction were mailed to community‐based, primary care physicians in Kentucky. Overall, physicians were satisfied with their practices, with physicians in larger communities being more satisfied than those from smaller communities. Professional satisfaction was associated with practice location, practice type, number of years since graduation from medical school, number of colleagues identified, and the quality of professional interactions with colleagues. The study concluded that collegial support for physicians is important in creating work environments that promote professional satisfaction.