bluuebunny/crossref_metadata_2025_split huggingface dataset:
Social Networks and Depression Among the Elderly: Metropolitan/Nonmetropolitan Comparisons*
Authors: Johnson Timothy P. , Hendricks Jon , Turner Howard B. , Stallones Lorann , Marx Martin B. , Garrity Thomas F. 
Published: April 2008

ABSTRACT:Contradictory findings have been reported about depression in the elderly living in metropolitan and nonmetropolitan regions of the United States. Additionally, the extent to which the same sets of variables are predictive of depression among the elderly living in metropolitan and nonmetropolitan environments is unknown. We examined these issues using the Center for Epidemiologic Studies Depression Scale (CES‐D) and a national sample of elderly respondents. Findings indicated no differences in the average depression scores of metropolitan and nonmetropolitan elderly. Differences were observed in the social network variables found to be predictive of depression within each subgroup. Among the metropolitan elderly, intimate social relations were found to be independently associated with depression, while secondary social attachments were related to depression among the nonmetropolitan elderly. An examination of the buffering effect of social ties upon the relationship between stress and depression revealed that a simple additive model may not be adequate to describe the association between social network elements and depression among the elderly.
Health Promotion for the Rural Elderly*
Authors: Lubben James E , Weiler Philip G. , Chi Iris , Jong Fred De 
Published: April 2008

ABSTRACT:There has been increased interest in developing health promotion programs for the rural elderly as a means to foster successful aging. The present study describes one such program and identifies rural and urban differences in health promotion activities. Data corne from the California Preventive Health Cane for the Aging Program (PHCAP) which is one of the oldest and largest such programs in the United States. A sample of over 5,000 PHCAP clients was draum from rural, semi‐rural and urban projects. Though the rural and urban clients differed significantly with respect to demographic characteristics, differences in health promotion practices were relatively minor. However, the health promotion practices of semi‐rural residents differed considerably from that in rural projects. Though less disabled, semi‐rural clients received a greater scope of health promotion activities than rural clients. The authors discuss possible site, practitioner and client factors which may bave accounted for rural health promotion activities being more restricted. Regardless of Project site, the California PHCAP detected many health problems and a majority of clients were referred to other health professionals for treatment.
Rural Hospital Nursing as an Elective*
Authors: Reimer Marlene , Mills Claire 
Published: April 2008

ABSTRACT:A rural hospital elective in a diploma nursing program is described. A need and opportunity for this unique practicum was identified in a Canadian province where one‐third of the acute care beds are in hospitals of under 100 beds, located primarily in towns outside of metropolitan areas. The six week course offers students 35 hours of classroom content focusing on rural health care concepts plus a 150 hour practicum in one of three participating hospitals. The course is seen as unique in that it focuses on rural health care and is offered within the context of a diploma nursing program. Vive student outcomes are identified: awareness of the differences between rural and urban health care; integration of knowledge and experience from previous nursing courses as it relates to the rural context; increasing understanding of how rural population groups affect health care delivery; awareness of rural employment opportunities; and, preparation for the graduate role. A shared vision and collaborative effort on the part of the School of Nursing, the rural hospitals and the host communities has been necessary to establish and maintain such a course.
Small Hospital Obstetrics: Is Small Beautiful?*
Authors: Fallis Geordie , Dunn Earl , Hilditch John 
Published: April 2008

ABSTRACT:The number of deliveries in small Canadian hospitals over the last 15 years was reviewed. The two provinces with the highest percentage of deliveries in small hospitals had similar patterns of Perinatal Mortality Rates to the two provinces with the lowest percentage of small hospital deliveries. Birthweight specific mortality rates for newborns weighing greater than 2,500 grams was lower in small hospitals compared to larger hospitals in the provinces of Ontario, Newfoundland and Saskatchewan for 1985. In Ontario, for the year 1985, even when corrected for perinatal transfers and the home address of the mother, there were no significant differences in perinatal mortality between those hospitals with less than 400 births, those between 401 and 2,999 births and those with 3,000 or more births. Within the present Canadian system of perinatal regionalization, small hospital obstetrics is safe.
Metropolitan and Nonmetropolitan Adolescents: Differences in Demographic and Health Characteristics*
Authors: McManus Margaret A. , Newacheck Paul W. , Weader Rebecca A. 
Published: April 2008

ABSTRACT:The demographic and health characteristics of metropolitan and nonmetropolitan adolescents are examined based on a nationally representative sample of 15,181 randomly selected adolescents from the 1984 National Health Interview Survey. One third of all adolescents reside in nonmetropolitan areas of the United States. Nonmetropolitan youth differed from their metropolitan counterparts in race, population concentration in the South, poverty status, family composition, education of household head, and marital status. While the health status of metropolitan and nonmetropolitan youth were similar, their patterns of health services utilization and health insurance coverage were not. Nonmetropolitan adolescents made fewer physician visits and were more apt to delay seeking physician care than metropolitan youth. Adolescents in nonmetropolitan areas were also 39percent more likely to be hospitalized and 30 percent more likely than metropolitan youth to be without any form of health insurance protection. Despite higher rates of poverty among nonmetropolitan adolescents, they were 20 percent less likely to be publicly insured. The delivery and financing implications of these distinct metropolitan and nonmetropolitan demographic and health characteristics are discussed.
A Rural Hospital's Impact on a Community's Economic Health*
Authors: Doeksen Gerald A. , Loewen Ron A. , Strawn David A. 
Published: April 2008

ABSTRACT:This research illustrates the importance of a hospital to the economic health of a community. A simulation model of a rural community in Oklahoma is used to demonstrate how the implementation of the DRG reimbursement policy has impacted a rural community, and to project how the closing of the hospital would impact the economy of the community. The results indicate that rural hospitals play a vital role in the economics of their communities. The closing of a rural hospital has a devastating impact on the community, while the DRG reimbursement policy has had a significant impact on the community.
HMOs and Managed Care: Implications for Rural Physician Manpower Planning*
Authors: Weiner Jonathan P. 
Published: April 2008

ABSTRACTAmerican health care is changing dramatically. Health maintenance organizations (HMOs) and other managed care plans are central to this change. Today, the majority of Americans living in metropolitan areas receive their care from these types of plans. The goal of this article is two‐fold. First, it will discuss the potential implications of HMOs and managed care for physician needs and supply in rural regions. Second, it will derive insight into alternative approaches for meeting rural health manpower needs by analyzing HMO staffing patterns.As HMOs and other managed care plans expand, rural physicians, their practices, and their patients will almost certainly be affected. As described in this paper, most of these effects are likely to be positive.The staffing patterns used by HMOs provide an interesting point of comparison for those responsible for rural health manpower planning and resource development. HMOs appear to meet the needs of their enrollees with significantly fewer providers than are available nationally or suggested by the federal standards. Moreover, HMOs make greater use of nonphysician providers such as nurse practitioners and physician assistants.
Future Trends in Nursing Practice and Technology*
Authors: Fuszard Barbara 
Published: April 2008

ABSTRACTRural hospitals will be affected by changes in nursing anticipated in the future. Welcome changes will be the maturity and life experiences new graduates will bring to the work setting, knowledge of computers, and a broadening database. New graduates will also know various methods of care delivery, including case management, and will be able to select the delivery system that best meets the needs of the patients and institution. They will be more autonomous and possess leadership and management skills. With their knowledge of community as well as institutional nursing, they will be able to draw upon the skills of both groups to bring the two areas of nursing into continuity of care for patients. A difficulty ahead for rural hospitals is recruitment of new graduates, the majority of whom will have established families and lives elsewhere. And the practice of developing their own employees for higher levels of nursing will be compounded by the doubling of time necessary to complete nursing programs in the future.
Geographic Barriers to Child Health Services in Rural Northern New England: 1980 to 1989
Authors: Goodman David C. , Barff Richard A. , Fisher Elliott S. 
Published: April 2008

ABSTRACT:Despite substantial recent increases in the number of rural physicians, it is unknown whether rural children still face significant barriers to medical care. To address this question, we determined travel times in 1980 and in 1989 to child health services for the rural pediatric population of northern New England–the area with the highest per‐capita primary care physician supply of any non‐metropolitan region in the United States. The study population in 1989 included 363,443 children living in 936 nonmetropolitan towns. The study revealed important spatial relationships in health service supply and demand not identified using other methods of assessing physician availability. Although travel times to physicians decreased slightly during the decade, we found that 15.5 percent of the children in our population were more than 30 minutes from pediatricians in 1989, and travel time to emergency rooms was more than 30 minutes for 9.9 percent of the children. In contrast, only 1.8 percent of children faced excessive travel times to family/general practitioners. While towns with pediatricians were likely to also have a family physician or an emergency room, the majority of towns with family physicians had neither a pediatrician nor an emergency room. Towns with poor geographic access to pediatricians and emergency rooms had low population densities and were distant from metropolitan areas. The analysis indicates that even in rural areas of high physician supply, access to pediatricians and emergency rooms for many children remains limited, and family physicians are the dominant medical providers for children. Future work using travel time variables will clarify the relative importance of travel to medical care as a factor in rural health outcomes.
Prenatal Diet Adequacy Among Rural Alabama Blacks
Authors: Leeper James D. , Nagy Christine , MD Sandral Hullett‐Robertson, 
Published: April 2008

ABSTRACT:Proper nutrition during pregnancy has a major effect on a mother's health, as well as that of her baby. This paper examines the adequacy of diet among low‐income, black, pregnant women residing in rural areas of west central Alabama. The factors associated with diet adequacy in this population are also examined. Data for this study were collected from 186 women who provided 24‐hour dietary recalls. The data indicate that these women have major deficiencies in their diets, particularly in terms of milk and milk products. Most women are receiving only about 60 percent of the number of servings of the four basic food groups recommended for a pregnant woman. Women younger than 20, unmarried or not heading their own household, receiving no post‐high school education, unemployed, experiencing an unplanned pregnancy, and not having a home visitor had less adequate diets than their counterparts. Diet adequacy had a low (r = .16) but statistically significant correlation with birthweight.
Rural Residence and Poor Birth Outcome in Washington State
Authors: Larson Eric H. , Hart L. Gary , Rosenblatt Roger A. 
Published: April 2008

ABSTRACTIt is often assumed that poor birth outcomes are more common among rural women than urban women, but there is little substantive evidence to that effect. While the effectiveness of rural providers and hospitals has been evaluated in previous studies, this study focuses on poor birth outcomes in a population of rural residents, including those who leave rural areas for obstetrical care. Rural and urban differences in rates of inadequate prenatal care, neonatal death, and low birth weight were examined in the general population and in subpopu‐lations stratified by risk and race using data from five years (1984‐88) of birth and infant death certificates from Washington state. Also examined were care and outcome differences between rural women delivering in rural hospitals and those delivering in urban facilities. Bivariate analyses were confirmed with logistic regression. Results indicate that rural residents in the general population and in various subpopulations had similar or lower rates of poor outcome than did urban residents but experienced higher rates of inadequate prenatal care than did urban residents. Rural residents delivering in urban hospitals had higher rates of poor outcomes than those delivering in rural hospitals. We conclude that rural residence is not associated with greater risk of poor birth outcome. White and nonwhite differences appear to exceed any rural and urban resident differences in rates of poor birth outcome.
Rural Community and Physician Perspectives on Resource Factors Affecting Physician Retention
Authors: Conte Susan J. , Imershein Allen W. , Magill Michael K. 
Published: April 2008

ABSTRACTThis study was undertaken to investigate issues affecting recruitment and retention of physicians in a rural north Florida community. As part of this investigation, the authors examined the relevant context of medical care and physician practice for this community. The results identify a number of problems not uncommon in rural communities and supported by previous literature. Physicians felt isolated, dissatisfied with job security and professional autonomy, and frustrated by a lack of cooperation among the major providers of health care. More importantly, upon closer scrutiny, some of the most appealing characteristics of this community for incoming physicians become its weaknesses. Access to a regional medical center nearby and nearness to a metropolitan area were both cited as positive attributes to their choice of practice location. In this community, however, these appear to have resulted in a highly divided medical system. Many of the employed and insured patients in the county prefer to get their medical care in the nearby city. At the same time three separate entities within the community—a federally funded community health center, a county public health unit, and a community hospital—are expected to provide services for the poor and uninsured. The resulting lack of a comprehensive approach to provision of services contributes significantly to the dissatisfaction among providers and to their ultimate retention.
Our Community Hospital: The Evolution of a Rural Primary Care Hospital
Authors: Kushner Christine , Bernstein James D. , Dihoff Serge 
Published: April 2008

ABSTRACTIn the next few years, Our Community Hospital, located in the small town of Scotland Neck, NC, will undergo a conversion through which it may serve as an appropriate model for similar small hospitals in distressed rural communities. With technical and grant assistance from the Office of Rural Health and Resource Development of the North Carolina Department of Human Resources, the hospital has begun to phase out almost all acute care services and will expand and strengthen its focus on primary care, emergency medical services, and services for elderly personsThis paper addresses four issues of greatest concern to hospital administrators, rural health professionals, academics, and rural residents interested in hospital conversions: (1) community involvement during the planning process; (2) the evolution of the program's structure; (3) financing for the project; and (4) the development of cooperation between state and federal governments, foundations, and private groups. This case study describes one possible course in addressing an acute health care problem facing rural America–the viability of rural hospitals.
State Health Policy and Rural Hospitals
Authors: Kovner Anthony R. , Kiel Joan M. , Runde Denise M. 
Published: April 2008

ABSTRACTMany rural hospitals are experiencing difficulties. This article explores the views of various government and hospital officials on state health policy for rural hospitals. The authors discuss how these officials define the rural hospital issues and suggest appropriate state interventions to assure hospital viability and local access to care. The authors recommend that states, hospitals, and communities decide through a formal process what level of health and medical care should be available in rural areas, and states assist in low‐cost ways those rural hospitals that are ready to change or that, with help, will be ready to make such operational changes as service reconfiguration, affiliations, and working agreements with other health care organizations to continue and improve local access to health care.
HIV Issues for Rural Hospitals in U.S. Frontier Areas
Authors: Carwein Vicky L. , Berry David E. 
Published: April 2008

ABSTRACTA Survey of 108 hospital administrators in the eight states of the Mountain Census Region was conducted to identify frontier rural hospitals’experiences (fewer than 50 beds) in the provision of care and services to patients with HIV infection; to assess the availability of HIV care and services in these small, remote rural hospitals; and to assess the status of education and policy development related to HIV infection.Of the 62 hospitals that responded, 16 (26%) had provided care and services to HIV‐infected patients. Acute inpatient and emergency room care were the services most commonly utilized. An additional 11 hospitals reported the presence of HIV‐positive individuals in their medical service areas. Thus, nearly 44 percent of the hospitals were aware of the importance of addressing HIV infection as a local concern. Employees in the hospitals that had experienced caring for HIV‐positive persons expressed more concern about acquiring HIV infection than those in hospitals that had not. Four nursing assistants, two registered nurses, and one dietary worker had refused to provide care. HIV education consisted primarily of video programs, presentations by in‐house staff, and sending employees away to workshops. Despite this HIV education, most staff remain fearful of caring for HIV infected patients. Major concerns expressed by the hospital administrators were related to enforcing universal precautions, confidentiality, staff response, community acceptance, and cost of care. Only 30 hospitals (48%) had AIDS policies in effect, and these focused primarily on infection control and universal precautions.The results of the study indicate that frontier rural hospital administrators are aware that increasing numbers of individuals with HIV infection will seek care and services from frontier hospitals. However, current HIV education of staff does not effectively relieve fears and concerns regarding providing care, and few hospitals have developed policies to deal with HIV‐related situations. More effective HIV education programs and policies specific to potential HIV related situations need to be developed.
A Three‐Tier Model for the Delivery of Rural Obstetrical Care Using a Nurse Midwife and Family Physician Copractice
Authors: Hueston William J. , Murry Mary 
Published: April 2008

ABSTRACTTo meet the needs of a large indigent rural population, a rural regional referral hospital in northeastern Kentucky developed a maternity program that utilizes nurse midwives and family physicians as the primary medical providers with support from obstetricians. After five years, the number of deliveries at the hospital has increased almost 30 percent, and the maternity center is now responsible for more than 70 percent of all deliveries at the medical center. Accounting for the large increase in the number of deliveries is an increasing number of women from surrounding areas who now utilize the maternity center and the hospital for their obstetric care. During the same time, there has been a corresponding decrease in deliveries to women with no prior prenatal care and a shift toward obtaining earlier prenatal care in the hospital service population. Results of the study suggest that combining the skills of nurse midwives and family physicians with surgical backup provided by a consulting obstetrician is an effective means of meeting the health care needs of an indigent, underserved rural population.
Economic and Health Needs of Wisconsin Migrant Farm Workers
Authors: Slesinger Doris P. , Ofstead Cynthia 
Published: April 2008

Abstract: Migrant farm workers play an essential role in the planting and harvesting of crops in our agricultural production system. In the United States today, about 6 percent of the paid farm labor force “follow the crops” across the nation. This article reports on the economic and health care needs of migrant farm workers who travel from the border areas of Texas to Wisconsin each year. Surveys conducted in 1978 and 1989 show that this population remains in serious need of health care and access to financial assistance programs.During the 11‐year interval between surveys, little change occurred in the health care status or use patterns of Wisconsin migrant workers, although housing and sanitary conditions in the work environment improved somewhat due to the passage of new federal regulations. This article discusses the problems and barriers that migrants continue to face and offers recommendations for government action.