TEXAS JOURNAL OF RURAL HEALTH

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ISSUE 19(3), 2001

TABLE OF CONTENTS
 
Editor’s Comments
James E. Rohrer, Ph.D.
FULL TEXT

Interview

Interview with Denny DeGross
Lee Ann Paradise
Texas Journal of Rural Health 2001; 19(3): 3-7
ABSTRACT

Notes From the Field

Consequences of Mold Exposure in Buildings
David C. Straus, Ph.D.
Texas Journal of Rural Health 2001; 19(3): 8-13
ABSTRACT

Policy and Law

Revision of Medicare Reimbursement for Telemedicine Services
Debbie Voyles, M.B.A.
Texas Journal of Rural Health 2001; 19(3): 14-17
ABSTRACT

Research

Prevalence and Patterns of Herbal Medications Usage in Self-treatment of Symptoms in Mexican-American Patients with Type 2 Diabetes Mellitus
Beth A. Wheeler, M.S., PA-C, Conice Boenicke, M.S., PA-C, Thomas A. Teasdale, Dr.P.H., Virginia F. Schneider, PA-C, J. David Holcomb, Ed.D.
Texas Journal of Rural Health 2001; 19(3): 18-28
ABSTRACT
Identifying Market Segments for Physician Services: Variations by Gender
Tyrone F. Borders, Ph.D., James E. Rohrer, Ph.D.
Texas Journal of Rural Health 2001; 19(3): 29-42
ABSTRACT
HIV Testing Experiences of Pregnant Women In South Texas
Patricia J. Kelly, Ph.D., R.N., Terence Doran, Ph.D., M.D., Sandra N. Duggan, M.A.
Texas Journal of Rural Health 2001; 19(3): 43-51
ABSTRACT

Brief Report

Health-Related Lifestyle Behaviors of Rural Health Care Providers
Josie Lu O'Quinn, Ph.D., R.N.
Texas Journal of Rural Health 2001; 19(3): 52-60
ABSTRACT

ABSTRACTS

Interview with Denny DeGross
Lee Ann Paradise
Texas Journal of Rural Health 2001; 19(3): 3-7

Often in Texas we discuss how the size of our state affects health care delivery. We address the challenges of distance and geography as we map out our community health care plans. We grapple with tough issues regarding cultural diversity, provider shortages, and meeting the needs of the poor. As the largest state in the nation (bigger than Texas, Montana, and California combined), Alaska is no stranger to these problems. However, like us, many Alaskans are working hard to improve health care in rural communities despite some of the challenges they face. I hope you will read the following interview with interest.

Denny DeGross is the Director of the Alaska Center for Rural Health in Anchorage, Alaska and has been involved in Alaska's health system since 1972. In 1983, Mr. DeGross began a seven-year term as Executive Director for the Alaska Native Health Board (ANHB), which is a statewide Alaska Native advocacy group. Under his leadership, the ANHB gained national recognition by achieving major amendments to Public Law 93-638, Public Law 94-437, and the Federal Tort Claims Act, which brought tribal health programs under federal tort protection. Additionally, during his tenure, programs were begun to: 1) recruit Alaska Natives into health careers; 2) reduce high Native suicide rates; 3) reduce high rates of teen pregnancy among Alaska Natives; 4) reduce high rates of Fetal Alcohol Syndrome (FAS); 5) clean up toxic waste left near Native villages by earlier private and military activities; and 6) initiate the first program to combat HIV/AIDS among Alaska's Native people.

DeGross is the author of Indians: A Handbook for Counselors as well as many articles on health issues in Alaska. He has provided cross-cultural/diversity training in more than 100 communities and professional settings. At the 1999 Annual Meeting of the National Rural Health Association in San Diego, DeGross was presented the National Louis Gorin Award for Excellence in Rural Health.

LP: How does the geography and extreme climate of Alaska affect health care delivery?

DD: Climate and geography is only a problem because of the low population density in Alaska. A larger population often contains the wide variety of human resources that are necessary to meet every medical contingency. Low population density often means that the people living in the geographic 'extremities' must travel to their services or those services must come to them on an itinerant basis. When the rivers freeze up, people can drive their snow machines to the clinic. When the river is flowing, but is not carrying huge logs and other debris, people might take their boat to the clinic. During storms or flood conditions none of this is possible.

Author Affiliations

  • Lee Ann Paradise, Managing Editor, Texas Journal of Rural Health, Texas Tech University Health Sciences Center, Lubbock, Texas

Consequences of Mold Exposure in Buildings
David C. Straus, Ph.D.
Texas Journal of Rural Health 2001; 19(3): 8-13

Abstract

Scientific evidence is mounting that fungi (a.k.a. mold) growing inside our buildings can be quite detrimental to human health. This problem was recognized over 4000 years ago and was accurately described in Leviticus in the Bible. What we have learned in the ensuing centuries is what fungi cause these types of problems and what the products are that they produce that can damage our health. The fungi most commonly found in 'sick buildings' are Penicillium species, Aspergillus species, Stachybotrys species, Chaetomium species, and Alternaria species. The products that these organisms produce that affect our health are conidia (a.k.a. spores) and mycotoxins.

Key words: mold, fungi, sick building syndrome, spores, mycotoxins. (Texas Journal of Rural Health 2001; 19(3): 8-13)

Author Affiliations

  • David C. Straus, Ph.D., Professor of Microbiology and Immunology, Texas Tech University Health Sciences Center, Lubbock, Texas

Revision of Medicare Reimbursement for Telemedicine Services
Debbie Voyles, M.B.A.
Texas Journal of Rural Health 2001; 19(3): 14-17

Abstract

From the inner city of Houston to the plains of west Texas, millions of Texans are struggling with having their health care needs met. Many people believe that the segment of the population most in need of better access to health care would be the urban poor. However, there are over 21 million people living in Texas with 3.9 million people living in rural areas. Of the 254 counties in Texas there are 24 counties with no primary care physician, 20 counties with only one primary care physician, and 17 counties with only two primary care physicians (Texas Department of Health, 2001). Residents in the 61 counties with two or fewer primary care physicians also have no direct access to specialty care.

In an effort to offset the barriers to health care that rural populations face, telemedicine systems have been established. Telemedicine is a telecommunications technology that allows the delivery of health care services when distance separates the provider and the patient. However, the use of telemedicine as a means to expand health care coverage to rural populations has faced many barriers, not the least of which is the lack of reimbursement.

Key words: BBA, HCFA, Medicare, rural health, telemedicine. (Texas Journal of Rural Health 2001; 19(3): 14-17)

Author Affiliations

  • Debbie Voyles, M.B.A., Administrative Director, Texas Tech Telemedicine, Texas Tech University Health Sciences Center, Lubbock, Texas

Prevalence and Patterns of Herbal Medications Usage in Self-treatment of Symptoms in Mexican-American Patients with Type 2 Diabetes Mellitus
Beth A. Wheeler, M.S., PA-C, Conice Boenicke, M.S., PA-C, Thomas A. Teasdale, Dr.P.H., Virginia F. Schneider, PA-C, J. David Holcomb, Ed.D.
Texas Journal of Rural Health 2001; 19(3): 18-28

Abstract

A survey was conducted with 67 subjects on the use of herbal medications in addition to or in place of prescribed medications, degree of acculturation, diabetes-related symptoms experienced during the previous month, level of patient involvement in the management of diabetes, and the perception of diabetes control during the previous month. On average, subjects were 64-year-old females, diagnosed with diabetes for 10 years, and exhibiting HbA1c levels of 8.3%. Twenty (30%) of the 67 subjects reported that they used one or more alternative therapies during the previous month, and all affirmed that they did so in addition to and not in place of prescribed hypoglycemic medications.

A significant association was found between herbal medication use and symptomatic disease. Patients who reported suffering more symptoms during the previous month were significantly more likely to add herbal medications to their treatment regimen. Use of a variety of alternative therapies was reported; including nopalitos (nopal cactus), savila (aloe plant), and garlic. Health care practitioners should be aware that many of their patients may be using herbal medications, and they should be familiar with the most commonly used products. Inclusion of these herbal products in the management and treatment plan of the individual patient may provide a mutual learning experience and an enhanced patient-provider relationship with the ultimate goal of controlling a progressive and potentially devastating disease.

Key words: herbal medications, Mexican-American, self-treatment, Type 2 diabetes mellitus. (Texas Journal of Rural Health 2001; 19(3): 18-28)

Author Affiliations

  • Beth A. Wheeler, M.S., PA-C, Physician Assistant, Department of Internal Medicine, New York Eye and Ear Infirmary, New York, New York
  • Conice Boenicke, M.S., PA-C, Physician Assistant, United Medical Center #3, Del Rio, Texas
  • Thomas A. Teasdale, Dr.P.H., Assistant Professor, Department of Medicine, Baylor College of Medicine, Houston, Texas
  • Virginia F. Schneider, PA-C, Director, Physician Assistant Program, Division of Allied Health Sciences, Assistant Professor, Family and Community Medicine, Baylor College of Medicine, Houston, Texas
  • J. David Holcomb, Ed.D., Head, Division of Allied Health Sciences, Professor, Family and Community Medicine, Baylor College of Medicine, Houston, Texas

Identifying Market Segments for Physician Services: Variations by Gender
Tyrone F. Borders, Ph.D., James E. Rohrer, Ph.D.
Texas Journal of Rural Health 2001; 19(3): 29-42

Abstract

Little attention has been given to the study or practice of market research in ambulatory care. Yet, market research could be quite valuable to physicians and managers attempting to assure patients' efficient and appropriate use of services in a managed care environment. After analyzing survey data with multivariate techniques, we determined that the market for physician services for men should be segmented according to marital status, employment status, and previous in-county hospitalization. This would enable physicians and managers to better develop strategies and implement programs aimed at increasing or decreasing physician service use.

Key words: gender, market research, physician services, rural. (Texas Journal of Rural Health 2001; 19(3): 29-42)

Author Affiliations

  • Tyrone F. Borders, Ph.D., Assistant Professor, Department of Health Services Research & Management, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
  • James E. Rohrer, Ph.D., Professor & Chairman, Department of Health Services Research & Management, Texas Tech University, Health Sciences Center, Lubbock, Texas

HIV Testing Experiences of Pregnant Women In South Texas
Patricia J. Kelly, Ph.D., R.N., Terence Doran, Ph.D., M.D., Sandra N. Duggan, M.A.
Texas Journal of Rural Health 2001; 19(3): 43-51

Abstract

Anti-retroviral drugs and testing of pregnant women has lowered perinatal HIV (human immunodeficiency virus) transmission in the United States. This study interviewed women with HIV infection in south Texas to examine how testing during pregnancy was experienced. While 27/29 women received HIV testing and anti-retroviral treatment, only four women received information about the test. Many physicians (55%) refused to continue prenatal care after learning the woman's HIV status. In addition to decreasing perinatal transmission, policymakers must consider unintended consequences of making HIV testing a de facto standard of prenatal care.

Keywords: anti-retroviral treatment, HIV testing, pregnant women, prenatal care, South Texas. (Texas Journal of Rural Health; 19(3): 43-51)

Author Affiliations

  • Patricia J. Kelly, Ph.D., R.N., Assistant Professor, Department of Family Nursing and Department of Pediatrics, University of Texas Health Science Center, San Antonio, Texas
  • Terence Doran, Ph.D., M.D., Medical Director, South Texas Family AIDS Network, Department of Pediatrics, Division of Community Pediatrics, University of Texas Health Science Center, San Antonio, Texas
  • Sandra N. Duggan, M.A., Coordinator, Department of Pediatrics, Division of Community Pediatrics, University of Texas Health Science Center, San Antonio, Texas

Health-Related Lifestyle Behaviors of Rural Health Care Providers
Josie Lu O'Quinn, Ph.D., R.N.
Texas Journal of Rural Health 2001; 19(3): 52-60

Abstract

The purposes of this study were to: 1) describe lifestyle behaviors of rural health care providers, and 2) examine relationships among select demographic variables and lifestyle behaviors of the providers using a descriptive, correlational design. One hundred and thirty-two health care providers from six rural areas were recruited while attending continuing education programs. Each subject completed a demographic sheet and a 148-item Health-Promoting Lifestyle Profile (HPLP), which had six subscales and an overall profile. Only four of the HPLP items were practiced by a majority of subjects either often or routinely. Eleven significant correlations were found among the sample demographic variables and the lifestyle behaviors. Four statistically high correlations were identified among lifestyle behaviors and the total lifestyle profile. Although several statistically significant correlations were found, mean scores for each subscale indicated that the subjects practiced health-related lifestyle behaviors only sometimes, but not often or routinely.

Key words: healthy behaviors, health promotion, lifestyle behaviors, lifestyle choices, rural health care providers, rural populations. (Texas Journal of Rural Health 2001; 19(3): 52-60)

Author Affiliations

  • Josie Lu O'Quinn, Ph.D., R.N., Assistant Dean, Undergraduate Programs, The University of Texas at Arlington, Arlington, Texas
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