Health-related disparities remain a persistent, serious problem across the nation's more than 60 million rural residents. Rural Populations and Health provides an overview of the critical issues surrounding rural health and offers a strong theoretical and evidence-based rationale for rectifying rural health disparities in the United States. This edited collection includes a comprehensive examination of myriad issues in rural health and rural health care services, as well as a road map for reducing disparities, building capacity and collaboration, and applying prevention research in rural areas. This textbook offers a review of rural health systems in Colorado, Kentucky, Alabama, and Iowa, and features contributions from key leaders in rural public health throughout the United States.

Background: Malignancy is a significant risk factor for venous thromboembolism (VTE), conferring a 4- to 7-fold increased risk in patients with cancer. Because of its effect on certain tumors, low-molecular-weight heparin (LMWH) has been evaluated as a treatment option for cancer and as an alternative to traditional warfarin therapy in patients with active cancer. LMWH is associated with a reduced recurrence of VTE, fewer adverse bleeding events, and, in some instances, decreased mortality. The American College of Chest Physicians/American Society of Clinical Oncology has recommended LMWH for at least the initial 3 to 6 months when treating VTE in patients with cancer, based on the positive outcomes associated with LMWH. Objective: The purpose of this study was to evaluate physician prescribing patterns for LMWH or warfarin in patients with acute VTE and active cancer. Methods: We conducted a retrospective chart review of hospitalized patients at a community teaching hospital with an affiliated regional cancer center located in a rural area of the United States. Patients included in the analysis had an International Classification of Diseases, Ninth Revision code indicative of any cancer type and a concomitant code for any VTE. The primary outcome was the drug prescribed at discharge for the treatment of VTE. Secondary outcomes included specialty of the prescribing physician, adverse bleeding events, and the need for transfusion. VTE treatment regimen was evaluated using the binomial test, and logistic regression analysis was used to determine correlation of the prescriber’s specialty with the patient’s prescribed regimen. Results: Of 129 patients included in the analysis, 107 (82.9%) were prescribed warfarin compared with 9 (7%) who were prescribed LMWH. Hematologists and oncologists were more likely to prescribe LMWH than general practitioners (odds ratio, 7.8; 95% hazard ratio, 1.5-42). Seven patients had a documented adverse bleeding event and 2 patients required a transfusion. Four of the 7 adverse bleeding events and 1 of the 2 transfusions occurred in the group receiving vitamin K antagonist therapy. Conclusion: Physicians in our system were significantly more likely to prescribe warfarin for acute treatment of VTE in patients with active cancer—despite consistent evidence and multiple evidence­-based guidelines recommending treatment with LMWH in this patient population. This was lower than other observations in Canadian populations but may more accurately represent nonteaching centers in the United States, particularly those in rural areas. Specialists in oncology were significantly more likely to prescribe LMWH than generalists.

Thesis (LLM.) -- University of Limpopo, 2011

Thesis (M.Cur.) -- University of Limpopo, 2014 / The purpose of this study was to explore effects of teenage motherhood on the secondary education of the female learner. A qualitative research method and a descriptive, exploratory research design were adopted to undertake the study. Five one-on-one interviews were conducted and the data was analysed by using Tesch’s method of analysis. Three themes and nine sub-themes were generated from the analysed data. The research findings indicate that teenage motherhood does not have a negative effect on the ability of the learner to continue attending school, but also suggest that the various challenges experienced by the learner do have adverse effects on her school performance and ultimate decision to suspend school. There were other factors that influenced her academic performance and decision to continue or suspend school attendance; namely family support, experiences at school, as well as the cultural beliefs, traditions, and perceptions of the society she was living in. Key concepts: Teenage motherhood, effects, secondary education.

The main theme of this thesis is the contradiction between discourse and practice in health promotion. Many health promoters continue to exert power-over the community through top-down programming whilst at the same time using an emancipatory discourse. The thesis has addressed this contradiction in three parts. The first part determines how the emancipatroty discourse has evolved and eplores the role of social movements in the development of contemporary health discourses and their influence on the legitimisation of empowerment. Central to this discourse is the empowerment of communities. To understand the role of this concept the thesis provides an interpretation of the different meanings of power and community, and the different levels of analysis of empowerment in the context of health promotion programming. The second part identifies the nature of health programming and the dominance of top-down, and to a much lesser extent, bottom-up approaches. The thesis argues that these two approaches are not, and do not have to be, mutually exclusive. To address this issue the thesis presents a new methodology is situated within a framework developed for the accomodation of empowerment goals within health promotion programmes. The study also identifies the organisational areas of influence on the processs of community empowerment and it is these which are used for the assessment of this concept. Both the framework and the methodology address the contradiction in health promotion by making community empowerment operational within a programme context. The third part of the thesis supports the rationale for the design of the methodology with field work in rural Fijian communities. The findings are presented as a composite case study to highlight the experiences of implementing the methodolgy and the main themes that emerged during the field work. the final chapter of the thesis brings together the central themes of the study and draws from these and 'emergent agenda' as a way forward for health promotion research and practice.

Ziele der Arbeit sind die Bestimmung der dominanten Landnutzungsarten im Untersuchungsgebiet von Edd Al Fursan (Sudan) sowie die Kartierung und Analyse der Veränderungen der Landnutzung im Zeitraum 1972 bis 2008 mit Hilfe von multi-temporalen Satellitenbildern (Landsat MSS, TM und ETM sowie Terra ASTER). Des weiteren erfolgt eine Evaluierung des Einflusses von Veränderungen der Landnutzung auf die Lebensbedingungen der ländlichen Bevölkerung in Hinblick auf die Verfügbarkeit von Ressourcen mit Hilfe von quantitativen Untersuchungsmethoden. Um diese Aussagen treffen zu können, werden drei Methoden der Bestimmung von Veränderungen der Landnutzung angewandt, und zwar Post Classification Comparison (PCC), Change Vector Analysis (CVA) basierend auf Tasseled Cap Transformation (TCT) sowie Iteratively Reweighted Multivariate Alteration Detection (IR-MAD) mittels Maximum Autocorrelation Factor (MAF). Neben den fernerkundlichen Untersuchungen wurde eine sozio-ökonomische Feldstudie durchgeführt, die vorstrukturierte Fragenkataloge, Interviews und Gruppendiskussionen mit Personen in regionalen und lokalen Schlüsselpositionen und mit älteren Menschen durchgeführt. Fünf Klassen der Landnutzung und Landbedeckung ergeben sich aus einer Klassifikation der Satellitenbilder mit der Methode der größten Wahrscheinlichkeit (Maximum Likelihood), explizit die Klassen Grasland, Waldland, Brachland, bebautes und landwirtschaftlich nicht genutztes Land. Die Klassifikation schafft eine genaue Grundlage für die Kartierung, Quantifizierung und Analyse der Änderungen. Die Gesamtgenauigkeit der Flächenermittlung beträgt 83% für die Jahre 1972 und 1984, 85% für 1989, 87% für 1999 und 92% für 2008. Die Untersuchungen zeigen, dass die Post Classification Comparison (PCC) eine vollinhaltlich geeignete und leicht anzuwendende Methode der Flächenanalyse darstellt. Change Vector Analysis (CVA) beruhend auf Tasseled Cap Transformation (TCT) wird ebenfalls für die Kartierung und Bestimmung von Landnutzungsänderungen verwendet. Durch TCT wird der spektrale Bildinhalt in die Komponenten Greeness und Brightness transformiert sowie in dem dadurch neu definierten Koordinatensystem die CVA durchgeführt. Die Ergebnisse in Form von Vektoren der Veränderung mit messbarer Richtung und messbarem Ausmass der Flächendynamik beweisen, dass die Methode für die Kartierung von Vegetationsbedeckung und insbesondere von Entwaldung und Wiederbewaldung geeignet ist. Durch die Anwendung der Multivariate Alteration Detection (MAD) in Kombination mit dem Maximum Autocorrelation Factor (MAF) werden Veränderungen der Landnutzungsklassen während des betrachteten Zeitraumes visualisiert. Die Ergebnisse beweisen, dass die MAD für die Veränderungsanalyse in multi-spektralen Satellitenbildern sehr gut geeignet ist. Darüber hinaus wird nachgewiesen, dass die Kombination mit dem MAF die Ergebnisse der MAD entscheidend verbessern kann, da Rauschen und geringfügige Änderungen unterdrückt und signifikante Änderungen klarer herausgestellt und damit besser interpretierbar werden. Um die Ursachen für die Veränderungen der Landnutzung und den Einfluss dieser Änderungen auf die Lebensbedingungen der ländlichen Bevölkerung im Projektgebiet zu identifizieren, wurde eine Befragung mittels vorstrukturiertem Fragenkatalog, Interviews und Gruppengesprächen mit 100 GesprächspartnerInnen im Alter zwischen 42 und 65 Jahren in vier nach dem Zufallsprinizip ausgewählten Dörfern ausgeführt. Die Auswertung der sozio-ökonomischen Daten erlaubt die Extraktion der Faktoren, die Landnutzung und deren Änderung beeinflussen, und die zu bestimmten Auswirkungen dieser Änderungen auf die Lebensbedingungen in den Dörfern in Hinsicht auf die Verfügbarkeit von Natur-Ressourcen führen. Die Ergebnisse der Forschungsarbeiten zeigen, dass Fernerkundung und sozio-ökonomische Datenanalyse effizient verknüpft werden können, um anthropogene Einflüsse auf Art und Dynamik von Landnutzung sichtbar zu machen. In bezug auf die gegenständliche Zeitreihe wird durch die Untersuchungen bewiesen, dass zunehmende Bevölkerungszahlen im Gebiet von Edd Al-Fursan in direktem Wirkungszusammenhang mit Veränderungen der Landnutzung stehen.

Many rural communities in South Africa do not have running water or electricity. The fetching and heating of water is therefore a time consuming and expensive daily ritual. The use of energy sources such as wood or coal are not readily available and cause environmental pollution. Although solar water heaters are commonly available in South Africa, they are very seldom used in rural areas. Whilst this can mostly be attributed to a high system cost, current designs also do not cater for specific rural problems such as the transporting or purification of water. A prototype model, designed with such an approach in mind, has already been constructed by TEMM International (Pty.) Ltd. The Solar Heat Barrow (SHB) was developed in the 1992 to 2003 period with the intention of combining a number of functions at low cost. Specific requirements were: low cost, a suitable design and materials for manufacture in large volume, sufficiently durable taking into account the harsh conditions of use. suitability for cases where no in-house piped water supply was available, the use of appropriate technology and the improvement of quality of life. The unit combines the absorption of solar radiation, the heating of a relatively small volume of water, the transport of the water from the point of supply and the storage of the hot water until it is used. Untreated water sources such as surface waters (streams, rivers, lakes, etc.) or unprotected open wells are the vehicles for waterborne bacterial diseases such as cholera and typhoid fevers. In the case where water is collected from these sources, the SHB has a build-in Purification Dispenser that purifies the water in the collector against waterborne bacterial diseases. Certain research questions need to be answered. They will be answered by demonstrating the SHB in two communities where no in-house piped water supply is available and by establishing the socio-economic response of the users. The research questions are as follow: What are the responses of the users concerning the SHB, in comparison to those of a control group, regarding its operation, durability, utility and satisfaction of needs? What is the daily use of hot water and the reduction in energy use and cost? To what extent will the target community purchase the SHB at the full or subsidised commercial price? Is there a business case that can be developed for the large scale production, marketing. financing and Small, Medium and Micro Enterprises (SMME) development of the SHB? It was decided to choose a community in the Valley of Thousand Hills in KwaZulu Natal as the demonstration site. The name of the community is Mabedlane. It is a remote rural area 20 km's north of Botha's Hill and is situated along the Umgeni River. The community is dependent on the river for domestic water. Most families are headed by women. The area has low levels of infrastructure, poor roads, a high unemployment rate and poor health facilities. The first survey, which was conducted before the test period started, showed a very positive response from potential users. From 112 questionnaires that were given to the people of Mabedlane, all indicated that they were interested in a product that can transport and heat water for domestic use. The socio-economic study has shown that the price per unit needs to be adapted as 85% of the people who participated in the survey indicated that they would only pay less than R100 for the product. 15% indicated that they would pay between RlOO and R200. From the second and third questionnaires it was clear that the users were satisfied with the heating performances of the SHB. The community was very interested in purchasing a SHB. They have realised that a SHB will improve their standard of living and regard it as a necessity in their day to day activities. It is apparent that people, who will benefit from a SHB most, are those who will not be able to pay the full retail price. Therefore, new business strategies have to be researched when implementing the SHB to the target market in South Africa. The idea of considering ways to sponsorlfund the SHB must also be investigated. / Thesis (M.Ing. (Mechanical Engineering))--North-West University, Potchefstroom Campus, 2004.

The purpose of this qualitative research study was to understand the facilitators and/or barriers to safer drug use and sexual practices among a sample of young female injection drug users (IDUs) who live in small towns/rural communities in Cape Breton, Nova Scotia. This study examined how economic status, relationships, social roles, small town/rural living, and stigma function as facilitators and/or barriers to safer practices. Eight female IDUs aged 20-31, living in small towns/rural communities in Cape Breton, engaged in face-to-face, semi-structured interviews. The women described what day-to-day life is like for female IDUs living in small towns/rural communities. They spoke about managing drug addiction, their understanding of safer and unsafe injection drug use and risky and safer sexual practices, as well as their experiences with services/supports. The information obtained from this study will help to inform harm reduction policy and program initiatives.

Contamination of groundwater that is suitable for drinking is of growing concern as the water supply of South Africa is becomingincreasingly limited. This is especially the case in the North West province, with its semi – arid climate and variable rainfall patterns. The aim of the study was to evaluate the microbiological and physico – chemical qualities of groundwater obtained from selected DWA (Department of Water Affairs) monitoring boreholes in the Mooi River and Harts River catchment areas. Physico -chemical parameters included temperature, pH, electrical conductivity (EC), salinity, total dissolved solids (TDS), sulphate and nitrate concentrations. Physical parameters were measured using a calibrated submerge-able multimeter and chemical parameters using specialised kits and a spectrophotometer. Microbiological parameters included heterotrophic plate counts and total and faecal coliform enumeration. Membrane filtration and culture based methods were followed for enumeration of bacteria. During the identification procedures multiplex PCR for E. coli identification and 16S rRNA gene sequencing for identification of heterotrophic plate count bacteria and amoeba resistant bacteria were used. For antibiotic resistance, the Kirby- Bauer (1996) disk diffusion method was used. During the warm and wet season high electrical conductivity and salinity were observed in the Trimpark (65.3 mS/m; 325 ppm), School (125.1 mS/m; 644 ppm), Warrenton (166.9 mS/m; 867 ppm) and Ganspan (83.3 mS/m; 421 ppm) boreholes. Warrenton borehole had a high sulphate level (450 mg/l) as well. High chemical oxygen demand was observed in the Blaauwbank (62 mg/l) and Warrenton (98.5 mg/l) boreholes. In the dry and cold season similar observations were made for the various boreholes. Electrical conductivity and salinity levels remained high for the Trimpark (70.1 mS/m; 427.5 ppm), School (127 mS/m; 645 ppm), Warrenton (173.3 mS/m; 896.5 ppm) and Ganspan (88.1 mS/m; 444.5 ppm) boreholes. Nitrate levels for the Trimpark (14.1 mg/l) and School (137 mg/l), as well as sulphate levels for the Warrenton (325 mg/l) borehole were also high. Total coliforms, faecal streptococci and HPC bacteria were enumerated from water samples from all boreholes, except Blaauwbank where no faecal streptococci were enumerated. Faecal coliforms were enumerated from 5 of the possible 7 boreholes during a warm and wet season (Trimpark – 42 cfu/100ml; School – 2 cfu/100ml; Cemetery – 175 cfu/100ml; Warrenton – 3.84 x 10³ cfu/100ml; Ganspan – 1.9 x 10³ cfu/100ml). Indicator bacteria (FC, TC, HPC) exceeded target water quality ranges (TWQR) for drinking water in each case. During the cold and dry sampling season, faecal coliforms were enumerated mainly from the Trimpark (11 cfu/100ml) borehole. Total coliforms, faecal streptococci and HPC bacteria were enumerated from all the boreholes, except for Blaauwbank that contained no faecal streptococci or total coliforms. Enumerated indicator bacteria levels again exceeded TWQR for domestic use. Total coliform counts for the Pad dam borehole, however, complied with TWQR for domestic use. Identified E. coli were resistant to Erythromycin, Cephalothin and Amoxicillin and susceptible to Ciprofloxacin. Escherichia coli isolated from the Mooi River catchment shared the same antibiotic resistance phenotype. The most abundant HPC bacterial genus identified was Pseudomonas spp. (7 isolates). Opportunistic pathogens isolated included Pseudomonas aeruginosa, Acinetobacter, Aeromonas, Alcaligenes, Flavobacterium, Bacillus cereus and Mycobacterium spp. Varying degrees of antibiotic resistance were observed. Generally, the same pattern between the same genera were observed. All HPC isolates were resistant to Cephalothin and Amoxicillin and a lower degree Erythromycin and Streptomycin. The most abundant amoeba resistant bacteria was identified as Pseudomonas spp. Other isolates included Alcaligenes faecalis and Ochrobactrum sp. and Achromobacter sp. All of these are opportunistic pathogens, except for Achromobacter. Resistance to more antibiotics (Streptomycin, Chloramphenicol, Cephalothin, and Amoxicillin) was observed in ARBs compared to HPC (Cephalothin, Amoxicillin) from bulk water from the same borehole. The water of all the aquifers sampled is of very poor physico - chemical or microbiological quality or both. Water may be used for irrigation or livestock watering only in the case where these boreholes comply with TWQR for said purposes. Results obtained indicate that the groundwater is faecally contaminated. Amongst the bacteria, opportunistic pathogens displaying various degrees of antibiotic resistance were frequently isolated. These results indicate health risks if untreated groundwater is consumed. Therefore groundwater needs to be treated before distribution especially if the water is for human consumption. / Thesis (MSc (Environmental Sciences))--North-West University, Potchefstroom Campus, 2013.

Contamination of groundwater that is suitable for drinking is of growing concern as the water supply of South Africa is becomingincreasingly limited. This is especially the case in the North West province, with its semi – arid climate and variable rainfall patterns. The aim of the study was to evaluate the microbiological and physico – chemical qualities of groundwater obtained from selected DWA (Department of Water Affairs) monitoring boreholes in the Mooi River and Harts River catchment areas. Physico -chemical parameters included temperature, pH, electrical conductivity (EC), salinity, total dissolved solids (TDS), sulphate and nitrate concentrations. Physical parameters were measured using a calibrated submerge-able multimeter and chemical parameters using specialised kits and a spectrophotometer. Microbiological parameters included heterotrophic plate counts and total and faecal coliform enumeration. Membrane filtration and culture based methods were followed for enumeration of bacteria. During the identification procedures multiplex PCR for E. coli identification and 16S rRNA gene sequencing for identification of heterotrophic plate count bacteria and amoeba resistant bacteria were used. For antibiotic resistance, the Kirby- Bauer (1996) disk diffusion method was used. During the warm and wet season high electrical conductivity and salinity were observed in the Trimpark (65.3 mS/m; 325 ppm), School (125.1 mS/m; 644 ppm), Warrenton (166.9 mS/m; 867 ppm) and Ganspan (83.3 mS/m; 421 ppm) boreholes. Warrenton borehole had a high sulphate level (450 mg/l) as well. High chemical oxygen demand was observed in the Blaauwbank (62 mg/l) and Warrenton (98.5 mg/l) boreholes. In the dry and cold season similar observations were made for the various boreholes. Electrical conductivity and salinity levels remained high for the Trimpark (70.1 mS/m; 427.5 ppm), School (127 mS/m; 645 ppm), Warrenton (173.3 mS/m; 896.5 ppm) and Ganspan (88.1 mS/m; 444.5 ppm) boreholes. Nitrate levels for the Trimpark (14.1 mg/l) and School (137 mg/l), as well as sulphate levels for the Warrenton (325 mg/l) borehole were also high. Total coliforms, faecal streptococci and HPC bacteria were enumerated from water samples from all boreholes, except Blaauwbank where no faecal streptococci were enumerated. Faecal coliforms were enumerated from 5 of the possible 7 boreholes during a warm and wet season (Trimpark – 42 cfu/100ml; School – 2 cfu/100ml; Cemetery – 175 cfu/100ml; Warrenton – 3.84 x 10³ cfu/100ml; Ganspan – 1.9 x 10³ cfu/100ml). Indicator bacteria (FC, TC, HPC) exceeded target water quality ranges (TWQR) for drinking water in each case. During the cold and dry sampling season, faecal coliforms were enumerated mainly from the Trimpark (11 cfu/100ml) borehole. Total coliforms, faecal streptococci and HPC bacteria were enumerated from all the boreholes, except for Blaauwbank that contained no faecal streptococci or total coliforms. Enumerated indicator bacteria levels again exceeded TWQR for domestic use. Total coliform counts for the Pad dam borehole, however, complied with TWQR for domestic use. Identified E. coli were resistant to Erythromycin, Cephalothin and Amoxicillin and susceptible to Ciprofloxacin. Escherichia coli isolated from the Mooi River catchment shared the same antibiotic resistance phenotype. The most abundant HPC bacterial genus identified was Pseudomonas spp. (7 isolates). Opportunistic pathogens isolated included Pseudomonas aeruginosa, Acinetobacter, Aeromonas, Alcaligenes, Flavobacterium, Bacillus cereus and Mycobacterium spp. Varying degrees of antibiotic resistance were observed. Generally, the same pattern between the same genera were observed. All HPC isolates were resistant to Cephalothin and Amoxicillin and a lower degree Erythromycin and Streptomycin. The most abundant amoeba resistant bacteria was identified as Pseudomonas spp. Other isolates included Alcaligenes faecalis and Ochrobactrum sp. and Achromobacter sp. All of these are opportunistic pathogens, except for Achromobacter. Resistance to more antibiotics (Streptomycin, Chloramphenicol, Cephalothin, and Amoxicillin) was observed in ARBs compared to HPC (Cephalothin, Amoxicillin) from bulk water from the same borehole. The water of all the aquifers sampled is of very poor physico - chemical or microbiological quality or both. Water may be used for irrigation or livestock watering only in the case where these boreholes comply with TWQR for said purposes. Results obtained indicate that the groundwater is faecally contaminated. Amongst the bacteria, opportunistic pathogens displaying various degrees of antibiotic resistance were frequently isolated. These results indicate health risks if untreated groundwater is consumed. Therefore groundwater needs to be treated before distribution especially if the water is for human consumption. / Thesis (MSc (Environmental Sciences))--North-West University, Potchefstroom Campus, 2013.