bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is Health Status Related to Residence in Medically Underserved Areas? Evidence and Implications for Policy
Authors: Kohrs Francis P. , Mainous Arch G. 
Published: April 2008

Abstract: This study sought to compare the health status of adult residents of medically underserved areas (MUAs) with adult residents of nonshortage areas (non‐MUAs). A random digit dialing telephone survey was used. Respondents were subsequently classified by their county of residence as residing in an MUA or non‐MUA. A sample of 421 adults (aged 18 years or older) residing in Kentucky during 1993 were included in the analysis. Health status was measured by the Medical Outcomes Study 20‐item Short‐Form Health Survey's (SF‐20) six subscales.After controlling in the multiple regression for demographic variables there were no significant differences between residents of MUAs and non‐MUAs for the physical functioning, role functioning, general mental health, self‐perception of health, or pain subscales. The social functioning subscale was significantly related to the residence in an MUA. The demographic variable “education” was a consistent predictor of each of the health status subscales.Excepting the social functioning subscale, residents of MUAs do not have significant differences in health status when compared to residents of non‐MUAs. Future policy may need to focus on other health services shortage area designators that are more highly associated with the health status of residents. Consideration should be given to including the education demographics of areas or populations in health services shortage designation criteria.
An Assessment of Practice Support and Continuing Medical Education Needs of Rural Pennsylvania Family Physicians
Authors: Forti Esther M. , Martin Kenneth E. , Jones Robert L. , Herman James M. 
Published: April 2008

Abstract: Family physicians provide the greatest proportion of care in rural communities. Yet, the number of physicians choosing family practice and rural practice has continued to decline. Undesirable aspects of rural practice, such as professional isolation and a lack of or inadequate resources, are assumed to be associated with this decline. This article reports on the practice support and continuing medical education needs of rural family physicians. A mail survey was conducted in 1993 on a purposive sample of family physicians in 39 of 67 rural‐designated or urban Pennsylvania counties with low population densities.The physicians identified needs that included patient education materials and programs, community health promotion, federal regulation updates, technical assistance with computers and business management, database software and a videotape lending library, a drug hotline, and mini fellowships on clinical skill development. A majority of respondents were willing to participate in clinical educational experiences for students and residents. Some physicians indicated a lack of interest in access to information through telecommunications, e.g., video conference referrals and consultations.Overall, findings revealed that family physicians need and are receptive to a variety of practice support and continuing education programs. A practice support program coupled with policy coordination among public and private organizations is likely to lessen complaints by rural primary care physicians.
Missouri Advantage
Authors: Casey Michelle , Yawn Barbara 
Published: April 2008

SummaryMissouri Advantage HMO is a newly developed, small HMO based in a rural area. Strongly committed to local control, Missouri Advantage has a highly decentralized organizational structure. Its four rural hospital owners have built Missouri Advantage's initial enrollment base with hospital employees, capitalizing on their positions as the largest employers in their communities. The HMOs future plans include recruitment of additional rural hospitals and physician organizations as new equity owners of the HMO, and development of new products, including a Medicare risk product.
Implications of HMOs for Rural Providers and Consumers
Authors: Wellever Anthony 
Published: April 2008

SummaryThe impact of the six HMOs studied on rural providers has, to this point, been relatively small. To expand their provider networks in rural areas, the HMOs have been responsive to provider concerns, implementing payment arrangements and utilization management approaches that are acceptable to most rural providers. However, at some sites, changes in HMO and provider relations appear to be on the horizon. These changes include the acceptance of greater financial risk by rural providers and the more aggressive management of costs by the HMOs.With respect to employers, the impact of HMOs have been largely positive. The presence of HMOs in the rural study areas has provided rural employers with new options for structuring health benefits programs. According to some rural employers, health insurance costs have been reduced, or at least constrained, as a result. Rural employers have dealt with employee concerns about access limitations by demanding that HMOs offer broad provider networks and products that permit the use of non‐network providers subject to co‐payments and deductibles.The impact on rural employees, as evidenced by their responses as well as the views of their employers, has been mixed. Rural employees generally appreciate the broader benefit coverage offered by HMOs as well as reduced paperwork and, sometimes, lower required out‐of‐pocket contributions toward premiums.However, as with their urban counterparts, rural employees are concerned about restrictions on access to providers of their choice and financial incentives in physician payment arrangements that may discourage the provision of services or the arrangement of referrals.
Do Rural and Urban Children Have Comparable Asthma Care Utilization?
Authors: Yawn Barbara P. , III Arch G. Mainous , Love Margaret M. , Hueston William 
Published: April 2008

ABSTRACT:This study compares asthma‐related health care visits and drug therapy for rural and nonrural Kentucky children with Medicaid health insurance in 1995. The 8,634 children with asthma had a mean age of 5.7 years. Ninety‐two percent made at least one asthma office visit, and 13 percent were hospitalized. The urban and rural patterns of care for childhood asthma varied in some potentially important ways. Urban children were twice as likely as rural children to see an asthma specialist (5 percent vs. 2.5 percent, P<0.05), 2.7 times as likely to receive asthma care in an emergency department (19 percent vs. 7 percent, P<0.01) and 1.4 times as likely to receive oral steroids (16 percent vs. 12 percent, P=0.04). If given inhaled anti‐inflammatory medication, rural children were more likely to receive inhaled steroids while urban children were more likely to receive cromoglycates.
Equipment Dealers’Perceptions of a Community‐based Rollover Protective Structures Promotion Campaign
Authors: Struttmann Timothy W. , Brandt Vickie A. , Morgan Susan E. , Piercy Larry R. , Cole Henry P. 
Published: April 2008

ABSTRACTFarming is one of the most hazardous occupations, and tractor overturns are the leading cause of agricultural fatalities. This article examines a community‐based injury intervention designed to increase the number of rollover protective structures (ROPS) and seat belts on tractors and to promote safe operation of farm tractors in two counties. Equipment dealers who sell retrofit ROPS kits to farmers were a critical component of the intervention. Interviews were conducted with dealers after the 31‐month intervention period to understand their perceptions, any difficulties they experienced as a result of the project and how a similar project could be improved. Comments were analyzed in relation to theories of persuasion. Results indicated that dealers believed the intervention was successful in producing behavior change among some farmers. Dealers also provided important insights into why some farmers continued to resist retrofitting tractors with ROPS. Recommendations are offered for designers of community‐based interventions beyond the ROPS project described here.
Rural Bioethical Issues of the Elderly: How Do They Differ From Urban Ones?
Authors: Glover Jacqueline J. 
Published: April 2008

ABSTRACT:Typical ethical issues in health care for the elderly include decision making for elderly patients with and without capacity, advance directives, the use of life‐sustaining technologies, and questions of access to services and justice. Obviously the same issues are relevant for elderly patients in rural settings. But the unique features of rural living add another dimension to ethical discourse and the care of patients, namely the primary importance of relationships. Rural bioethics is based on an ethic of familiarity, which alters our attention to such issues as confidentiality, multiple relationships, scope of practice, and access issues. The following article briefly outlines the unique features of rural bioethics and provides a case analysis.
Finding and Using Rural Aging Data: An International Perspective
Authors: Havens Betty , Stloukal Libor , Racher Fran , Norris Doug , Keefe Janice , Coppin Antonia 
Published: April 2008

ABSTRACT:This article reports on a workshop in which participants identified sources of data on rural aging. Such sources are typically part of larger data collection efforts or special aging studies with large rural components. Finding and using data on rural aging are not only two different processes but they also face somewhat different obstacles and the solutions are likewise different. The workshop addressed both of these issues. Participants shared many innovative and creative means for collecting, finding and adapting more general data sources, and analyzing and using these data, to further our understanding of rural aging phenomena.
Social Services for the Elderly Based on the New Rurality: The Japanese Experience
Authors: Ogawa Takeo 
Published: April 2008

ABSTRACT:Since the 1920s, Japan has changed from being a relatively youthful society, with an average age of about 26, to an elderly society with an average age of over 40 (Fordyce, 1999). The number of elderly is rising and the number of births is falling. Concurrently, the health and infrastructure needs of many of the retired elderly are increasing while, for the same retirees, their contribution to productivity and revenue is diminishing (Fordyce, 1999). As the population ages, inevitably the burdens of taxes, pensions, public medical insurance and social services have been rapidly increasing. To meet the challenges of these changes in population structure, Japan has established policies such as the Gold Plan and the Public Long‐term Care Insurance Program and it has expanded social services into rural agricultural areas. This article examines those policies and the care services and productive aging programs that have developed due to population aging and new rural patterns in Japan.
Rural Highpoints from Other Journals
Authors: Vail Robin 
Published: April 2008

AIDS Care: HIV/AIDS‐Related Services for Women and the Rural Community Context by Castaneda, D.Teaching and Learning in Medicine: Interim Evaluation of the Rural Health Scholars Program by Lynch, DC, Teplin, SE, Willis, SE, Pathman, DE, Larsen, LC, Steiner, BD, & Bernstein, ID.Telemedicine Journal and e‐Health: Improved Rural Provider Access to Continuing Medical Education Through Interactive Videoconferencing by Callas, PW, Ricci, MA, & Caputo, MI.Journal of Air Waste Management Association: A Comparison of Measured and Simulated Ozone Concentrations in the Rural Areas of the Eastern United States during Summer 1995 by Sistla, G, Civerolo, K, Hao, W, & Rao, ST.
Brief Report:Participant Satisfaction in an Adult Telehealth Education Program Using Interactive Compressed Video Delivery Methods in Rural Arkansas
Authors: Bynum Ann B. , Cranford Charles O. , Irwin Cathy A. , Denny George S. 
Published: April 2008

Abstract: Context: Rural Americans have less access than their urban counterparts to health promotion information Purpose: To assess differences in program satisfaction associated with age, gender, ethnicity, community size, and education among participants in an Arkansas adult telehealth education program that utilized interactive video technology Methods: A program evaluation instrument was administered to a convenience sample of 2567 people who participated in the program from 1996 through 1999 Findings: The evaluation instrument demonstrated adequate internal consistency reliability (Cronbach's alpha = 0.85) and construct validity. Older adults, blacks, American Indians, and participants from smaller rural communities and with a high school degree or less had significantly greater satisfaction (P<0.001 to P = 0.03) Conclusions: The findings suggest that socioeconomic and demographic factors can affect satisfaction with telehealth education programs
Using the Theory of Reasoned Action to Model Retention in Rural Primary Care Physicians
Authors: Feeley Thomas Hugh 
Published: April 2008

Abstract: Context: Much research attention has focused on medical students', residents', and physicians' decisions to join a rural practice, but far fewer studies have examined retention of rural primary care physicians Purpose: The current review uses Fishbein and Ajzen's Theory of Reasoned Action (TRA) to organize the literature on the predictors and correlates of retention of rural practicing physicians. TRA suggests turnover behavior is directly predicted by one's turnover intentions, which are, in turn, predicted by one's attitudes about rural practice and perceptions of salient others' (eg, spouse's) attitudes about rural practice and rural living. Methods:Narrative literature review of scholarship in predicting and understanding predictors and correlates of rural physician retention. Findings: The TRA model provides a useful conceptual model to organize the literature on rural physician retention. Physicians' subjective norms regarding rural practice are an important source of influence in the decision to remain or leave one's position, and this relation should be more fully examined in future research
Children's Agricultural Health: Traumatic Injuries and Hazardous Inorganic Exposures
Authors: Perry Melissa J. 
Published: April 2008

Abstract: Context: Farming is one of the most hazardous occupational industries in the USA, and farms pose numerous health risks for youth visiting, living in, or working in the farm environment Purpose: This review discusses both potential traumatic injuries and hazardous inorganic exposures that are common in agricultural settings Findings: An estimated 2 million youth under the age of 20 currently live or work on US farms. Approximately 103 farm fatalities occur in this age group each year; over 32 000 nonfatal youth injuries occurred on farms in 1998. Children working in US agriculture make up only 8% of the population of working minors overall, yet they account for 40% of work‐related fatalities among minors. Farm children and youth are also exposed to potentially harmful chemicals, such as pesticides and solvents, and many of these exposures go undetected. The long‐term health effects of exposure to pesticides or solvents are not known, but the developmental vulnerabilities of children and youth are of particular concern. Conclusions: Clinical and epidemiologic research in pediatric populations is needed to expand the empirical data, particularly for inorganic and organic exposures, musculoskeletal trauma, skin disorders, occupation‐induced hearing loss, and psychosocial stress. Rural health professionals can work to reduce these risks to farm youth by becoming more aware of the problem, by conducting clinical and epidemiologic research, and by engaging in advocacy at state and local levels
Use of and Attitudes Toward Complementary and Alternative Medicine Among Family Practice Patients in Small Rural Illinois Communities
Authors: Herron Michael , Glasser Michael 
Published: April 2008

Abstract: Context: Complementary and alternative medicine (CAM) use continues to increase in the United States. Data on rural patients' use and extent of integration of CAM with conventional medicine are lacking, although this is a population often associated with use of “folk remedies” and self‐care strategies Purpose: To examine rural primary care patients' attitudes toward and use of CAM Methods: A total of 176 surveys (70% response rate) were returned by patients at 5 geographically dispersed, rural Illinois family practice clinics to examine rural patients' use of, attitudes toward, and experiences with alternative medicine and providers. Findings: Nearly two thirds of patients reported use of alternative medicine. Therapies most often used were vitamins/megavitamins, chiropractic, relaxation, and prayer/faith healing. Rural patients with more medical problems and a higher level of education were more likely to use alternative techniques. Three fifths of the patients felt that their doctor should discuss alternative medicine and therapies with them Conclusions: Physician understanding and communication regarding CAM may be especially important in rural areas, where access to care is more limited and where there is greater reliance on the primary care physician as a “gatekeeper” for patient health
Rural‐Urban Differences in Health Care Benefits of a Community‐Based Sample of At‐Risk Drinkers
Authors: Fortney John C. , Booth Brenda M. , Kirchner JoAnn E. , Han Xiaotong 
Published: April 2008

Abstract: Context: Different types of health plan costcontainment strategies (eg, gatekeeping, selective contracting, and cost‐sharing) may affect the utilization of behavioral health services differently in urban and rural areas Purpose: This research compares the cost‐containment strategies used by the health plans of insured at‐risk drinkers residing in rural and urban areas Methods: A screening instrument for at‐risk drinking was administered by phone to approximately 12 000 residents of 6 southern states; 442 at‐risk drinkers completed 4 interviews over a 2‐year period and consented to release insurance and medical records. Two thirds of the sample (n=294) were insured during the last 6 months of the study. In 1998, health plan characteristics were successfully collected for 217 (72.3%) of the insured at‐risk drinkers, representing 113 different health plans and 206 different policies. Findings: Compared with urban at‐risk drinkers, rural at‐risk drinkers were significantly less likely to be enrolled in a health plan with gatekeeping policies for both behavioral health (P = 0.001), and physical health (P = 0.031). Compared with urban enrollees, rural enrollees were significantly more likely to pay deductibles (P = 0.042), to pay coinsurance for physical health services (P = 0.002), and to have limits placed on physical health services use (P = 0.067), but they were less likely to pay copayments for physical health (P = 0.046). Rural enrollees were less likely to face higher copayments (P = 0.007) and higher coinsurance (P = 0.076) for mental health than for physical health, compared to urban enrollees Conclusions: Because rural residents were more likely to be enrolled in indemnity plans and less likely to be enrolled in health maintenance organizations, rural at‐risk drinkers were enrolled in plans that relied less on supply‐side cost‐containment strategies and more on demand‐side cost‐containment strategies targeting physical health service use, compared with their urban counterparts. Rural at‐risk drinkers were less likely to be enrolled in health plans with greater cost‐sharing for mental health than for physical health compared to urban at‐risk drinkers
Portosystemic encephalopathy in two young dogs: some additional diagnostic and therapeutic considerations
Authors: MADDISON JILL E. 
Published: April 2008

ABSTRACTCongenital portosystemic encephalopathy was diagnosed in two young dogs. A venous ammonia tolerance test was found to have limitations as a diagnostic aid in certain circumstances. Therapy with a synthetic disaccharide, lactulose, resulted in a period of clinical improvement in one dog.
Osteochondritis dissecans of the lateral ridge of the trochlea of the tibial tarsal bone in the dog
Authors: ROBINS G. M. , READ R. A. , CARLISLE C. H. , WEBB S. M. 
Published: April 2008

ABSTRACTThe diagnosis and treatment of two cases of osteochondritis dissecans affecting the lateral ridge of the trochlea of the tibial tarsal bone is described. Radiographs taken in medio‐lateral and oblique projections proved to be the most valuable for diagnosis. The lesions were treated surgically via a limited cranio‐lateral approach. The lameness improved following surgery.
Laryngeal leiomyoma in a dog
Authors: LIGHTFOOT R. M. , BEDFORD P. G. C. , HAYWARD A. H. S. 
Published: April 2008

ABSTRACTLaryngoscopy and radiography demonstrated that the cause of severe dyspnoea in a middle‐aged Old English Sheepdog was obstruction of the laryngeal vestibule and glottis by a large intralaryngeal tumour. The post mortem histological examination demonstrated that the tumour was a leiomyoma, but its smooth muscle origin could not be defined with any certainty.
Primary aldosteronism (Conn's syndrome) in a cat; a case report and review of comparative aspects
Authors: EGER CLIVE E. , ROBINSON WAYNE F. , HUXTABLE CLIVE R. R. 
Published: April 2008

ABSTRACTAn aged cat was presented with a history of chronic relapsing weakness and depression. Profound hypokalaemia was detected in association with increased serum aldosterone levels and marginally subnormal plasma renin activity. A diagnosis of primary aldosteronism (Conn's syndrome) was made and the cat was successfully treated for 2 ½ months with spironolactone. When renal failure developed, the cat was destroyed and at autopsy a large adrenal cortical adenocarcinoma was found.
Bacteriology of the horizontal ear canal of dogs
Authors: DICKSON D. B. , LOVE DARIA N. 
Published: April 2008

ABSTRACTOf 57 dogs included in a survey of the bacteriology of the horizontal ear canal, 31 showed clinical signs consistent with ear irritation. Twenty‐six dogs were presented for other reasons and were asymptomatic for ear irritation.All dogs sampled were anaesthetized and sterile moistened swabs used to sample the horizontal ear canal. Swabs were introduced through a sterilized (121°C for 15 min) polypropylene otoscope cone and care was taken to prevent contamination of the cone with material from elsewhere in the ear canal. Swabs were processed within 20 min of sampling and cultures were incubated aerobically and anaerobically. Swabs from the ears of asymptomatic dogs were mixed in broth prior to plating to ensure optimal elution of small numbers of organisms from the swabs.Very small numbers of bacteria and yeasts were isolated from asymptomatic dogs while Pseudomonas spp. and Proteus spp. were frequent isolates from symptomatic dogs with chronic irritation.The significance of these findings is discussed in relation to the sampling and culturing techniques used in this and other surveys.
Haemophilia A in the cocker spaniel: a case report
Authors: D.Pearce R. , Cooper M. L. 
Published: April 2008

ABSTRACTA four‐year‐old entire male cocker spaniel was presented with a history of dyspnoea due to tracheal stenosis.As part of the clinical approach, a coagulation screening profile revealed moderately reduced levels of Factor VIII procoagulant activity (VIII: C), but elevated factor VHI‐related antigen levels (VIIIR: Ag). A diagnosis of haemophilia A (classic haemophilia) was made and the tracheal stenosis attributed to a mediastinal haematoma.The dyspnoea was alleviated by the surgical insertion of a tracheostomy tube and the dog was treated with citrated whole blood and fresh‐frozen canine plasma.Response to treatment was excellent and follow‐up radiography three months later revealed resolution of the tracheal stenosis.