Rural population--rural vitality.
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Conservation of Natural Resources↗
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Rural populations and rural physicians: estimates of critical mass ratios, by specialty.
As 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.
Catchment Area, Health↗
Exposure to a rural population in a rural residency training program.
Previous reports of rural training programs conducted by medical schools have not examined the relationship between the population residing in an area and the population receiving medical services through the clinical training program. In the present study rural household survey data were compared with patient encounter data from a rural ambulatory cliinic engaged in training Family Practice residents from the Texas Tech University School of Medicine. Clinic patients were found to resemble the rural population subgroup that visits a physician at least once a year. Wide variations in individual clinical experiences were observed when health problems and conditions encountered by residents were compared with problems encountered in the clinic as a whole. In light of current national efforts to increase medical care access in unserved and underserved populations, the demographic findings raise questions concerning appropriate patient exposure goals in clinical training programs.
Adolescent↗
Costs of mobile screening for diabetic retinopathy: a practical framework for rural populations.
Australia's rural and remote residents experience considerably higher hospitalisation and death rates due to diabetes than their metropolitan counterparts. There is clearly a need for improved diabetes care services in these areas and interventions that target conditions associated with diabetes will yield beneficial results for the community. All people with diabetes are at risk for diabetic retinopathy, which can cause vision loss and blindness. Although vision loss and blindness due to diabetes is nearly 100% preventable through regular eye examinations, 35% of Victoria's rural population with diabetes do not have their eyes examined on a regular basis. A pilot, mobile screening program for the early detection of diabetic eye disease was conducted in rural Victoria and proved to be a successful model of adjunct eye care for people with diabetes. Actual costs from the pilot screening were applied to a permanent model for rural eye care. At A$41 per participant, costs for mobile screening were competitive with Medicare rebate costs for eye examinations. The model addresses barriers of accessibility and availability, targets a portion of the rural population with diabetes that is not otherwise having eye examinations, and is cost-saving to the Government.
Cost Savings↗
[Population-genetic characteristic of the rural population of southern Tajikistan].
The results of genetic and demographic study of the inhabitants in south Tadjikistan are presented. It had been shown that the population studied is a typical rural population of Middle Asia and is characterized by the extended reproductive capacity, homogeneity of national composition and a high proportion of consanguineous marriages. Genetic variation in blood groups (AB0, MN, Rh-D, P1), serum proteins and red cell enzyme systems (Tf, Gc, Hp, PGM1, PGD, EsD, AcP1) was examined. A comparative analysis of gene frequencies in the population studied and some other Middle Asia populations has been carried out.
Adolescent↗
The impact of arthritis in rural populations.
OBJECTIVE: Rural residents may experience more arthritis and disability than urban dwellers. This paper reviews data on arthritis in rural areas and describes a new study, the Johnston County Osteoarthritis Project, a population-based study of osteoarthritis [OA] of the knee and hip in rural North Carolina. METHODS: Published reports of urban and rural comparisons of arthritis were reviewed. Data from the first 1,432 African-American and Caucasian participants in the Johnston County Osteoarthritis Project were analyzed. Radiographic knee and hip OA were defined as a Kellgren-Lawrence grade > or = 2. Functional ability was assessed by the Health Assessment Questionnaire, timed chair stands, and 8-foot walk time. Unweighted prevalences of knee and hip OA were calculated for age, sex, and racial groups. Associations between hip and knee OA, and hip and knee pain and functional ability were examined. RESULTS: Hip OA was present in 27.9% and knee OA in 38.4% of participants. Both were strongly related to age (P < 0.0001), but only knee OA to female sex (odds ratio = 1.33, 95% confidence interval 1.05, 1.68). Neither hip OA nor knee OA was related to race. Hip OA, hip pain, knee OA, and knee pain was each associated with self-reported and observed functional ability. CONCLUSION: Residents in rural areas may experience more arthritis and disability than previously expected. Contrary to other studies, African-American and Caucasian residents of rural Johnston County, North Carolina, have similar high rates of knee and hip OA. Further study is needed to address urban/rural differences in arthritis and its impact, with adequate control of confounders, standard definitions of rural/urban and of disease, and assessment of multiple arthritis outcomes.
Activities of Daily Living↗
[Refractive defects of the eye in descendents of a rural population in western Moravia].
The results from longitudinal follow-up of the incidence of refractive eye errors in a population from rural region have contributed to the characteristics of the regional gene pool. Generation born within 1950-1964 (Generation I.) was compared with that born within 1980-1994 (Generation II.). At the same time, a long-term follow-up has demonstrated changes in the quantity of phenotypes in absolute number (values of morbidity: generation I.--all types of refractive errors: urban population men 104/1000, women 132/1000. Rural population men 119/1000, women 135/1000. Generation II.: urban men 132/1000, women 169/1000, rural men 124/1000, women 136/1000. The difference in morbidity between women and men in the Ist and IInd generations, both urban and rural, has not changed. A more pronounced difference can be seen in urban population, namely at myopia in both generations (myopia urban population: generation I. men 40.8%, women 59.2%, generation II. men 43.9%, women 56.1%, myopia rural population: generation I.: men 44.2%, women 55.8%, generation II.: men 47.2%, women 52.8%. Hyperopia urban population: generation I., men 46.7%, women 53.3%, generation II. men 47.3%, women 52.7%. The incidence of astigmatism has shown constant ratio 1:1 both between men and women, and urban and rural populations. These changes were demonstrated most markedly in urban population, but these deviations are caused by emigration from rural to urban districts, especially from a hinterland. 10% of IInd generation (1980-1994) are relatives of Ist generation (1950-1964) only.
Adolescent↗
[Prevalence of hepatitis C virus in urban and rural populations of northeast Brazil-pilot study].
Hepatitis C virus can be found in all continents. However, differences exist with respect to its prevalence. In Brazil, epidemiological data are scarce, and are based, in their majority, on information obtained from blood donors and not from the general population. Our objective is to show the prevalence of anti-HCV in two distinct populations: one rural and one urban: Salvador, a metropolis, and Castro Alves, a rural village with very little contact with other populations. Eight hundred individuals from Salvador and 800 from Castro Alves were randomly visited. After obtaining consent, we collected blood samples for serology tests and determination of ALT levels. The anti-HCV antibody was tested using ELISA II (ABBOTT Labs), and confirmed by RIBA III (Chiron). We studied the prevalence of anti-HCV in two populations and its distribution with respect to age group and sex and ALT level. chi 2 and Fisher exact were used for the statistical analysis. Of the 800 individuals from Salvador, 44% were women and 56% were men. The age group varied from 10 to 70 years, with an average age of 42. Ten (1.25%) individuals were anti-HCV positive in the urban population and none in the rural population (P < 0.001). No evident correlation was found regarding sex and ALT level, between anti-HCV positive and anti-HCV negative individuals in the urban population. In conclusion, our results suggest a higher prevalence of HCV infection in the urban population probably due to a high level of exposure. The sero-epidemiological studies using blood donors do not reflect the epidemiological reality of HCV in Brazil due to selection bias which could overestimate its seroprevelence.
Adolescent↗
[Results of automatic screening for ischemic heart disease and arterial hypertension among the rural population].
The results of automated screening for coronary disease and arterial hypertension within large-scale preventive checkups of rural populations are reported. A system was developed, on the basis of Rose's questionnaire and the Minnesota Code, for the assessment of resting ECG, using a remote-control advisory panel and new mini-computers of domestic manufacture. A total of 6133 residents from several districts were examined. The efficiency and quality of the operation of the automated screening system was assessed. The use of automated data collection and analysis in conditions of large-scale preventive checkups was shown to be an important contribution towards the objective of universal preventive medical examinations of the population, rural population in particular.
Angina Pectoris↗
Rural epidemiology: insights from a rural population laboratory.
To study the epidemiology of rural populations in the context of contemporary issues in public health, a population laboratory (Health Census '89) was established in Otsego County, New York, by the Research Institute of the M.I. Bassett Hospital, affiliated with the Columbia University School of Public Health. Such a laboratory is needed because of an apparent lag in positive health indices in rural populations across the United States, resulting in rates of chronic diseases, such as coronary heart disease, for which rural areas now exceed urban ones. This was confirmed for Otsego County by the survey Health Census '89, the foundation of a rural population laboratory, in which all residents were enumerated and characterized as to their prevalent diseases, health behaviors, use of preventive services, and environmental exposures. Heart disease, cancer, and diabetes mellitus rates were found to exceed average rates for US urban areas, while the data on preventive health behaviors suggest this is a population of "late adopters." The survey, conducted in 1989, had an 86.6% response rate, and enumerated 17,147 households and 44,406 persons. The authors discuss adults aged 17-64 years, 58 percent of the total census (n=25,614). Sharp gradients in disease prevalence, risk factors, and utilization of preventive services were observed across educational strata. Data from Health Census '89 were used as the basis for a successful community intervention program, which targeted identified high risk groups. Rural populations are excellent settings for community interventions, offering laboratories where new strategies of risk reduction and provision of preventive services might be tested.
Adolescent↗
The role of federally funded health centers in serving the rural population.
CONTEXT: Federally funded health centers attempt to improve rural health by reducing and eliminating access barriers to primary care services. PURPOSE: This study compares rural health center patients with people in the general rural population for indicators of access to preventive services and health outcomes. METHODS: Data from the annual reporting system for federally funded health centers, the 1999 Uniform Data System, and published national census data were used to provide sociodemographic comparisons. Selected health status indicators, preventive services utilization, and health outcomes were obtained from a survey of health center patients, and the results were compared with the National Health Interview Survey and National Vital Statistics. FINDINGS: Unlike the nation's rural population, the majority of rural health center patients are of minority race/ethnicity, live at or below poverty, and are either uninsured or on Medicaid. Despite having higher prevalence of traditional access barriers than the general rural population, rural health center patients are significantly more likely to receive certain preventive services and also to experience lower rates of low birthweight, particularly for African American infants. However, rural health center patients are not more likely to have received influenza vaccination or up-to-date mammogram screening. CONCLUSIONS: Health centers provide access to essential preventive care for many of the most vulnerable rural residents. A national strategy to expand the rural health center network will likely help to ensure improved health for the considerable proportion of rural residents who still lack access to appropriate services.
Adolescent↗
The distribution and significance of hepatitis B surface antigen in a rural population in Kenya.
A rural population in Kenya was studied and a prevalence of HBsAg of 5-0% and an antibody prevalence of 50% in HBsAg in negative subjects has been found; 1-2% of the negative subjects converted to positive over a six-month period. A group of HBsAg positive subjects was compared with a matched group of HBsAg negative controls clinically in liver function tests and past medical history. No statistically significant differences were found between the two groups and neither group had experienced in the past significantly more skin scarification, injections or illness with jaundice. Both ad and ay subtypes occurred in the population. This is an unexpected and important finding, which gives scope for further detailed epidemiological studies in this population.
Adolescent↗
[Methods of population projections of urban and rural population by sex and age group].
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Demography↗
Prevention of folate deficiency by food fortification. IV. Identification of target groups in addition to pregnant women in an adult rural population.
In a rural Negro population subsisting on a predominantly maize meal diet, the incidence of folate deficiency was 43.8% in nonanaemic women in late pregnancy, 32.1% in nonpregnant women, and 18.6% in adult males. More than one-third of all subjects older than 60 were deficient. No instance of unequivocal vitamin B12 deficiency was revealed in 431 subjects sampled, and it is considered that the hazards of giving a small daily dose of folic acid in this population are negligible. These findings warrant food fortification with folic acid in this and similar population groups.
Adolescent↗
[The recent development of the active rural population in France, 1968-1975].
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Demography↗
Shifts in the distribution of rural population in the non-Chernozem zone of the RSFSR.
"Rural population change within the Non-Chernozem zone of the RSFRS [Russian Soviet Federated Socialist Republic] is examined over the period 1959-79 at several levels of analysis: the Non-Chernozem zone as a whole, its major economic regions, individual oblasts, individual rayons and individual farms and rural places. The overriding tendency at all levels of analysis has been the increasing spatial concentration of rural population." The authors observe that "this concentration assumes a variety of forms, from the concentration of rural population in the suburban zones of large cities and the immediate surroundings of rayon seats to a decline in the number of rural places (from 180,000 in 1959 to 118,000 in 1979) and the growth of local centers against a general background of rural population decline. The authors hint that the observed tendency is a positive development, in keeping with the policy of converting Soviet agriculture to a more intensive path of development."
Agriculture↗
[Medical genetic study of the population of Kostroma Province. V. The hereditary pathology burden of urban and rural populations].
Medical genetic study was carried out in the urban and rural populations of Kostroma Province. Urban populations were shown to have lower frequencies of "rare" forms of autosomal recessive diseases, in comparison with those in the rural populations. Analysis of interrelationship between genetical structure of populations and prevalencies of hereditary diseases in the populations revealed clear relations between the load of autosomal recessive diseases and the level of inbreeding in the populations.
Chromosome Aberrations↗
Substance abuse during pregnancy in a rural population.
Drug abuse during pregnancy in rural populations has received less attention than that in urban populations. Urban studies have reported alarming rates, but it is unknown whether the situation is the same in rural areas. To investigate this, urine samples were collected anonymously from 181 pregnant women who presented to the University of Missouri clinics for care and who resided in communities of less than 25,000. Each urine specimen was tested for cocaine, marijuana, amphetamines, barbiturates, opiates, phencyclidine, benzodiazepines, ethanol, and nicotine. Of the 181 specimens, 83 (46%) contained nicotine, 17 (9.4%) contained marijuana, and one each (0.6%) tested positive for cocaine, barbiturates, ethanol, and benzodiazepines. No other tested substances were detected. Excluding nicotine and ethanol, 20 (11%) of the urine samples tested positive for the screened substances. Review of the prenatal records revealed that 46% of the women reported using tobacco, 15% reported using alcohol, and 8.3% reported illicit drug use during pregnancy. This study indicates that there is a substantial drug abuse problem in rural populations, and that the profile of abuse differs from that of urban populations. Tobacco, ethanol, and marijuana were the most prevalent substances abused during pregnancy, but cocaine was a minor problem. This information may help in directing resources to reduce drug abuse during pregnancy.
Female↗