National survey of ethical practices across rural and urban communities.

This study examines ethical dilemmas and problems that are encountered by psychologists across rural and urban communities. A survey instrument was created on the basis of previous surveys of ethical practices. A national sample of 1,000 psychologists stratified into urban and nonurban practitioners was surveyed; 447 usable surveys were returned. Data analysis revealed significant differences between small town/rural and urban/suburban groups for several ethical categories. Notably, small town/rural psychologists are more likely to encounter several types of multiple relationships than their urban counterparts. Small town/rural practitioners are also more likely to be highly visible, or well-known, in their communities. Qualitatively, respondents described their struggles with dual relationships, and several offered suggestions to cope with boundary issues. These findings suggest the need to study the practice of psychology in rural communities in more depth, to study the impact of rural characteristics on clients and practitioners, and to create a conceptual model of best practices for rural practitioners. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of return to a psychiatric hospital

Examined social factors as measured by a community adjustment scale and other known variables associated with recidivism for their ability to predict rehospitalization of 108 former psychiatric inpatients. One-third of this sample were readmitted to a psychiatric hospital during the 6-mo period. Multiple linear regression analyses indicated that 2 of the subscales of the Self-Assessment Guide, the number of previous hospital admissions, and whether the individual had been in the hospital during the year prior to admission accounted for a sizable portion of variance. Results suggest that social factors are important determinants of recidivism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceptions of care access: the experience of rural and urban women following brain injury

To examine care access among women with brain injuries, a qualitative, phenomenological study was conducted. Twenty-one women with acquired brain injuries were recruited for the inquiry, representing rural and urban regions of Colorado. The phenomenological approach allowed the investigators to examine the shared experiences of women with brain injuries as they sought rehabilitative supports and services, and attempted to re-enter their lives and communities. Each woman was interviewed one or two times, the interviews were transcribed and then coded and analysed by both authors separately. Thematic analysis of the data revealed two major emergent themes: issues surrounding diagnosis and barriers to accessing care. A total of 10 women interviewed experienced difficulty obtaining a diagnosis of brain injury and experienced serious personal and professional consequences as a result. All the women experienced barriers to accessing care, including problems with service providers and service systems, financial challenges, travelling for services, lack of information or services in their area, lack of care coordination and funneling. Some of the barriers cannot be changed secondary to cost, efficiency and logistics. Other barriers, could be changed through education, training and policy making.     

Pattern of paediatric blood pressure in rural, semi-urban and urban communities in Ilorin, Nigeria

The blood pressures of 2,526 children aged between 1 and 14 years were measured in their home environments in rural, semi-urban and urban communities in Ilorin. Blood pressure increased with age, but there was no significant difference between the communities. Girls had higher blood pressures than boys between the ages of 9 and 13 years, in the semi-urban and rural communities. The prevalence of high blood pressure in the urban community (9.5%) was higher, though not significantly so, than the rural community (6.3%). It is concluded that the prevalence of paediatric high blood pressure in the African is higher than previously reported.     

Perceptions of diabetes among rural Maori elders and spokespersons

AIMS: To assess knowledge and opinions of diabetes among rural Maori elders and spokespersons. METHODS: Interviews were conducted in rural South Auckland. Subjects were identified through their affiliation with one marae (meeting house), residence near the marae and being recognised locally as either male (kaumatua) or female (kuia) elders or spokespersons. The main researcher was a kuia chosen by and from within the local community. Interviews were conducted with 43/44 (98%) subjects identified. RESULTS: While specific diabetes knowledge was low, diabetes was seen, along with cancer, as one of the two major health issues for Maori. Results need to be understood in the context of the holistic understanding of health by Maori. CONCLUSION: The recognition of diabetes as a major health problem was accompanied by a call for diabetes education in a form that will generate interest and participation by Maori. It is timely for the introduction of marae based diabetes awareness and sustained exercise programmes as part of a diabetes prevention and control strategy among Maori communities where diabetes risk is high.     

Admission to hospital versus home care for stroke]

The incidence and prevalence of cerebrovascular disease is very high. This is a major sanitary problem. There are no studies comparing the management of acute stroke as inpatient or outpatient, publications about each of these items are analyzed. General Practitioners may play a very important role, not only at the first step in the attention of stroke patients. Admission criteria for stroke and hospitalization span for its different ethiopathogenic types are revised.     

Spine fractures in active duty soldiers and their return to duty rate

To evaluate the outcome of thoracolumbar spine fractures in active duty soldiers, we conducted a retrospective review of 23 soldiers followed at a single institution. Twenty-two charts were available for review. The average age was 31.9 years (range, 19-49 years), and the average follow-up was 3.6 years (range, 2-11 years). There were 20 males and 2 females. All injuries except one occurred between 1990 and 1994, and all were treated by a single surgeon. We attempted to correlate five independent variables with regard to whether the patient returned to his or her previous duty or was required to undergo a medical evaluation board to determine fitness for duty. The variables included military rank, physical job demands, fracture type, initial neurological status, and initial treatment (operative versus nonoperative). Fourteen of the 22 soldiers (64%) underwent medical evaluation boards, whereas 8 (36%) returned to their previous duties. We found a strong correlation between increasing military rank and return to preinjury duties. As expected, physical job demands correlated strongly with eventual disposition, in that soldiers in jobs with low physical demands were more likely to be retained on active duty in their present position. Neurologic status (except motor deficit), type of fracture (except fracture-dislocation), and initial treatment did not correlate well with eventual disposition.     

Factors associated with decisions about return to work in mothers of infants.

To better understand career-related choices made by mothers of infants, 82 mothers were interviewed in the maternity ward and 3 times in the next 12 mo. Mothers who were consistent in their plans not to work, from the maternity ward through the next 12 mo, were compared with mothers who in the maternity ward said they were not going to work but later changed their minds. The groups were similar in their anxiety about separation from their infants; they differed significantly with respect to accepting and adapting to infant discontent, beliefs about their babies' attachment, and the importance of a job or career in their lives. (2 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Talking with patients about their use of alternative therapies

Discussion of alternative therapy use provides the primary care clinician with important information regarding patients' health-related practices and beliefs. The dialogue itself may also serve as an important foundation for effective and mutually rewarding doctor-patient relationships. This article reviews demographic and ethnographic data that document patterns and rationales of complementary and alternative therapy use in the United States. Specific principles to facilitate discussion in counseling patients who use, or who consider use of, alternative therapies are discussed.     

Comparing the severity of obstructive sleep apnea in patients referred by urban and rural physicians

The occurrence of a subdural hematoma caused by the rupture of an intracranial aneurysm is rare. In our case, the patient is a 43-year-old woman who suffered from sudden onset of severe headache. Computed tomographic (CT) scan disclosed a subdural hematoma associated with subarachnoid hemorrhage. CT angiography and digital subtraction angiography revealed an elongated aneurysm adhering to the dura in the left Sylvian fissure. The subdural hematoma was evacuated and the aneurysm clipped. The patient made a full recovery.     

强化社会管理创新推动城乡统筹发展

一、垫江县近两年所取得的成效(一)社会政治稳定全县各级调解组织2010年度受理人民调解案件年度13553件,调解成功率99.2%.2010年全县信访件次、人次同比分别下降5.3%、3.6%.群众到县集访批次、人次,同比分别下降11.8%、9.5%;到市集访批次、人次,同比分别下降69.6%、42.2%;到京访人次同比下降47.6%.     

Abusive mothers: Perceptions of their own and their children's behavior.

Examined the role of parental perceptions, interpretations, and attributions in child abuse within a social-situational model. This model assumes that certain stimuli (e.g., perceptions) elicit and/or maintain abusive interactions in specific social "triggering" contexts. 12 abusive and 12 nonabusive mothers' (mean age 24.4 yrs) perceptions of their own and their children's behavior, particularly perceptions of intent, negative disposition, and childrearing abilities were studied in 3 triggering contexts: breaking an object, disobedience, and continual crying. Ss also completed the Social Readjustment Rating Scale. No group differences were found in perceptions of intent and disposition. Abusive Ss offered more positive explanations in situations in which their child broke an object and would not stop crying, and they felt significantly more doubt and anger in the disobedience and crying situations. Abusive Ss also faced significantly more stress than the nonabusive group. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exposure to polycyclic aromatic hydrocarbons in occupational versus urban environmental air

OBJECTIVES: To evaluate the balance between occupational and environmental exposure to suspended particulate matter (SPM) and polycyclic aromatic hydrocarbons (PAHs), comparison measurements were performed in a coal-fired power plant and the urban atmosphere from the town nearby. METHODS: The analysis of SPM for PAH content was done according to a high-performance liquid chromatography (HPLC)-based method. The microscopic assessment was performed using scanning electron microscopy (SEM) by silver coverage of the samples derived by air filter. RESULTS: Contrary to expectations, the results showed low levels of particle-bound PAHs in the occupational environment (< 1 ng benzo(a)pyrene/m3 air) and high levels in urban air (range 80-1250 ng benzo(a)pyrene/m3). The SPM collected from the power plant exhibited non-respirable characteristics (particles larger than 10 microm), whereas urban SPM almost exclusively contained respirable airborne particles (<3 microm). CONCLUSIONS: The PAH burden, combined with the enhanced probability of respiratory absorption, confers a much greater hazard potential to the urban SPM. Under these conditions, in areas or countries in which old technologies remain in use, occupational exposure to SPM containing PAHs might represent a severe underestimation of the total risk as it does not take into account the background air pollution.     

Impact of antitrust laws on physician networking and rural communities

After reviewing the history of antitrust legislation and established zones of safety for providers and the application of antitrust laws to the healthcare industry in two earlier installments, the authors explore the consequences of the vigorous application of antitrust laws to physician networking, with an emphasis on rural communities. They review common exemptions to antitrust laws that maintain the uneven distribution of power in the evolving healthcare market. Acknowledging the tenuous ground that providers hold in the struggle for control of the healthcare industry, the authors argue for greater consideration of the unique circumstances and barriers that tend to prohibit the formation of strong, physician-sponsored, integrated healthcare networks. The authors have tested the climate for relief from the antitrust enforcement agencies in Washington, DC, and have found no easing of antitrust legislation forthcoming. However, following the resolution of several antitrust cases in recent months, barriers to physician-led organizations appear to be lessening. The authors close with a review of several strategies to minimize the risk of antitrust challenges.     

How should we talk about acute leukaemia to adult patients and their families?

Problems of communication with patients with acute leukaemia and their families were explored by interviewing the next of kin of 26 patients, six of whom were still alive. In all but two cases the diagnosis had been disclosed to the relatives before the patient, but almost one-third of the relatives were not entirely satisfied with the way in which the diagnosis was presented. Medical prognostications at these initial interviews were, on the whole, regarded as being realistic by the relatives. Nine patients learnt of their diagnosis at an early stage, but relatives were undecided whether patients should be told of the diagnosis in explicit terms. Patients often established complete dependence on the hospital and its staff and had difficulties in relating to their own general practitioners while at home during their illness. Social chats were preferred by the relatives rather than regular progress reports from the doctors.     

Prevalence of wheeze and asthma and relation to atopy in urban and rural Ethiopia

BACKGROUND: Asthma and allergy in developing countries may be associated with adoption of an urbanised "western" lifestyle. We compared the rates of asthma symptoms and atopy in urban populations in Jimma, southwest Ethiopia, at an early stage of economic development with those among the population of remote, rural, subsistence areas, and assessed the potential role of environmental aetiological factors leading to the differences. METHODS: Information on wheeze of 12 months' duration, diagnosed asthma, and cough for 3 months of the year was gathered by questionnaire in random household samples of 9844 people from urban Jimma and of 3032 from rural areas. Atopy was defined by allergen skin-test response to Dermatophagoides pteronyssinus and mixed threshings measured in a one-in-four subsample of those aged 5 years and older from both groups. FINDINGS: All respiratory symptoms were rare in children and were significantly less common overall in the rural than in urban group (wheeze odds ratio 0.31 [95% CI 0.22-0.43], p < 0.0001). Asthma was reported by 351 (3.6%) of the urban group, with a median reported duration of 8.5 years (IQR 4-17 years) that was unrelated to age. Atopy was a strong risk factor for asthma in urban Jimma. In the rural areas, skin sensitivity to mixed threshings was only slightly less common than in urban Jimma (0.67 [0.40-1.12], p = 0.13), whereas sensitivity to D pteronyssinus was significantly more common (3.24 [2.40-4.38], p < 0.0001), and since none of the 119 atopic individuals in the rural area reported wheeze or asthma, atopy was possibly associated with a reduction in the risk of disease among this group. Wheeze or D pteronyssinus sensitivity were positively associated with housing style, bedding materials, and use of malathion insecticide, but no single factor accounted for the urban-rural differences. INTERPRETATION: Wheeze and asthma are especially rare in rural subsistence areas, and atopy may be associated with a reduced prevalence of these symptoms in this environment. In urban Jimma, self-reported asthma seemed to emerge as a clinical problem about 10 years before our study began, which is consistent with an effect of new environmental exposures. The factor or factors leading to the increase in asthma and allergy have not been identified, although exposures related to general changes in the domestic environment are likely to be involved.