bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Rural Hospital as a Provider of Health Promotion Programs
Authors: Dorresteyn‐Stevens Christine 
Published: April 2008

Abstract: Although patient education has always been recognized as an essential function of a hospital, it was not until the health concerns of the nation focused on prevention that hospitals began to develop activities aimed at primarily healthy individuals. Hospital health promotion evolved from patient education about specific diseases to programs focused on modifying of lifestyle practices to prevent future debilitating conditions.Studies conducted in the early 1980s show hospital‐based health promotion programs increasing in number and including such target populations as senior citizens, children, business people, and hospital employees. However, the extent of involvement of the rural hospital in offering health promotion programs has not been clearly established. The current study was conducted to determine the status of health promotion programs in rural North Carolina hospitals. Elements considered were types of programs, target audiences, methods of financing, staff use, and availability of specialized facilities for health promotion programs.The results indicate rural hospitals do offer health promotion programs, but their primary focus is on hospital employees. Most programs are offered at low or no cost, making those offered for the community readily accessible. If input from the community is used and programming is aimed at specific health needs of rural populations, the rural hospital could make a significant contribution to an overall primary prevention strategy, lowering community health care costs.
The North Carolina Obstetrics Access and Professional Liability Study: A Rural‐Urban Analysis
Authors: Fondren Lise K. , Ricketts Thomas C. 
Published: April 2008

Abstract: During the 1980s a rapid rise in the costs of malpractice coverage for obstetrical services caused many practitioners to stop delivering babies. Other factors also influenced the decision by physicians to exclude obstetrics from their practices, including: increases in malpractice claims made against obstetrical providers and the subsequent fear of being sued; closures of hospital obstetrics units; issues involving Medicaid; and the daily stresses inherent in providing obstetrical care. Rural areas were particularly vulnerable to these factors.North Carolina was not unlike other states in recognizing a severe drop in access to obstetrical services in many communities, and policies were proposed to address this problem through tort reform, malpractice subsidies, and Medicaid program expansion. The exodus of obstetrical providers seemed especially critical in rural areas, and this article presents a metro‐politan‐nonmetropolitan analysis of the results of a survey of all obstetricians and gynecologists active and licensed to practice in North Carolina.The analysis is focused on provider responses to proposed policies and also examines the clinical support networks for these physicians to determine if this might also be an area for future policy activity. Important differences were found between rural and urban providers in terms of intensity of obstetrical practice, adequacy of backup, Medicaid participation and caseload, ideas about tort reform, and recent changes in obstetrical practice. The results indicate that policies to increase demand or income can help solve the rural obstetrical access problem but that states should pay equal attention to the clinical support system for practitioners.
Geographic Imbalances of Physician Supply: An International Comparison
Authors: Blumetithal Daniel S. 
Published: April 2008

ABSTRACT:This study was undertaken to compare geographic imbalances of physician manpower in developed and developing countries and to evaluate the success of policies designed to alleviate the imbalances. Data were drawn from a mail survey of countries conducted by the World Health Organization, from national statistical summaries, and from published information on national policies and programs. Information was available from 26 developing countries and 15 developed countries. Among developing countries, the degree of urbanization and rural economic development appeared to be the most important determinants of the level of geographic imbalance. Among developed countries, those with very high overall physician/ population ratios tended to have the least degree of imbalance, but this effect was not consistent. At the national level in most countries, the effect of policies or programs specifically designed to redistribute physician manpower appeared to be limited.
Studying the Retention of Rural Physicians
Authors: Pathman Donald E. , Konrad Thomas R. , Agnew Christopher R. 
Published: April 2008

ABSTRACT:Rural communities and policy‐makers struggle with efforts to enhance the retention of rural physicians. Research available to guide these efforts is often weak methodologically and thus may be pointing retention efforts in nonproductive directions. This article discusses a range of methodologic issues encountered in rural physician retention studies for the purpose of strengthening future studies.Ideal study approaches to answer causal questions, including questions about the “causes” of rural physician retention, must demonstrate good internal validity, for which chance, bias, and confounding are accounted. Retention studies that rely simply on asking physicians why they stay or leave rural areas can be useful at times, but are too prone to bias and their findings difficult to verify. Simply identifying what physicians find satisfying or dissatisfying about rural work also will not reliably reveal why they stay or leave, a related but still distinct question. Stronger approaches to studying retention include the traditional quantitative study – in which retention factors are identified when they are statistically related to physicians’retention, and the increasingly popular qualitative study – in which retention issues are revealed through prolonged, in‐depth interactions with physicians.This article also discusses various definitions of retention, the use of survival curves to present retention findings, and the importance of studying retention in inception cohorts. The benefits and downside of studying retention with prospective and retrospective study designs are described.
Geographic Benefit from Decentralized Medical Education: Student and Preceptor Practice Patterns
Authors: Fryer George E. , Stine Curtis , Krugman Richard D. , Miyoshi Thomas J. 
Published: April 2008

ABSTRACT:The performance of area health education center (AHEC)‐stimulated programs and decentralized education for medicine is not well understood. The Statewide Education Activities for Rural Colorado's Health (SEARCW/AHEC project at the University of Colorado School of Medicine was examined to determine if the program had an effect on the practice location of its graduates. Practice location and specialty of graduates of the University of Colorado School of Medicine (UCSOM) classes 1980‐1985 were compared for students who had participated in decentralized SEARCH/AHEC experiences versus students who had not. The majority of the graduates were practicing out of state in 1990. Non‐Colorado doctors were more often practicing in rural (non‐metropolitan statistical area [MSA]) counties and in towns of fewer than 2,500, 5,000 and 10,000 residents, respectively. In addition, of the 251 active patient care physicians practicing in Colorado communities of fewer than 10,000 in non‐MSA counties in 1986, those who precepted UCSOM students on SEARCH rotations were more likely to have remained in their same practice location in 1992 (77.8% versus 62.1% for those who had not precepted students). This analysis of both student and preceptor practice patterns documents the value of decentralized medical education in addressing the geographic and specialty maldistribution of physicians. These results have important policy implications for funding medical education programs.
Wash Day Blues: Secondhand Exposure to Agricultural Chemicals
Authors: Grieshop James I. , E.Villanueva Ninfa , Stiles Martha C. 
Published: April 2008

ABSTRACT:The issue of personal cleanliness for farm workers exposed to pesticides is a significant health problem. One area that requires more attention centers on the issues of handling and laundering of clothing suspected of being contaminated by pesticides. This exploratory research focused on the handling and laundering behaviors of California farm workers with pesticide contaminated clothing. Of particular interest was the phenomenon of “secondhand” exposure that may result from improper handling and unsafe laundering practices.Members of farm worker families (N=109) were interviewed at two California health clinics that serve a large portion of low income farm worker families. The sample was divided into three groups based on exposure to pesticides: direct exposure, indirect exposure, nonexposed. The findings revealed the least safe handling and laundering behaviors were reported by the group most at risk from first hand exposure (i.e., handlers, loaders, applicators). Also, secondhand exposure to pesticides appears to be related to storage and laundering practices reported by those who are directly or indirectly exposed to pesticides.The findings revealed the actual laundering practices of farm workers and their knowledge of what constitutes unsafe laundering behavior, including “secondhand” contamination. This information can help to identify realistic safe laundering practices for farm worker families who come in contact with pesticides in the field or at home.
Cancer Prevention Strategies Among California Farmworkers: Preliminary Findings
Authors: Goldsmith David F. , Sisneros Gil C. 
Published: April 2008

Abstract: This study was conducted to identify barriers to cancer prevention and evaluate the effectiveness of a cancer prevention project to increase screening for cervical and breast cancer among Spanish‐speaking farmworkers in California's Central Valley. Bilingual health educators met with farmworker communities near Merced and Modesto, CA, to determine barriers that prevented women from seeking screening for breast and cervical cancer. Using information from focus groups and health fairs, a targeted outreach protocol was developed that will eventually enroll 2,500 farmworkers in a cancer education and screening program. Participants received a presentation in Spanish on breast and cervical cancer that included a pretest and post‐test to assess increases in knowledge. Clients were encouraged to attend Golden Valley Health Centers Inc. (GVHC) to receive free breast and cervical cancer screenings. Vouchers, redeemable for modest personal hygiene gifts by clients, were tracked to assess prevention behavior when appointments were kept at GVHC.Sixty farmworkers attended focus groups and 363 attended health fairs to provide input to the cancer prevention program. As of December 1,1995,1,732 female farmworkers were enrolled in an outreach program designed to increase knowledge and promote cancer screening. Data from pretests and post‐tests indicated a statistically significant increase in knowledge about cancer and its prevention among participants. Furthermore, 317 participants redeemed vouchers for cancer screenings at GVHC.Active community collaboration and culturally appropriate intervention strategies, employed in conjunction with clinical services, can be successful in increasing cancer prevention awareness and screenings among female farmworkers.
Metropolitan Versus Nonmetropolitan Differences in Functional Status and Self‐care Practice: Findings from a National Sample of Community‐dwelling Older Adults
Authors: Rabiner Donna J. , Konrad Thomas R. , DeFriese Gordon H. , Kincade Jean , Bernard Shulamit L. , Woomert Alison , Arcury Thomas , Ory Marcia G. 
Published: April 2008

Abstract:The objective of this study was to use a recent national probability survey of the noninstitutionalized older adult population to compare the functional status and self‐care practices of older adults residing in metropolitan and nonmetropolitan communities and to identify differences associated with residential location. The survey used in this study was the National Survey of Self‐care and Aging (NSSCA). A cross‐sectional design was employed using weighted bivariate and multivariate logistic regression analyses to examine the relationship between metropolitan and nonmetropolitan residential location and self‐reported ability to perform basic, mobility, and instrumental activities of daily living (ADLs), as well as to assess the degree to which the levels and types of functional limitations affect metropolitan versus nonmetropolitan older adults' performance of self‐care activitiesThe bivariate logistic analyses pointed to modest, often insignificant metropolitan versus nonmetropolitan differences in the ability to perform functional tasks. However, larger positive effects of nonmetropolitan residence were generally observed once other factors likely to account for some of these differences were taken into account. Older adults from nonmetropolitan areas were more likely to report being able to perform functional activities but also were more likely to report performing self‐care activities both in the presence and absence of disability. This study, therefore, concluded that nonmetropolitan older adults may discount the significance of declining functional status, thus normalizing the trajectory of aging in a different way than do their metropolitan counterparts. If this process occurs, it may affect how nonmetropolitan persons use primary health care and/or long‐term care services, challenging the economists' concept of demand, the clinicians' concept of need, and the policy analysts' concept of equity. Additional work is required to assess whether such a normalization process actually occurs and, if so, to explore its distribution, causes, correlates, and consequences
Economic Burden of Agricultural Machinery Injuries in Ontario, 1985 to 1996
Authors: Locker Alison R. , Dorland John L. , Hartling Lisa , Pickett William 
Published: April 2008

Abstract: Context: Agricultural injuries are an important and understudied category of occupational injuries Purpose: This study estimated the economic burden of agricultural machinery injuries that occurred in Ontario, Canada's largest province, between 1985 and 1996 Methods: Conventional methodology for estimating economic burden, as embodied in a computer program previously developed for this purpose, was applied to hospitalized, nonhospitalized, and fatal agricultural machinery injuries Findings: The total economic burden of these injuries over the 12‐year study period was estimated to be £228.1 million, or £19.0 million annually (1995 Canadian dollars, 3.0% discount rate). By extrapolation, the economic burden of all farm injuries in Canada is estimated to be between £200 and £300 million annually Conclusions: Costing information about agricultural injuries provides support for the prioritization and development of injury‐control initiatives
Scuffing Performance of a Hard Coating Under EHL Conditions at
Sliding Speeds up to 16m∕s and Contact Pressures up
to 2.0GPa
Authors: Snidle R. W. , Dhulipalla A. K. , Evans H. P. , Cooper C. V. 
Published: April 2008

Abstract
Scuffing experiments were conducted using 76mm diameter disks both with and without a metal-containing, carbon-based hard coating. The operating conditions in the experiments were severe with sliding speeds up to 16m∕s and maximum Hertzian contact pressures up to 2.0GPa. The disks were of alloy steel, which was case carburized and hardened followed by axial grinding. Four different surface conditions were investigated as follows: ground/uncoated, ground/coated, superfinished/uncoated, and superfinished/coated. Experiments were also carried out in which ground/coated disks were run against ground/uncoated disks. The results of the experiments show that the addition of the hard coating to the ground disks significantly improved both their scuffing resistance and frictional behavior, but the coating was less effective in producing an improvement in the durability and friction of the superfinished disks.
Numerical Analysis of Thermoelastohydrodynamic Behavior of Elastomer
Radial Lip Seals
Authors: Maoui A. , Hajjam M. , Bonneau D. 
Published: April 2008

Abstract
This work is a numerical analysis of the thermal effect on the elastohydrodynamic behavior of elastomer radial lip seals. Two thermal approaches are considered, a local approach that determines the distribution of temperature in the contact zone and a simplified global approach that considers a mean temperature of fluid film. In addition, the thermoelastic behavior of the lip surface is taken into account with a relationship between Young’s modulus and the mean temperature of the lip surface. It is shown that the local temperature of the contact zone increases sensitively according to the shaft speed. Moreover, all operating characteristics such as film thickness and power loss are significantly influenced by the local temperature effect.
The Diabetic Foot Load Monitor: A Portable Device for Real-Time Subject-Specific Measurements of Deep Plantar Tissue Stresses During Gait
Authors: Atlas Eran , Yizhar Ziva , Gefen Amit 
Published: April 2008

Abstract
Elevated stresses in deep plantar tissue of diabetic neuropathic patients were associated with an increased risk for foot ulceration, but only interfacial foot pressures are currently measured to evaluate susceptibility to ulcers. The goals of this study were to develop a real-time patient-specific plantar tissue stress monitor based on the Hertz contact theory. The biomechanical model for stress calculations considers the heel and metatarsal head pads, where most ulcers occur. For calculating stress concentrations around the bone-pad interface, plantar tissue is idealized as elastic and incompressible semi-infinite bulk (with properties measured by indentation), which is penetrated by a rigid sphere with the bone’s radius of curvature (from X-ray). Hertz’s theory is used to solve the bone-pad mechanical interactions, after introducing correction coefficients to consider large deformations. Foot-shoe forces are measured to solve and display the principal compressive, tensile, and von Mises plantar tissue stresses in real time. Our system can be miniaturized in a handheld computer, allowing plantar stress monitoring in the patient’s natural environment. Small groups of healthy subjects (N=6) and diabetic patients (N=3) participated in an evaluation study in which the differences between free walking and treadmill walking were examined. We also compared gait on a flat surface to gait on an ascending/descending slope of 3.5deg and when ascending/descending stairs. Peak internal compression stress was about threefold greater than the interface pressure at the calcaneus region. Subjects who were inexperience in treadmill walking displayed high gait-cycle variability in the internal stresses as well as poor foot loading. There was no statistical difference between gait on a flat surface and gait when ascending/descending a slope. Internal stresses under the calcaneus during gait on a flat surface, however, were significantly higher than when ascending/descending stairs. We conclude that the present stress monitor is a promising tool for real-time patient-specific evaluation of deep tissue stresses, providing valuable information in the effort to protect diabetic patients from foot ulceration. Clinical studies are now underway to identify which stress parameters can distinguish between diabetic and normal subjects; these parameters may be used for establishing injury threshold criteria.
Tolevamer, an Anionic Polymer, Neutralizes Toxins Produced by the BI/027 Strains of
Clostridium difficile
Authors: Hinkson Paul L. , Dinardo Carol , DeCiero Daniel , Klinger Jeffrey D. , Barker Robert H. 
Published: April 2008

ABSTRACT

Clostridium difficile
-associated diarrhea (CDAD) is caused by the toxins the organism produces when it overgrows in the colon as a consequence of antibiotic depletion of normal flora. Conventional antibiotic treatment of CDAD increases the likelihood of recurrent disease by again suppressing normal bacterial flora. Tolevamer, a novel toxin-binding polymer, was developed to ameliorate the disease without adversely affecting normal flora. In the current study, tolevamer was tested for its ability to neutralize clostridial toxins produced by the epidemic BI/027 strains, thereby preventing toxin-mediated tissue culture cell rounding. The titers of toxin-containing
C. difficile
culture supernatants were determined using confluent cell monolayers, and then the supernatants were used in assays containing dilutions of tolevamer to determine the lowest concentration of tolevamer that prevented ≥90% cytotoxicity. Tolevamer neutralized toxins in the supernatants of all
C. difficile
strains tested. Specific antibodies against the large clostridial toxins TcdA and TcdB also neutralized the cytopathic effect, suggesting that tolevamer is specifically neutralizing these toxins and that the binary toxin (whose genes are carried by the BI/027 strains) is not a significant source of cytopathology against tissue culture cells in vitro.
Bactericidal and Sterilizing Activities of Several Orally Administered Combined Regimens against
Mycobacterium ulcerans
in Mice
Authors: Ji Baohong , Chauffour Aurélie , Robert Jérome , Jarlier Vincent 
Published: April 2008

ABSTRACT

Treatment with rifampin-clarithromycin or moxifloxacin-clarithromycin for 8 weeks displayed promising bactericidal activity against
Mycobacterium ulcerans
in mice; none of the mice treated with rifampin-clarithromycin relapsed, whereas 59% of those treated with moxifloxacin-clarithromycin relapsed after treatment was stopped. The bactericidal and sterilizing activities of the five-times-weekly (5/7) administration of 5 mg of rifapentine/kg of body weight, either alone or in combination, were virtually identical to those of the corresponding regimens with 10 mg of rifampin/kg of body weight; however, because of the long half-life of rifapentine, accumulation of the drug after 5/7 administration is a concern. The bactericidal activity of 20 mg/kg rifapentine in monotherapy or 20 mg/kg rifapentine in combination with 150 mg/kg streptomycin or 200 mg/kg moxifloxacin administered twice weekly was as effective as the corresponding regimens containing 10 mg/kg rifampin administered 5/7, suggesting that Buruli ulcer might be treated with intermittently administered rifapentine-containing combinations.
In Vitro Activity of Anidulafungin against
Candida albicans
Biofilms
Authors: Jacobson Melissa J. , Piper Kerryl E. , Nguyen Gary , Steckelberg James M. , Patel Robin 
Published: April 2008

ABSTRACT

We tested the activity of anidulafungin against 30
Candida albicans
isolates. The planktonic MICs for 50 and 90% of the isolates tested (MIC
50
and MIC
90
) were ≤0.03 and 0.125 μg/ml, respectively (MIC range, ≤0.03 to 2 μg/ml). The sessile MIC
50
and MIC
90
were ≤0.03 and ≤0.03 μg/ml, respectively (MIC range, ≤0.03 to >16 μg/ml).
First Report of
cfr
-Mediated Resistance to Linezolid in Human Staphylococcal Clinical Isolates Recovered in the United States
Authors: Mendes Rodrigo E. , Deshpande Lalitagauri M. , Castanheira Mariana , DiPersio Joseph , Saubolle Michael A. , Jones Ronald N. 
Published: April 2008

ABSTRACT

Linezolid resistance has dominantly been mediated by mutations in 23S rRNA or ribosomal protein L4 genes. Recently,
cfr
has demonstrated the ability to produce a phenotype of resistance to not only oxazolidinones, but also other antimicrobial classes (phenicols, lincosamides, pleuromutilins, and streptogramin A). We describe the first detection of
cfr
-mediated linezolid resistance in
Staphylococcus aureus
and
Staphylococcus epidermidis
recovered from human infection cases monitored during the 2007 LEADER Program.