Richard L. Ludtke

Effects of an Expanded Medical Curriculum on the Number of Graduates Practicing in a Rural State.

In 1973 the University of North Dakota School of Medicine (UNDSM), following the national trend toward four-year medical programs, expanded its previous two-year medical school curriculum to include all four years of medical education. It was hoped that this change, along with a renewed emphasis on primary care-oriented residency training within the state, would encourage medical students to establish practices within the state. In 1985 the UNDSMs Center for Rural Health mailed questionnaires to the 2,230 living graduates of the UNDSM to document a variety of their personal and practice characteristics. Based on the responses to the 924 completed questionnaires, the authors found that (1) the students from rural North Dakota were more likely than were urban students to practice in rural areas of the state, as were the students with primary care specialty training; and (2) the alumni completing residencies in North Dakota following the curriculum expansion (1976–1985) were more than twice as likely to establish practices in North Dakota. It was concluded that recruiting medical students (preferably in-state “natives”) from rural areas, training them in primary care specialty areas, and enabling them to remain in North Dakota for the duration of their medical training (including residency training) combined to exert a considerable “retaining” effect on the UNDSM alumni.

Community perceptions of rural hospital closure

Hospital closure, a devastating event in the life of small communities, can have long-lasting medical, economic, and psychological consequences. This study focuses on a 1991 closure that occurred in the rural North Dakota town of Beach that left local residents 40 and 61 miles away from the nearest hospitals. Two hundred residents of the hospitals former service area were selected via systematic random sampling to share their perceptions on the causes and effects of closing their local hospital. According to respondents, this hospital closure was caused by a number of influences, with the most commonly cited being under-utilization of services by local residents, exacting government rules and regulations, doleful economic climate, dwindling population, poor and unstable local physician care, and poor management of hospital matters. Findings further indicated that Beach area residents were most concerned with poor access to emergency medical care as a result of the closing. Area dwellers perceived that the hospital closures aftermath would include the loss of local jobs, further declines in the local economy, the suffering of elderly and children, transportation problems, and out-migration of some area residents. These concerns, coupled with the notable decrease in hospital care access, motivated many area residents to think of solutions to these problems rather than to place blame on others for the closure.

Recruiting and retaining registered nurses in rural community hospitals. Some administrative assessments.

The costs and impacts associated with the recruitment and retention of nurses are substantial. In rural areas, these efforts are hampered by the recurring maldistribution of available nurses away from such environments. Based on a survey of 195 directors of nursing (DONs) practicing in rural community hospitals, the authors compare administrative assessments of recruitment and retention efforts of DONs practicing in various-sized rural facilities. Current full-time equivalent registered nurse staff vacancy rates are also reported in relation to these differing assessments.

Body Mass Index and Cancer Screening in Older American Indian and Alaska Native Men

CONTEXT Regular screenings are important for reducing cancer morbidity and mortality. There are several barriers to receiving timely cancer screening, including overweight/obesity. No study has examined the relationship between overweight/obesity and cancer screening among American Indian/Alaska Natives (AI/ANs). PURPOSE To describe the prevalence of fecal occult blood testing (FOBT) and prostate-specific antigen (PSA) testing among AI/AN men within the past year by age and rurality, and determine if body mass index (BMI) is associated with screening. METHODS A national cross-sectional survey was administered face-to-face to 2,447 AI/AN men at least 55 years of age in 2004-2005. Participants were asked when they last had FOBT and PSA testing. BMI was derived from self-reported height and weight, and rurality of residence was defined by rural-urban commuting area codes. We assessed the association of cancer screening and BMI with logistic regression models, adjusting for demographic and health factors. FINDINGS Prevalence of up-to-date FOBT and PSA testing were 23% and 40%, respectively. Older men were more likely than younger men to have FOBT and PSA testing. BMI was not associated with receipt of FOBT or PSA testing. CONCLUSIONS This is the first study to examine obesity and health care in AI/ANs. As in other populations, FOBT and PSA testing were suboptimal. Screening was not associated with BMI. Studies of AI/AN men are needed to understand the barriers to receiving timely screenings for prostate and colorectal cancer.