Compulsory medical service programs for physicians and other health care professionals have been installed in developing countries around the world. The underlying assumption for the creation of these programs is that the increased presence of physicians will improve the health status of rural populations which exhibit higher rates of morbidity and mortality compared to urban populations. This assumption, however, has been challenged by recent evaluative studies of compulsory service programs in Latin America. This paper reports on the physician's perspective of Ecuador's compulsory service program, known as medicatura rural. Based on responses to a self-administered questionnaire completed by 127 physicians who had fulfilled or were currently fulfilling their medicatura rural requirement, in-depth interviews with physicians and other officials, and visits to several rural placement sites, the paper examines some of the fundamental programmatic and logistical problems that have impeded the successful implementation of the program since its inception in 1970. While the majority of the physicians reported that the medicatura rural experience was both professionally and personally rewarding, many view the program as conceptually flawed with respect to its goal of improving the health status of rural communities. The physicians' suggestions for improving the medicatura rural, which elucidate some of the program's basic conceptual flaws and reflect the criticisms of compulsory medical programs in other Latin American countries, are discussed. Finally, Ugalde's (1988) recommendation for replacing compulsory medical service programs with a 'rural health corps' is considered.

Context: Rates and types of screening for depression in rural primary care practices are unknown. Purpose: To identify rates of depression screening among rural women in a sample of rural health clinics (RHCs). Methods: A chart review of 759 women's charts in 19 randomly selected RHCs across the nation. Data were collected from charts of female patients of rural primary care providers, using trained data collectors (inter-rater reliability.88 to.93). The Women's Primary Care Screening Form, designed by the authors, was used to collect demographic, health, and screening data. Data describing the characteristics of the clinics were collected using the National Rural Health Clinic Survey. Data regarding formal screening (validated instrument used) or informal (documentation of specific questions and answers regarding depression) in the previous 5 years were recorded. Findings: Characteristics of participating clinics and demographics of the women were similar to published data. Formal screening was documented in 2.4% of patients' charts. Informal screening was documented in 33.2% of charts. Patients with a history of anxiety were more likely to be screened (P <.001), and younger women were more likely to be screened than older women (P <.001). Conclusions: Primary care providers in RHCs use more informal than formal depression screening with their female patients. Providers are more likely to screen younger patients or patients with a diagnosis of anxiety.

Federal block grants are intended as non-competitive, formula grants mandated by the U.S. Congress that provide flexibility and increased capacity to state and local governments to provide services based on community need, including on such issues as social services and public health. It is unclear whether those resources are distributed in an equitable manner based on geography and other community characteristics. The population-based formulas that guide block grant distribution may make it difficult for sparsely populated states to distribute sufficient funds to less populated areas. Similarly, funding available through specific block grants may be insufficient to meet all community needs, placing rural communities at a disadvantage in resource prioritization. The purpose of the current study was to characterize distribution of five federal block grants to each of the 50 states based on state-level population and rurality. The study combined publicly available state-year-level data from 2018-2019 for all 50 states. Key data sources included funding amounts allocated to each state for selected block grant programs, American Community Survey data, and measures of rurality from the U.S. Census Bureau and the U.S. Department of Agriculture. Block grants considered included: 1) Preventive Health and Health Services (PHHS) Block Grant; 2) Community Services Block Grant (CSBG); 3) Child Care and Development Block Grant (CCDBG); 4) Substance Abuse Prevention and Treatment Block Grant (SABG); and 5) Community Mental Health Services Block Grant (MHBG). Analyses included descriptive statistics of distribution of block grants per 1,000 population and by three measures of state rurality. Mean funding amounts ranged from $614 per 1,000 to $5,562 per 1,000 people. Associations between measures of rurality and state block grant allocations were mixed in terms of direction and significance. For example, there was a significant positive relationship between percent of the population that lives in nonmetro counties and PHHS block grant allocations while there was a significant negative relationship between this measure of rurality and MHBG allocations. There was no significant relationship with the other three block grants. In contrast, there were significant positive associations between population density and allocation amounts for all block grants considered except for the CCDBG. Overall, our findings suggest that there are differences in how block grants are allocated to states based on their rurality both by the specific block grant and the measure of rurality considered. Importantly, these findings only assess state-level allocations based on state-level characteristics and do not directly measure amounts of funding that make it to rural communities within states. Findings provide insight on the implications of different block grant formulas and structures.

Intro: Rural America experiences disparities in healthcare access, socioeconomic status, health-related behaviors, and chronic conditions, compared to non-rural America. The Appalachian region, specifically the counties within Central Appalachia (CA), are among the poorest and most rural in the country with very poor health, economic, and educational outcomes. Moreover, Appalachia is faces a unique set of challenges even when compared with other rural or disadvantaged regions in the U.S. This study compares such outcomes between the counties of Central Appalachia to the counties of the rest of the United States. Methods: Data from County Health Rankings, American Community Survey, and the Institute of Health Metrics and Evaluation were combined using FIPS codes to create the analytic dataset. Demographic, health outcome/behaviors, socioeconomic, and clinical care characteristics were compared between Central Appalachia (238) and the rest of the U.S. (2,902) using independent samples t-tests. Results: In 26 different measures, Central Appalachia performed significantly worse (p =.05) when compared to the rest of the U.S. Among the most striking results is the difference between years of potential life lost (YPLL), where Central Appalachian counties have a mean YPLL of 10,657 years and the rest of the United States have a mean YPLL of 8,399 years. Discussion: This research highlights health disparities faced by rural areas, such as Central Appalachia, compared to the rest of the U.S. Ultimately, these results indicate the need to examine regional differences and variation in population-level characteristics in order to understand and improve the health of these disparate populations.

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Excerpt: The study by Black (2011) concluded that pets may be valuable in reducing loneliness among adolescents based on the finding that pet owners had lower loneliness scores. As appealing and logical as this conclusion may appear, there are a number of shortcomings in the study that prevent it from actually supporting this conclusion.