TEXAS JOURNAL OF RURAL HEALTH

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ISSUE 18(2), 2000

TABLE OF CONTENTS
 
Editorial
Lee Ann Paradise
FULL TEXT
 
Hart ISD School-based Clinic and Telemedicine Program
Don McBeath, Shannon Kennedy
Texas Journal of Rural Health 2000; 18(2): 3-7
ABSTRACT
 
Balanced Budget Act Legislation and Rural Health: Change and Consequences
Keith J. Mueller, Ph.D.
Texas Journal of Rural Health 2000; 18(2): 8-16
ABSTRACT
Rural Health Programs: Lessons Learned
Karunesh Tuli, M.D., M.P.H.
Texas Journal of Rural Health 2000; 18(2): 17-20
ABSTRACT
 
Border Environment Issues
Richard L. Durbin, M.B.A., M.P.A., M.P.H.
Texas Journal of Rural Health 2000; 18(2): 21-33
ABSTRACT
'Advanced Practice' Family Physicians as the Foundation for Rural Emergency Medicine Services (Part II)
Kim Bullock, M.D., F.A.A.F.P., B.C.E.M., Wm. MacMillan Rodney, M.D., F.A.A.F.P., F.A.C.E.P., Tony Gerard, M.D., F.A.A.F.P., Ricardo Hahn, M.D., F.A.A.F.P.
Texas Journal of Rural Health 2000; 18(2): 34-44
ABSTRACT
 
Skin Cancer Prevention Practices Among Rural Texas Farm Women
Serey Shum, Ph.D., R.N., Lana Skarke, M.S.N., R.N., Rebecca Robinson, Ph.D., R.N.,
Paula Toland, Ph.D., R.N., Heidi Taylor, Ph.D., R.N.
Texas Journal of Rural Health 2000; 18(2): 45-52
ABSTRACT

ABSTRACTS

Hart ISD School-based Clinic and Telemedicine Program
Don McBeath, Shannon Kennedy
Texas Journal of Rural Health 2000; 18(2): 3-7

Abstract

A unique partnership between Hart Independent School District (ISD) and the Texas Tech University Health Sciences Center (TTUHSC) has fostered the development of a school-based clinic that provides pediatric health care through physician visits, both on-site and via telemedicine.

Whenever one thinks of health care in school, images come to mind of a school nurse taking a student's temperature and wiping his face with a cold cloth. School-based health clinics are not a new concept, but few school districts have committed to provide the level of care that Hart ISD provides at its clinic.

The innovative partnership involves the school in Hart, Texas, a small rural farming community in the Texas Panhandle, and Texas Tech University Health Sciences Center, with its main campus located in Lubbock, Texas - approximately 70 miles southeast of Hart. The uniqueness of the Hart program is that it incorporates both on-site primary pediatric health care and distance health care via an electronic telemedicine system. The school clinic is believed to be the first in Texas with telemedicine and one of only a few such programs in the nation.

Author Affiliations

  • Don McBeath, Director, Center for Telemedicine, Texas Tech University Health Sciences Center, Lubbock, Texas
  • Shannon Kennedy, M.B.A., Special Projects Coordinator, Center for Telemedicine, Texas Tech University Health Sciences Center, Lubbock, Texas

Balanced Budget Act Legislation and Rural Health: Change and Consequences
Keith J. Mueller, Ph.D.
Texas Journal of Rural Health 2000; 18(2): 8-16

Abstract

Seeds have been planted that could significantly alter the landscape of health care delivery in rural America. For the near future, the principal motivation behind change in rural health care delivery will be the implementation of changes in the Medicare program (and in some states, the Medicaid program). Those changes have been included in the Balanced Budget Act of 1997 (BBA) and the Medicare, Medicaid, and State Child Health Insurance Program (SCHIP) Balanced Budget Refinement Act of 1999 (BBRA).

Author Affiliations

  • Keith J. Mueller, Ph.D., Professor and Director, Nebraska Center for Rural Health Research, Univeristy of Nebraska Medical Center, Omaha, Nebraska

Rural Health Programs: Lessons Learned
Karunesh Tuli, M.D., M.P.H.
Texas Journal of Rural Health 2000; 18(2): 17-20

Abstract

In our quest to improve the health status of Texans we face many challenges. Two-thirds of the counties in our state suffer from a shortage of health professionals (Center for Rural Health Initiatives, 1999). Rural counties are particularly hard-hit and find it extremely difficult to attract and retain health care providers. To add to the problem of poor access to care for existing disease, there is a high potential for emergence of new disease because of unhealthy behaviors. Nearly half of all newborn Texans are not breastfed (Texas Department of Health, 1998a). One-fourth of the population between 19 and 35 months of age is not fully vaccinated (Texas Department of Health, 1999). Nearly a third of public middle school students use tobacco products (Texas Department of Health, 1998b). People living in the colonias on the border with Mexico have little access to public drinking water or wastewater systems; the threat of water-borne disease is high in these communities (Health Resources and Services Administration, 1999).

Around the world, countries, states, and communities are trying to overcome similar problems. Major global initiatives to control disease such as the successful international effort to eradicate smallpox are well known (Center for Disease Control, 1998). Equally important to the health of communities are smaller-scale efforts that go unreported in the United States. We can also learn much from these less publicized international health initiatives and apply the lessons to problems that affect us in Texas.

Author Affiliations

  • Karunesh Tuli, M.D., M.P.H., Research Associate, Rural and Community Health, Texas Tech University Health Sciences Center, Lubbock, Texas

Border Environment Issues
Richard L. Durbin, M.B.A., M.P.A., M.P.H.
Texas Journal of Rural Health 2000; 18(2): 21-33

Abstract

In 1993, the Air Quality Board and the Water Control Board merged to form the Texas Natural Resource Conservation Commission (TNRCC). In 1994, environmental responsibilities formally carried out by the Texas Department of Health were assigned to the TNRCC; affectionately referred to by some as the "train wreck." The responsibility for soil, air, and water quality monitoring and enforcement was not clearly defined by statute. A source of confusion as to whether state, local, or federal agencies had authority ensued.

This article attempts to sort out who does what, particularly in the fast-growing area of the United States/Mexico Border. To further identify areas of responsibility, a questionnaire was designed and sent to health and TNRCC locations, asking their understanding of assignments. The results will be discussed in this article.

Author Affiliations

  • Richard L. Durbin, M.B.A., M.P.A., M.P.H., Graduate Student, University of Texas at Houston, Houston, Texas

'Advanced Practice' Family Physicians as the Foundation for Rural Emergency Medicine Services (Part II)
Kim Bullock, M.D., F.A.A.F.P., B.C.E.M., Wm. MacMillan Rodney, M.D., F.A.A.F.P., F.A.C.E.P., Tony Gerard, M.D., F.A.A.F.P., Ricardo Hahn, M.D., F.A.A.F.P.
Texas Journal of Rural Health 2000; 18(2): 34-44

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 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

Skin Cancer Prevention Practices Among Rural Texas Farm Women
Serey Shum, Ph.D., R.N., Lana Skarke, M.S.N., R.N., Rebecca Robinson, Ph.D., R.N.,
Paula Toland, Ph.D., R.N., Heidi Taylor, Ph.D., R.N.
Texas Journal of Rural Health 2000; 18(2): 45-52

Abstract

The objective of this study was to identify the knowledge and attitudes regarding skin cancer causes and prevention practices among rural Texas farm women. This study was drawn from a larger survey focusing on women's and children's health behaviors, practices, and injuries sustained in a twelve-month period. The work was supported by a subcontract grant from the Southwest Center for Agricultural Health, Injury Prevention, and Education at the University of Texas in Tyler, Texas.

Six hundred and sixty five women responded to a thirty-minute telephone interview. A high incidence (11%) of skin cancer was noted. The results indicated that knowledge, the history of skin cancer, and age were statistically significant predictors to prevention practices.

Author Affiliations

  • Serey Shum, Ph.D., R.N., Assistant Professor, Community Health Nursing, Division of Nursing, West Texas A&M University, Canyon, Texas
  • Lana Skarke, M.S.N., R.N., Instructor/Director, Rural Farm Health Study, Division of Nursing, West Texas A&M University, Canyon, Texas
  • Rebecca Robinson, Ph.D., R.N., Assistant Professor, Graduate Research, Division of Nursing, West Texas A&M University, Canyon, Texas
  • Paula Toland, Ph.D., R.N., Instructor, Leadership & Management, Division of Nursing, West Texas A&M University, Canyon, Texas
  • Heidi Taylor, Ph.D., R.N., Assistant Professor, Division of Nursing, West Texas A&M University, Canyon, Texas
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