- 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 Zuņiga, 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 Zuņiga, 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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