Rural Health Research and Rural Health in the 21st Century: The Future of Rural Health and the Future of Rural Health Services Research

Rural health research is a unique field. It is neither a nested subcategory under general health services research nor a separate field of policy analysis or advocacy. Rural health research faces three potential crises: of content, of applicability, and of credibility. The content of the field is driven often by funds, its applicability is thus limited by its purview as well as its special constituency, and its credibility is challenged by its findings, sometimes contrary to accepted positions in the larger health services field. Rural health research can strength its position by accepting the paradoxes it presents, especially the paradox of continuing disparity in the face of substantial investment to eliminate differences, and by seeking to answer why this occurs across the rural-urban spectrum. Rural health research can answer questions about why the distribution of resources is unfair without depending solely on pure definitions of rural.     

Personal Response Services Present and Future

No abstract available for this article.     

Questioning the Future of Family Medicine

The Future of Family Medicine Report is a milestone in the development of the discipline devoted to generalist physicians and the patients and communities they serve. From this vantage point, we must take stock of our past as well as our future. In this personal essay, I question the process of the Project and the conclusions of the Report. Important questions remain, and I list 10 that seem too important to leave unasked. Hope for the future springs from the capacity of the family physician to learn from experience, adapt to change, and care for people.     

Lifecourse Health Development: Past, Present and Future

During the latter half of the twentieth century, an explosion of research elucidated a growing number of causes of disease and contributors to health. Biopsychosocial models that accounted for the wide range of factors influencing health began to replace outmoded and overly simplified biomedical models of disease causation. More recently, models of lifecourse health development (LCHD) have synthesized research from biological, behavioral and social science disciplines, defined health development as a dynamic process that begins before conception and continues throughout the lifespan, and paved the way for the creation of novel strategies aimed at optimization of individual and population health trajectories. As rapid advances in epigenetics and biological systems research continue to inform and refine LCHD models, our healthcare delivery system has struggled to keep pace, and the gulf between knowledge and practice has widened. This paper attempts to chart the evolution of the LCHD framework, and illustrate its potential to transform how the MCH system addresses social, psychological, biological, and genetic influences on health, eliminates health disparities, reduces chronic illness, and contains healthcare costs. The LCHD approach can serve to highlight the foundational importance of MCH, moving it from the margins of national debate to the forefront of healthcare reform efforts. The paper concludes with suggestions for innovations that could accelerate the translation of health development principles into MCH practice.     

An Assessment of Practice Support and Continuing Medical Education Needs of Rural Pennsylvania Family Physicians

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.     

Education of Health Care Providers for the Rural Setting: A Family Nurse Practitioner Demonstration Program*

Spurred by mass concern over shortages of health care providers, the country's educational system has, over the past ten years, produced an ample supply (in some areas a near glut) of health care professionals. Studies demonstrate, however, that these professionals tend to cluster in the affluent metropolitan and suburban areas. Residents of rural areas are still significantly underserved. In the heavily rural southern half of Georgia, this problem has reached a critical peak. Georgia Southern College (GSC) is a rural based college located in the heart of rural south Georgia. In order to address some of the health care problems of its constituency, GSC, with federal support, established a Nursing Department and a Family Nurse Practitioner program with a commitment to recruit nursing students from the rural area, educate them in rural settings, and provide appropriate preparation for the unique experience of working in the rural environment. The program has been very successful in producing highly skilled graduates who do stay and work in the rural areas, providing health care at reasonable costs. This paper describes the setting (rural south Georgia), the need, the program implementation, and the impact (numbers of graduates actually working in rural settings, and innovative projects initiated by graduates).     

四川省农村学校健康教育现状调查

目的 了解当前农村学校健康教育和健康促进工作现状,为农村学校健康教育政策和策略的制定提供科学依据.方法 采用多阶段、分层、整群抽样的原则,通过对3县6个乡镇的小学五年级和初中二年级学生,进行专题小组访谈和问卷调查,回收有效问卷初中二年级599份,小学五年级583份.结果 小学五年级学生健康知识知晓率2001年与2006年数据比较,渠县差异有统计学意义(x=5.31,P＜0.05),新都和三台县差异无统计学意义;初中二年级健康知识知晓率2001年与2006年数据比较,三台县和渠县差异均有统计学意义(x=20.56,P＜0.05;x2=56.9,P＜0.05).新都区差异无统计学意义.结论 四川省农村学校健康教育还需进一步加强.     

Maternal and Child Health Graduate and Continuing Education Needs: A National Assessment

Objectives: The purpose of this report is to describe the methodology and results of a recent national assessment of long-term graduate and short-term continuing education needs of public health and health care professionals who serve or are administratively responsible for the U.S. maternal and child health population and also to offer recommendations for future training initiatives. Methods: The target of this needs assessment was all directors of state MCH, CSHCN and Medicaid agencies, as well as a 20% random sample of local public health departments. A 7-page needs assessment form was used to assess the importance of and need for supporting graduate and continuing education training in specific skill and content areas. The needs assessment also addressed barriers to pursuing graduate and continuing education. Respondents (n = 274) were asked to indicate the capacity of their agency for providing continuing education as well as their preferred modalities for training. Results: Regardless of agency type, i.e., state MCH, CSHCN, Medicaid or local health department, having employees with a graduate education in MCH was perceived to be of benefit by more than 70% of the respondents. Leadership, systems development, management, administration, analytic, policy and advocacy skills, as well as genetics, dentistry, nutrition and nursing, were all identified as critical unmet needs areas for professionals with graduate training. Education costs, loss of income, and time constraints were the identified barriers to graduate education. More than 90% of respondents from each agency viewed continuing education as a benefit for their staff, although the respondents indicated that their agencies have limited capacity to either provide such training or to assess their staff's need for continuing education. Program managers and staff were perceived in greatest need of continuing education and core public health skills, leadership, and administration were among the most frequently listed topics to receive continuing education training support dollars. Time away from work, lack of staff to cover functions, and cost were the top barriers to receiving continuing education. While attending on-site, in-state, small conferences was the continuing education modality of first preference, there was also considerable interest expressed in web-based training. Conclusions: Six recommendations were developed on the basis of the findings and address the following areas: the ongoing need for continued support of both graduate and continuing education efforts; the development of a national MCH training policy analysis center; the incorporation of routine assessments of training needs by states as part of their annual needs assessments; the promotion of alternative modalities for training, i.e., web-based; and, the sponsorship of academic/practice partnerships for cross-training.     

痛风患者的健康知识需求与健康教育

随着人们生活水平的普遍提高及饮食结构的逐渐改变 ,痛风的发患者数正在逐年增加 ,预计痛风在我国可能成为仅次于糖尿病的第二号代谢疾病。[1 ] 如何让痛风患者了解该病的基本知识 ,并能长年坚持有效的防治措施 ,从而享受和正常人一样的优质生活 ,是一个值得重视的问题。浙江省桐庐县第一人民医院 1 997年 1月至 1 999年 7月 ,共收治痛风 1 2例 ,住院期间由专人实施健康教育 ,收效满意 ,特报告如下。一般资料1 2例均为男性 ;年龄 49～ 67岁 ;病程最长 1 7年 ,最短 3年 ,平均 6年 ,入院时血尿酸最高为 990 μｍｏｌ/Ｌ ,平均为 670 μｍｏｌ/…