Tesi: "Rural medicine"

1

Jensen, Samantha, e Amanda Stoltz. "Assessing Resident Physician Knowledge about Breastfeeding Medicine in a Rural Family Medicine Clinic". Digital Commons @ East Tennessee State University, 2021. https://dc.etsu.edu/asrf/2021/presentations/51.

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Title: Assessing Resident Physician Knowledge about Breastfeeding Medicine in a Rural Family Medicine Clinic Authors: Samantha Jensen, MD and Amanda Stoltz, MD, Bristol Family Medicine Residency Program, Department of Family Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN Introduction: Many residents and faculty encourage the long-term goal of breastfeeding, and our residency program provides extensive training in obstetrics and newborn nursery. However, there is little structure and direct guidance for breastfeeding medicine already built in to the family medicine residency training. We aimed to develop a dedicated breastfeeding medicine longitudinal curriculum to improve the effectiveness of family medicine physician residents as teachers and advocates by improving residents’ fund of knowledge, provide structure for encouraging breastfeeding at prenatal visits, and incorporate breastfeeding into our family medicine practice by improving the on-site locations for breastfeeding and pumping. Method: The method of research was pre-lecture and post-lecture surveys comprised of 15 questions, including knowledge-based questions, assessment of confidence level, and a question on perceived barriers to breastfeeding. Participants attending two educational sessions during the study, and additional educational sessions have continued after study conclusion. The post-lecture survey was completed 12 weeks after first lecture. Lecture topics included an overview of breastfeeding medicine, how to encourage breastfeeding at prenatal appointments, contraindications, maternal nutritional supplements, formula supplementation, galatogogues, and the storage of breastmilk. Results: Results were compiled from the responses of 20 pretests and 9 posttest surveys. Results showed an increase in correct responses to the knowledge portion 61.15% pretest versus 77.69% posttest (t(28) 3.41, p<0.01). Resident physician confidence also increased by the conclusion of the study (t=28, p<.01). Conclusions: It can be concluded that educational lectures increase knowledge and confidence in resident physicians with regards to breastfeeding medicine. Areas for future study include specific research focusing on methods to increase access to resources for breastfeeding mothers.

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Beebe, Michele Morgen. "Use of complementary and alternative medicine among rural Montanans". Thesis, Montana State University, 2004. http://etd.lib.montana.edu/etd/2004/beebe/BeebeM0805.pdf.

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3

Pal, Deb Kumar. "Control of childhood epilepsy in rural India". Thesis, University College London (University of London), 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.298246.

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Meyers, Emily Breanne. "Rural Health and Radiology: Health and Ethical Implications for Rural Citizens". NEOMED College of Graduate Studies / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=ne2gs1619525106309102.

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5

Hagemeier, Nicholas E., Sarah Blevins, Kyle Hagen, Emily Sorah, Richa Shah e Kelly Ferris. "Integration of Rural Community Pharmacies into a Rural Family Medicine Practice-Based Research Network: A Descriptive Analysis". Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/1476.

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Purpose: Practice-based research networks (PBRN) seek to shorten the gap between research and application in primary patient care settings. Inclusion of community pharmacies in primary care PBRNs is relatively unexplored. Such a PBRN model could improve care coordination and community-based research, especially in rural and underserved areas. The objectives of this study were to: 1) evaluate rural Appalachian community pharmacy key informants’ perceptions of PBRNs and practice-based research; 2) explore key informants’ perceptions of perceived applicability of practice-based research domains; and 3) explore pharmacy key informant interest in PBRN participation. Methods: The sample consisted of community pharmacies within city limits of all Appalachian Research Network (AppNET) PBRN communities in South Central Appalachia. A descriptive, cross-sectional, questionnaire-based study was conducted from November 2013 to February 2014. Bivariate and multivariate analyses were conducted to examine associations between key informant and practice characteristics, and PBRN interest and perceptions. Findings: A 47.8% response rate was obtained. Most key informants (88%) were very or somewhat interested in participating in AppNET. Enrichment of patient care (82.8%), improved relationships with providers in the community (75.9%), and professional development opportunities (69.0%) were perceived by more than two-thirds of respondents to be very beneficial outcomes of PBRN participation. Respondents ranked time constraints (63%) and workflow disruptions (20%) as the biggest barriers to PBRN participation. Conclusion: Key informants in rural Appalachian community pharmacies indicated interest in PBRN participation. Integration of community pharmacies into existing rural PBRNs could advance community level care coordination and promote improved health outcomes in rural and underserved areas. Type: Original Research

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6

Shirely, Kaitlyn, Margaret Smith, Kacie Denton, Blair Brandt, Ivy A. Click e Joseph Gravel. "Social Determinants of Health in Rural Tennessee Clinics". Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6383.

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Click, Ivy A., Jeri Ann Basden, Joy L. Bohannon, Heather Anderson e Fred Tudiver. "Opioid Prescribing in Rural Family Practices: A Qualitative Study". Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/6366.

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Background: Rural Tennessee, especially rural East Tennessee has seen a dramatic increase in rates of controlled drug prescriptions and controlled drug overdose deaths in recent years. However, little is known about the individual decisions to prescribe or continue prescriptions with relation to addiction concerns. Objectives: The purpose of this study was to learn more about what factors lead to physicians’ prescribing control drugs for non-cancer pain through the use of focus groups. Methods: A qualitative study, using focus groups, in five family medicine clinics in East Tennessee and Southwest Virginia. The investigators used a semi-structured interview guide designed to facilitate group discussions about prescription drug abuse and misuse. Results: There were four main themes identified by the focus groups: (1) prescribers’ changing prescribing patterns over time; (2) factors that influence controlled drug prescribing; (3) use and barriers to using state prescription drug monitoring programs (PDMPs); (4) prescribing controlled drugs to women of childbearing age. Each theme had several subthemes. Conclusions: The balance between treating the patient's symptoms and causing potential harm is a challenge. The patient's pain cannot be ignored, but the potential harm of opioid therapy is not taken lightly. As the public health concern of prescription drug abuse in rural Appalachia continues to spread, prescribers are aware of their connection to the problem, and ultimately the solution.

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Lawrenson, Ross Alexander. "Screening for undiagnosed diabetes in rural New Zealand". Thesis, Imperial College London, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.263224.

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Kennedy, Craig. "Impact of telemedicine in a rural community /". St. Lucia, Qld, 2001. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe16114.pdf.

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Harris, Kimberly D. "Acceptance of computer-based telemedicine in three rural Missouri counties /". free to MU campus, to others for purchase, 1999. http://wwwlib.umi.com/cr/mo/fullcit?p9945181.

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11

Walker, Paul Charles. "Community based epidemiological study of Chagas Disease in rural Peru". [New Haven, Conn. : s.n.], 2008. http://ymtdl.med.yale.edu/theses/available/etd-12092008-165846/.

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12

Simpson, Savannah, e Jodi Polaha. "Educating Rural Psychologists: An Analysis of Professional Training Programs". Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/etsu-works/6636.

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In rural areas, the lack of psychologists available makes it difficult for patients to receive the care they need. The lack of psychologists available perpetuates the stigma that it is not “normal” to go to a psychologist. Also, working in rural areas is difficult for psychologists because there is a need for special training and instruction and there is not enough funding for training in rural psychology. This study aims to describe the current educational practices of graduate counseling and clinical psychology programs and post graduate internship and fellowship programs in preparing professionals to serve rural populations. Surveys created to assess rural professional training programs were sent to internship/fellowship programs and graduate programs in the United States identified as having a rural focus. Surveys were completed by 33 doctoral programs (21% response rate) and 61 internship/fellowship programs (19% response rate). Then, the responses from both types of programs were compared and contrasted. The three main barriers to educating psychologists to serve rural populations as indicated by the internship/fellowship programs are lack of interest of students working in rural areas, lack of employment opportunities in rural areas, and lack of third party reimbursement for counseling services provided. For the doctoral programs, the top three barriers are lack of qualified supervisors, accreditation requirements not allowing students enough electives to take a course related to rural mental health, and a tie between lack of employment opportunities and distance of university from rural areas. Results were also analyzed for the educational approaches to educating rural psychologists and the steps being taken to address the barriers to educating rural psychologists. The main action taken to overcome barriers by fellowship programs is providing didactic experiences related to providing behavioral health services for rural populations 55% and for graduate programs 53.8% chose integrating content related to providing behavioral health services to rural populations in required courses. Also, recommendations were made for enhancing rural training, improving internship and fellowship experiences, and addressing policy issues for graduate and post graduate programs. Both the graduate programs and fellowship programs agree that students are not as interested in going to rural areas. This could be because lack of funding in rural areas, lack of employment opportunities, and lack of third- party reimbursement for services provided by the graduate student or intern. Rural training should include educating students about rural areas by allowing students to take courses in rural psychology, placing students in rural areas, greater funding for training psychologists in rural areas, possible tele-health training to make working with rural patients easier if the location is distant from university or internship, ways for students to have an internship available after graduate school and a job after the internship, and teaching students ways to reduce the stigma of psychology in rural areas. Integrating psychology into primary care would help rural patients not worry as much about the stigma associated with seeing a psychologist and seeing a psychologist would not require an extra co-pay.

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13

Polaha, Jodi, William T. III Dalton e Suzanne Allen. "The Prevalence of Psychosocial Concerns in Pediatric Primary Care Serving Rural Children in Pediatric Primary Care Serving Rural Children". Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/etsu-works/6745.

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Objectives: To examine the prevalence of parent-reported emotional and behavior problems in pediatric primary care clinics serving rural Appalachia using methods commensurate with studies of broader samples. Methods: Parents presenting to pediatric primary care clinics completed a rating scale (Pediatric Symptom Checklist) of psychosocial problems for their child. Results: Approximately 21% of all rating scales were in the clinically significant range. Across all parents, 63% identified the child’s physician as their most common source of help. In contrast, mental health professionals had been sought out by only 24% of the sample. Conclusions: These data replicate previous findings showing high rates of parent-rated psychosocial problems in pediatric primary care. Given the prevalence of these problems in primary care and parents’ frequent help seeking in this setting, more research is needed on innovative approaches to integrated care in rural settings.

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Madge, Clare. "Medicine, money and masquerade : women, collecting and rural development in The Gambia". Thesis, University of Birmingham, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.550929.

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This thesis assesses development theory by investigating the role of collecting to rural Gambians. Theories of development are based on the implicit acceptance of models of evolutionary development of society. Such models assume that societal development is linear, societies 'developing' from hunting and gathering (collecting) to farming to urban industrial modes of production as they ascend the 'evolutionary ladder'. Each stage is assumed to be distinct and not to overlap with the preceding or following stage. This thesis disputes such a model by revealing the vital importance of collecting to a so-called agricultural community in The Gambia. Research in Africa has hitherto concentrated on the farming system and cultivated crops and there is a large research gap concerning work on the collecting system and wild indigenous plant and animal species. Collecting is significantly more important than hitherto realized, suggesting that evolutionary models, and therefore theories on which development are based, are not only inaccurate but also potentially damaging. Collecting is only one aspect of rural individuals' adaptive survival strategies, interacting through time and space with farming and domestic activities. The importance of collecting is shown in this thesis, not only in subsistence terms to overcome seasonal stress both within and between years, but also as a vital component to the income-formation strategy of rural individuals and cosmology of socio-cultural life. Through an interdisciplinary approach this work attempts to dispel artificial boundaries placed on previous research in Africa. Since women are involved in collecting this thesis also contributes to the debate on gender and, through a methodology based on the individual, shows the importance of obtaining a differentiated view of women at both inter- and intra-household levels.

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Allred, Delayne, Laura Helmly e Amanda Stoltz. "IMPROVING CODING BEHAVIORS AMONG PHYSICIANS IN A RURAL FAMILY MEDICINE RESIDENCY PROGRAM". Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/asrf/2018/schedule/164.

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Appropriate coding is a daunting task for new physicians just entering the world of medical practice. This is mostly due to the ever-changing standards for reimbursement, and the constant demand on provider time from an ever-growing number of patients to serve from a primary care perspective. It has been shown that family physicians lose up to 10- 20 percent of reimbursement each year because of incorrect coding. Physicians are the ones responsible for appropriately coding their work and documentation so that the clinic can be fairly reimbursed. In the East Tennessee State University Family Physicians of Bristol residency program, there is a strong tendency for most physicians to under-code the majority of office visits to a 99213, despite the fact that their documentation of these visits reflects coding at much higher levels. The goal of this project is to provide more intensive education to resident physicians on the requirements for coding, and thus change behaviors that led to continued under-coding. Researchers in this project utilized aggregate data collected in the course of the usual practice of business to show the present state of coding behaviors as broken down by resident, and then re-assessed these numbers after the presentation of more intensive education regarding appropriate coding. Education was provided in a variety of formats, including 4 short lectures at didactic sessions over the course of several months, as well as handouts for residents to keep with them at nurses’ stations containing guidelines for coding. Data analysis is currently underway. It is expected that the implementation of the educational program will have led to a statistically significant increase in appropriate coding within the clinic. This result has important implications regarding education to improve appropriate coding and reimbursement, particularly for small clinics operating in rural regions that are at the highest risk of harm from under-reimbursement due to inaccurate coding.

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Miranda, Renee M., Martha Cole e Patricia Conner. "Measuring Patient Interest in Complementary and Alternative Medicine (CAM) in a Rural/Community Family Medicine Residency Program in Northeast Tennessee". Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/6871.

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Complementary and Alternative Medicine (CAM) has been demonstrated to be an effective addition to traditional medical practice. However, patient awareness of CAM techniques may be low, particularly in rural areas. The aim of this study is to measure adult patient interest in CAM, particularly Osteopathic Manipulative Medicine (OMT), acupuncture, meditation, nutrition, and breathing techniques in a community Family Medicine practice. An anonymous survey was given to 200 adult patients in an outpatient clinic over the course of 3 months. Survey items were designed to assess if patients were aware of CAM, if they had experience with any of the mentioned modalities, if they were interested in the mentioned modalities, and which CAM services patients would like to see offered in clinic. In regards to having heard of CAM, 57.3% of patients had reported that they were aware of CAM, while 42.7% were not. Of those that had heard of CAM, 42.4% had experience with OMT, 55.1% had experienced acupuncture, 7.6% had experienced breathing techniques group, 14.4% had experienced nutrition groups, and 5.1% had experienced meditation groups. 22.3% of patients were not interested in any form of CAM being offered in clinic, while 77.7 were interested in at least one type of CAM. OMT held the highest rating among interested patients, with 29.1% wanting to see it offered in clinic. These results indicate that, while many patients were not aware of CAM, there was nonetheless a high degree of interest in seeing CAM techniques offered. The implication of this study is that CAM should be implemented in the clinic as soon as possible. Future research should assess the degree to which patients actually utilize these services, once offered.

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Watts, Anne E. "A model for epilepsy management in an African rural community". Thesis, Queen's University Belfast, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.336192.

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Nicholson, Laura. "The health, support needs, access to healthcare services and social exclusion of adults with intellectual disabilities living in rural areas : a rural-urban comparison". Thesis, University of Glasgow, 2012. http://theses.gla.ac.uk/3738/.

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Background: Almost all intellectual disabilities research is conducted in urban areas, and very little is known about the population of adults with intellectual disabilities living in rural areas. It is important to know whether there are significant rural-urban differences, in order to provide appropriate services and address inequalities. In particular, the general rural population is known to be disadvantaged with respect to access to healthcare and social exclusion. Adults with intellectual disabilities are also disadvantaged in these areas, and therefore adults with intellectual disabilities living in rural areas may have a double disadvantage. Method: A sample of adults with intellectual disabilities living in a rural area on the West Coast of Scotland participated in a face-to-face semi-structured interview; their medical notes were also accessed. Demographics, healthcare, access to services, daytime opportunities, access to community facilities, recent contact with others, the quality of personal relationships, and area deprivation by postcode were measured. Data were already available for a pre-existing urban sample. Data were analysed using direct comparison and binary logistic regression. Results: A representative sample of adults with intellectual disabilities from rural (n=39) and urban (n=633) areas were compared. There were no significant rural-urban differences over a wide range of variables including: age, gender, ethnicity, level of intellectual disabilities, mental ill health and common co-morbidities such as mobility, visual impairment, incontinence and epilepsy. Both direct comparison and binary logistic regression showed the rural sample to have had significantly more contact with primary (Odds Ratio = 4.02, 95% CI 1.56 -10.35, P = 0.004) and secondary health care (OR = 3.93, 95% CI = 1.81 – 8.55, P = 0.001.) Participants from rural areas were significantly more likely to have any regular daytime opportunity (Odds Ratio = 10.8, 95% CI = 2.3 – 51.5) including employment (OR = 22.1, 95% CI = 5.7 - 85.5) and attending resource centres (OR = 6.7, 95% CI = 2.6 – 17.2) than were participants from urban areas. They were also more likely to have been on holiday (OR = 17.8, 95% CI = 4.9 – 60.1); however, were less likely to use community facilities on a regular basis. Participants from urban and rural areas had a similar number of contacts with other people in a wide range of situations, but the quality of relationships may have been less close in rural areas. Finally, rural participants lived in significantly less deprived areas (Mann Whitney U = 7826, Z = -3.675, P ≤ 0.001). Conclusion: There were no significant demographic and health differences between the rural and urban samples. The study was underpowered with respect to some of these findings, and some results may reflect a Type II error. Nevertheless this is an important negative finding. Contrary to original hypothesis, the rural sample was found to have better access to healthcare services, had better opportunities and lived in less deprived areas than adults with intellectual disabilities living in urban areas. However, the results suggest that the rural sample may not have held such positive or close relationships, and this may be important when considering the subjective experience of social exclusion. Additional qualitative sub-study: A qualitative sub-study investigated the difficulties experienced with recruitment to the original study. 10 semi-structured telephone interviews were held with professionals who had helped with recruitment. These were transcribed verbatim and anonymised, then analyzed using the Framework approach. A number of themes arose, including participant factors (interview anxiety, worry about negative feedback), the importance of the researcher (using a personal approach, meeting potential participants prior to recruitment) and motivators (enjoyment of the research interview (participant), obtaining a medical assessment (carer)). The themes were then used to generate strategies to improve recruitment to intellectual disabilities research: these include the research team applying a more personal approach, and considering motivators for both participants and carers. The findings of this study have implications in terms of both time and money. However, successful recruitment is essential to intellectual disabilities research, and the results can be used by intellectual disabilities researchers to review and improve their recruitment processes.

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Lilly, C. E., Jodi Polaha, Stacey Williams e M. Schrift. "Rural Parents’ Perspectives on Mental Health Services: A Qualitative Study". Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/6594.

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Chadwick, Caleb N., Lauren Brinkley-Rubinstein, Mark McCormack e Abbey K. Mann. "Experiences of HIV Stigma in Rural Southern Religious Settings". Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/6436.

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Experiences of stigma, including stigma in religious settings, among individuals who are HIV positive have been widely documented. However, research related to stigma has predominantly focussed on urban locations. As a result, stigma incurred via religious settings in non-urban areas has been underexplored. The aim of this study is to uncover the experiences of individuals who are HIV positive with religious institutions, leaders and congregants in the non-urban American South. A total of 22 participants were interviewed. Experiences with stigma were pervasive with participants often describing anticipation of future stigma (often based on past negative experiences), the experience of stigma, and, for some participants, intersectional or layered stigma related to being both gay, or being perceived as gay, and HIV positive. Our findings suggest that the conditions of the non-urban setting in which this research took place made specific contributions to participants’ experiences of stigma.

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Polaha, Jodi, W. T. III Dalton, S. Allen, A. Enlow, N. Bagwell e S. Cumpston. "Pediatric Wellness and Integrated Health Care in Rural Appalachia". Digital Commons @ East Tennessee State University, 2008. https://dc.etsu.edu/etsu-works/6610.

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Cirone, B., J. Ellison e Jodi Polaha. "Mental Health Seeking by Young Adults in Rural Areas". Digital Commons @ East Tennessee State University, 2009. https://dc.etsu.edu/etsu-works/6642.

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Polaha, Jodi. "Pediatric Behavioral Telehealth for Underserved Patients In Rural Tennessee". Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/6680.

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Cutts, Christopher. "Identification of influences on the quality use of medicines in general practice in rural Australia /". [St. Lucia, Qld.], 2002. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe16591.pdf.

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Polaha, Jodi. "Breaking Down Silos in Rural Healthcare: A Five-Part Blog Series". Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/6764.

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Morgan, Dilys. "Natural history of HIV-1 infection in adults in rural Uganda". Thesis, University of Liverpool, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.250460.

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Schultz, Abby, L. Crosnoe-Shipley, Brett T. Morgan e Ivy A. Click. "Improving Evidence-Based Contraceptive Management Among Clinicians in Rural Tennessee". Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/6384.

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Hoover-Thompson, Alysia, Catherine Jones-Hazledine e Jodi Polaha. "Overcoming Rural Service Delivery Barriers: Three Examples in Integrated Care". Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/6593.

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Integration in rural primary care has well-delineated advantages, but there are barriers to developing a workforce in these areas. In this presentation, representatives from three novel rural service delivery programs will discuss specific strategies for overcoming these barriers. Attendees will learn how a rural Federally Qualified Health Center grew from 0 to 6 full-time psychologists in two years, how a graduate training program uses telehealth to provide services at rural primary care clinics, and how integrated clinics in the Frontier counties of Nebraska ensure a future workforce starting by targeting high school students.

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Evans, J. H., R. J. Valleley e Jodi Polaha. "Integrating Pediatric Behavioral Health Into Rural Primary Care: Research Findings". Digital Commons @ East Tennessee State University, 2006. https://dc.etsu.edu/etsu-works/6617.

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Sun, Qi. "Traditional medicine in rural China and the southern United States: an exploratory study". DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 1989. http://digitalcommons.auctr.edu/dissertations/1722.

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This study compared the differences and similarities of the traditional remedies, the biochemical values of traditional remedies for hypertension, and the characteristics of the theories of traditional medicine between rural China and the rural southern United States. The data for rural China were collected from three popular medical books published by Chinese government and a periodical of Henan Province, China. The data for the rural southern United States were previously collected through Life History Interviews on 234 older blacks living in six southern states of the United States during 1978-1980. The original study of older blacks in the southern United States was carried out by The National Center on Black Aged under a grant from the Administration on Aging for a study of ways of meeting the needs of older blacks. The comparison of traditional remedies for hypertension was focused on the differences and similarities of the action principles. Some traditional remedies used in rural China have action principles similar to those of traditional remedies used in the rural southern United States. Through analyzing the data previously collected by The Navel Treatment Research Group of The Traditional Chinese Medicine Institute in Henan 1979, the significant biochemical values of traditional remedies for hypertension were found. The comparison of the theories of traditional medicine between rural China and the rural southern United States was based on reviews of previous studies. This study provides an initial exploration of comparisons of traditional medicine between rural China and the rural southern United States. However, due to the fact that in the southern United states, data on the therapeutic effects of traditional remedies for hypertension were not explicit, the findings reported in this study are tentative. Secondly, because the comparison of the theories of traditional medicine between rural China and the rural southern United States was based on the literature reviews, the findings lack a foundation in primary data. Further research should include studies of data on the therapeutic effects multiple traditional remedies. Finally, theories of traditional medicine of China and the southern United States should be compared in detail, including their different histories, cultures, and ecological-botanical contexts. In this thesis, eating medicine means taking medicine.

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Бігунець, Вікторія Сергіівна, e Жанетта Анатоліївна Ревенко. "Prevention of arterial hypertension among rural population in the aspect of evidential medicine". Thesis, "Хист" Всеукраїнський журнал студентів та молодих вчених. Міністерство охорони здоровя України. Буковинський державний медичний університет. Студентське наукове товариство. Рада молодих вчених.: Чернівці, 2015. Випуск 17, 2015, 2015. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/9597.

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Kent, Ruth Margaret. "Health needs of disabled people in a rural community". Thesis, University of Newcastle Upon Tyne, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.363892.

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Ellison, J., Jodi Polaha e S. North. "Rural Parents’ Mental Health Service Delivery Preferences: Overcoming Barriers to Care". Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/etsu-works/6599.

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Polaha, Jodi, e K. Brooks. "A Wellness Approach to Service Delivery in Rural Pediatric Primary Care". Digital Commons @ East Tennessee State University, 2007. https://dc.etsu.edu/etsu-works/6613.

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Malindi, Phumzile. "Methods for providing rural telemedicine with quality video transmission". Thesis, Cape Peninsula University of Technology, 2007. http://hdl.handle.net/20.500.11838/1197.

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Thesis (DTech (Electrical engineering))--Cape Peninsula University of Technology, Cape Town, 2007
Telemedicine has been identified as a tool to distnllUte medical expertise to medically underserved rural community. However, due to the underdeveloped or non-existent telecommunication infrastructure, which is needed as the platform for telemedicine, the full benefits of telemedicine are yet to be realized in most parts of South Africa and Africa as a whole. This study aims to explore ways on how to provide lP-based lCI system that can be used as a communication platform for telemedicine in rural areas. In order to emulate the onsite face-to-face consultation experience, the rural telemedicine system must be able to provide quality video transmission. Quality video is also important in order for the physician at the distant end to be able to make correct diagnosis. Hence the main focus of this study is on ways ofproviding quality video over lP-based multiservice network. A conceptual model of a rural area network that can be used for rural telemedicine has been deVeloped, and different access technologies that can be used for rural areas are presented. Techniques for compesating IP best effort datagram delivery are provided. Factors that can affect the quality of video transmission on an lP-based packet network are identified, and a holistic approach to mitigate them is proposed. That includes adopting coding techniques that will provide coding efficiency, high quality video that is consistent at high and low bit rates, resilience to transmission errors, scalability, and network friendliness, which will result in perceived quality improvement, highcompression efficiency, and possibility of transportation over different networks. Secondly, it also includes mechanisms to compensate for packet networks idiosyncrasy, especially JP best-effort debilities, in order to meet the latency and jitter requirements of real-time video traffic. For video coding, H.264 is proposed as it meets most of the encoding requirements listed above, and for prioritising and protecting.video traffic from JP network's best-effort debilities a combination of differential services (DiflServ) and multi-protocol label switching (MPLS) have been adopted, where DiflServ is used for traffic classification and MPLS is used for traffic engineering and fast-rerouting in the event of route failure. To verify and validate the proposed solutions, modelling and simulation has been used, where the Network Simulator (NS-2.93) has been used to simulate network functions, and PSNR, VQM score and double stimulus impairment scale (DSIS) have been used for evaluating video quality.

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Porter, Ashley Erin. "An assessment of health literacy about complementary and alternative medicine in adult residents of a frontier county in Northwestern Montana". Thesis, Montana State University, 2010. http://etd.lib.montana.edu/etd/porter/PorterA0510.pdf.

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The purpose of this study was to examine CAM health literacy among residents of a frontier county. Health literacy levels in the United States have historically been low. CAM use in the United States continues to grow each year. The combination of the two issues creates the potential for poor health outcomes. Previous research indicates that rural and frontier residents have high rates of CAM use and lower health literacy when compared to urban populations. Quantitative research methods and Pender's Health Promotion Model provided the underlying framework for this study. A systematic sampling of 100 residents of a frontier county in Northwestern Montana participated in the study. The data were collected by use of a mail survey that included a ten-item CAM health literacy quiz and was analyzed using the SPSS 18 version statistical software program. The results indicated that more than half of the participants used some from of CAM, either through visits to a CAM provider or a self-directed CAM. Participants reported they most often obtained information about CAM through self-study and about health issues from a health care provider. Greater than half of the participants were rated as Average for their CAM health literacy score. When exploring selected sociodemographics, a significant relationship was found between gender and CAM health literacy. Females had higher CAM health literacy rates. Health literacy about CAM scores were similar between frontier residents in this study and a previous study of CAM health literacy in rural residents. The majority of both populations had Average CAM health literacy. The implications of the study for nursing research include a) further research regarding CAM health literacy, b) establishing a valid and reliable CAM health literacy measurement tool and c) further research to identify and trend resources utilized to obtain information about health problems and CAM. The implications of the study for nursing practice include a) self evaluation of CAM knowledge and feeling about CAM use by health care providers b) directing patients to reputable resources about CAM and c) assessing patient CAM use.

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Cook, C. L., Jodi Polaha e S. L. Williams. "Brief report: Rural Parents’ Perceptions Of Mental Health Services: A Qualitative Study". Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6760.

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38

Polaha, Jodi. "Telehealth Services for Rural Behavioral Health: Directions for Development and Research". Digital Commons @ East Tennessee State University, 2007. https://dc.etsu.edu/etsu-works/6704.

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39

Tolliver, Robert M., C. Lilly, S. Reed, Stacey L. Williams e Jodi Polaha. "Primary Care: An Opportunity to Address Behavioral Health Among Rural Children". Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/6598.

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40

Xiang, Zheng. "The transformation of the 3-tier health network in rural China 1979-1990". Thesis, Queen Mary, University of London, 1994. http://qmro.qmul.ac.uk/xmlui/handle/123456789/1669.

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Abstract (sommario):

Since 1979, the organisation of Chinese health care has undergone extensive changes as the result of government health reforms. These changes have particularly affected the '3-tier health network' of rural health care organisation. The '3 tier health network' which is a vertically organised linkage of village, township and county health units, has formed the basic health structure for the rural areas since the early 50's. The '3 tier network'(3TN) has been subject to the introduction of a market competitive system which is the economic responsibility system. Township hospitals have been placed under the control of township government, and a decision has been made to introduce a county level hospital of Chinese traditional medicine(CTM) for each county. Changes in the basis of health care financing and the encouragement of private practice have accompanied the decline of the co-operative medical system (CMS), a system of health insurance set up in the 1960's. On the basis of the empirical study described below, this thesis argues that there is an urgent need to evaluate these reforms, and develop policies for China's 800 million rural residents, focussing in particular on the 3TN. In 1989,7 counties, 12 townships and 30 villages were chosen by a structured random sampling technique in Jiangxi Zhejiang and Shandong provinces in East-China. A survey was carried out, covering health organisation, health personnel, the economics of rural health and health services for rural residents in county, township and village. In this survey, a comparison was made of the various types of health system, including those that have come into being since reform policies were instituted. In addition, the survey also considered the general influences of health reforms on the health service for rural residents and the management situation of the 3TN. This study found that in general the health reforms weakened the 3 tier health network in the rural areas. The health status of rural residents has deteriorated due to privatisation of the rural health care market. The main effects observed were the financial crises of township hospitals, high turnover and lack of health personnel in the rural areas, a standstill in preventive health, and the limited utilisation of health services by rural residents, since private health care replaced the CMS. The thesis argues that the main cause of these negative developments is health policies because the process of health policy making is 'top-down' in China, lacks community participation and is affected by political factors. The policies made during health reform actually worsened the already uneven allocation of health resources between urban areas and the rural areas. Urban areas have an inequitably large share and the gap continues to widen. The thesis suggests that Chinese health policy and organisation should put the stress on the rural areas once more, as happened during the 1960's and 70's. The reestablishment of the CMS is a better way to guarantee the health of rural residents and to implement primary health care. This method of health financing could be applied not only in China but throughout the developing world.

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Polaha, Jodi. "Dissemination of Evidence Based Treatments to Rural Communities: Exploring the Role of Telehealth". Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/6684.

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Tolliver, Matthew, Jodi Polaha, Stacey L. William e Christina R. Studts. "Evaluating the Prevalence of Child Psychosocial Concerns in Rural Primary Care". Digital Commons @ East Tennessee State University, 2021. https://doi.org/10.1037/rmh0000130.

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Child psychosocial concerns in rural areas are assumed to be greater than national averages due to mental health provider shortages, however, there is minimal empirical support for this claim. The present study aimed to replicate findings showing a higher prevalence of child psychosocial concerns in rural areas. In addition, this study evaluated six distinct definitions of “rural” to determine whether the operational definition of rurality was associated with prevalence of psychosocial concerns. Caregivers presenting with their child at 8 pediatric primary care sites (N = 2,672) completed a demographic questionnaire and the Pediatric Symptom Checklist (PSC). Logistic regression models tested associations between operational definitions of rurality and prevalence of clinically significant child psychosocial concerns. Multiple logistic regression models were used to test additional independent effects of maternal education level while controlling for child age. The effects of rurality on prevalence of clinically significant psychosocial concerns were inconsistent across the 6 measures of rurality; when significant, however, effects were small and in the opposite direction than hypothesized. These findings highlight discrepancies in results based on disparate operational definitions and measures of rurality. When rurality was associated with child psychosocial concerns, children in more highly populated areas reported more psychosocial concerns than children in smaller rural areas.

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Pangrazzi, Elizabeth. "The Rural Provider's Perspective| Conversations With Patients About Mental Health". Thesis, Union Institute and University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10624346.

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The rural primary care provider is likely to treat patients with mental health issues in rural populations due to lack of mental health providers, comorbidity and multimorbidity of patient illness, and stigma associated with seeking mental health services. The very nature of rural primary care allows for patients to be comfortable with their PCP and therefore, rely on the strong foundational relationship they have in entrusting them with their mental health concerns. Being a primary care provider in a rural setting offers both rewards and challenges unique to the rural culture.

The main goal of the study was to explore what might enhance, diminish, or otherwise give meaning to the rural primary care provider’s experience of engaging in discussions about mental health issues with their patients. This was achieved through identifying themes in response to two primary research questions. The primary research questions were: (a) How do rural primary care providers engage in conversations about mental health issues with their patients?; and (b) What are factors of being in a rural setting that affect and/or influence the primary care provider in having these conversations?

Data from ten participants across the three rural primary care clinics was analyzed using the qualitative method of thematic analysis to identify embedded themes. Five themes were revealed: (a) The relationship between the patient and the rural primary care provider allows for the conversation about mental health issues; (b) Rural primary care providers routinely provide mental health services; (c) Rural primary care providers experience challenges treating complex mental health issues; (d) Rural primary care providers navigate barriers in rural communities; and (e) There are benefits and drawbacks of rural living.

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Allen, S., W. T. III Dalton e Jodi Polaha. "Pediatric Overweight and Psychosocial Concerns Among Youth Presenting to Rural Primary Care". Digital Commons @ East Tennessee State University, 2008. https://dc.etsu.edu/etsu-works/6609.

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45

Reed, Sara, Matthew Tolliver, Jodi Polaha e Stacey Williams. "Rural Primary Care Integration: Facilitating Identification and Management of Childhood Psychosocial Concerns". Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/6634.

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Rural children have less access to mental health services and more health disparities than their urban counterparts. Additionally, pediatricians rank psychosocial problems as a top presenting concern in child care visits, making recognition and appropriate management of behavioral health problems an important aspect to primary care. Few studies, however, have examined the prevalence of childhood psychosocial concerns in rural Appalachia. This paper describes the results of a larger study that examined prevalence rates of parent-reported psychosocial concerns and parental help-seeking behavior. Research Assistants recruited parents of children (N= 2672) scheduled to see physicians from 8 regional primary care clinics, to fill out a demographic/help-seeking questionnaire and the Pediatric Symptom Checklist (PSC), a parent- report screening measure to help identify psychosocial problems. Consistent with national averages, the current study showed overall, 13.70% of children had clinically significant PSC scores. Furthermore, 62.4% of parents reported speaking to their child’s physician about psychosocial concerns. Given the high prevalence rate of psychosocial dysfunction, lack of services in rural areas and a majority of parents seeking help from their child’s physician for emotional and behavioral concerns, the results of this study seem to support integration of mental health professionals into primary care, as a way to help identify and treat psychosocial dysfunction.

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Lennon-Dearing, Robin, Joe Florence, Linda Garrett, Ivy A. Click e Suzanne Abercrombie. "A Rural Community-Based Interdisciplinary Curriculum: A Social Work Perspective". Digital Commons @ East Tennessee State University, 2008. https://dc.etsu.edu/etsu-works/6371.

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Although social workers are frequently part of interdisciplinary teams in health care and community settings, interdisciplinary training is often lacking in social work education (Berg-Weger & Schneider, 1998). This article describes a study of the effects of an interdisciplinary community-based experiential course preparing new health care professionals for work as part of interdisciplinary teams. The interdisciplinary curriculum was established for a summer course taught in 2006 by faculty from five disciplines: social work, nutrition, medicine, nursing, and public health. The course, Quality Improvement in Rural Healthcare, which focused on health literacy in people with a diagnosis of diabetes that live in northeast Tennessee, provided a model environment for learning interdisciplinary teamwork. Evaluation of this course found that social work students displayed a statistically significant increase in positive attitude toward interdisciplinary teamwork. Course strengths, weaknesses, obstacles, and opportunities for curriculum improvement are elaborated.

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Enlow, Angela D., e Jodi Polaha. "Evaluating the Role of a Psychologist in Pediatric Wellness Visits in Rural Tennessee". Digital Commons @ East Tennessee State University, 2009. https://dc.etsu.edu/etsu-works/6644.

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The aim of this project was to examine key medical and behavioral health issues identified in the context of integrated wellness visits. Specifically, this study sought to examine the role of psychologists in pediatric wellness visits, including the early identification of behavioral, developmental, and learning problems, as well as the delivery of brief, effective interventions. The study was conducted at Cherokee Health Systems, a fully integrated pediatric practice in East Tennessee, which follows a fully integrated model of integrated primary care. Data was obtained from a record review of 100 participants, providing a total of 373 well visits. Outcomes demonstrate that behavioral and developmental concerns are raised at a higher rate than in non-integrated practices. Specifically, visits in which the psychologist was present, 44.42% resulted in some concern being raised. Further, 36.24% of visits resulted in psychosocial concern(s) being raised. This figure is significant given that 22% of well visits typically result in discussion of some psychosocial concern consistently found in the research literature. Additionally, of concerns raised, 81.87% were raised directly with/by the psychologist on staff, who is able to offer immediate interventions when concerns are raised.

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48

Rutherford, Shaunta N. "Breastfeeding Perceptions, Rates of Initiation, and Duration Among Urban and Rural Women". ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5653.

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Breastfeeding is the optimal feeding method for infants up to the age of 2. Breast milk is suited to fulfill the nutritional needs of infants while providing immunological and neurological benefits. Breastfeeding rates of initiation and duration are low in the United States, especially in the state of Georgia. The purpose of this cross-sectional study was to investigate how breastfeeding initiation and duration, self-efficacy, perceptions, and community breastfeeding resources differ based on geographical location. The social ecological model was used as the theoretical framework for this study. An online and in-person survey that combined the Iowa Feeding Attitude Scale, Breastfeeding Self-Efficacy Questionnaire and The Breastfeeding in Public Survey was administered to 150 English speaking mothers aged 18 and older with a child 1 year or younger. The research questions were addressed using various statistical analyses (crosstabs, Mann Whitney U-test, and t test). The study results showed no differences in the odds of breastfeeding initiation and duration among mothers in urban and rural Georgia. No differences in breastfeeding perception or the use of breastfeeding community resources were observed. The results of this study contribute to social change by identifying the need to develop breastfeeding interventions that will address breastfeeding perceptions, community resources, and breastfeeding self-efficacy in urban and rural areas.

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Mike, Derrick. "Lived Experiences of African Americans 65 and Older After Rural Hospital Closures". ScholarWorks, 2020. https://scholarworks.waldenu.edu/dissertations/7825.

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African Americans 65 and older have had varied experiences due to losing immediate access to nearby hospitals for urgent treatment for emergency medical conditions. This phenomenological study was conducted to explore the lived experiences of those residing in areas after a rural hospital closure occurred. The hospital was the primary and nearest facility for receiving immediate access to urgent treatment. The research questions focused on the encounters experienced by the participants after the hospital closure. The Health Belief Model was the conceptual framework used for this study. The method and data analysis procedures included interviews, field notes, a life-course chart, and specified demographic information. Eight African Americans 65 and older from Webster and Stewart County Georgia were interviewed. The other inclusion criteria were the participants' previously being treated for an emergency medical condition at Stewart Webster Hospital at least 1 year before the hospital closure and at another hospital at least 1 year after the hospital closure. The results of this research were that the participants encountered negative experiences on a higher level than positive experiences with accessing immediate treatment. Also, participants encountered and needed to make various, and undue changes to receive treatment for the critical medical condition treatment. The positive social change significance included providing information on experiences encountered by the participants after rural hospital closures and suggestions for others in rural areas to prepare for hospital closures. Moreover, this research could help state, local, and federal agencies provide alternatives for immediate treatment for emergency medical conditions in other rural towns after hospital closures occurred.

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Horng, Lily Ming-Sha. "A pilot study of changes in physician prescribing practices after rural mutual health care implementation in China". [New Haven, Conn. : s.n.], 2008. http://ymtdl.med.yale.edu/theses/available/etd-12022008-134152.

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Tesi sul tema "Rural medicine"

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