Opportunities for research in rural practice.

The contributions of Denis Burkitt, William Budd, Sir James MacKenzie and Will Pickles, among others, are examples of the research that can be accomplished by busy doctors in a general practice or a rural setting with a minimum of equipment. It is still possible to undertake worthwhile research in rural areas of Canada. This contention is supported by many examples of published work from northern Newfoundland and Labrador. The studies have dealt with conditions that are particularly frequent in each region, including those due to nutritional deficiency, infection, extremes of climate and genetic factors. Epidemiologic studies have compared the occurrence of disease in different geographic regions and in different races. The content of general practice and methods of health care delivery have also been investigated. It is suggested that some of these observations could have been made only in the context of rural medical practice.     

Recruiting physicians to rural practice. Suggestions for success.

Medical school graduates from 1986 to 1988 and current residents in 12 family practice residency programs in the Northwest (N = 302) were surveyed to identify important factors in the recruitment process for their first postresidency placement. The study sought to compare the recruitment practices of rural communities and urban sites. Specific questions addressed in the study concerned sources of information about practice opportunities, stage in training when job search was initiated, factors related to unsuccessful site visits, and activities scheduled in the visit. Results indicated that referrals from faculty were the most valued source of information. Most job searches were initiated in the first 6 months of the third year in training. An unreceptive physician community and a reluctant spouse or partner were substantial problems for residents making site visits to rural communities. Rural sites tended to provide a broader mix of professional and personal activities during the visit.     

Thirty one years of herpes zoster in a rural practice.

The principal finding in this study of 151 cases of herpes zoster in a rural practice was the predominance of patients who had a lesion on the right side. This supports the proposition that the site of occurrence may be determined by repeated trauma. The decline in the frequency of attacks in older men was significant. Studying these cases and published reports has elucidated some of the problems of the occurrence and distribution of herpes zoster in the body, which still await definition. Others may be encouraged to carry these studies further.     

The role of computers in preventive medicine in a rural family practice.

Five family physicians in a group practice in rural Quebec have introduced a computer system to improve the delivery of preventive medicine. In addition to billing, the computer is used mainly to recall specific groups of patients for preventive measures, to prompt the physicians to carry out certain procedures at the patient''s next visit, to indicate which procedures are required for the family members and to generate reminder letters. The physicians are conducting a randomized controlled trial to evaluate the impact of computer-generated reminder letters on patient compliance and disease prevention among families in their practice.     

Hypercalciuria Relative to Total Solutes in Nephrolithiasis

Urines obtained from normal controls, from patients with calcium-containing renal stones, and from acutely ill patients suffering from various other renal or electrolyte disorders were analysed for Na, K, NH₄, Ca, Mg, inorganic phosphate and sulphate, pH, and osmolality.The stone-formers'' urines were found to be characterized by hypercalciuria relative to Na, K, Mg, SO₄, osmolality, and ionic strength. Hypercalciuria relative to osmolality was a more consistent finding than hypercalciuria relative to Na.These findings are in keeping with the supposition that calcium-containing renal stones occur in urine saturated with calcium salts.     

Child spacing and two child policy in practice in rural Vietnam: cross sectional survey.

OBJECTIVE: To explore the reproductive pattern of women in rural Vietnam in relation to the existing family planning policies and laws. DESIGN: Cross sectional survey with question-naires on reproductive history. SETTING: Tien Hai, a district in Red River Delta area, where the population density is one of the highest in Vietnam. SUBJECTS: 1132 women who had at least one child under 5 years of age in April 1992. MAIN OUTCOME MEASURES: Birth spacing and probability of having a third child. RESULTS: The mean age at first birth was 22.2 years. The average spacing between the first and the second child was 2.6 years. Mothers with a lower educational level, farmers, and women belonging to the Catholic religion had shorter spacing between the first and second child and also a higher probability of having a third child. In addition, women who had no sons or who had lost a previous child were more likely to have a third child. CONCLUSION: Most families do not adhere to the official family planning policy, which was introduced in 1988, stipulating that each couple should have a maximum of two children with 3-5 years'' spacing in between. More consideration should be given to family planning needs and perceptions of the population, supporting the woman to be in control of her fertility. This may imply improved contraceptive services and better consideration of sex issues and cultural differences as well as improved social support for elderly people.     

Th Rh factor in rural practice; responsibility of the general practitioner

As the incidence of erythroblastosis fetalis is as high in rural as in urban areas, it behooves physicians in rural areas to anticipate the disease, to make special antepartum studies to determine the Rh status of obstetrical patients, and to be prepared to treat the affected baby if the aid of a specialist and special facilities are not obtainable.Exchange transfusions have been carried out, by means described, in a small rural hospital.