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The criminalization of persons with serious mental illness living in rural areas

JOURNAL OF RURAL HEALTH 1997年第1期13卷 6-13页

作者： Sullivan, G Spritzer, K UNIV ARKANSAS MED SCI HOSP 5800 W 10TH STSUITE 605LITTLE ROCKAR 72204 USA

In the context of restrictive admissions policies at public inpatient facilities, rates of arrest and incarceration of persons with serious mental illness (SMI) have been increasing, leading to the perception that SMI persons are being unduly ''criminalized.'' This paper describes the characteristics of persons with SMI (N=177) in Mississippi who have been (1) jailed without charges while awaiting a hospital bed and (2) jailed for a criminal offense. Seventy-five percent (N=132) of the 177 subjects had been held in local jails awaiting state hospital admission at least once in their lives, most for move than five days. Fifteen percent (N=26) had contact with the police for a criminal offense in the past year. Rural residence markedly increased the risk for waiting in jail (OR=4.24) but was not related to committing a criminal offense. Protective factors for any type of criminal justice contact were female gender, caucasian ethnicity, better compliance with medication regimes, and nonrural residence. The phenomenon of rural criminalization, i.e., waiting in jail without criminal charges, differs qualitatively from the criminalization that occurs in urban areas and may require a different solution. To avoid criminalization of SMI persons in rural areas, public mental health systems must develop effective crisis interventions in the community or work with local law enforcement officials and medical and mental health facilities to create more immediate access to acute inpatient care.

关键词：刑法数据收集人口统计学医院精神病/利用精神障碍/流行病学精神卫生服务/利用密西西比/流行病学病人入院囚犯/分类囚犯/心理学囚犯/统计学和数值数据监狱/利用公共卫生管理农村卫生/统计学和数值数据青少年成年人女(雌)性人类男(雄)性中年人

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The role of race and residence in determining stage at diagnosis of breast cancer

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JOURNAL OF RURAL HEALTH 1997年第2期13卷 99-108页

作者： Amey, CH Miller, MK Albrecht, SL UNIV FLORIDA DEPT HLTH POLICY & EPIDEMIOL POB 100177 GAINESVILLE FL 32610 USA

Breast cancer kills more than 46,000 women each year. Previous research has found that minorities and those who reside in geographically remote settings are particularly vulnerable. However;virtually no research has been done on the potential ''double jeopardy'' faced by rural minority women. This research examines (1) the extent to which racial and residential differences contribute to differences in stage at diagnosis;(2) the existence of an interaction between race and residence, which may place black rural women at greater risk;and (3) the influence of both individual and structural characteristics on racial and residential differences. The findings indicate that rural black women are diagnosed with breast cancer much later than are black urban women or whites of either residence. A number of individual and structural variables were influential in predicting stage at diagnosis, yet none of these accounted entirely for racial differences.

关键词：非洲裔美国人/统计学和数值数据乳腺肿瘤/诊断乳腺肿瘤/死亡率乳腺肿瘤/病理学大陆人口群人口统计学卫生服务易得程度/统计学和数值数据肿瘤分期病人接受卫生保健的程度/统计学和数值数据居住特征危险因素农村卫生/统计学和数值数据时间因素美国妇女卫生成年人老年人女(雌)性人类中年人

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Rural Residence and Poor Birth Outcome in Washington State

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The Journal of Rural Health 1992年第3期8卷 162-170页

作者： Larson, Eric H. Hart, L. Gary Rosenblatt, Roger A. Rural Health Research Center Department of Family Medicine University of Washington Seattle United States Department of Family Medicine School of Medicine University of Washington Seattle United States

It is often assumed that poor birth outcomes are more common among rural women than urban women, but there is little substantive evidence to that effect. While the effectiveness of rural providers and hospitals has been evaluated in previous studies, this study focuses on poor birth outcomes in a population of rural residents, including those who leave rural areas for obstetrical care. Rural and urban differences in rates of inadequate prenatal care, neonatal death, and low birth weight were examined in the general population and in subpopu‐lations stratified by risk and race using data from five years (1984‐88) of birth and infant death certificates from Washington state. Also examined were care and outcome differences between rural women delivering in rural hospitals and those delivering in urban facilities. Bivariate analyses were confirmed with logistic regression. Results indicate that rural residents in the general population and in various subpopulations had similar or lower rates of poor outcome than did urban residents but experienced higher rates of inadequate prenatal care than did urban residents. Rural residents delivering in urban hospitals had higher rates of poor outcomes than those delivering in rural hospitals. We conclude that rural residence is not associated with greater risk of poor birth outcome. White and nonwhite differences appear to exceed any rural and urban resident differences in rates of poor birth outcome. Copyright © 1992, Wiley Blackwell. All rights reserved

关键词：数据收集医院乡村/标准医院市区/标准婴儿死亡率婴儿出生时低体重多元分析妇产科医院/标准妊娠结局产前保健/标准卫生保健质量回归分析农村卫生/统计学和数值数据城市卫生/统计学和数值数据华盛顿/流行病学女(雌)性人类婴儿新生妊娠

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Stress and Coping Among Missouri Rural and Urban Children

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The Journal of Rural Health 1993年第2期9卷 149-156页

作者： Krantz, Steven School of Nursing University of Missouri—Kansas City Kansas City Missouri 64108‐2676 2220 Holmes St. United States

Abstract: A cross‐sectional survey using a convenience sample of 157 Missouri rural and urban children (ages 8–13 years) yielded no significant differences in perceptions of stressors or use of coping strategies for dealing with those stressors between rural and urban children. The Feel Bad Scale and the Schoolagers' Coping Strategies Inventory measured the children's perceptions of stressors and use of coping strategies. Rural children experienced stressor levels equivalent to urban children, yet they were underserved in mental and physical health needs. The children studied reported self‐care through coping strategies for management of their stressors. Longitudinal research is needed to identify the impact of stress and interventions on the health and behavior of children in rural settings. Copyright © 1993, Wiley Blackwell. All rights reserved

关键词：适应心理学青少年健康态度儿童横断面研究女(雌)性卫生服务需求/统计学和数值数据人类婴儿新生男(雄)性缺医地区精神卫生服务密苏里/流行病学知觉精神病状态评定量表农村卫生/统计学和数值数据院校应激心理学/流行病学城市卫生/统计学和数值数据

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Geographic Barriers to Child Health Services in Rural Northern New England: 1980 to 1989

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The Journal of Rural Health 1992年第2期8卷 106-112页

作者： Goodman, David C. Barff, Richard A. Fisher, Elliott S. Department of Maternal and Child Health Dartmouth Medical School in Hanover New Hampshire United States Geography Department Dartmouth College Hanover New Hampshire United States

Despite substantial recent increases in the number of rural physicians, it is unknown whether rural children still face significant barriers to medical care. To address this question, we determined travel times in 1980 and in 1989 to child health services for the rural pediatric population of northern New England–the area with the highest per‐capita primary care physician supply of any non‐metropolitan region in the United States. The study population in 1989 included 363,443 children living in 936 nonmetropolitan towns. The study revealed important spatial relationships in health service supply and demand not identified using other methods of assessing physician availability. Although travel times to physicians decreased slightly during the decade, we found that 15.5 percent of the children in our population were more than 30 minutes from pediatricians in 1989, and travel time to emergency rooms was more than 30 minutes for 9.9 percent of the children. In contrast, only 1.8 percent of children faced excessive travel times to family/general practitioners. While towns with pediatricians were likely to also have a family physician or an emergency room, the majority of towns with family physicians had neither a pediatrician nor an emergency room. Towns with poor geographic access to pediatricians and emergency rooms had low population densities and were distant from metropolitan areas. The analysis indicates that even in rural areas of high physician supply, access to pediatricians and emergency rooms for many children remains limited, and family physicians are the dominant medical providers for children. Future work using travel time variables will clarify the relative importance of travel to medical care as a factor in rural health outcomes. Copyright © 1992, Wiley Blackwell. All rights reserved

关键词：儿童保健服务/人力儿童保健服务/供应和分配数据收集地理学卫生服务易得程度/统计学和数值数据卫生服务需求/统计学和数值数据新英格兰医师家庭/供应和分配医师家庭/利用农村卫生/统计学和数值数据时间因素运输青少年儿童儿童学龄前人类

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Cholera-like diarrhoeal disease and rivers in rural Mozambique

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TROPICAL DOCTOR 2000年第1期30卷 53-54页

作者： La Raja, M Coll Univ Aspiranti Med Zambzia Mozambique

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Geographic Imbalances of Physician Supply: An International Comparison

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The Journal of Rural Health 1994年第2期10卷 109-118页

作者： Blumetithal, Daniel S. Department of Community Health Morehouse School of Medicine in Atlanta Georgia United States

This study was undertaken to compare geographic imbalances of physician manpower in developed and developing countries and to evaluate the success of policies designed to alleviate the imbalances. Data were drawn from a mail survey of countries conducted by the World Health Organization, from national statistical summaries, and from published information on national policies and programs. Information was available from 26 developing countries and 15 developed countries. Among developing countries, the degree of urbanization and rural economic development appeared to be the most important determinants of the level of geographic imbalance. Among developed countries, those with very high overall physician/ population ratios tended to have the least degree of imbalance, but this effect was not consistent. At the national level in most countries, the effect of policies or programs specifically designed to redistribute physician manpower appeared to be limited. Copyright © 1994, Wiley Blackwell. All rights reserved

关键词：发展中国家地理学卫生人力/统计学和数值数据卫生政策卫生服务需求/统计学和数值数据医师/供应和分配问卷调查农村卫生/统计学和数值数据城市卫生/统计学和数值数据世界卫生世界卫生组织

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Rural Primary Care Program Survival: An Analysis of Financial Variables

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The Journal of Rural Health 1994年第3期10卷 173-182页

作者： Shi, Leiyu Samuels, Michael E. Konrad, Thomas R. Porter, Carol Q. Stoskopf, Carleen H. Richter, Donna L. Department of Health Administration School of Public Health University of South Carolina in Columbia South Carolina United States Department of Health Administration in the School of Public Health University of South Carolina Columbia South Carolina United States Department of Health Administration School of Public Health University of South Carolina Columbia South Carolina United States Department of Education School of Public Health University of South Carolina Columbia South Carolina United States

This study examines the effect of financial characteristics of rural primary care programs on the probability of their continuing as federally funded entities. A randomly selected national cohort of rural primary care programs (n=162) was used to compare financial measures of programs that were continuing and those that were noncontinuing. Financial data were obtained from 1978‐1987 Bureau Common Reporting Requirements (BCRR) forms submitted to the Bureau of Health Care Delivery and Assistance of the Department of Health and Human Services as part of the requirement to receive federal grant support for the programs. The results emphasize the importance of both outside funding and increased level of self‐sufficiency in the continuation of rural primary care programs. Noncontinuing programs often suffer from both a lack of self‐sufficiency and a lack of outside funding, mostly from federal sources. To a lesser extent, the number of patients also affects the program's chance of continuation. From a policy perspective, government intervention is both necessary and likely if rural primary care programs are to succeed and fulfill their mission of providing primary care for the medically underserved who are primarily poor, uninsured, and unable to pay. Copyright © 1994, Wiley Blackwell. All rights reserved

关键词：队列研究人口统计学财务管理/方法财务管理/统计学和数值数据筹资政府卫生服务研究缺医地区未参加医疗保险者贫困区初级卫生保健/经济学初级卫生保健/利用方案评价/经济学回归分析农村卫生/统计学和数值数据社会经济因素美国

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Birth Outcomes to Rural Illinois Residents: Is There a Crisis?

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The Journal of Rural Health 1994年第2期10卷 122-130页

作者： Rock, Steven M. Straub, LaVonne A. Department of Economics Western Illinois University Macomb Illinois United States

In recent years, the supply of obstetric services in rural areas has been a concern. At the same time, the demand for such services has been affected by the reduction in population and economic base. This article explores the extent of these trends in Illinois and whether they have led to a deterioration in amount of prenatal care and birth outcomes. Using birth certificate and infant death data for residents of rural Illinois counties in 1983 and 1988, prenatal care and birth outcomes for each year are compared within rural areas and to the rest of the state, as well as between the two time periods. Although rural residents began prenatal care later, they obtained similar qualities of care as their urban counterparts. The data revealed no adverse impact on birth outcomes of residing in increasingly rural areas, nor was there a deterioration during the time period. An attempt was made to identify rural counties that lost providers and/ or facilities and those that gained them. Although such a classification scheme is subjective, similar results ensued. While indirect costs such as time and effort to obtain care may have increased, at 1988 levels of care availability there was no crisis in Illinois. Copyright © 1994, Wiley Blackwell. All rights reserved

关键词：数据收集欧洲大陆世系人群/统计学和数值数据卫生服务易得程度/统计学和数值数据伊利诺伊/流行病学产妇卫生保健服务/供应和分配产科学/人力妇产科医院妊娠结局/流行病学产前保健/标准产前保健/统计学和数值数据产前保健/利用农村卫生/统计学和数值数据女(雌)性人类婴儿新生妊娠

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The Effects of On‐ and Off‐reservation Residence on In‐home Service Use Among Great Lakes American Indians

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The Journal of Rural Health 1995年第3期11卷 204-216页

作者： Chapleski, Elizabeth E. Institute of Gerontology Wayne State University Detroit Michigan 48202 87 E. Ferry United States

Abstract: Community‐based, in‐home services are a crucial component in the long‐term care continuum. Research has shown rural populations to be less likely to use these services. American Indian elders are more likely than their non‐American Indian counterparts to reside in non‐metropolitan areas, yet little rural research has focused on this subpopulation. The purpose of this article is to explore differences in in‐home service use among urban, rural off‐reservation, and rural on‐reservation older American Indians using data from a statewide needs assessment. The sample includes 206 206 Great Lakes American Indians aged 55 and older. Predictor variables include the residential classification variable (rural off‐reservation, rural on‐reservation, and urban) along with sociodemographic, social support, health and functional status, and general knowledge of services. Results of logistic regression analysis indicate that the odds are significantly greater for on‐reservation rural American Indian elders use of home services, home health aides, and home visits, than for urban American Indian elders. The off‐reservation rural American Indian elder is significantly less likely than the urban American Indian elder to use a home health aid. Health rating, activities of daily living/instrumental activities of daily living (ADL/IADL) impairments, and general knowledge of in‐home service availability increase the odds for all groups use of home services and home health aides. Copyright © 1995, Wiley Blackwell. All rights reserved

关键词：大湖地区/流行病学家庭医疗保健服务/利用印第安人北美洲/统计学和数值数据密执安/流行病学居住特征农村卫生/统计学和数值数据社会支持美国/流行病学城市卫生/统计学和数值数据老年人人类中年人

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