ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1996.tb00789.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:This study sought to determine the effects of mental health variables on rural adolescents' use of ambulatory health care services and whether these effects varied across common outpatient settings. Using a cross‐sectional survey design, 2,297 adolescents who attended public schools in grades 7 through 12 in one isolated rural Mississippi River Delta county were assessed via a standardized health behavior survey. This self‐report measure inquired about relevant health behaviors such as alcohol use, depressive symptoms, and health service use. The students' mean age was 15 years and 58 percent of the sample were black. Approximately 11 percent of the sample reported symptoms of depression, 16.5 percent reported problem drinking, and slightly fewer than 6 percent reported both. After controlling for predisposing, enabling, and need factors, the reporting of depressive symptoms, problem drinking, or both was related to an increased number of outpatient visits in three of four sites examined. However, differences among sites were observed. These data suggest that mental health problems are associated with increased visits to ambulatory settings, and these problems affect service use differentially. Thus, effective interventions and better linkages between ambulatory settings and mental health providers may reduce unnecessary

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1996.tb00790.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Hispanics are the fastest growing minority in the United States and are currently Washington state's largest minority, with the highest growth rates found in the rural agricultural areas of eastern Washington state. Because breast and cervical cancer mortality rates are higher in Hispanics than other U.S. women, subgroups of Hispanic women with the lowest cancer screening utilization rates need to be identified and targeted for cancer control intervention to most effectively reduce late‐stage cancer diagnoses and mortality. A study was conducted at six migrant health clinics located throughout eastern Washington state to discern age‐specific proportions for utilization of mammography, breast self‐examination, and Pap smears among Hispanic migrants to the United States. Knowledge and attitudes regarding these procedures also were assessed and face‐to‐face interviews were completed with 512 women.Among women 20 years or older, 15 percent had never heard of a Pap smear, only 78 percent had ever received a Pap smear, and only 44 percent had received a Pap smear within the prior year. In all, 73 percent of the women had been taught breast self‐examination, 62 percent performed breast self‐examination, and 41 percent had performed a breast self‐examination in the prior month. Among women 40 years or older, only 38 percent had never heard of a mammogram, 38 percent had ever received a mammogram, and only 30 percent had received a mammogram in the prior two years. Cost was reported as a major barrier for screening in this population. Additionalzy, a substantial proportion of the women perceived Pap smears and mammography as unnecessary or diagnostic procedures, rather than preventive health measures.The above breast and cervical cancer screening rates fall well below those documented in national studies of US. women and Hispanic women, as well as below the recommended guidelines of the American Cancer Society and the National Cancer Institute. Culturally sensitive in tmentions to increase cancer screening knowledge and rates are urgently needed for high‐risk groups of Hispanic women, especially those

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1996.tb00791.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Expansion of the world's elderly populations has increased concerns about aging‐related medical disorders like Alzheimer's disease and other dementias. In the United States, one fourth of those older than age 65 and at greatest risk for developing dementia live in rural environments that may influence its manifestation. The objectives of this study were to determine the need for and potential benefits of further epidemiological research concerning dementia and similar disorders in rural U.S. populations and to identify pertinent methodological issues related to rural dementia research. This study employed a National Library of Medicine (MEDLINE) document search based on the key words “cognitive disorders,”“dementia,”“Alzheimer's disease,” and “rural,” followed by recovery of literature resources referenced in the bibliographies of selected articles.Nineteen studies focusing on dementia or related disorders in rural settings have been reported from around the world. While four of these were conducted in the United States, only one rural dementia prevalence study has been undertaken in this country. Because of methodological variability, comparisons of prevalence estimates between these rural studies, as well as with those from urban investigations, is difficult. Nonetheless, there is reason to believe that certain potentially dementing illnesses are more common in rural populations. There is also evidence to suggest that the screening instruments commonly used in such studies tend to misclassify rural elders as “false positive” dementia cases.Information regarding dementing disorders, particularly Alzheimer's disease, in rural populations is scarce. Preliminary observations that dementia may be more common in rural settings and that rural families are more likely to maintain their dementing elders in the community imply that further rural dementia research could yield important insights into the risk factors for these illnesses, the variables influencing their course, and the methods by which they can be more effectively managed. A determination of the reliability and validity of commonly used dementia screening instruments in rural populations would represent an important advancement in

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1996.tb00792.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:This study examined the relationships among gender, perceived financial barriers to health care, and selected health status indicators in a randomly selected rural Appalachian sample. The data were gathered through the Johnson County Health Survey. The survey was conducted through personal interviews with 207 females and 178 males representing 197 households. The Duke Health Profile was used to measure the perceived health of the respondents. Analysis of variance, t tests, and descriptive statistics were used to analyze the data. Analysis of the data revealed that women perceive financial barriers to health care significantly more than men(P<0.01),even when living in the same household; women had significantly poorer health than men(P<0.01);and both women and men with perceived financial barriers experienced poorer health(P<0.01)than those who did not perceive such barriers. Conclusions from the study suggest that in this rural sample women were the most compromised by both gender and health status, and that they perceived that their health care needs were not being adequately met.

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1996.tb00793.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:As the national health debate evolved over the past two years, a need to better understand the differential constraints of rural health delivery and popular attitudes toward policy initiatives became apparent. Selected 1994 and 1995 results of two national surveys designed to compare rural and urban household responses are reported. The average distance those living in rural households must travel to access medical providers and emergency care is nearly double that of urban household residents. Rural household resident responses show a higher level of acceptance of nonphysician health care providers such as physicians assistants and registered nurses. Means testing of Medicare programs and use of special indicators for providing more Medicaid funds to states with medically underserved and sparsely populated areas are examples of two policy initiatives that receive favorable responses from both urban and rural household residents, but would disproportionately benefit rural areas.

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1996.tb00794.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Health values, behaviors, and status are shaped by place of residence, region, race, and socio‐economic status, among other social factors. Consequently, this article examines barriers to preventive health services for lower‐income blacks in five rural counties in Georgia. Qualitative and quantitative data were collected through 281 household, 51 community leader, and six focus group interviews. Female respondents who had been pregnant were most Iikely to have received pregnancy‐related services and all respondents least likely to have received vision and dental screenings. Six of the seven types of services inquired about were most likely to have been received in a private practice setting. Primary barriers to preventive service utilization included ability to pay, perception of need, service availability, accessibility of services, and the perception of racism. The relationship between structural and nonstructural barriers, their impact on preventive service utilization, and research recommendations also were developed and pres

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1996.tb00795.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:This study sought to compare the health status of adult residents of medically underserved areas (MUAs) with adult residents of nonshortage areas (non‐MUAs). A random digit dialing telephone survey was used. Respondents were subsequently classified by their county of residence as residing in an MUA or non‐MUA. A sample of 421 adults (aged 18 years or older) residing in Kentucky during 1993 were included in the analysis. Health status was measured by the Medical Outcomes Study 20‐item Short‐Form Health Survey's (SF‐20) six subscales.After controlling in the multiple regression for demographic variables there were no significant differences between residents of MUAs and non‐MUAs for the physical functioning, role functioning, general mental health, self‐perception of health, or pain subscales. The social functioning subscale was significantly related to the residence in an MUA. The demographic variable “education” was a consistent predictor of each of the health status subscales.Excepting the social functioning subscale, residents of MUAs do not have significant differences in health status when compared to residents of non‐MUAs. Future policy may need to focus on other health services shortage area designators that are more highly associated with the health status of residents. Consideration should be given to including the education demographics of areas or populations in health services shortage d

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1996.tb00796.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:This study of firms offering mobile hospital technology to rural hospitals in eight northwestern states found that several permanently parked computerized tomography (CT) units were found where mobile routes had atrophied due to the purchase of fixed units by former mobile CT hospital clients. Based on a criterion of 140 scans per month per unit as a threshold of profitable production, units owned by larger firms (those that operate five or more units) were more likely to be profitable than units owned by smaller firms (71% versus 20%, P=0.03). A substantial number of rural hospitals lose money on mobile CT due to low Medicare reimbursement. In some areas, mobile hospital technology is a highly competitive industry. Evidence was found that several firms compete in some geographic areas and that some firms have lost hospital clients to competing vendors.

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1996.tb00797.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

“Research Reviews” are a regular feature ofThe Journal of Rural Health,presenting current research on a particular theme or topic of inter

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1996.tb00798.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY