Reimagining Rural: Shifting Paradigms About Health and Well-Being in the Rural United States.

Rural health disparities have attracted increased national attention, compelling an expanded focus on rural health research. In this article, we deconstruct the definitions and narratives of "rural" communities and suggest that a paradigm shift is needed that centers the complexity and strength of rural places. We discuss the relevance of health equity frameworks, implementation science, and community-engaged approaches to promote rural well-being. Focusing on rural in its own right will lead to intervention innovations and reinvention with implications beyond rural areas. We conclude with suggestions for research and practice to inspire renewed interest in partnering with rural communities to promote health equity.

Evidence on yoga for health: A bibliometric analysis of systematic reviews.

OBJECTIVE: To support the research agenda in yoga for health by comprehensively identifying systematic reviews of yoga for health outcomes and conducting a bibliometric analysis to describe their publication characteristics and topic coverage. METHODS: We searched 7 databases (MEDLINE/PubMed, Embase, PsycINFO, CINAHL, AMED, the Cochrane Database of Systematic Reviews, and PROSPERO) from their inception to November 2019 and 1 database (INDMED) from inception to January 2017. Two authors independently screened each record for inclusion and one author extracted publication characteristics and topics of included reviews. RESULTS: We retrieved 2710 records and included 322 systematic reviews. 157 reviews were exclusively on yoga, and 165 were on yoga as one of a larger class of interventions (e.g., exercise). Most reviews were published in 2012 or later (260/322; 81 %). First/corresponding authors were from 32 different countries; three-quarters were from the USA, Germany, China, Australia, the UK or Canada (240/322; 75 %). Reviews were most frequently published in speciality journals (161/322; 50 %) complementary medicine journals (66/322; 20 %) or systematic review journals (59/322; 18 %). Almost all were present in MEDLINE (296/322; 92 %). Reviews were most often funded by government or non-profits (134/322; 42 %), unfunded (74/322; 23 %), or not explicit about funding (111/322; 34 %). Common health topics were psychiatric/cognitive (n = 56), cancer (n = 39) and musculoskeletal conditions (n = 36). Multiple reviews covered similar topics, particularly depression/anxiety (n = 18), breast cancer (n = 21), and low back pain (n = 16). CONCLUSIONS: Further research should explore the overall quality of reporting and conduct of systematic reviews of yoga, the direction and certainty of specific conclusions, and duplication or gaps in review coverage of topics.

Spatial and temporal regulation of GH-IGF-related gene expression in growth plate cartilage.

Previous studies of the GH-IGF system gene expression in growth plate using immunohistochemistry and in situ hybridization have yielded conflicting results. We therefore studied the spatial and temporal patterns of mRNA expression of the GH-IGF system in the rat proximal tibial growth plate quantitatively. Growth plates were microdissected into individual zones. RNA was extracted, reverse transcribed and analyzed by real-time PCR. In 1-week-old animals, IGF-I mRNA expression was minimal in growth plate compared with perichondrium, metaphyseal bone, muscle, and liver (70-, 130-, 215-, and 400-fold less). In contrast, IGF-II mRNA was expressed at higher levels than in bone and liver (65- and 2-fold). IGF-II expression was higher in the proliferative and resting zones compared with the hypertrophic zone (P < 0.001). GH receptor and type 1 and 2 IGF receptors were expressed throughout the growth plate. Expression of IGF-binding proteins (IGFBPs)-1 through -6 mRNA was low throughout the growth plate compared with perichondrium and bone. With increasing age (3-, 6-, 9-, and 12-week castrated rats), IGF-I mRNA levels increased in the proliferative zone (PZ) but remained at least tenfold lower than levels in perichondrium and bone. IGF-II mRNA decreased dramatically in PZ (780-fold; P < 0.001) whereas, type 2 IGF receptor and IGFBP-1, IGFBP-2, IGFBP-3, and IGFBP-4 increased significantly with age in growth plate and/or surrounding perichondrium and bone. These data suggest that IGF-I protein in the growth plate is not produced primarily by the chondrocytes themselves. Instead, it derives from surrounding perichondrium and bone. In addition, the decrease in growth velocity that occurs with age may be caused, in part, by decreasing expression of IGF-II and increasing expression of type 2 IGF receptor and multiple IGFBPs.

Age differences in health effects of stressors and perceived control among urban African American women.

A conceptual model of the stress process has been useful in examining relationships among a variety of stressors, health status, and protective factors that modify the health-stress relationship. The model can contribute to an understanding of variations in health among people living in urban environments experiencing high degrees of stress. This study examines social contextual stressors in the neighborhood, health outcomes, and perceived control at multiple levels beyond the individual as a protective factor, among a random sample (N = 679) of predominantly low-income African American women who reside on Detroit's east side. Findings suggest that although stress has a consistently negative impact on health, perceived control may buffer against the deleterious effects of stress. The buffering role of perceived control, however, depends on age, the type of stressor examined, and the context or level at which perceived control is assessed (e.g., organizational, neighborhood, beyond the neighborhood). For young women, perceived control was found to be health protective. Among older women, perceived control in the face of stressors was inversely related to health. These findings suggest the need for health and social service programs and policy change strategies to both increase the actual influence and control of women living in low-income urban communities and to reduce the specific social contextual stressors they experience.

Enhanced systemic transgene expression after nonviral salivary gland transfection using a novel endonuclease inhibitor/DNA formulation.

Gene transfer to the major salivary glands is an attractive method for the systemic delivery of therapeutic proteins. To date, nonviral gene transfer to these glands has resulted in inadequate systemic protein concentrations. We believe that identification of the barriers responsible for this inefficient transfection will enable the development of enhanced nonviral gene transfer in salivary glands and other tissues. One potential barrier is the degradation of plasmid DNA by endonucleases. To test this hypothesis, we coadministered two endonuclease inhibitors ((zinc and aurintricarboxylic acid (ATA)) with plasmid DNA, containing the secreted alkaline phosphatase gene (SEAP), to the submandibular glands of rats. The effect of zinc and ATA on SEAP expression, tissue accumulation of plasmid DNA, and plasmid DNA stability was then characterized. We observed that mixtures containing zinc/DNA, ATA/DNA, and zinc/ATA/DNA significantly enhanced both systemic transgene expression and the amount of plasmid DNA associated with treated tissues. The relative endonuclease inhibitory activity of zinc, ATA, and zinc/ATA correlated with the observed effects on transfection efficacy. The use of zinc/ATA enhanced the efficacy of salivary gland transfection by at least 1000-fold versus DNA alone. Importantly, this improved performance resulted in robust systemic secretion of an exogenous protein (SEAP), thus demonstrating the potential this nonviral gene transfer technology has as a method to treat systemic protein deficiencies.

Disentangling measures of individual perceptions of community social dynamics: results of a community survey.

This study examined how different measures of individual perceptions of community social dynamics relate to each other and how these measures relate to self-reported general health and depressive symptoms. Results of a principal components analysis conducted to investigate the interrelationships between these individual measures suggest that these measures measure separate phenomena. In addition, in results of multiple-regression analyses conducted to examine associations between the various measures of individual perceptions of community social dynamics and the dependent variables of self-reported general health and depressive symptoms, sense of community, perceived neighborhood control, and neighborhood participation were all associated with the outcome variables in separate regression models. In a regression model with these three variables added to control variables, only sense of community was significantly, albeit modestly, associated with depressive symptoms and self-reported general health.

The East Side Village Health Worker Partnership: integrating research with action to reduce health disparities.

This article describes the work of the East Side Village Health Worker Partnership as a case study of an initiative that seeks to reduce the disproportionate health risks experienced by residents of Detroit's east side. The Partnership is a community-based participatory research and intervention collaboration among academia, public health practitioners, and the east side Detroit community. The Partnership is guided by a steering committee that is actively involved in all aspects of the research, intervention, and dissemination process, made up of representatives of five community-based organizations, residents of Detroit's east side, the local health department, a managed care provider, and an academic institution. The major goal of the East Side Village Health Worker Partnership is to address the social determinants of health on Detroit's east side, using a lay health advisor intervention approach. Data collected from 1996 to 2001 are used here to describe improvements in research methods, practice activities, and community relationships that emerged through this academic-practice-community linkage.

Community-based participatory research: policy recommendations for promoting a partnership approach in health research.

Community-based participatory research in public health focuses on social, structural, and physical environmental inequities through active involvement of community members, organizational representatives, and researchers in all aspects of the research process. Partners contribute their expertise to enhance understanding of a given phenomenon and integrate the knowledge gained with action to benefit the community involved. This article presents key principles of community-based participatory research (CBPR), discusses the rationale for its use, and provides a number of policy recommendations at the organizational, community and national levels aimed at advancing the application of CBPR. While the issues addressed here draw primarily upon experiences in the United States, the emphasis throughout this article on the establishment of policies to enhance equity that would serve both to increase the engagement of communities as partners in health research, and to reduce health disparities, has relevant applications in a global context.

Who speaks for public health agencies: assessing the core functions in local health departments.

Several large-scale studies have attempted to measure public health agency performance of core functions by interviewing health directors. Because it is not self evident that a single respondent results in a valid performance assessment, the purpose of this study was to examine the relationship between two characteristics--position in the agency and racial/ethnic identity--and perceptions of the performance of core functions. Supervisors differed from nonsupervisors and Whites differed from African Americans in their perceptions of practices reflecting assessment and policy development. Efforts to develop surveillance measures of a complex institution such as a health department should incorporate methodologies to validate the responses.

Review of community-based research: assessing partnership approaches to improve public health.

Community-based research in public health focuses on social, structural, and physical environmental inequities through active involvement of community members, organizational representatives, and researchers in all aspects of the research process. Partners contribute their expertise to enhance understanding of a given phenomenon and to integrate the knowledge gained with action to benefit the community involved. This review provides a synthesis of key principles of community-based research, examines its place within the context of different scientific paradigms, discusses rationales for its use, and explores major challenges and facilitating factors and their implications for conducting effective community-based research aimed at improving the public's health.

Detroit's East Side Village Health Worker Partnership: community-based lay health advisor intervention in an urban area.

In recent years, there have been few reports in the literature of interventions using a lay health advisor approach in an urban area. Consequently, little is known about how implementation of this type of community health worker model, which has been used extensively in rural areas, may differ in an urban area. This article describes the implementation of the East Side Village Health Worker Partnership, a lay health advisor intervention, in Detroit, Michigan, and notes how participatory action research methods and principles for community-based partnership research are being used to guide the intervention. Findings are presented on how the urban context is affecting the design and implementation of this intervention. Implications of the findings for health educators are also presented and include the utility of a participatory action research approach, the importance of considering the context and history of a community in designing a health education intervention, and the importance of recognizing and considering the differences between rural and urban settings when designing a health education intervention.

Conducting a participatory community-based survey for a community health intervention on Detroit's east side.

This article describes a participatory action research process that brought together community members, representatives from community-based organizations and service providers, and academic researchers to collect, interpret, and apply community information to address issues related to the health of women and children in a geographically defined urban area. It describes the development and administration of a community-based survey designed to inform an intervention research project; discusses the establishment of a community/research partnership and issues that the partnership confronted in the process of developing and administering the survey; and examines the contributions of participants, and implications for research and collective action.

Coalition building for prevention: lessons learned from the North Carolina Community-Based Public Health Initiative.

This article examines the four-year development of the North Carolina Community-Based Public Health Initiative consortium (NC CBPHI). The NC CBPHI consisted of four separate county coalitions and differed in both its agenda and membership from the many examples of coalitions described in the literature. This article presents and describes evaluation findings that identify six factors as important in coalition functioning and success in the CBPHI coalitions. These factors are: participation, communication, governance and rules for operation, staff/coalition member relationships, technical assistance and skills training, and conflict recognition and containment. Selected CBPHI coalition activities are also described and implications for public health practitioners are presented.

Rural gonorrhea in the southeastern United States: a neglected epidemic?

Some rural counties in the southeastern United States are experiencing high rates of gonorrhea; however, existing knowledge of epidemiologic patterns of gonorrhea within communities is from urban areas. This paper describes the epidemiology of gonorrhea within a rural county of North Carolina and compares it with the patterns described for large cities. Data include gonorrhea reports from private physicians and the county health department from August 11, 1992, to August 10, 1993, and ethnographic interviews. The rate among males (1,602 cases per 100,000 person-years) was twice that among females. The risk of reinfection within 6 months of an initial infection (12.9%) was high compared with risks in urban settings. Although case numbers did not cluster by geographical area as described for some cities, case rates did. Factors favoring transmission in rural communities include greater poverty and fewer health care resources than in urban settings, the exchange of sex for crack cocaine, and a lack of anonymity that may cause some people to avoid seeking treatment or acknowledging risky sexual behaviors in a clinical setting. Addressing high rural rates will entail improving access to care, taking extra measures to ensure confidentiality, and dispelling the myth that high rates are limited to cities.

The ecological significance of rapid wound-induced changes in plants: insect grazing and plant competition.

This paper investigates the hypothesis that a rapidly induced phytochemical response to grazing damage, such as that seen in tomato, serves to deflect insect herbivores away from leaves soon after damaging them (the grazing dispersal hypothesis). As a result, grazing damage is more dispersed than it otherwise would be, and young leaves, which may be of particular importance to a plant in competition for light, are not damaged excessively. In the first experiment, artificial removal of c. 15% of leaf area led to a significant reduction in plant performance compared with undamaged controls, but only when the plants were grown together in competition for light. The second experiment demonstrated that the distribution of grazing damage within the plant was an important factor in the outcome of competition; in those plants in which grazing was applied to the lower leaves there was no effect of damage upon performance compared with undamaged controls, whereas grazing to the upper leaves significantly reduced plant performance. A third experiment provided some insight into how this interaction between damage and competition comes about. It was shown that damage to leaves led to a rapid drop in the rate of extension growth of the main shoot, especially when the upper leaves were damaged, and normal rates of growth were not resumed for at least 3 days. It is argued that in a rapidly growing canopy, such an effect may mean that a damaged plant loses its position in the height hierarchy. The final experiment showed that previous damage to plants can affect the distribution of subsequent grazing by larvae of Spodoptera littoralis, apparently through a wound-induced reduction in leaf palatability. Plants which had been artificially damaged 48 h previously were grazed significantly less than controls, and the avoidance effect was greatest in the young leaves. These results are consistent with the grazing dispersal hypothesis, and suggest that rapid wound-induced responses may be of greatest significance in species characteristic of fertile environments where competition for light is particularly intense.

Intravenous administration sets--an overview.

Intravenous administration sets continue to become more sophisticated in response to advances in medical therapy. A number of design options are available to meet specialized needs. It behooves the pharmacist to become familiar with them in order to insure that sets compatible with and optimal for their intended application are selected in his or her institution. Doing so will fully execute his or her increasing responsibilities in I.V. therapy.