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Knowing when but not how! - Mothers' perceptions and use of antibiotics in a rural area of Viet Nam

TROPICAL DOCTOR 2000年第1期30卷 6-10页

作者： Halfvarsson, J Heijne, N Ljungman, P Ham, MN Holmgren, G Tomson, G Uong Bi Hospital Quang Ninh Province Viet Nam.

Given the world-wide focus on how to rationally use antibiotics, national drug policy programmes have been developed in many countries in order to minimize the environmental antibiotic pressure and thereby hopefully limit increasing bacterial resistance. This study investigated perceptions of antibiotics in a health system with weak drug regulation. The study was conducted in two rural communes in Viet Nam, with a drug market characterized by the increased accessibility and consumption of pharmaceuticals. The study focused on rural mothers' perceptions and use of antibiotics in the treatment of acute respiratory infections (ARI) in children 5 years and under. A combination of qualitative and quantitative methods were used including key informant interviews, focus group discussions, and interviews with mothers and drug vendors. The study demonstrated that using a combination of qualitative and quantitative methods gives a better understanding of the prevailing perceptions and use of antibiotics in communities. The results showed that the mothers recognized well the signs of severe ARI and that antibiotics were reserved for more severe illness episodes, where penicillin V and ampicillin were first drugs of choice. However, the mothers' perceptions and use of antibiotics reflects indigenization of antibiotics into traditional Vietnamese thinking and medical practice. This resulted in self-medication and a respect for antibiotics from the mothers point of view. A first step towards the rational use of antibiotics is already taken where mothers, as the health decisionmaker, know when to initiate antibiotic treatment and try to limit unnecessary use of antibiotics. The next step is to develop a well-functioning health education programme in order to promote the correct use of antibiotics for a successful clinical outcome. This requires acknowledgement of the mothers' culture based behaviour.

关键词：急性病抗菌药/治疗应用健康态度/人种学药物利用集中研讨小组健康教育/组织和管理健康知识态度实践医学东方传统母亲/教育母亲/心理学问卷调查呼吸道感染/药物疗法农村卫生/统计学和数值数据自我投药法/方法自我投药法/统计学和数值数据越南成年人儿童学龄前女(雌)性人类男(雄)性

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Studying the Retention of Rural Physicians

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The Journal of Rural Health 1994年第3期10卷 183-192页

作者： Pathman, Donald E. Konrad, Thomas R. Agnew, Christopher R. 1 Pathman is an assistant professor in the Department of Family Medicine and research associate of the North Carolina Rural Health Research Program of the Cecil G. Sheps Center for Health Services Research of the University of North Carolina at Chapel Hill NC. His research interests include rural and primary care health manpower issues and federal and state health programs evaluation. He is a past rural physician.2 Agnew is a doctoral candidate in the Social Psychology Program in the Department of Psychology and a statistical consultant at the Institute for Research in Social Science at the University of North Carolina at Chapel Hill. He also is a predoctoral fellow at the Carolina Population Center. His research interests include the application of social scientific research and methodology to a broad range of societal problems.

Rural communities and policy‐makers struggle with efforts to enhance the retention of rural physicians. Research available to guide these efforts is often weak methodologically and thus may be pointing retention efforts in nonproductive directions. This article discusses a range of methodologic issues encountered in rural physician retention studies for the purpose of strengthening future studies. Ideal study approaches to answer causal questions, including questions about the “causes” of rural physician retention, must demonstrate good internal validity, for which chance, bias, and confounding are accounted. Retention studies that rely simply on asking physicians why they stay or leave rural areas can be useful at times, but are too prone to bias and their findings difficult to verify. Simply identifying what physicians find satisfying or dissatisfying about rural work also will not reliably reveal why they stay or leave, a related but still distinct question. Stronger approaches to studying retention include the traditional quantitative study – in which retention factors are identified when they are statistically related to physicians’retention, and the increasingly popular qualitative study – in which retention issues are revealed through prolonged, in‐depth interactions with physicians. This article also discusses various definitions of retention, the use of survival curves to present retention findings, and the importance of studying retention in inception cohorts. The benefits and downside of studying retention with prospective and retrospective study designs are described. Copyright © 1994, Wiley Blackwell. All rights reserved

关键词：职业流动性队列研究卫生服务研究职业满意个人满足人员的忠诚人员调整/统计学和数值数据医师/供应和分配专业场所/统计学和数值数据农村卫生/统计学和数值数据美国人类

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Evaluation of a campaign to improve immunization in a rural headstart program

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JOURNAL OF COMMUNITY HEALTH 1999年第1期24卷 13-27页

作者： Mayer, JP Housemann, R Piepenbrok, B St Louis Univ Sch Publ Hlth Div Behav Sci & Hlth Educ St Louis MO 63108 USA St Louis Univ Sch Publ Hlth Prevent Res Ctr St Louis MO 63103 USA

This study evaluated an intervention to improve immunization rates in a high poverty, medically underserved rural area employing a pretest-posttest design. The intervention expanded immunization availability, established walk-in appointment policies, and introduced intensified parent education. Formative evaluation indicated specific messages with high salience to parents. As a result, the susceptibility and severity of childhood infectious disease, the outcome efficacy of vaccines, and methods to reduce barriers to immunization were emphasized in communications with parents. Data on DTP1-4, OPV1-3, and MMR were obtained from preschools, local health departments and private medical practices before (n = 567) and after the intervention (n = 331). Following adjustment for birth order and demographics, at post-intervention a significantly greater proportion of children received 6 of 8 vaccines on time. Effect sizes were large. For example, post MMR rates were at least 2X greater than pre rates. Time-series analysis of vend data on local newspaper coverage of child health topics suggested history was not a major threat to the internal validity of this pre-post only design. The findings indicate that comprehensive intervention, targeting improvements in the availability of pediatric care, health system policies and parent behavior, can improve immunization.

关键词：健康态度人口统计学健康知识态度实践免疫接种规划/统计学和数值数据缺医地区密苏里贫困方案评价问卷调查可重复性结果农村卫生/统计学和数值数据女(雌)性人类男(雄)性

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Predictors of alcohol use among rural adolescents

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JOURNAL OF RURAL HEALTH 1996年第5期12卷 378-385页

作者： Felton, GM Parsons, MA Pate, RR Ward, D Saunders, R Valois, R Dowda, M Trost, S UNIV S CAROLINA SCH PUBL HLTHDEPT EXERCISE SCICOLUMBIASC 29208 UNIV S CAROLINA DEPT HLTH PROMOT & EDUCSCH PUBL HLTHCOLUMBIASC 29208

There is increasing evidence that alcohol rise is becoming more common during childhood and early adolescence. However, little is known about alcohol use among rural youths. This article reports a study of alcohol use among 367 fifth-grade students in two rural South Carolina school districts. More than one third (n=131) of the fifth graders reported having used alcohol. Of these, 34 percent (n=44) reported drinking during the previous month;8 percent had been intoxicated during the previous two months;and 54 percent reported drinking in the home with or without parental approval. Logistic regression analysis was used to determine the predictors of alcohol use by fifth graders. The results indicated that gender (OR=2.82), mother's alcohol use (OR=1.86), father's alcohol use (OR=2.13), and smoking (OR=8.30) were significantly associated with alcohol use. The findings suggest that prevention programs address cigarette smoking and drinking behaviors of parents to reduce alcohol use and the acquisition of other health compromising behavior by youths. Early intervention approaches must go beyond the schools and target families as well as community populations.

关键词：青春期行为饮酒/流行病学饮酒/发展趋势数据收集预测健康行为冒险农村卫生/统计学和数值数据农村卫生/发展趋势性别因素吸烟/流行病学南卡罗来纳/流行病学青少年女(雌)性人类男(雄)性

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The Use of Health Service Areas for Measuring Provider Availability

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The Journal of Rural Health 1991年第4期7卷 347-356页

作者： Makuc, Diane M. Haglund, Bengt Ingram, Deborah D. Kleinman, Joel C. Feldman, Jacob J. Centre for Primary Care Research of Uppsala University in Uppsala Sweden Division of Analysis National Center for Health Statistics Hyattsville Maryland United States National Center for Health Statistics at the Centers for Disease Control Hyattsville Maryland United States

Measurement of the availability of health care providers in a geographic area is a useful component in assessing access to health care. One of the problems associated with the county provider‐to‐population ratio as a measure of availability is that patients frequently travel outside their counties of residence for health care, especially those residing in nonmetropolitan counties. Thus, in measuring the number of providers per capita, it is important that the geographic unit of analysis be a health service area. We have defined health care service areas for the coterminous United States, based on 1988 Medicare data on travel patterns between counties for routine hospital care. We used hierarchical cluster analysis to group counties into 802 service areas. More than one half of the service areas include only nonmetropolitan counties. The service areas vary substantially in the availability of health care resources as measured by physicians and hospital beds per 100,000 population. For almost all of the service areas, the majority of hospital stays by area residents occur within the service area. In contrast, for 39 percent of counties, the majority of hospital stays by county residents occur outside the county. Thus, the service areas are a more appropriate georgraphic unit than the county for measuring the availability of health care. Copyright © 1991, Wiley Blackwell. All rights reserved

关键词：卫生服务范围/统计学和数值数据聚类分析卫生人力/统计学和数值数据卫生服务易得程度/统计学和数值数据卫生服务需求/统计学和数值数据缺医地区国家卫生统计中心(美国) 医师/供应和分配农村卫生/统计学和数值数据小地区分析旅行美国城市卫生/统计学和数值数据

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Health Promotion for the Rural Elderly

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The Journal of Rural Health 1988年第3期4卷 85-96页

作者： Lubben, James E Weiler, Philip G. Chi, Iris Jong, Fred De Dordt College Sioux Center Iowa United States

There has been increased interest in developing health promotion programs for the rural elderly as a means to foster successful aging. The present study describes one such program and identifies rural and urban differences in health promotion activities. Data corne from the California Preventive Health Cane for the Aging Program (PHCAP) which is one of the oldest and largest such programs in the United States. A sample of over 5,000 PHCAP clients was draum from rural, semi‐rural and urban projects. Though the rural and urban clients differed significantly with respect to demographic characteristics, differences in health promotion practices were relatively minor. However, the health promotion practices of semi‐rural residents differed considerably from that in rural projects. Though less disabled, semi‐rural clients received a greater scope of health promotion activities than rural clients. The authors discuss possible site, practitioner and client factors which may bave accounted for rural health promotion activities being more restricted. Regardless of Project site, the California PHCAP detected many health problems and a majority of clients were referred to other health professionals for treatment. Copyright © 1988, Wiley Blackwell. All rights reserved

关键词：加利福尼亚健康促进/组织和管理生活方式转诊和会诊农村卫生/统计学和数值数据农村人口社会经济因素郊区人口市区人口老年人人类

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Access to Health Care: Urban‐Rural Comparisons from a Midwestern Agricultural State

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The Journal of Rural Health 1995年第2期11卷 128-136页

作者： Comer, John Mueller, Keith Nebraska Center for Rural Health Research University of Nebraska Medical Center Omaha Nebraska 68198‐4350 600 S. 42nd St United States

Abstract: Lack of access to quality health care for a large number of Americans, particularly those living in rural areas, is a major health care problem. Differences in access between rural and urban areas are caused by obstacles to providing adequate care, such as hospital closures and physician shortages, and low income and/or employment that does not provide health insurance as an employee benefit. This study, based on a random sample of 6,000 households in Nebraska, finds that access to health care is better for residents of rural than urban areas. The relationship holds with controls for health status and health insurance. The pattern in Nebraska reflects an absence of differences in income, health insurance, and health status that produce differences in access between rural and urban areas nationwide. The findings suggest that any serious proposal to reform health care delivery should involve the states and use established patterns of seeking care among state residents. Copyright © 1995, Wiley Blackwell. All rights reserved

关键词：数据收集卫生服务易得程度/统计学和数值数据健康状况医院/利用收入/统计学和数值数据保险健康/统计学和数值数据内布拉斯加诊室就医/利用农村卫生/统计学和数值数据城市卫生/统计学和数值数据

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Enhancing the Representation of Rural Areas in the National Medical Expenditure Survey

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The Journal of Rural Health 1993年第3期9卷 188-203页

作者： Cohen, Steven B. Ward, Edward P. Agency for Health Care Policy and Research Rockville Maryland 20852 2107 E. Jefferson St. Suite 500 United States

Abstract: This study examines the issues associated with enhancing the representation of rural areas in the National Medical Expenditure Survey (NMES). It reviews alternative definitions of rural areas and describes the classification schemes considered for future cycles of the NMES. A review of the NMES sample representation in rural areas and an examination of the analytical capabilities and limitations of the current design for deriving health care estimates of the rural population is provided. The options presented in this article would extend the analytical capacity of the NMES to permit estimates of rural areas of the national classified by census region, by gradations of rural classification, and for individuals residing in rural frontier counties. Copyright © 1993, Wiley Blackwell. All rights reserved

关键词：卫生服务范围/经济学卫生服务范围/统计学和数值数据数据收集评价研究卫生经费支出/分类卫生经费支出/统计学和数值数据卫生服务研究/方法可重复性结果研究设计农村卫生/统计学和数值数据抽样研究美国美国卫生保健研究和质量评估署

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Self‐Care and Illness Response Behaviors in a Frontier Area: Rural Health Research

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The Journal of Rural Health 1992年第1期8卷 4-12页

作者： Bartlome, Jeffrey A. Bartlome, Patricia Bradham, Douglas D. 1 Bartlome is director of the Institute of Rural Health Studies in the College of Health Related Professions at Idaho State University. He is currently a doctoral candidate in the Department of Pharmacy Practice and Administrative Sciences College of Pharmacy. His research interests include pharmaceutical health care with emphasis in areas of rural primary health issues of providers and consumers.2 Bartlome is assistant professor in the Department of Pharmacy Practice and Administrative Sciences in the College of Pharmacy at Idaho State University. She received her doctorate followed by a residency and the ASHP Post-Doctorate Fellowship in Geriatric Pharmacotherapy at the University of Utah. Her research interests include pharmacotherapeutic effects on physical and psychological function of geriatric patients primary care chronic disease management and patient medication education.3 Bradham is an associate professor in the Department of Health Policy and Management at the University of South Florida's College of Public Health in Tampa FL. He has been involved in rural health primary care and public agency fiscal and managerial analysis and technical assistance for nearly 20 years. Bradham's research has focused on elderly health services since in Florida as well as cost effectiveness and efficiency in home health and rural primary care.

Self‐care and illness response to a recent medical event were examined based on a mailed questionnaire to a random sample of 416 adults in a frontier area in north‐central Idaho. A total of 494 questionnaires were returned (45% response rate), and 78 were eliminated. Self‐care behaviors were classified as: (1) waiting to see what would happen, (2) purchasing or taking a nonprescription medication, (3) taking a prescription medication that was on hand, (4) taking both a prescription and a nonprescription medication, (5) contacting a physician, and (6) going to a hospital. These six variables were classified into three intervention constructs of no intervention (waiting), informal intervention (self‐medicating), and formal intervention (contacting a health care professional). Fifty‐six percent of the respondents reported self‐medicating behaviors. Correlation analysis indicated that initial self‐care and illness response behaviors in this frontier area were generally appropriate. Three multiple discriminant models were tested to differentiate those people who waited, self‐medicated, and contacted formal providers from those who did not. A significant model could not discriminate between those who waited and those who did not. Models for self‐medicating and contacting formal providers correctly classified cases 60 to 70 percent of the time. The analyses indicate that self‐medicating was more likely to be reported by younger individuals, by those who lived further from the hospital, who perceived their health status to be better, who reported less satisfaction with community health care services, and that the self‐medicating was appropriate. Those respondents most likely to contact the physician reported a lower perceived health status, a higher level of appropriateness of seeking formal health care services, a perceived physician shortage as a serious community problem, greater use of a number of prescription medications in the previous two weeks, and reported living i

关键词：判别分析评价研究健康知识态度实践卫生服务研究/方法健康状况爱达荷/流行病学病人接受卫生保健的程度/统计学和数值数据问卷调查农村卫生/统计学和数值数据自我护理/心理学自我护理/统计学和数值数据自我护理/利用自我投药法/心理学自我投药法/统计学和数值数据自我投药法/利用社会经济因素成年人女(雌)性人类男(雄)性

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Economic impact of hospital closure on small rural counties, 1984 to 1988: Demonstration of a comparative analysis approach

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JOURNAL OF RURAL HEALTH 1999年第4期15卷 375-390页

作者： Probst, JC Samuels, ME Hussey, JR Berry, DE Ricketts, TC Univ S Carolina Sch Med Dept Family & Prevent Med Columbia SC 29203 USA Univ S Carolina Sch Publ Hlth Masters Publ Hlth Program Dept Hlth Adm Columbia SC 29208 USA Univ S Carolina Sch Publ Hlth Dept Epidemiol & Biostat Columbia SC 29208 USA Univ Nevada Dept Hlth Adm Sch Business Las Vegas NV 89154 USA Univ N Carolina Dept Hlth Policy & Adm Chapel Hill NC USA

Hospital closure in a rural community may affect the locale's economic prospects as well as the health of its residents. Studies of economic effects have primarily relied on modeling techniques rather than observation of actual change. This study demonstrates the use of a comparative analysis approach for estimating the economic effects of hospital closure on small rural counties. The experiences of 103 small rural counties at which a hospital closed between 1984 and 1988 was compared with a matched group of counties at which no closure took place. "Comparable" counties were selected based on seven scales measuring the similarity between a closure county and potential comparisons. Three scales examined population and economic characteristics in the year before closure;two scales measured change throughout a three-year period preceding closure;and two scales measured change throughout a five-year period preceding closure. Closure effects were measured through a multivariate analysis of the post-closure economic history of closure and comparison counties. The key assumption is that similar counties should have similar experiences over time. If an event occurs within some of these counties but not others, this event should have visible effects. Comparative analysis suggested that earned income in closure counties (excluding farming and mining income) was lower than in comparison counties subsequent to closure and that labor force growth was similarly affected. A comparative analysis approach produces results that parallel those obtained from economic modeling and should be considered for further research.

关键词：卫生设施关闭/经济学卫生服务研究健康状况医院乡村/经济学收入/统计学和数值数据模型经济计量学多元分析人口增长农村卫生/统计学和数值数据美国人类

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