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PubMedDate not supplied

Secondary sexual development in rural and urban South African black children.

The timing and duration of secondary sexual development in two samples of rural and urban South African black children were investigated using the Tanner staging techniques and compared to similar data from Switzerland and England. In general rural black children were consistently delayed in the age at which they entered the events of puberty, and took longer to pass through each of the stages. Urban black children, from good socioeconomic backgrounds, were advanced in relation to their rural peers and slightly ahead of the European samples. There were no significant differences in the sequence of events. Estimates of testicular volume on the well-off urban boys demonstrated that they exhibited similar volumes to European boys at similar ages. It is suggested that the British clinical longitudinal growth standards could be effectively used to sensitively monitor the growth and maturation of black urban children from good socioeconomic backgrounds.

Adolescent↗
PubMed1981

The relationship between physical growth and infant behavioral development in rural Guatemala.

The present study investigated the relationship between a number of anthropometric indices and behavioral development during the first 2 years of life in rural Guatemala. Length and weight were the indices most strongly correlated with behavioral development. If the effect of the infant's length and weight was statistically controlled for, none of the other anthropometric variables explained a significant proportion of the variance in behavioral development. Controlling the length (or weight) assessed at the same age as the behavioral assessment, length (or weight) for younger ages was not significantly correlated with behavioral development. Changes in length or weight over time correlated with changes in behavioral performance. We were unable to explain the association between physical growth and behavioral development by a number of variables including gestational age, nutrient intake, prevalence of disease, and familial characteristics.

Body Height↗
PubMed1997

Developing a rural primary care practice network.

Establishing and managing a primary care practice in rural communities is particularly challenging. Many rural practices are closing, and relatively few new practices are initiated independently. The integrated health system can provide at least part of the solution to the lack of physicians in the rural setting. The following article describes the objectives, methods, and results of an integrated health system's development of a rural primary care provider network.

Community Networks↗
PubMedDate not supplied

A dental school's role in developing a rural, community-based, dental care delivery system for individuals with developmental disabilities.

The long-standing problem of access to dental care for persons with developmental disabilities in rural Northern California has been addressed in several communities by a unique community-based program. The goal was to create a coalition to coordinate dental school resources with those of a consortium of agencies to address problems in the local communities. This program established a community-based model demonstrating the provision of quality preventive and therapeutic dental services to these individuals. Through this program, dental care delivery systems were formed in three rural communities involving local community dentists and agency personnel. The role of the dental school was: (1) to establish and then work with a consortium of hospitals, agencies, dentists, and other dental personnel; (2) to train local dental personnel; (3) to establish and equip hospital dental facilities; (4) to conduct dental screening and triage clinics; (5) to consult with local agencies and dentists; (6) to act as a referral center for patients with complex medical situations; and (7) to develop and disseminate preventive dentistry training materials.

California↗
PubMed1976

Developing a rural mental health service from a base in an academic clinical psychology program.

The development of a Community Mental Health Service for a multiethnic rural area by an academic psychology department clinical program was carried out for the purpose of providing relevant training for grauate students through realistic service functions. The population served was largely lower socioeconomic, and the available resources very limited. The Community Psychology course was used to assist the planning and negotiating for the clinic. Services provided during the first year are summarized. The graduate students' not-too-happy view of the program is presented. The problems and issues raised by this experience, for both training and service, are discussed.

Community Mental Health Services↗
PubMed1999

Agricultural policy and sustainable livestock development.

Future agricultural and rural development is, to a large extent, influenced by the projected food needs of 2.5 billion people expected to swell the world population by 2020. This increase will require more food in general and, in view of recent experience in East Asia, more animal products. To achieve this increase will require judicious use of resources, and trade, especially in those countries where natural resources are insufficient to support food production. Achieving food sufficiency in a sustainable manner is a major challenge for farmers, agro-industries, researchers and governments. The latter play an important role as many of the farmers' choices are, to a large extent, directed by government or supra-government, often through macro- and micro-economic policy. In many countries the economic, environmental, trade and agricultural policies have not been conducive to an agricultural development that is risk-free with respect to the environment, animal welfare or public health. The recent decline of government support in agriculture forced farmers in Western countries to think about more risk adverse agricultural practices and more efficient production systems. On the other hand, many countries in Eastern Europe and the former Soviet Union, as well as other developing countries, are still going through a painful process of adjustment to new market conditions. International banks and development agencies have a mandate to help developing countries, but are somewhat restricted both by needing to work directly with governments and by their perceived dogmatic approach to development. Changing policies do, now and in the future, also affect the development of animal disease control programmes, including the control of parasitic diseases. On the one hand there is an increasing interest in risk-free control practices, and on the other hand a demand for greater regulatory control over the production process. As parasitic diseases of animals are closely linked to the environment (i.e. grazing and waste management) and public health (i.e. parasitic zoonoses), the new interest in sustainable agriculture provides a challenge for those concerned with the control and prevention of animal parasitism.

Agriculture↗
PubMed1995

MSU Rurality Index: development and evaluation. Montana State University.

The construction and validation of a residence-based index of the degree of rurality are reported. The MSU Rurality Index is a locally normal index and assigns a quantitative measure of rurality to each participant in a study. Data required to compute the index are minimal; only two variables need be measured. Statistical analysis effort required to compute the index is somewhat more intensive than usual, but this tradeoff between data collection and data analysis seems sensible. Data collection is generally more expensive than data analysis. The two required variables, county population and distance to emergency care, are optimally transformed to achieve normality and weighted to achieve validity. A measure of departure from normality is automatically obtained while constructing the index. A positive score reflects a rural residence and a negative score reflects an urban residence relative to the group under study. A score of zero reflects average rurality. Reliability and construct validity were examined using two data sets. The MSU Rurality Index has high test-retest reliability, is appropriately related to a set of ordered categories concerning place of residence, and is as or more strongly related to these categories than alternative indices computed from distance or population alone. The validity of the MSU Rurality Index does not appear to be compromised by its parsimony. Even though the MSU Rurality Index is based on only two variables, it was found to be associated with various health care variables as strongly or more strongly than an 11 variable county-based index developed in Texas.

Adult↗
PubMed1977

[Rural health center in Bali].

The rural Health Centre of Mengwi, on the island of Bali, was built and equipped for US $ 15,000 by Project Concern, a non-sectarian, medical relief organization. It has been run so successfully by them since it opened in 1974, that not only has the Centre gained the trust of the local community into which it is now fully integrated, but it is also regarded by the Indonesian Government as a pilot project. Amongst the factors leading to this success, the author underlines the following points: a suitable location for the Centre, easily accessible by the villagers; a local staff recruited from the villages of Mengwi District, well trained and sympathetic to the population; constant retraining of the staff leading to better medical care; the availability of a doctor and nurse around the clock; an adequate supply of drugs. Evaluation of the operation is best done by the acceptance of special programmes such as the Under-Five Clinic, the Family Planning Scheme, Ante-Natal Clinic and vaccinations. The mere success of the general clinic would not mean that the Centre had been integrated into the community and become a factor in rural development. The success of these special clinics, as well as the out-reach programmes, demonstrates that through adequate delivery of medical care, the Health Centre of Mengwi can now fulfil its role of being an important factor in the development of a rural community in the tropics.

Delivery of Health Care↗
PubMedDate not supplied

Enhancing the family medicine curriculum in deliveries and emergency medicine as a way of developing a rural teaching site.

BACKGROUND: The urban family practice residencies of Memphis were not providing sufficient training or encouragement to young physicians for practice in rural communities. METHODS: In 1990, the Department of Family Medicine, in partnership with the State of Tennessee Health Access Act and the Baptist Health Care System, developed a teaching practice in a rural county of western Tennessee. The family practice curriculum included special skills in advanced women's health care and emergency medicine so that uniformly trained physicians could provide around-the-clock coverage in the hospital, including the delivery of babies and first-hour emergency care. RESULTS: After 7 years, the group now includes six full-time board-certified, OB-capable family physicians. In addition, faculty members from the department's urban program in Memphis are required to contribute a "mini locum tenens" of 2-3 days of rural coverage per month. Since 1992, the practice has provided care for more than 54,000 continuity office visits, 81,000 emergency department visits, more than 3,500 hospital admissions, and 621 obstetrical deliveries. Since 1994, residents have been assigned to the site full time, with growth to 12 (4-4-4) residents assigned to this location as of 1997. Several graduates from the initial group of residents have remained in the community after graduation, and three others have established practices in rural areas. Most recently, control of the practice is being transferred from the family medicine department to the university's corporate group practice. This may result in fundamental changes in the practice's operation. CONCLUSIONS: The approach described in this report may be useful for the expansion of urban departments of family medicine into rural and underserved communities.

Curriculum↗
PubMed1980

Nutrition and cognitive development among rural Guatemalan children.

Women and children from four Guatemalan villages participated in a voluntary food supplementation program for seven years. In two of the villages, they received a vitamin and mineral fortified, high-protein calorie supplement. In the other two villages, the vitamin-mineral fortified supplement contained no protein and a relatively small number of calories. Cognitive tests were administered regularly to children ages three to seven, and anthropometric measures obtained. In addition, measures of families' social milieu were collected at several points in time. Using multiple regression analysis, we find that both nutritional and social environmental measures are related to various dimensions of cognitive competence. The results suggest that nutritional intake, independent of social factors, affects cognitive development. There is also some evidence that the children who receive the high-protein calorie supplement (and whose mothers received it during pregnancy and lactation) are more likely to score high in cognitive performance. Our results, while not diminishing social environmental explanations of differences in cognitive function, suggest benefits from nutrition intervention programs in rural areas of lesser-developed countries.

Anthropometry↗
PubMed1977

Model for the development of rural pharmaceutical services.

The Central Pharmacy of Presbyterian Medical Services (PMS) a nonprofit corporation operating a rural comprehensive health care system in New Mexico, is discussed. PMS Central Pharmacy provides pharmaceutical services to a 34-bed acute care hospital and 24 widely scattered clinics for ambulatory patients. The financial base, administration, development of a formulatory, purchasing, prepackaging of medications, and consulting services of the PMS Central Pharmacy are described. Central Pharmacy acts as a drug wholesaler for PMS; the gross margin between acquisition cost and average wholesale price covers 90% of the cost of the pharmacy operation. In addition, the clinics pay a fee and travel expenses for pharmacist consultation. Seven clinics employ drug technicians who are trained and supervised by Central Pharmacy. It is concluded that this system may serve as a model for the development of pharmaceutical services in other rural areas or in poverty-stricken urban areas.

Costs and Cost Analysis↗