Trustee 2002; 55: 36-40, 42, 1.
The Maine squeeze on health coverage. Is Maine's health care crisis a harbinger of rural health care's future?
The state of Maine--mostly rural with an economy supported by small businesses--is struggling with a health care insurance crisis. Are Maine's problems a harbinger of what's to come in other rural states?
J Agric Saf Health 2002; 8: 95-111.
Agricultural injuries in Central India: nature, magnitude, and economic impact.
Tiwari PS, Gite LP, Dubey AK, Kot LS.
Agricultural Mechanization Division, Central Institute of Agricultural Engineering, Nabibagh, Bhopal, India. email@example.com
A study was carried out in Madhya Pradesh (Central India) to collect data on injury-causing agricultural incidents during the period 1995-1999. The overall incidence rate was 1.25/1000 workers/year. About 9.2% of the incidents were fatal, and most of the fatal incidents were due to tractors and snakebites (42.9% each). About 77.6% of all incidents were due to farm machinery, 11.8% were due to hand tools, and the remaining 10.6% were due to other sources like snakes, wells, etc. Data on 1,911 incidents reported in 10 leading newspapers published during the five-year period (1995-1999) from different regions of the state were also collected and analyzed, which indicated that only major or roadside agricultural incidents were reported in newspapers. Based on the survey data, it was estimated that in the year 2000 there would have been about 17,480 agricultural incidents in Madhya Pradesh, causing death to about 2,050 workers and injuries to about 16,770 workers, including amputations of limbs, burns, cuts, etc. Total monetary loss due to agricultural injuries in the state of Madhya Pradesh has been estimated as US $27 million/year.
J Manag Med 2002; 16: 113-32.
ERP implementation in rural health care.
Trimmer KJ, Pumphrey LD, Wiggins C.
College of Business, Department of Computer Information Systems, Idaho State University, Pocatello, USA.
Enterprise resource planning (ERP) systems provide organizations with the opportunity to integrate individual, functionally-oriented information systems. Although much of the focus in the popular press has been placed on ERP systems in large for-profit organizations, small hospitals and clinics are candidates for ERP systems. Focusing information systems on critical success factors (CSFs) allows the organization to address a limited number of areas associated with performance. This limited number of factors can provide management with an insight into dimensions of information that must be addressed by a system. Focuses on CSFs for small health-care organizations. In addition, also considers factors critical to the implementation of health-care information systems. Presents two cases. The results indicate support for the continuing use of CSFs to help focus on the benefits of ERPs. Focusing on groups of tangible and intangible benefits can also assist the rural health-care organization in the use of ERPs.
Proc AMIA Symp 2002; : 792-5.
Crossing the "Digital Divide:" implementing an electronic medical record system in a rural kenyan health center to support clinical care and research.
Tierney WM, Rotich JK, Smith FE, Bii J, Einterz RM, Hannan TJ.
Indiana University School of Medicine, Roudebush VA Medical Center, Indianapolis, IN, USA.
To improve care, one must measure it. In the US, electronic medical record systems have been installed in many institutions to support health care management, quality improvement, and research. Developing countries lack such systems and thus have difficulties managing scarce resources and investigating means of improving health care delivery and outcomes. We describe the implementation and use of the first documented electronic medical record system in ambulatory care in sub-Saharan Africa. After one year, it has captured data for more than 13,000 patients making more than 26,000 visits. We present lessons learned and modifications made to this system to improve its capture of data and ability to support a comprehensive clinical care and research agenda.
Proc AMIA Symp 2002; : 637-41.
Providing Context-Sensitive Decision-Support Based on WHO Guidelines.
Ray HN, Boxwala AA, Anantraman V, Ohno-Machado L.
Decision Systems Group, Brigham & Women's Hospital, & Harvard-MIT Division of Health Science, Chestnut Hill, MA, USA.
A decision support system was developed implementing the WHO guideline for diarrhea management. The decision-support system is integrated into a medical records application on a handheld computer. The system will be used by primary health care workers in rural India. The guideline was encoded as a set of chained rules in CLIPS format. To enhance adherence to guidelines, we use a model based on a context-adapted guideline to provide decision support at the point of care in a particular setting. The purpose of the system is to tailor the recommendations based on the patient's condition and the local factors such as resource availability in order to create feasible uniformity in a practice across different providers of care.
Proc AMIA Symp 2002; : 12-6.
Open Source Handheld-Based EMR for Paramedics Working in Rural Areas.
Anantraman V, Mikkelsen T, Khilnani R, Kumar VS, Pentland A, Ohno-Machado L.
Decision System Group, Brigham and Women's Hospital, Boston, MA, USA.
We describe a handheld-based electronic medical record (EMR) for use in certain rural settings. The system is based on the Linux operating system and allows access to large mobile databases. The open source system is designed for paramedical health workers serving remote areas in rural India. A PDA loaded with the handheld-based EMR provides workers who have little access to medical doctors with different kinds of decision support and alerts. It addresses two important problems in developing countries: prenatal care and child health. This paper describes the technical challenges and innovation needed in the design, development, adaptation and implementation of the handheld EMR in a real setting in India.
An Esp Pediatr 2002; 57: 524-8.
[Incidence of childhood tuberculosis in southern Pontevedra (Spain).]
[Article in Spanish]
Vazquez Nieves Mf MH, Sanisidro Vilaso F, Fluiters Casado E, Vazquez Gallardo R.
Atencion Primaria Area Sur de Pontevedra. Centro de Salud de Bembrive. Vigo. Pontevedra. Spain.
Background Epidemiological pattern of tuberculosis in Galicia is closer to that in developing countries than to that in Europe.ObjectivesThe aim of the present study was to determine the incidence and development of childhood tuberculosis, to analyze its clinical presentation and to quantify accurate diagnoses of pulmonary tuberculosis.MethodsObservational descriptive retrospective study in children aged 0-14 years old admitted to the Tuberculosis Unit of Vigo from 1 January 1995 to 31 December 1999.ResultsA total of 146 patients were included; 144 initial cases (98.63%), one relapse (0.68%), one withdrawal/recovery (0.68%) and none with chronic disease or treatment failure. The incidence rate of tuberculosis showed no significant variations, changing from 46.08 x 5 in 1995 to 24.81 x 5 in 1998. The incidence rate was higher in younger children and was 111.38 x 5 in 1995 in children aged 0-4 years old. There were 78 boys (54.42%) and 68 girls (46.75%). A total of 51.36% of the patients were from urban areas and 48.68% were from rural areas. The most common location was the lung, with 132 cases (83.54%). The diagnosis of pulmonary tuberculosis was accurate in 59% of the patients and this percentage rose to 90.3% in the group of patients aged 0-2 years old.ConclusionsIncidence of childhood tuberculous disease is high, especially in children aged 0-4 years old. A high percentage of diagnoses of pulmonary tuberculosis were accurate.
Int J Adolesc Med Health 2002; 14: 101-9.
Socio-cultural factors influencing adolescent pregnancy in rural Nepal.
Tribhuvan University, Institute of Medicine, Maharajgunj Nursing Campus, Kathmandu, Nepal. firstname.lastname@example.org
Early child bearing is a widely observed phenomenon in Nepal. However, little information is available in regard to its contributing factors. This retrospective exploratory study was carried out to determine factors contributing to adolescent pregnancy in rural Nepal. Cluster sampling technique was used to select the study settings. The findings on variable contributing to pregnancy from the sample of 575 mothers, who had their first pregnancy at an age below 19 years, were compared with the findings from an equal number of mothers who had their first pregnancy at the age of 20 years or above. The adolescent mothers were married at a comparatively younger age with a mean age of 15.9 years. Parents or elders, with/without the girl's consent, decided the majority of adolescent marriages. The age at marriage exposed women to early pregnancy regardless of who decided the marriage. Comparatively, most adolescent mothers were from a low social class, engaged in agricultural work, and they had low literacy rate. Majorities of the mothers from both groups had no prior knowledge about conception until they conceived. Peers were the main source of information regarding conception. Although the majority of the respondents knew at least one method of contraception, less than 1% had used it before their first pregnancy. To conclude, early pregnancy had put the adolescent mothers at the risk of unwanted pregnancy and obstetric complications. Women empowerment through compulsory girls' education would be the most effective strategy to prepare them for late marriage, planned and delayed pregnancy, and better motherhood.
Environ Health Perspect 2002; 110: A787-92.
Evaluation of Take-Home Organophosphorus Pesticide Exposure among Agricultural Workers and Their Children.
Curl CL, Fenske RA, Kissel JC, Shirai JH, Moate TF, Griffith W, Coronado G, Thompson B.
Department of Environmental Health, School of Public Health and Community Medicine, University of Washington, Seattle, Washington, USA.
We analyzed organophosphorus pesticide exposure in 218 farm worker households in agricultural communities in Washington State to investigate the take-home pathway of pesticide exposure and to establish baseline exposure levels for a community intervention project. House dust samples (n = 156) were collected from within the homes, and vehicle dust samples (n = 190) were collected from the vehicles used by the farm workers to commute to and from work. Urine samples were obtained from a farm worker (n = 213) and a young child (n = 211 in each household. Dust samples were analyzed for six pesticides, and urine samples were analyzed for five dialkylphosphate (DAP) metabolites. Azinphosmethyl was detected in higher concentrations (p < 0.0001) than the other pesticides: geometric mean concentrations of azinphosmethyl were 0.53 micro g/g in house dust and 0.75 micro g/g in vehicle dust. Dimethyl DAP metabolite concentrations were higher than diethyl DAP metabolite concentrations in both child and adult urine (p < 0.0001). Geometric mean dimethyl DAP concentrations were 0.13 micro mol/L in adult urine and 0.09 micro mol/L in child urine. Creatinine-adjusted geometric mean dimethyl DAP concentrations were 0.09 micro mol/g in adult urine and 0.14 micro mol/g in child urine. Azinphosmethyl concentrations in house dust and vehicle dust from the same household were significantly associated r2 = 0.41, p < 0.0001). Dimethyl DAP levels in child and adult urine from the same household were also significantly associated r2 = 0.18, (p < 0.0001), and this association remained when the values were creatinine adjusted. The results of this work support the hypothesis that the take-home exposure pathway contributes to residential pesticide contamination in agricultural homes where young children are present.