Approach In Rural Areas Research Articles

Evaluation of several screening approaches for detection of cervical lesions in rural Shandong, China.

The study was designed to: (1) investigate the prevalence of high-risk human papillomavirus (HR- HPV) infection and cervical neoplasia; and (2) evaluate clinical performance of visual inspection with acetic acid/ Lugol's iodine (VIA /VILI), Pap smear, high-risk human papillomavirus (HR-HPV) DNA test for detecting cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and (3) explore appropriate screening approach in rural areas of Shandong Province. A total of 3,763 eligible women from Yiyuan County in Yimeng mountainous areas of rural Shandong, China, were enrolled and underwent Pap smear, HR-HPV DNA testing by Hybrid Capture 2 (HC2), and VIA /VILI tests. Women positive in any test were referred to colposcopy and biopsy as indicated. The prevalence of HR-HPV infection among all enrolled women was 11.1% and that in healthy women was 9.9%. In total 33 cases of CIN1, 16 cases of CIN2, 6 cases of CIN3 but none of cervical cancer were detected and the crude prevalence of CIN2+ was 0.58%. For detecting CIN2+, the sensitivity of HR-HPV DNA testing, VIA/VILI, Pap smear was 90.9%, 77.3%, 81.8%, respectively. Pap smear had the best specificity of 98.2%, followed by HR-HPV DNA testing with specificity of 89.4%, VIA/VILI had the lowest specificity of 81.2%. Colposcopy referral rate of HR-HPV DNA testing, VIA/VILI, Pap smear was 11.1%, 18.5%, 2.3%, respectively. Our results suggest that HR-HPV DNA testing alone might be appropriate for primary cervical cancer screening in rural low-resource areas of Shandong Province, China.

La dimensión territorial en la programación comunitaria y el nuevo marco de políticas públicas: Desarrollo rural territorial, reforma de la PAC y nuevo LEADER

What we’ve been calling as territorial development perspective is a rather recent phenomenon in the context of the European Union, just two decades. In essence this perspective has focused on the local approach to development processes in rural areas, guided mainly of instruments such as LEADER. The need to integrate the territorial dimension of development processes comes not only from the overall success of these instruments, but also by the belief that they can be a key factor in the economic and social cohesion within the EU. Recent advances, such as the Green Paper on Territorial Cohesion, the approval of the Territorial Agenda 2020 and what will be the policy of cohesion for the period 2014- 2020, show the willingness of the authorities to deepen the territorial dimension of sectoral policies and to advance in the necessary greater coordination of policies maintaining territorial criteria. On the other hand, the reform of the CAP which is discussed in these months, which will result in the design of the instruments to be applied during the period 2014-2020, is also a great opportunity to consolidate this territorial approach in rural areas. This article examines, first, the public framework policy in terms of the territorial dimension in the context of the European Union, deepening on the meaning of the recent advances in this field. Second, we analyze the main elements that are leading, to date, the reform of the CAP and to what extent this reform includes a component as important as the territorial perspective for the development of rural areas. The findings point to the continuity and even deepening in the productivist and environmentalist orientation of the CAP. Third, we analyze what is going to be the territorial rural development policy in the strict sense, ie the continuation of the LEADER approach. In this regard we emphasize that the drop in the next programming period 2014-2020 of the structure by the four axis of the 2007-2013 period, and its replacement by a more simple, and apparently more flexible and powerful structure, will (always depending on the final budget allocations) deepen and consolidate LEADER as the main instrument for implementing local development strategies in rural areas. In this context, in the coming years they would be open possibilities for cooperation between rural and urban areas, in both cases under the focus of publicprivate partnerships and implementing local development strategies. These possibilities of territorial cooperation require vision by the regional stakeholders and a high capacity for commitment towards the implementation of these effective ways of cooperation and regional development.

Risk factors for virological failure and subtherapeutic antiretroviral drug concentrations in HIV-positive adults treated in rural northwestern Uganda

BackgroundLittle is known about immunovirological treatment outcomes and adherence in HIV/AIDS patients on antiretroviral therapy (ART) treated using a simplified management approach in rural areas of developing countries, or about the main factors influencing those outcomes in clinical practice.MethodsCross-sectional immunovirological, pharmacological, and adherence outcomes were evaluated in all patients alive and on fixed-dose ART combinations for 24 months, and in a random sample of those treated for 12 months. Risk factors for virological failure (>1,000 copies/ml) and subtherapeutic antiretroviral (ARV) concentrations were investigated with multiple logistic regression.ResultsAt 12 and 24 months of ART, 72% (n = 701) and 70% (n = 369) of patients, respectively, were alive and in care. About 8% and 38% of patients, respectively, were diagnosed with immunological failure; and 75% and 72% of patients, respectively, had undetectable HIV RNA (<400 copies/ml). Risk factors for virological failure (>1,000 copies/ml) were poor adherence, tuberculosis diagnosed after ART initiation, subtherapeutic NNRTI concentrations, general clinical symptoms, and lower weight than at baseline. About 14% of patients had low ARV plasma concentrations. Digestive symptoms and poor adherence to ART were risk factors for low ARV plasma concentrations.ConclusionEfforts to improve both access to care and patient management to achieve better immunological and virological outcomes on ART are necessary to maximize the duration of first-line therapy.

The Future of Rural Social Work

Over the years, the extensive literature on rural social work has been consistent in its recommendations for local community-based practice and rural generalist practice. However, rural social work is embedded in the larger social work profession which has been moving in the opposite direction from the one advocated by rural social workers. The gradual process of centralization and specialization in the profession now make it almost impossible for social workers to use community-based generalist practice approaches in rural areas. In order to ensure a positive future for rural social work, urban and rural social workers must work together to re-introduce a level of community-based generalist practice within regionalized and specialized social and health service systems. A range of alternative approaches to link community-based rural programs with regional programs is presented.

Models for Integrating and Managing Acute and Long-Term Care Services in Rural Areas

States and the federal government are searching for new managed-care strategies, such as capitated financing and coordinated case management, that integrate the financing and delivery of primary, acute, and long-term care services. For rural communities, the development of organizational and delivery systems, which better integrate and manage primary, acute, and long term care services, may help address long-standing problems of limited access to long-term care services. This article discusses the concept of integrated acute (medical) and long-term care service networks; model programs; challenges that health care providers, state policymakers, and others have faced in developing these new integrated structures; and the future of service-integration and coordination approaches in rural areas.