Differences in access to health care services among adults in rural America by rural classification categories and age

Objective: To study differences in excess to health care services between different population groups in rural areas of the United States. Design: Using data from the 1994 National Health Interview Survey and the 1991 Area Resource File, we examined the differences in excess with seven measures: having a regular source of care, having a usual place of care, having health insurance coverage, delaying medical care because of cost for all rural residents; number of doctor visits, number of hospital discharges and length of hospital stay per discharge for those who reported their health as being either poor or fair. Rural residents were classified by ages and grouped into four rural classification categories that were characterised along two dimensions: adjacent to a metropolitan statistical area (MSA) (yes/no) and inclusion of a city of at least 10 000 people (yes/no). Setting: Rural areas Subjects: Rural populations. Results: Residents aged 18–24 years had the worst access to services and the residents aged 65 years and over had the best access to services when measured by regular source of care, a usual place of care and health insurance status. Compared to those aged 50–64 years, residents aged 25–49 years were less likely to report having health insurance and more likely to report delaying seeking medical care because of costs. Rural residents who lived in a county adjacent to an MSA generally were less limited in access than those who lived in a county not adjacent to an MSA. Conclusions: Rural America is not a homogeneous entity in many aspects of the access to health care services.     

A common pathway toward women's health

Abstract

This paper calls for an alternate approach to studying the aetiology of women's health conditions. Instead of the long-established disease-specific, compartmentalized approach, it recommends focusing on risk exposures that allows for the identification of multiple disease conditions that stem from the same risk factors. Identifying common risk factors and the related pathways to adverse health outcomes can lead to the development of interventions that would favourably affect more than one disease condition. The utility of such an approach is illustrated by a review of literature from across the globe on the association between gender inequity-related exposures and women's health (namely, three health conditions: sexually transmitted infections [STIs], including Human Immunodeficiency Virus [HIV], blindness, and depression; as well as two risk behaviours: eating disorders and tobacco use). The review demonstrates how women's health cannot be viewed independently from the larger social, economic, and political context in which women are situated. Promoting women's health necessitates more comprehensive approaches, such as gender-sensitization of other family members, and the development of more creative and flexible mechanisms of healthcare delivery, that acknowledge the gender inequity-related constraints that women face in their daily lives.     

The utility of EMR address histories for assessing neighborhood exposures

PurposeElectronic medical records (EMRs) include residential address histories, which may alleviate exposure misclassification caused by exclusion of patient spatiotemporal location. EMR data are increasingly available but rarely leveraged as a measure of cumulative environmental exposure, in part due to limited understanding of the validity of EMR-derived address histories.MethodsWe compared EMR address histories to self-reported histories among 100 patients of a safety-net health care system completing a telephone survey. We assessed agreement and compared seven neighborhood-level environmental exposures as assessed using both data sources.ResultsWhile 17.1% of respondents did not live at the most recent EMR-derived address during the survey, nearly all (98%) lived there at some point. For respondents with more than one EMR-derived address (N = 64), 87.5% had once lived at the previous EMR address. Of these, 30.4% lived at 1 or more additional residences between the two most recent EMR address. For all measures, neighborhood-level environmental exposures did not differ when using EMR-derived versus self-report addresses.ConclusionsMore recent EMR-derived addresses are more accurate, and differences compared to self-reported addresses in neighborhood-level exposures are negligible. EMR-derived address histories are incomplete and likely suffer from collection bias; future research should further assess their validity and reliability.     

Regional Differences in the Effects of Social Relations on Depression Among Korean Elderly and the Moderating Effect of Living Alone

ObjectivesSocioeconomic disadvantages interact with numerous factors which affect geriatric mental health. One of the main factors is the social relations of the elderly. The elderly have different experiences and meanings in their social lives depending on their socio-cultural environment. In this study, we compared the effects of social relations on depression among the elderly according to their living arrangement (living alone or living with others) and residential area.MethodsWe defined social relations as “meetings with neighbors” (MN). We then analyzed the impact of MN on depression using data from the Korean Longitudinal Study of Aging Panel with the generalized estimating equation model. We also examined the moderating effect of living alone and performed subgroup analysis by dividing the sample according to which area they lived in.ResultsMN was associated with a reduced risk of depressive symptoms among elderlies. The size of the effect was larger in rural areas than in large cities. However, elderly those who lived alone in rural areas had a smaller protective impact of MN on depression, comparing to those who lived with others. The moderating effect of living alone was significant only in rural areas.ConclusionsThe social relations among elderlies had a positive effect on their mental health: The more frequent MN were held, the less risk of depressive symptoms occurred. However, the effect may vary depending on their living arrangement and environment. Thus, policies or programs targeting to enhance geriatric mental health should consider different socio-cultural backgrounds among elderlies.     

Cross-sectional epidemiological study of respiratory disease in Turkey farmers

This study was a cross-sectional epidemiological investigation of respiratory disease in farmers involved in the turkey growing industry. Pulmonary function tests and health history questionnaires were administered to a total of 95 turkey farmers throughout Minnesota. Respiratory symptoms were greatest during the winter months when exposure to environmental agents was highest. Prevalence of symptoms was higher for smokers, personnel who worked in hen barns, and for persons who had worked in the turkey growing industry for more than 10 years. Pulmonary function was found to decrease during the work day. Also, pulmonary function was lowest for personnel working in hen bars, and for persons who had been employed in the industry for more than 10 years. These data support the association between respiratory disease and exposure to the environment in confinement farm buildings. © 1993 Wiley-Liss, Inc.     

昆明市西山区参合农民对定点医疗机构服务质量的评价

目的：探讨参合农民对新农合定点医疗机构服务质量的评价情况。为改进其服务质量提供科学依据。方法：2007年1月采用分层抽样和单纯随机抽样相结合,以问卷方式调查了506名昆明市西山区参合农民对新农合定点医疗机构服务质量的意见和建议。结果：参合农民选择县乡级医院门诊就诊的比例低于省市级医院;县级医院收费比乡镇卫生院高;山区和半山区的农民认为县乡村级医疗机构交通不方便;村卫生室的设备陈旧．结论：西山区县乡级医疗机构布局存在不合理现象;加强对县级医院医疗行为的监管,避免产生不必要的医疗费用;政府应增加对村卫生室的投人。     

Matroniya: The Lived Experiences of Rural Auxiliary Midwives in Koutiala,Mali

Our team explored the lived experiences of rural auxiliary midwives, or matrones, in Mali. Since matrones attend more births than all other health workers combined, they are critical to efforts to reduce maternal mortality. Currently, their experiences are not well understood. This study used interpretive phenomenology to describe the experiences of seven matrones. We suggest that matrones provide a vital connection between traditional approaches to birth and the biomedical services offered by the formal health sector. Matrones’ unique role as both health professionals and rural women creates challenges and opportunities that affect their effectiveness and personal lives.     

The Keokuk County Rural Health Study

ABSTRACT

The Keokuk County Rural Health Study is a unique, population-based, prospective study of an agricultural community. The study is expected to continue for twenty years. The research includes systematic assessment of respiratory disease, injury, and other health outcomes in relation to agricultural, occupational, and environmental exposures. The aims of the environmental surveys are: (1) to conduct a systematic assessment of rural households in order to characterize the environmental exposures associated with the resi-dences and properties of the study subjects comparing farm, rural non-farm, and town households; and (2) to characterize occupational exposures associated with activities of the study subjects, particular-ly those related to farming and the rural environment. The environ-mental surveys consist of a combination of personal interviews, walk-through observations, and measurement of a selected number of environmental parameters. The focus of these assessments is on the environment and operations of the household and farm. Four instruments are used to record data: a Home Environmental Ques-tionnaire; a Home/Grounds Environmental Checklist; a Farm Envi-ronmental Questionnaire; and a Farm Environmental Checklist. Pre-liminary results from the first 106 environmental assessments are described, including the first 26 farms. More than half of residences were built before 1950, and they are primarily heated with liquid propane gas, natural gas, or wood. Dangerously high levels of car-bon monoxide were measured in several homes during winter 1995/96. Only 77 of 148 smoke detectors functioned. Farms ranged from 7 to 1,600 acres, with a mean of 324 acres. Eleven raised swine in enclosed systems. The average age of tractors in use was 26 years. Twenty-eight percent of all tractors had cabs, 25% had ROPS, and 39% had PTO shields.     

从农民卫生服务需求看新农合制度的设计

目的：比较不同地区农民卫生服务需求特征,研究不同社会、经济文化背景下新农合制度的设计。方法：选取新农合试点的太原市城区（迎泽区、万柏林区、杏花岭区和尖草坪区）和农村（娄烦县）,利用家庭健康询问调查,收集农民卫生服务需要资料。比较城乡农民卫生服务需要特点,研究其影响因素。结果：城乡农民所处社会经济环境不同,社会人口学特征有显著差异;城乡农民卫生服务需要差别显著,娄烦县农民两周患病和慢性病患病率高于城区农民（P〈O．001）,两周患者平均卧床天数是城区农民的16．75倍。结论：贫困农村地区居民卫生服务需要量大、筹资能力低,为加强新农合在贫困地区的可持续发展,建议以地市为单位进行基金统筹,同时,有差别地在贫困农村实施以“大病统筹为主,兼顾特殊人群门诊利用”的制度设计模式。     

北京市农村社区老年人跌倒情况调查及影响因素研究

目的 探究北京市农村社区老年人跌倒发生情况。方法 2014年6-9月整群抽取北京市密云县城乡结合部巨各庄镇和山区农村冯家峪镇老年人群,采用问卷收集老年人跌倒流行病学特征、心理及躯体健康数据。结果 调查研究对象共2397人(男性967人,女性1430人),跌倒发生的总人数为347人,发生率为14.5%,其中男性跌倒93人(9.6%),女性跌倒254人(17.8%),女性跌倒发生率明显高于男性;在家庭院落发生的跌倒次数最多(282次),山地/田地跌倒(57次)为农村社区跌倒地点分布的特征;跌倒损伤率为27.2%,跌倒后引起的损伤部位以髋部损伤最多。跌倒的多因素分析中发现,体育锻炼及月收入较高为保护因素;起立行走试验异常、视力问题及脑卒中为跌倒的危险因素。男性老年人中独有的危险因素为轻度认知障碍,女性则为尿失禁,同时午睡在女性老年人跌倒中有保护意义。结论 北京市农村社区跌倒发生率相对较高,且有其独特的地区分布特点;跌倒对老年人的躯体及相关心理健康有较大危害。     

Birth Weight and Environmental Pollution in the County of Telemark,Norway

Abstract

The possible effect of environmental pollution on fetal growth was examined in 3,231 consecutively live born single infants (≥37 weeks' gestation) of Caucasian parents born between 1986 and 1988. The parents lived in an industrial area or in less polluted urban and rural residential areas. Information about lifestyle, health, and work exposures was collected from the parents. A significantly lower arithmetic mean birth weight was observed for newborns in the industrial residential area (3,517 g, SD, 482), compared with the urban (3,592 g, SD 495) and rural (3,618 g, SD 517) areas (P < 0.05). Even controlling for gestational age, sex, parity, maternal smoking habits, and social class, residential area still had a significant effect on birth weight. Among other factors examined, only maternal psychological stress at work had a significant effect on birth weight. If the observed association reflects a causal relationship, birth weight may represent a potential outcome parameter for surveillance of effects on humans of environmental exposures.     

新型农村合作医疗住院补偿流向分析

目的：了解宁夏新型农村合作医疗住院补偿流向。方法：采用系统随机抽样的方法,随机抽取宁夏的平罗县和隆德县2005年1月至2006年12月新型农村合作医疗住院补偿病人费用资料,利用国际系统疾病分类（ICD-10）对疾病分类,从补偿人数、补偿费用及病种3个角度分析住院补偿流向。结果：两县新型农村合作医疗住院补偿均以县级医院为主,但隆德县外医院住补偿费用、补偿人次数占比例较高,以较重、较复杂的慢性病为主;平罗县以0－岁、20－岁年龄组为主,隆德县以20－岁、40－岁龄组为主;顺产、剖宫产、阑尾炎、疝气、胆囊炎、胆结石、骨折病种较为常见。结论：山区基层医疗机构不能满足参合农民就医需求,农民疾病防范意识不高。应加强基层医疗机构建设,充分利用新型农村合作医疗家庭账户资金促进健康教育,增强健康意识;对较常见、治疗效果容易保证、质量容易控制的病种实施单病种付费。     

玉溪市农村居民慢性病卫生服务利用公平性分析

目的对玉溪市农村慢性病患者进行健康公平性和卫生服务利用公平性分析。方法采用集中指数、单因素分析方法对玉溪市3个县农民的卫生服务公平性进行评价。结果玉溪市农村居民慢性病患病率为6．3％,低于全国农村水平,慢性病患者卫生服务利用的集中指数为-0．02801。结论玉溪市农村居民慢性病患病率较低,且存在不公平性,慢性病患病人群集中在较低收入组,应加强对低收入人群的健康教育。玉溪市慢性病患者卫生服务利用公平性较好。     

The Aging Farm Population and Rural Aging Research

ABSTRACT

This article explores the potential and the promise of convergence between gerontological and occupational health researchers to better understand challenges faced by aging farmers including declining economic viability of family farms, the aging of the population of working farmers, and probability of work-related injury or disability among older farmers. Although the need for research seems obvious, the economic, demographic, and psychosocial dynamics of continued work among aging farmers is under-studied in the occupational health literature and absent in the gerontological literature. Following examination of studies of aging farmers drawn from the occupational health literature, we review studies of rural aging in the gerontological literature. First, we compare varying definitions of rural across federal agencies that impact the ability of researchers using these data to examine variability across rural places. Next, we review studies based upon primary data that include rural residence among their independent variables. We describe different definitions of rural residence across federal agencies with an eye toward their methodological and conceptual impact on the rural aging literature. Then we describe inadequate and incomplete definition and measurement of rural residence across published studies of primary data. Following discussion of the implications of these shortcomings for rural aging research including farmers and others engaged in extractive activities, we discuss the potential for joint work among gerontologists and occupational health researchers to better understand the significance of aging for transition in the agricultural economy and the viability of family farms. We recommend attention to the definition and measurement of rural residence to include variability in rural farm and non-farm populations and refocusing the occupational health literature on aging farmers to include a life course perspective from gerontological theory applied through longitudinal research designs.     

Biofuels and North American Agriculture – Implications for the Health and Safety of North American Producers

ABSTRACT

This decade has provided North American agricultural producers with opportunity to not only produce fiber and food, but also fuel and other industrial products. The drivers incenting this development could be sustained well into the future, therefore workforce safety and health implications are likely to persist for some time. Within production agriculture, the ‘feedstock growth and harvest cycle’ and ‘transport’ sectors possess the changing exposures experienced by workers. The Conference explored the following exposures: distiller's grains and bio-processing byproducts, spent catalyst, solvent brine, microbial agents, genetically modified organisms, discharge effluent, H2O dilutes, change in cropping patterns and resultant use of different seeding and harvest technologies, pests (whether target or non-target), and rural traffic resulting from concentrated movement of massive quantities of biomass and grain. Other issues of a more general public health nature such as watershed implications, other environmental impacts, emissions, uneven economic development potential, public safety issues associated with transport of both fuel and other industrial products, and rural emergency medical service need were explored. And, agronomic impacts were noted, including tillage change, potassium buildup in soil, nutrient depletion, sedimentation and erosion of tillable soil, and local esthetics. It was concluded that rural venues for formation and exploration of public policy need to be created.     

Environmental health perceptions of urban youth from low-income communities: A qualitative photovoice study and framework

Background

Children are amongst the most susceptible groups to environmental exposures, for both immediate and life-course health outcomes. Despite their increased susceptibility, children's knowledge, experiences and voices are understudied. A deeper understanding of children's environmental health perceptions has the potential to better inform policy, develop targeted interventions and improve public health outcomes.

Methods

In this study, our community–academic partnership used the Photovoice research method to examine how urban children from low-income communities perceive environmental influences on their health. Twenty children, ages 10–12, took photographs and participated in focus group interviews regarding their perspectives on how the environment influences their health.

Results

Qualitative analyses revealed five major thematic categories: environmental exposures, environmental health sentiments, environmental health outcomes, interest in environmental health and environmental health solutions. We used the findings to develop an environmental health perspective theoretical framework that can inform future work designed to promote the environmental health and well-being of children from low-income communities in urban communities.

Conclusion

Photovoice enabled children from low-income communities to capture and communicate their environmental health perceptions. These findings have the potential to inform and identify potential targets and opportunities for environmental health interventions and promotion in their communities.

Patient or Public Contribution

Partnerships with community-based organizations were central to the present study. By design, these community-based partners were involved in the conduct and procedures of the study.     

泸水县不同民族农村居民行为和自评健康状况调查

[目的]了解云南省泸水县各民族农村居民的行为方式、自评健康状况,为完善少数民族地区卫生政策提供依据。[方法]2007年10月,现场问卷调查随机抽取的泸水县246户农村居民。[结果]调查对象吸烟率为45.9%,男性吸烟者的烟龄平均为21.24±9.36年,日均吸烟量为16±5支;饮酒率为30.5%,男性饮酒者的酒龄为16.89±9.51年,日均饮酒量为250ml。男性吸烟率、饮酒率均明显高于女性(P0.001)。傈僳族男性农民的饮酒量高于白族(P=0.005)。调查对象认为不生病就是健康,自评健康状况较好。[结论]村民普遍存在吸烟、饮酒的行为,傈僳族男性农民更加突出,积极的健康观尚未广泛形成,应加强对农民的健康教育。     

Behavior Change,Environmental Hazards and Respiratory Protection Among a Southern Farm Community

ABSTRACT

The agricultural industry ranks as one of the most dangerous in terms of occupational deaths and injuries. A wide variety of respiratory illnesses can result from the exposure to grain and organic dusts and working in animal confinement facilities and barns. This article analyzes the Transtheoretical Model of Change for implications relevant to health promotion and education. This study explored differences of perception of occupational health, environmental exposures, and stages of change consistent with the readiness to take action and the confidence to act toward respiratory health among farmers who report respiratory symptoms with physical activity and those who do not. A convenience sample of 123 farm owners and agricultural employees recruited from community-based agricultural events in southeast and central Louisiana completed three surveys: (a) Health Risk and Environmental Assessment; (b) Identification of Respiratory Mask Use; (c) Stage of Awareness and Preventive Respiratory Health; and demographic information. Subjects performed pulmonary function tests including three Forced Vital Capacity (FVC) maneuvers while connected to a Renaissance spirometer. Even though the majority of subjects rated themselves in action stage of change, subjects reported using respiratory protective devices less than 10% of the time. No significant differences were found in environmental exposures. Using chi-square analysis, those farmers who reported breathlessness were significantly more likely to report fatigue, chest pain, and dizziness. Those farmers who report breathlessness are significantly less likely to perceive respiratory health as important compared to other occupational illnesses/conditions. There is a need for additional studies to further examine the relationship between respiratory symptoms, exposure risks, and behavior change theory.     

Risk factors for injury in rural Iowa: round one of the Keokuk County Rural Health Study

BACKGROUND: Unintentional injuries represent a major cause of morbidity and mortality in rural communities. This study aimed to determine the distribution of injury risk factors in a rural Iowa community and to identify the rural subgroups at highest risk for injury. METHODS: We reported on 1583 participants, aged > or =25 years, from Round One of the Keokuk County Rural Health Study, a longitudinal panel study of a rural community. The self-reported data were collected during face-to-face interviews. RESULTS: Our data suggested that several risk factors for injury are not uniformly distributed among rural populations. Male farmers were significantly less likely to wear their seatbelts than townspeople or rural nonfarmers. However, farm women were as likely to wear seatbelts as other women. Both male and female farmers were more likely to use all-terrain vehicles than townspeople or rural nonfarmers. In contrast, townspeople were more likely to ride bicycles than either farmers or rural nonfarmers. Townspeople were less likely to have firearms in their homes than either farmers or rural nonfarmers. Farmers were most likely to have fired a gun in the last year. Male farmers aged <65 years were less than half as likely as other men the same age to report a history of alcohol abuse. Binge drinking was equally frequent among farmers, rural nonfarmers, and townspeople. CONCLUSIONS: These differences in risk behavior in a rural county suggest the possibility of targeting specific rural injury prevention interventions at those with the highest risk for dangerous behavior.