Opinions of rural physicians about their practices,community medical needs,and rural medical care.

In a study in the State of Washington during 1971-73, 41 general practitioners in rural areas were asked their opinions about (a) their present practices, (b) the medical care needs of their communities, and (c) rural medical care in general. The most frequently mentioned enjoyable aspects of their practices were the variety and challange of medical problems confronted, the favorable working conditions of the practices, and the types of communities in which the practices were located. The most frequently mentioned sources of frustration to the physicians were the "excess work, responsibility, demands and expectations by patients and community." The physicians were more reluctant to criticize the care received by the residents of their communities than they were to criticize the care that patients received in other rural areas. Suggestions made by the physicians for improving medical care in rural Washington focused on ways to increase the number of resources used to produce medical care, rather than on structural changes in the way medical care is organized, delivered, and financed.     

加强新型农村合作医疗工作推进社会主义新农村建设

建立新型农村合作医疗制度(简称新农合)对于减轻农民就医的经济负担,提高农民医疗服务水平,促进农村社会协调发展具有重要意义,是落实科学发展观、促进城乡协调发展、建设社会主义新农村的重要举措。2003年以来,我市始终把加强新农合的规范化管理放在突出的位置,通过建章立制,不断提高规范化管理水平,使新农合工作始终保持运行平稳、健康发展的良好态势。截止到2005年年底,全市已有506.43万人参加新农合,参合率达82.5%,合作医疗基金使用率达95.6%。缓解了农民“看病难、看病贵”和因病致贫、因病返贫的问题。1加强领导,实行目标管理,从组织…     

Rural health disparities, population health, and rural culture

In this commentary, I place the maturing field of rural health research and policy in the context of the rural health disparities documented in Health United States, 2001, Urban and Rural Health Chartbook. Because of recent advances in our understanding of the determinants of health, the field must branch out from its traditional focus on access to health care services toward initiatives that are based on models of population health.In addition to presenting distinct regional differences, the chartbook shows a pattern of risky health behaviors among rural populations that suggest a "rural culture" health determinant. This pattern suggests that there may be environmental and cultural factors unique to towns, regions, or United States Department of Agriculture (USDA) economic types that affect health behavior and health.     

Race, rural residence, and control of diabetes and hypertension

PURPOSE: African Americans are at increased risk for diabetes mellitus and hypertension, and rural residents have historically had decreased access to care. It is unclear whether living in a rural area and being African American confers added risks for diagnosis and control of diabetes and hypertension. The purpose of this study was to examine the prevalence of diagnosed diabetes and hypertension, as well as control of both conditions, among rural and urban African Americans and whites. METHODS: We conducted an analysis of the Third National Health and Nutrition Examination Survey (1988-1994). Non-Hispanic African Americans and non-Hispanic white adults 20 years and older were classified according to rural or urban residence (n = 11,755). Investigated outcomes were previously diagnosed diabetes mellitus and hypertension and control of diabetes and hypertension. RESULTS: The prevalence of diagnosed diabetes was 4.5% for urban whites, 6.5% for rural whites, 6.0% for urban African Americans, and 9.5% for rural African Americans. Among patients with diagnosed diabetes, 33% of rural whites, 43% of urban whites, 45% of urban African American, and 61% of rural African Americans had glycosylated hemoglobin (HbA(1c)) levels of 8% or higher (P < .01). Among patients with diagnosed hypertension, 11% of rural whites, 13% of urban whites, 20% of urban African Americans, and 23% of rural African Americans had diastolic blood pressure greater than 90 mmHg (P < .01). In regression models controlling for relevant variables, including body mass index, health status, access to care, education, income, and insurance, compared with rural African Americans, rural and urban whites were significantly more likely to have better glycemic control and diastolic blood pressure control. Urban African Americans also had better diabetes control than rural African Americans. CONCLUSIONS: In this nationally representative sample, rural African Americans are at increased risk for a lack of control of diabetes and hypertension.     

Interaction between humans and poultry, rural Cambodia

Because avian influenza H5N1 infection risks are associated with exposure to infected poultry, we conducted a knowledge, attitudes, and practices survey of poultry-handling behavior among villagers in rural Cambodia. Despite widespread knowledge of avian influenza and personal protection measures, most rural Cambodians still have a high level of at-risk poultry handling.     

Health, disease and health-care in rural Bangladesh

During two periods of almost 3 months each, a study was done in three villages of Tangail District in Bangladesh. One of the objectives was to find out how the fields of traditional medicine (Ayurveda and Unani), folk medicine and allopathic medicine were related to each other, and which processes could be discerned in these interrelationships. In this respect an important outcome was that traditional medicine had almost disappeared in this area and that Western medicine holds a very strong position. Another objective was to study the illness-behaviour of various economic categories of villagers. Here we found that the poor made much more use of the government facilities than the rich. In fact, these facilities have a large potential, but there are many defects in the way they are operating, so that the potential is not realized at all. We also studied the cures which the practitioners of folk medicine and those of Western medicine are offering to their clients. One of the conclusions was that the practices of the unqualified allopathic practitioners, who hold a strong position in the countryside, are often a hazard to health.     

Bioethics and rural health: theorizing place,space, and subjects

The field of bioethics has been criticized for its universalizing tendencies, attributed in a large part to its foundations in moral philosophy and the level of abstraction of much bioethical discourse. Efforts to particularize bioethics have included the "turn toward casuistry", the emergence of feminist and disability rights critiques of mainstream bioethics, and ethnographic contributions that examine the situatedness of ethical acts, practices, and meanings in local contexts. Such work introduces into bioethics dimensions of space, place, and time; nonetheless, these remain relatively unexplored as constitutive elements and/or influences of the phenomena of ethics discourse and ethics-related practices. Drawing from an ethnographic study of genetics in rural health, this paper presents a sociological discussion of space/time and bioethics through examination of rural health settings. Issues raised include intersections of spatial and power relations, socio-spatial gradients of expertise, and socio-spatial dimensions of ethics knowledge and practices within medical settings.     

Sanitation, community environments, and childhood diarrhoea in rural Zimbabwe

Childhood diarrhoea can be transmitted within the household and community environments. This study examined the effect of partial latrine coverage on diarrhoeal morbidity at the household and community levels. Weekly morbidity data on 272 children, aged less than five years, were collected for 45 weeks from October 1996 to August 1997 in two neighbouring semi-arid communities in rural Zimbabwe. The communities were similar except for sanitation. In Community A, 62% of the children lived in households with a latrine, and in Community B, there was no sanitation. Diarrhoeal morbidity was 68% lower in Community A than in Community B. In addition, the children from the households in Community A without a latrine had lower diarrhoeal morbidity than the children in Community B. The inter-community difference in diarrhoeal morbidity was likely to be due to the latrines and associated hygiene education interrupting intra- and inter-household transmission of diarrhoea. The latrines reduced faecal contamination of the community environment, and as diarrhoeal morbidity fell, contact between infectives and susceptibles within the community would also have fallen. The neighbourhoods in Community A where the adjacent households did not have sanitation had higher diarrhoeal morbidity than in the neighbourhoods where one household did have sanitation. The results of the study suggest that sanitation programmes, which share building costs between the state and individuals, i.e. households, and hence, do not achieve complete coverage in a community, benefit the whole community, because the households that cannot afford a latrine experience lower diarrhoeal morbidity due to the safer community environment.     

Issues in rural health: access, hospitals, and reform

This overview discusses articles published in this issue of the Health Care Financing Review, entitled "Access to Health Care Services in Rural Areas: Delivery and Financing Issues." These articles focus on the following topics: rural hospitals (including closures, the impact of Federal grants, network development, and costs), managed care in rural areas, telemedicine, and the delivery of mental health services to rural Medicaid beneficiaries.     

Poverty, health services, and health status in rural America

Access to health services for everyone has been a major policy goal in the United States: inequitable access is assumed to lead to inequitable health status, particularly for low-income groups. A sophisticated model of the relation between poverty, health care needs, service use, and health outcomes is used to analyze cross-sectional data on 7,823 adults from 36 rural communities. Improved access and use are helpful, but evidence clearly indicates that combined health and social initiatives will be necessary to reduce inequalities in health status.     

发展农村卫生事业服务新农村建设——对利川市农村卫生组织服务新农村建设的调查

发展农村卫生事业是实现农村全面发展的重要途径,农民是社会主义新农村建设的主体,农民的健康问题占有极其重要的位置。为及时总结农村卫生组织在新农村建设中的成功经验和存在的     

改革村卫生室管理体制推动农村卫生事业发展

1村卫生室管理中存在的问题 1.1观念陈旧．市场意识差无论是管理者还是村医生，对计划经济仍心存留念，思想保守，裹足不前，等、靠、要思想严重，否认农村卫生是一个大市场，不敢、不愿、也不会用市场经济的规律来调整农村卫生工作的思路，害怕竞争，使得村卫生室难以进入市场，融入市场经济的大潮，以至于村卫生室的发展在市场经济中落伍。