TEXAS JOURNAL OF RURAL HEALTH

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ISSUE 18(1), 2000

TABLE OF CONTENTS
 
Editor’s Comments
Leonel Vela, M.D., M.P.H.
FULL TEXT
Articles
 
Use of State Tobacco Settlement Funds: A Legal and Strategic Analysis with Implications for Rural and Public Health
Roberto Anson
Texas Journal of Rural Health 2000; 18(1): 5-11
ABSTRACT
 
The Critical Access Hospital Program: A Service Delivery Model for Selected Rural Hospitals
Richard Hoeth, F.A.C.H.E.
Texas Journal of Rural Health 2000; 18(1): 12-18
ABSTRACT
 
'Advanced Practice' Family Physicians as the Foundation for Rural Emergency Medicine Services (Part I)
Kim Bullock, M.D., Wm. MacMillan Rodney, M.D., Tony Gerard, M.D., Ricardo Hahn, M.D.
Texas Journal of Rural Health 2000; 18(1): 19-29
ABSTRACT
 
Promotora Training as a Preparation for Entry into the Work Force
Lorenza Zu�iga, Guadalupe Ramos, Darryl M. Williams, M.D.
Texas Journal of Rural Health 2000; 18(1): 30-34
ABSTRACT
Issues in Studying Health-Related Hardiness and Use of Services Among Older Rural Adults
Jeanine K. Niemoller, R.N.C., Bette A. Ide, Ph.D., Elizabeth G. Nichols, R.N.
Texas Journal of Rural Health 2000; 18(1): 35-43
ABSTRACT
 
The Borders Without Boundaries Project: Introducing Health Profession Students to Border Health Concerns and Practices
Barbara D. Adams, M.S.A., Claudia Coggin, M.S., Robert J. Hastings, M.A., Henri Migala, M.P.H., Muriel Marshall, D.O., M.P.H., Dr.P.H.
Texas Journal of Rural Health 2000; 18(1): 44-51
ABSTRACT
 
Acanthosis Nigricans in Youth: A Type 2 Diabetes Marker
Paul Villas, D.Ed., C.H.E.S., David Salazar, Doreen D. Garza, M.P.H., Evangelina T. Villagomez, R.N., M.S.N., Teresa Lightner, M.D.
Texas Journal of Rural Health 2000; 18(1): 52-58
ABSTRACT

ABSTRACTS
Use of State Tobacco Settlement Funds: A Legal and Strategic Analysis with Implications for Rural and Public Health
Roberto Anson
Texas Journal of Rural Health 2000; 18(1): 5-11
 
Abstract
 
In November 1998, the attorneys general of 46 states signed a legal agreement with the five largest tobacco firms that are projected to net states about $206 billion over the next 25 years. These payments are linked to tobacco sales. This is the largest legal settlement in the industry. Many states are not targeting the use of these funds for health education and/or smoking cessation programs. Legislative sessions for this year and the year 2000 are focusing on how to spend these state tobacco funds. The significant opportunity is assuring that rural health and public health advocates voice their concerns and become significant "players" in assuring that funds are used for rural health needs involving tobacco cessation and health education and prevention. The window of opportunity for influencing the fiscal allocation process is narrowing. Funds won't start flowing until June 30, 2000 or until 80% of the states, representing 80% of the payout, finalize settlement details.

Author Affiliations

  • Roberto Anson, Director, State Office of Rural Health Program, Office of Rural Health Policy, Health Resources & Services Admin., Rockville, Maryland

The Critical Access Hospital Program: A Service Delivery Model for Selected Rural Hospitals
Richard Hoeth, F.A.C.H.E.
Texas Journal of Rural Health 2000; 18(1): 12-18
Abstract
 
The Critical Access Hospital Program is a limited-service hospital design that combines potentially improved reimbursement with cost savings from relaxed operating requirements to help ensure financial viability. In communities that have difficulty recruiting doctors, services at these facilities may be provided by a non-physician practitioner under the remote supervision of a physician.
The Critical Access Hospital Program offers a new option to rural communities working toward ensuring adequate access to high-quality health care services for its residents. This is not to say that the Critical Access Hospital option is necessarily the preferred model for delivering health care services in every community. For an individual hospital, the decision to seek designation as, or conversion to, a Critical Access Hospital involves careful review of the capacity of the model to meet the health care needs of the community and to support the continued financial viability of the organization.

Author Affiliations

  • Richard Hoeth, F.A.C.H.E, Vice President, Rural Health/Membership, Texas Hospital Association, Austin, TX

'Advanced Practice' Family Physicians as the Foundation for Rural Emergency Medicine Services (Part I)
Kim Bullock, M.D., Wm. MacMillan Rodney, M.D., Tony Gerard, M.D., Ricardo Hahn, M.D.
Texas Journal of Rural Health 2000; 18(1): 19-29
Abstract
 
This article reviews the medical specialties of emergency medicine and family medicine as they currently exist. Although both are unrestricted in their general scope of practice, family medicine is perceived as primary care and community-based. Emergency medicine is hospital-based and a subspecialty discipline. In rural and under-served communities, these two specialties blend together by necessity. This two-part article provides background for bridge building and innovation by blending these specialties.
 
In response to long-standing community needs, a group of family practice educators established and sustained a teaching practice built upon the foundation of family practice, public health, and emergency medicine. A one-year fellowship in rural family and emergency medicine was part of the infrastructure of this project.
 
The project, now in its ninth year, specifically addresses the issue of using an advanced curriculum in family/emergency medicine to assist with improving the access, cost, and quality of care in rural and under-served communities.

Author Affiliations

  • Kim Bullock, M.D., F.A.A.F.P., B.C.E.M., Assistant Professor, Department of Family/Community Medicine, Georgetown University, Washington, D.C.
  • Wm. MacMillan Rodney, M.D., F.A.A.F.P., F.A.C.E.P., Professor, Department of Family/Emergency Medicine, University of Tennessee, Memphis, Tennessee
  • Tony Gerard, M.D., F.A.A.F.P., Assistant Clinical Professor, Department of Family/Emergency Medicine, Pennsylvania State University, Hershey, Pennsylvania
  • Ricardo Hahn, M.D., F.A.A.F.P., Chairman, Department of Family Medicine, University of Southern California, Los Angeles, California

Promotora Training as a Preparation for Entry into the Work Force
Lorenza Zu�iga, Guadalupe Ramos, Darryl M. Williams, M.D.
Texas Journal of Rural Health 2000; 18(1): 30-34
Abstract
 
In the United States, the promotora movement has focused on the training of individuals, usually women, to provide volunteer services within the community. These services include liaison with clinics, home visits, and activities tied to the goals of the organization providing the training. An unanticipated benefit of the training has been the preparation of women for the workforce as they acquire marketable skills through volunteer activities. At least 21 have been able to obtain employment as a result of this program. Trained promotoras interact with medical, education, and social service professionals as they work with a target population in their communities, providing a bridge to a better future.

Author Affiliations

  • Lorenza Zu�iga, Project Associate, Office of Border Health, Texas Tech University Health Sciences Center, El Paso, Texas
  • Guadalupe Ramos, Practicing Promotora, Kellogg Community Partnership Clinic, Fabens, Texas
  • Darryl M. Williams, M.D., Director, Office of Border Health, Texas Tech University Health Sciences Center, El Paso, Texas

Issues in Studying Health-Related Hardiness and Use of Services Among Older Rural Adults
Jeanine K. Niemoller, R.N.C., Bette A. Ide, Ph.D., Elizabeth G. Nichols, R.N.
Texas Journal of Rural Health 2000; 18(1): 35-43
Abstract
 
A pilot study to explore the relationship between Health-Related Hardiness and the use of services among 20 older rural adults identified a number of factors to be considered when conducting research with elderly rural subjects. Health-Related Hardiness scores tended to be moderate, positively correlated with the use of total and delivered services and negatively correlated with the use of outpatient services, including health maintenance and preventive services. The low Health-Related Hardiness group had higher total and delivered service use but lower outpatient service use than did the high-rated group. The results suggested that if resources are available, they will be used. While these study findings were inconclusive in good part due to the small sample size, several important theoretical and methodological issues were identified. Most importantly, the results generated questions about the applicability of the concept of Health-Related Hardiness, the measurement of service use, and the use of complicated Likert-type tools and lengthy survey techniques with older adults.

Author Affiliations

  • Jeanine K. Niemoller, R.N.C., M.S., Administrator, Extended Care Facility, Ivinson Memorial Hospital, Laramie, Wyoming
  • Bette A. Ide, R.N., Ph.D., Associate Professor, College of Nursing, University of North Dakota, Grand Forks, North Dakota
  • Elizabeth G. Nichols, R.N., D.N.Sc., Dean, College of Nursing, University of North Dakota, Grand Forks, North Dakota

The Borders Without Boundaries Project: Introducing Health Profession Students to Border Health Concerns and Practices
Barbara D. Adams, M.S.A., Claudia Coggin, M.S., Robert J. Hastings, M.A., Henri Migala, M.P.H., Muriel Marshall, D.O., M.P.H., Dr.P.H.
Texas Journal of Rural Health 2000; 18(1): 44-51
Abstract
 
As part of a larger effort to develop culturally competent health care professionals, health profession students visited the Texas-Mexico border area to learn about health care concerns and practices from the people who live and work there. Through first-hand exploration students gained an understanding of the influence of culture and other issues involved in providing health care in a multicultural environment. This article will describe the field experience, its impact on students, and the educational model used.

Author Affiliations

  • Barbara D. Adams, M.S.A., Instructor, Department of Family Medicine, UNT Health Science Center, Fort Worth, Texas
  • Claudia Coggin, M.S., C.H.E.S., Instructor, Department of Public Health & Preventative Medicine, UNT Health Science Center, Fort Worth, Texas
  • Robert J. Hastings, M.A., Associate Director, Office of Border Health, Texas Tech Health Sciences Center, El Paso, Texas
  • Henri Migala, M.P.H., M.A., Director, Program Office (North Central Division - East Texas Area Health Education Center), UNT Health Science Center, Fort Worth, Texas
  • Muriel Marshall, D.O., M.P.H., Dr.P.H., Associate Professor, Departments of Family Medicine and Public Health & Preventative Medicine, UNT Health Science Center, Fort Worth, Texas

Acanthosis Nigricans in Youth: A Type 2 Diabetes Marker
Paul Villas, D.Ed., C.H.E.S., David Salazar, Doreen D. Garza, M.P.H., Evangelina T. Villagomez, R.N., M.S.N., Teresa Lightner, M.D.
Texas Journal of Rural Health 2000; 18(1): 52-58
Abstract
 
This study examined the association between acanthosis nigricans markings on the neck region of Mexican-American sixth-grade students and glucose and insulin levels, obesity, hypertension and hyperlipidemia. Acanthosis nigricans is a skin marker associated with hyperinsulinemia, indicative of insulin resistance and the propensity to develop Type 2 diabetes. The physical appearance is characterized by light brown-black, velvety, rough, or thickened areas on the surface of specific body regions, usually the neck and axillae. Two hundred forty-one sixth grade students were examined during a required scoliosis screening and 48 were identified with acanthosis nigricans markings on the neck region. Data were collected from 34 sixth-grade students. Descriptive mean scores indicated a positive relationship between acanthosis nigricans markers and exiting conditions that signaled the potential for future health problems. The presentation of the skin marker in this study was more common than in previously reported studies of Mexican-American children with diabetes risk and suggested that the condition can be used as a predictor of future consequential medical circumstances.

Author Affiliations

  • Paul Villas, D.Ed., C.H.E.S., Executive Director, Texas-Mexico Border Health, Coordination Office, University of Texas-Pan American, Edinburg, Texas
  • David Salazar, Health Education Director, Texas-Mexico Border Health Coordination Office University of Texas-Pan American, Edinburg, Texas
  • Doreen D. Garza, M.P.H., Assistant Director, Texas-Mexico Border Health, Coordination Office, University of Texas-Pan American, Edinburg, Texas
  • Evangelina T. Villagomez, R.N., M.S.N., Diabetes Specialty Representative, Bayer Corporation, San Antonio, Texas
  • Teresa Lightner, M.D., Professor of Internal Medicine, Valley Diagnostic Clinic, Harlingen, Texas
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