bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trauma in Tourist Towns*
Authors: Waller Julian A. , Brink Susan 
Published: April 2008

ABSTRACTCommunities with major recreational attractions tend to be rural and to have high injury experience both because of environmental hazards unique to rural areas and because they attract urban visitors who may be unfamiliar with the area andits roads, engaging in activities for which they are poorly prepared, and using equipment that is rented, in poor condition, or even of inherently hazardous design or construction. Alcohol abuse by visitors is often aproblem. Once injured, visitors may have difficulty gaining access to emergency care andwhen received, such care may be limited in both quantity and quality. While the influx of visitors to rural areas brings jobs and income, it also may bring crowding, violence, unintentional injury and other stresses. Most rural recreational communities do not actively plan as a community to deal with these problems, but rather approach them piecemeal and with limited communication among all necessary participants. Such planning is essential if progress is to be made.
Social Supports of the Rural Widowed Elderly*
Authors: Matthews Anne Martin 
Published: April 2008

ABSTRACT:A brief demographic profile of rural aging in Canada is provided along with an overview of Canadian research findings on the rural aged in general. The findings from a study of 152 widowed residents of two urban and two rural communities in southern Ontario, Canada, are reported. Three measures of social support were used: i.e., perceived support, patterns of support, and preferred sources of support. The data indicate many more similarities than differences in the social support patterns of this sample of rural and urban widowed elders. Where differences did emerge, the rural widowed reported higher levels of frequency of contact with support members. The rural elderly, however, also had lower socio‐economic status and had been widowed for a shorter period of time. Thus, some of the differences between the support patterns of the rural and urban widowed were accounted for by background differences, rather than by residential location per se. Despite these findings, the respondents perceived that living in a rural area was an advantage in widowhood.
Rural‐Urban Differences in Access to Iowa Child Health Services*
Authors: Levey Linda M. , Curry James P. , Levey Samuel 
Published: April 2008

ABSTRACT:Indicators of access, utilization, and quality of available child health services as well as health status were obtained through a telephone survey of Iowa households with children under age six. These indicators were compared for rural‐urban subsamples within an AFDC sample drawn from Iowa Department of Human Service files (N=637), and within poverty (N=129) and nonpoverty groups (N=631) drawn from the population of all households in the state with children under age six. About 55 percent of all households studied were rural. Rural households were generally larger than urban households, more likely to be intact maritally, white, and earning a living from farming. The findings support the hypothesis that place of residence has an impact on access, utilization, and quality of child health services over and above family income, although not always to the disadvantage of rural children. Typical problems for rural children, irrespective of income, were access to pediatric care, greater travel time to providers, and discontinuity of well care and sick care. Rural children in all income groups had lower seat belt use than urban children; they were also less likely to have well visits and their providers showed less attentiveness to behavioral and developmental issues at these visits. Rural residency exacerbated problems in access to care for low income children, who were less likely to be eligible for AFDC/ Medicaid than their urban counterparts. Medicaid coverage, however, did not eliminate rural‐urban differences in receiving desired medical care.
Research Reviews
Authors: Cordes Sam M. 
Published: April 2008

Selected Annotations: Medicine Use Among the Rural Elderly. T. R. Sharpe and A. R. BarbeSelected Annotations: Use of Marijuana Among Rural High School Students: A Test of a Facilitative‐Constraint Model. W. R. Goe, T. L. Napier, and D. C. BachtelSelected Annotations: Early Adolescent Alcohol Abuse in Rural Northern Michigan. P. D. Sarvela and E. J. McClendonSelected Annotations: The New Environment for Rural HMOs. J. B. Christianson, M. Shadle, M. M. Hunter, S. Hartwell, and J. McGeeSelected Annotations: Changes in the Distribution of Physicians in Rural Areas of Minnesota, 1965–85. T. Dennis
Recruitment and Retention of Rural Physicians: Issues for the 1990s*
Authors: Crandall Lee A. , Dwyer Jeffrey W. , Duncan R. Paul 
Published: April 2008

ABSTRACT:This paper briefly describes a number of structural and economic changes in the profession of medicine and in the rural medical care delivery system that have occurred since about 1970. Changes in the national physician supply; in the training, work, and practice characteristics of physicians; in the demographic characteristics of physicians; in the medical resources available in rural communities; and in federal and state support for the provision of medical services are noted. Four conceptual models that underlie physician recruitment and retention programs for small towns and rural communities are described. These include affinity models, which attempt to recruit rural persons into training or foster interest in rural practice among trainees; economic incentive models, which address reimbursement or payment mechanisms to increase economic rewards for rural practice; practice characteristics models, which address technical, collegial, referral, and other structural barriers to rural practice; and indenture models, which recruit temporary providers in exchange for scholarship support, loan forgiveness, or licensure. Examples of applications of each model are provided and the effects of changes in the medical care system on the effectiveness of each model are assessed. Finally, it is argued that elements of an optimal model for the recruitment of physicians to rural practice include the promotion of medical careers among rural high school students, the provision of financial and cultural support for their training, the development of technical and collegial support systems, and the limited use of indenture mechanisms to meet the needs of the most impoverished or isolated rural settings.
Is There a Role for the Small Rural Hospital?*
Authors: Hart L. Gay , Amundson Bruce A. , Rosenblaff Roger A. , Hart L. Gary , Amundson Bruce A. , Rosenblatt Roger A. 
Published: April 2008

ABSTRACT:Rural hospitals represent almost half of all short‐stay nonfederal general hospitals in the United States, but have been more severely affected than their urban counterparts by changes in reimbursement, regulation, and technology. Two hundred and six rural community hospitals closed during thefirst nineyears of the 1980s, and the rate of closure is accelerating. Using secondary data sources to examine the structure, role, and content of rural hospitals, small rural hospitals are described and compared to larger and nonrural hospitals. Rural hospitals differ systematically from other hospitals in the United States, with smaller daily censuses, lower occupation rates, shorter lengths of stay, and disproportionately high shares of Medicare patients. They are dominated by very small institutions, with more than 1,000 rural hospitals having fewer than 50 beds. Small rural hospitals offer a core of basic services to the populations they serve. Emergency, obstetric, and newborn services are virtually ubiquitous in rural hospitals of all sizes, and they are also more likely to offer long‐term nursing and home care services than urban hospitals of similar size. The inpatient diagnostic and procedural mix of these institutions demonstrates that they provide care for common medical and surgical conditions of low complexity. Rural hospitals are also relatively inexpensive, representing only 6 percent of total expenditures for hospital care. Given their central role in supporting the provision of health services to rural areas, the apparent appropriateness of the conditions they treat, and their relatively modest cost, it would seem reasonable to use federal policy to stabilize our previous investment in these institutions.
Strategic Adaptations to PPS by Rural Hospitals: Implications for Theory and Research*
Authors: Smith Howard L. , Piland Neill F. 
Published: April 2008

ABSTRACT:Medicare's Prospective Payment System (PPS) has introduced a new environment in which hospitals must either alter their strategies for delivering services or face closure. This is a challenge for rural hospitals that often lack the resources and supportive economic climate of their urban counterparts. Few guidelines are available to assist rural hospitals in responding organizationally to PPS‐induced constraints. This article examines the plight of rural hospitals from the perspective of strategic adaptation. A conceptual framework is proposed for studying strategic adaptations to PPS by rural hospitals. The implications for developing a sound research methodology are also discussed. On the basis of this research agenda, it may be possible to clarify how rural hospitals should adapt to PPS (and similar) constraints now, and in the future.
An Exploratory Study of the Correlates of Intent to Quit among Certified Registered Nurse Anesthetists in North Dakota*
Authors: Szigeti Elvira , Largent Rebecca N. , Eberhardt Bruce J. 
Published: April 2008

ABSTRACTCertified registered nurse anesthetists (CRNAs) provide the majority of anesthesia services in rural hospitals. Some services provided by CRNAs are routine, while others are for emergency conditions. The effect of the current nurse shortage on the potential pool of nurse anesthetists becomes a critical concern when considering the nature of CRN A services in rural areas. This study investigated the potential factors that relate to the desire of CRN As to continue practicing in rural hospitals of North Dakota. All CRNAs licensed in North Dakota (n = 125) were mailed survey questionnaires. Approximately five weeks later responses were received from 54 respondents for an overall return rate of 43 percent. Correlational analyses were used to examine responses of the subjects. A moderate degree of relationship was found among the work‐related variables. The average interscale correlation, calculated using an r to transformation, for the seven work‐related variables was 0.47. Overall, pay and promotion satisfaction exhibited strong (r > 0.60) correlations with turnover intentions. Supervisory satisfaction was only moderately (r=‐0.33) related to intention to quit. These results are discussed in terms of their implications for the management of CRN As in rural hospitals. Revised salary schedules, clinical ladders for promotions, supervisory training, and the identification of potential performance constraints are suggested as areas in which rural hospitals should focus attention in an attempt to manage turnover in CRNAs.
Education of Nurses for Rural Practice
Authors: Pickard Myrna R. 
Published: April 2008

SummaryThere is an excitement about the potential for nursing to make a difference in meeting rural health needs in the 1990s. Work places are attempting to respond to salary compressions and offering more autonomy for nursing over its own practice. There is better communication among hospital administrators, physicians, and nurses. Schools of nursing are more responsive to the needs of nontraditional students, and the federal and state governments are working together to find solutions. Innovation and creativity are key ingredients in our approach to ensuring rural nurse providers for the future.
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

ABSTRACTAs 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

ABSTRACT: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

ABSTRACT: 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

ABSTRACT: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.
Entrance and Exit of Obstetrics Providers in Rural Alabama
Authors: Bronstein Janet M. 
Published: April 2008

ABSTRACT: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

ABSTRACT: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.