The delivery of high-quality emergency care in a rural setting requires a conceptual framework quite different from that required in urban and suburban environments, given that available resources are limited in the r...
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The delivery of high-quality emergency care in a rural setting requires a conceptual framework quite different from that required in urban and suburban environments, given that available resources are limited in the rural setting. The intermittent and episodic nature of seriously ill and injured patients who present to rural emergency departments makes it difficult to plan, staff, and equip in order to provide emergency medical care at the same level seen at higher volume urban or suburban institutions. The objective of this article is to describe the distinctive nature and widely unrecognized features of emergency medicine in rural and remote areas, with a focus on clinical, workforce, and economic issues. We present recommendations for a shift in thinking and a call to action an behalf of all emergency medicine professionals that are based on a realistic assessment of the current status of emergency medicine and that are needed to develop and sustain high-quality emergency medical care in rural America.
Background. For adolescents, there is no specific needs assessment instrument that assesses significant problems that can benefit from specified interventions. A new instrument (***) was developed by incorporating and...
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Background. For adolescents, there is no specific needs assessment instrument that assesses significant problems that can benefit from specified interventions. A new instrument (***) was developed by incorporating and adapting three well established adult needs assessment instruments. The *** covers 21 areas of functioning including social, psychiatric, educational and life skills. Method. Client and carer interviews were conducted by different researchers. A week later the interviews were repeated using a crossover design. Significant (cardinal) problems were generated from the clinical interviews using a pre-defined algorithm. Final need status (three categories) was made by clinicians assessing the cardinal problems against defined interventions. The interventions were generated from discussions with clinicians and a survey of appropriate professionals working with adolescents. Results. Pre-piloting led to the final version being administered to 40 adolescents from secure units, forensic psychiatric and adolescent psychiatric services. There were 25 males and 15 females, mean age 15.5 years. Overall there were moderate to good inter-rater and test-retest reliability coefficients, the test-retest reliability coefficients for the total scores on the needs assessment interviews ranged from 0.73 to 0.85. Consensual and face validity was good, the adolescents and staff finding the instrument useful and helpful. Conclusions. This new needs assessment instrument shows acceptable psychometric properties. It should be of use in research projects assessing the needs and the provision of services for adolescents with complex and chronic problems.
Although consumers’ need assessment generally suggest that, what consumers need as products or services influence their consumption, little research on consumption of disability resources, relating to musculoskeletal...
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The Southern Nations, Nationalities, and People's Region of Ethiopia (SNNPR) is home to 11 million people constituting more than 45 language and ethnic groups, most of whom live in extremely poor rural communities...
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The Southern Nations, Nationalities, and People's Region of Ethiopia (SNNPR) is home to 11 million people constituting more than 45 language and ethnic groups, most of whom live in extremely poor rural communities. Data for currently married, fecund women aged 15-49 from demographic surveys conducted in the SNNPR in 1990 and 1997 are used to investigate contraceptive knowledge and communication, and the use and future need for family planning services in this population. This study focuses on how these processes are affected by household organization and women's status, and on their implications or population policies and programs. Considerations for the implications of these results for understanding the fertility transition of a highly diverse African population under severe stress are presented. Although household extension and polygamy characterize one-third of the women sampled, they do not affect the women's contraceptive behavior. Women's literacy and autonomy ave, by far, the mast significant forces in the movement toward lower fertility in the region.
This article explores reasons why women's fertility preferences and their contraceptive behaviors often appear to be contradictory. Ninety-eight separate interviews with women and their husbands conducted in rural...
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This article explores reasons why women's fertility preferences and their contraceptive behaviors often appear to be contradictory. Ninety-eight separate interviews with women and their husbands conducted in rural Chitwan District, Nepal, over a 12-month period in 1993-94 revealed that people continually and self-consciously weigh the perceived benefits and risks of practicing family planning relative to their situations. Temporary and, especially, hormonal methods are perceived to carry unacceptable health risks. Contraceptive technologies are evaluated in relation to competing priorities and interests. Household poverty heightened the perceived risk of family planning use;poor people fear they can ill afford negative effects to their health that might result. People assess their health status and physical workload, factors that they believe condition their ability to use family planning methods without experiencing damaging health effects. Strategies employed to lower contraceptive risk include altering the method of choice, manipulating relationships with spouses, timing the adoption of contraceptives, managing the context of service provision, and acting in light of the experiences of others. Qualitative findings from the fieldwork are complemented by analysis of data from a standardized fertility survey.
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