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Both research and medical education make substantial contributions to rural primary care and health. An inaugural Scholarly Intensive for Rural Programs was conducted in January 2022 to connect rural programs within a community of practice focused on promoting scholarly activity and research in rural primary health care, education, and training. Participant evaluations confirmed that key learning objectives were met, including stimulating scholarly activity in rural health professions education programs, providing a forum for faculty and student professional development, and growing a community of practice that supports education and training in rural communities. This novel strategy brings enduring scholarly resources to rural programs and the communities they serve, teaches skills to health profession trainees and rurally located faculty, empowers clinical practices and educational programs, and supports the discovery of evidence that can improve the health of rural people. Key words: rural health; primary health care; research; professional education https://doi.org/10.1370/afm.2928, PURPOSE Both research and medical education make substantial contributions to rural primary care and health. Engagement in scholarly activity is associated with rural health care improvements (1) and development of [...]

Introduction: Research suggests that the Montreal Cognitive Assessment (MoCA) normal cutoff score of 26 may not be appropriate for all populations and ages. We sought to determine an appropriate MoCA cutoff score for community-dwelling seniors living in a rural Canadian community. Methods: We conducted a retrospective chart review at a health centre in rural northern Ontario. The sample included community-dwelling seniors presenting between Dec. 1, 2013, and July 31, 2015. We generated a receiver operating characteristic curve to evaluate MoCA cutoff scores in relation to functional assessment, using the dichotomous categories of 'no deficiencies in activities of daily living/instrumental activities of daily living (ADL/IADL) and 'deficiencies in ADL/IADL.' Results: A total of 95 charts were included in the chart review. We identified MoCA scores of 20 (sensitivity 85%, specificity 62%) and 21 (sensitivity 77%, specificity 77%) as cutoff scores for the identification of impairment in this rural population. Conclusion: Our results suggest the normal range in MoCA score for the community-dwelling rural senior to be between 22 and 30. Although the MoCA demonstrated satisfactory performance as a screening measure, the importance of including ADL and IADL functional assessments before making clinical decisions cannot be overemphasized. Introduction : Des etudes semblent indiquer que le seuil habituellement utilise dans la Montreal Cognitive Assessment (MoCA), soit un score de 26, pourrait ne pas convenir a tous les groupes et a toutes les tranches d'ages. Nous avons cherche a determiner un seuil approprie pour l'evaluation des personnes agees habitant dans la communaute d'une region rurale canadienne. Methodes : Nous avons mene un examen retrospectif des dossiers dans un centre de sante d'une region rurale du Nord de l'Ontario. Notre echantillon etait compose des personnes agees habitant dans la communaute qui se sont presentees au centre entre le 1er decembre 2013 et le 31 juillet 2015. Nous avons genere une courbe caracteristique de la performance afin d'evaluer la validite des scores MoCA par rapport a une evaluation fonctionnelle reposant sur des categories dichotomiques, soit 'aucune deficience dans les activites de la vie quotidienne (AVO)/activites instrumentales de la vie quotidienne (AIVO)' et 'deficiences dans les AVO/AIVO'. Resultats : En tout, 95 dossiers ont ete examines. Nous avons conclu que des scores MoCA de 20 (sensibilite de 85%, specificite de 62%) et de 21 (sensibilite de 77%, specificite de 77%) seraient des seuils appropries pour detecter la deficience chez cette population rurale. Conclusion : Nos resultats indiquent que la plage normale de scores MoCA chez les personnes agees habitant dans la communaute en milieu rural est de 22 a 30. Bien que la MoCA se soit revelee d'une efficacite satisfaisante comme outil de depistage, nous nous devons d'insister sur l'importance capitale de tenir compte de l'evaluation fonctionnelle des AVO et des AIVO dans la prise de decisions cliniques., INTRODUCTION The Montreal Cognitive Assessment (MoCA) is a screening instrument designed to assist primary care providers in the detection of mild cognitive impairment. There is evidence to suggest that diminished [...]

As a part of the Millennium Development Goals, India seeks to substantially reduce its burden of childhood mortality. The success or failure of this goal may depend on outcomes within India's most populous state, Uttar Pradesh. This study examines the level of disparities in under-five and neonatal mortality across a range of equity markers within the state. Estimates of under-five and neonatal mortality rates were computed using five datasets, from three available sources: sample registration system, summary birth histories in surveys, and complete birth histories. Disparities were evaluated via comparisons of mortality rates by rural-urban location, ethnicity, wealth, and districts. While Uttar Pradesh has experienced declines in both rates of under-five (162-108 per 1,000 live births) and neonatal (76-49 per 1,000 live births) mortality, the rate of decline has been slow (averaging 2% per annum). Mortality trends in rural and urban areas are showing signs of convergence, largely due to the much slower rate of change in urban areas. While the gap between rich and poor households has decreased in both urban and rural areas, trends suggest that differences in mortality will remain. Caste-related disparities remain high and show no signs of diminishing. Of concern are also the signs of stagnation in mortality amongst groups with greater ability to access services, such as the urban middle class. Not-withstanding the slow but steady reduction of absolute levels of childhood mortality within Uttar Pradesh, the distribution of the mortality by sub-state populations remains unequal. Future progress may require significant investment in quality of care provided to all sections of the community. Keywords Childhood mortality * Under-five mortality * Health disparities * Uttar Pradesh * India, Introduction In 2007 an estimated 1.84 million deaths under the age of five occurred in India, with over a quarter of these deaths occurring within the country's most populous state, [...]

Objective To determine whether a complex community intervention in rural Zambia improved understanding of maternal health and increased use of maternal health-care services. Methods The intervention took place in six [...]

Le Quebec a, depuis les annees 1990, amorce un virage ambulatoire dans la prestation des services de sante et sociaux. En reponse a certains problemes de coordination existants entre les acteurs interprofessionnels et interetablissements engendres par ce modele ambulatoire, que nous qualifions de domicilocentrique, le ministere de la Sante et des Services sociaux a implante une vaste reforme d'integration des services. Celle-ci favorisait l 'implantation de dispositifs de coordination, dont celui professionnel de la gestion de cas. Dans cet article, nous analysons comment la gestion de cas, dans le contexte des reseaux de services integres pour personnes agees en perte d'autonomie, participe aux politiques domicilocentriques. Pour faire ceci, nous avons realise une etude qualitative et exploratoire utilisant un devis de recherche de type etude de cas unique imbriquee. Pour chacun des trois centres de sante et de services sociaux que nous avons etudies, nous avons employe trois methodes de collecte de donnees: une analyse documentaire, une analyse thematique d'entretiens d'explicitation, et, de l'observation directe des pratiques des gestionnaires de cas. Nous constatons que la coordination avec les hopitaux demeure au centre des activites des gestionnaires de cas, detournant en partie leur fonction de soutien a domicile vers les besoins des hopitaux, ou la liberation rapide des lits de courte duree est encore consideree comme une priorite. Since the 1990s, the government of Quebec has undertaken a shift called virage ambulatoire (ambulatory care) in its delivery of health care and social care services. In response to a number of coordination related problems between interprofessional and interinstitutional actors engendered by the implementation of this ambulatory, or home- centric model, Quebec's Ministry of Health and Social Services decided to implement a major reform pertaining to services integration. This involved the creation of different coordination devices, including the professional device of case management. This article analyses how case management, in the specific context of integrated care networks for frail elderly individuals, contributes to home-centric governmental policies. We conducted a qualitative exploratory study using an embedded case study design. In each of the three Health and Social Services Centres covered by our study, we used three data collection methods: a documentary analysis, face-to-face interviews, and direct observation of case mangers practices. We note that coordination with hospitals remains at the center of case managers' activities, diverting in part their function regarding home care towards hospitals' needs, where rapid discharge planning of short-term care beds is still viewed as a priority., Problematique A l'instar d'autres pays, le Quebec a mise depuis le milieu des annees 1990 sur l'adoption d'un modele ambulatoire de services de sante et de services sociaux, que nous [...]

BACKGROUND: Exposure to arsenic via drinking water has been associated with adverse pregnancy outcomes and infant morbidity and mortality. Little is known, however, about the effects of arsenic on child [...]

BACKGROUND/OBJECTIVES: There is a paucity of information from developing countries on total calcium intake during infancy, and potential consequences for growth and bone development. DESIGN: Observational longitudinal study of rural Gambian infants (13 males and 17 females) at 3 and 12 months of age. SUBJECTS/METHODS: Breast-milk intake and calcium concentration, weighed dietary intake, anthropometry, midshaft radius bone mineral content (BMC) and bone width (BW). RESULTS: At 3 and 12 months (mean ± s.d.) calcium intake from breast milk was 179 ± 53 and 117 ± 38, and from other foods 12 ± 38 and 73 ± 105 mg/day. There was no difference in total calcium intake; 94% and 62% of calcium came from breast milk. At 3 and 12 months, weight s.d.-scores were -0.441 ± 1.07 and -1.967 ± 1.06; length s.d.-scores were - 0.511 ± 1.04 and - 1.469 ± 1.13. Breast-milk calcium intake positively predicted weight (P = 0.0002, P ≤ 0.0001) and length (P = 0.056, P = 0.001). These relationships were not independent of breast-milk intake, which positively predicted weight (P ≤ 0.002) and length (P = 0.06, P = 0.004). At 3, but not 12 months, weight and length correlated with total calcium intake. There were no relationships between total calcium intake and breast-milk intake with BW or BMC. CONCLUSION: The combination of low calcium intake from breast milk and complementary foods resulted in a low total calcium intake close to the estimated biological requirement for bone mineral accretion. Relationships between calcium intake and growth were largely accounted for by breast-milk intake, suggesting that low calcium intake per se was not the limiting factor in the poor growth. These findings have potential implications for deriving calcium requirements in developing countries. European Journal of Clinical Nutrition (2012) 66, 673-677; doi:10.1038/ejcn.2012.7; published online 15 February 2012 Keywords: calcium intake; breast-milk intake; breast-milk calcium concentration; infant growth; dose-to-the-mother method; The Gambia, INTRODUCTION Worldwide ~200 million children 2 s.d. below reference population mean). There are many causes including poor nutrition and micronutrient deficiencies during infancy. Adverse outcomes include higher morbidity and mortality, [...]