An audit of structured diabetes care in a rural general practice

Objective: To assess the impact of structured diabetes care in a rural general practice. Design and setting: A cohort study of structured diabetes care (care plans, multidisciplinary involvement and regular patient recall) in a large general practice in a medium-sized Australian rural town. Medical care followed each doctor's usual practice. Participants: The first 404 consecutive patients with type 2 diabetes who consented to take part in the program were evaluated 24 months after enrolment in July 2002 to December 2003. Main outcome measures: Change in cardiovascular disease risk factors (waist circumference, body mass index, serum lipid levels, blood pressure); change in indicators of risks associated with poorly controlled diabetes (glycated haemoglobin [HbA1(c]) concentration, foot lesions, clinically significant hypoglycaemia); change in 5-year cardiovascular disease risk. Results: Women had a lower 5-year risk of a cardiovascular event at enrolment than men. Structured care was associated with statistically significant reductions in mean cardiovascular disease risk factors (waist circumference, -2.6 cm; blood pressure [systolic, -3 mmHg; diastolic -7 mmHg]; and serum lipid levels [total cholesterol, -0.5 mmol/L; HDL cholesterol, 0.02 mmol/L; LDL cholesterol, -0.4 mmol/L; triglycerides, -0.3 mmol/L]); and improvements in indicators of diabetic control (proportion with severe hypoglycaemic events, -2.2%; proportion with foot lesions, -14%). The greatest improvements in risk factors occurred in patients with the highest calculated cardiovascular risk. There was a statistically significant increase in the proportion of patients with ideal blood pressure (systolic,

Manoel Moises, Mãe Bela e o protestantismo rural na história da Igreja Presbiteriana em Cabeceira Grande-MG (1947-1970

A ideia de um protestantismo rural é caracterizada pela relação dos crentes com o lúdico e a familiaridade com o sagrado. Este tipo protestante tupiniquim, genuinamente brasileiro, se desenvolveu em locais de pouca ou nenhuma resistência por parte do catolicismo, religião hegemônica no contexto brasileiro, fator que possibilitou arranjos e rearranjos que o diferenciam do protestantismo dito oficial. Esta pesquisa procura, pois, identificar algumas características deste protestantismo rural, principalmente sua interação com as culturas populares tradicionais no contexto fundante da Igreja Presbiteriana de Cabeceira Grande-MG. Através da metodologia de pesquisa em história oral e micro-história, o foco do estudo será aproximado à vida de duas importantes figuras que se destacaram neste contexto: o lavrador Manoel Moises e a parteira Mãe Bela. Manoel Moises, pioneiro protestante, chega à região em 1947, trazendo a sua mudança em um carro de bois. A origem da Igreja Presbiteriana em Cabeceira Grande deve-se às atividades deste pregador leigo e autônomo. Posteriormente, a comunidade já formada recebe a visita de pastores vinculados às Agências Missionárias estrangeiras atuantes na região. Assim como Manoel Moises é referência constante nas memórias locais, Mãe Bela, uma das primeiras convertidas ao protestantismo naquele lugar, é também lembrada por sua atuação como parteira e pelos seus conhecimentos da medicina tradicional, articulados com o imaginário religioso local. Mãe Bela também foi a doadora do terreno em que foi construído o templo da Igreja Presbiteriana, inaugurado em 1970.

Menopause, rurlity, and obesity in rural African American women

In the US, one in every eight deaths is due to an obesity-related chronic health condition (ORCHC). More than half of African American women (AAW) 20 years old or older are obese or morbidly obese, as are 63% of menopausal AAW. Many have ORCHC that increase their morbidity and mortality and increase health care costs. In 2013, 42.6 percent of AAs living in South Carolina (SC) were obese. The purpose of this cross-sectional study was to identify the cognitive, behavioral, biological, and demographic factors that influence health outcomes (BMI, and ORCHC) of AAW living in rural SC. A sample of 200 AAW (50 in each of the 4 groups of rurality by menopausal status), 18-64 years, completed the: Menopausal Rating Scale (symptoms); Body Image Assessment for Obesity (self-perception of body); Mental Health Inventory; Block Food Frequency Questionnaire; Eating Behaviors and Chronic Conditions, Traditional Food Habits, and Food Preparation Technique questionnaires — and measures for Body Mass Index. Most rural, and premenopausal AAW were single and not living with a partner. Premenopausal women had significantly higher educational levels. Sixty percent of AAW had between 1 and 5 ORCHC. Most AAW used salt based seasonings, ate deep fried foods 1 to 3 times a week, and ate outside the home 1 to 3 times a month. Few AAW knew the correct daily serving for grains and dairy, and most consumed less than the recommended daily serving of fruits, vegetables and dairy. Morbidly obese AAW used more traditional food preparation techniques than obese and normal-weight AAW. Rural, and menopausal AAW had significantly higher morbid obesity levels, consumed larger portions of meats and vegetables, and reported more body image dissatisfaction than very rural AAW, and premenopausal AAW, respectively. Controlling for socioeconomic factors the relationships between perceptions of body images, psychological distress, and psychological wellbeing remained significant for numbers of ORCHC^

Sustainable use of organic resources for bioenergy, food and water provision in rural Sub-Saharan Africa

Acknowledgements We are grateful to the United Kingdom Economic and Social Research Council Nexus Network for funding this work.

Sustainable use of organic resources for bioenergy, food and water provision in rural Sub-Saharan Africa

Acknowledgements We are grateful to the United Kingdom Economic and Social Research Council Nexus Network for funding this work.

Differences in expenditure and amounts of fresh foods, fruits & vegetables and fish purchased in urban and rural Scotland

Peer reviewed

Differences in expenditure and amounts of fresh foods, fruits & vegetables and fish purchased in urban and rural Scotland

Peer reviewed

Sustainable use of organic resources for bioenergy, food and water provision in rural Sub-Saharan Africa

Acknowledgements We are grateful to the United Kingdom Economic and Social Research Council Nexus Network for funding this work.

Inter-Species Microbial Sharing in Rural Madagascar: A Study of Environmental Influences on the Skin Microbiome

The skin is home to trillions of microbes, many of which are recently implicated in immune system regulation and various health conditions (33). The skin is continuously exposed to the outside environment, inviting microbial transfer between human skin and the people, animals, and surfaces with which an individual comes into contact. Thus, the aim of this study is to assess how different environmental exposures influence skin microbe communities, as this can strengthen our understanding of how microbial variation relates to health outcomes. This study investigated the skin microbial communities of humans and domesticated cattle living in rural Madagascar. The V3 region of the 16S rRNA gene was sequenced from samples of zebu (the domesticated cattle of Madagascar), zebu owners, and non-zebu owners. Overall, human armpits were the least diverse sample site, while ankles were the most diverse. The diversity of zebu samples was significantly different from armpits, irrespective of zebu ownership (one-way ANOVA and Tukey’s HSD, p<0.05). However, zebu owner samples (from the armpit, ankle forearm, and hand) were more similar to other zebu owner samples than they were to zebu, yet no more similar to other zebu owner samples than they were to non-zebu owner samples (unweighted UniFrac distances, p<0.05). These data suggest a lack of a microbial signature shared by zebu owners and zebu, though further taxonomic analysis is required to explain the role of additional environmental variables in dictating the microbial communities of various samples sites. Understanding the magnitude and directionality of microbial sharing has implications for a breadth of microbe-related health outcomes, with the potential to explain mosquito host preference and mitigate the threats of vector-borne diseases.

Rural Health Program Update, 2014

Rural Health works with key partners to explore and fund innovative means of delivering rural health services.

Iowa Rural Health IT Collaborative "It Worker", December 19, 2012

The purpose of this paper is to share information about the Iowa Rural HIT Collaborative efforts to help rural hospitals and providers attain electronic medical records meaningful use status. Information from this paper can be helpful to others who are pursuing solutions related to integration of health information technology in rural areas.

Orthodox versus unorthodox care: A qualitative study on where rural women seek healthcare during pregnancy and childbirth in Southwest, Nigeria

Introduction Utilization of orthodox health facilities for maternal health services is determined by factors operating at the individual, household, community and state level. The prevalence of small family norm is one of the identified variables operating within the community which influences the decision of where to access care (orthodox/traditional). The objective of the study was to determine the use of orthodox versus unorthodox maternity healthcare and determinants among rural women in southwest Nigeria. Methods A qualitative study was done and involved three focus group discussions. A semi-structured interview guide was used to collect information from women of reproductive age group within a rural Local Government Area in Lagos state. Results Most of the women access some form of healthcare during pregnancy, orthodox, unorthodox or both. Those who patronize both services concurrently do so to benefit from the two as each has some unique features such as herbal concoctions for traditional, ultrasound and immunization of babies for orthodox. Traditional belief exerts a strong influence on decision of where to access maternal healthcare services. Actual place of delivery is determined by individual and household factors including financial resources. Conclusion Rural women utilize one or both orthodox and unorthodox maternal health services for different reasons. Ward Development Committees should be strengthened so as to reach the communities, educate and convince women to dispel myths which limit their use of orthodox care. Training and monitoring of Traditional Birth Attendants (TBAs) are vital to eliminate harmful practices. We also recommend improved financial access to orthodox healthcare.