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PubMed1994

Stroke incidence and mortality in rural and urban Shanghai from 1984 through 1991. Findings from a community-based registry.

BACKGROUND: Mortality from stroke has declined in many countries. This decline may result from a fall in incidence of stroke or a decrease in case fatality from stroke. The present study was conducted to investigate the temporal trends of incidence rate, mortality rate, and case fatality of stroke in an urban and rural Chinese population. METHODS: A community-based registry study was established in 1983 in defined rural and urban areas of Shanghai with a population aged 35 to 74 years of approximately 86,000 subjects, adhering to the methods and definitions of the World Health Organization MONICA protocol. All stroke events occurring in the population aged 35 to 74 years in these areas were registered by a special three-level case-registration system. RESULTS: From 1984 through 1991, 1391 stroke cases were identified. No significant change in the incidence rate of stroke was observed from 1984 through 1991 in men and women living in rural and urban areas. Age-standardized mortality rates (per 100,000 person years) of stroke declined significantly during this period, except for rural women. The annual changes and 95% confidence intervals of age-standardized mortality rates were: for rural men -4.6% (-5.4, -3.9), for rural women -0.6% (-1.6, 0.5), for urban men -2.5% (-3.5, -1.6), and for urban women -4.7% (-5.2, -4.2). A significant decrease in case fatality from stroke from 1984 through 1991 was found among men living in rural areas (from 62.4% to 46.0%) and among women living in urban areas (from 48.4% to 33.3%). Overall case fatality, however, showed a nonsignificant decline over time. CONCLUSIONS: We observed a decline in stroke mortality rate in a rural and urban Chinese population. No significant changes in stroke incidence were found in this study, whereas case fatality appeared to have decreased, in particular among men living in rural areas and women living in urban areas.

Adult↗
PubMed2006

Rural and urban disparities in health-related quality of life among veterans with psychiatric disorders.

OBJECTIVE: The authors studied whether rural and urban disparities in health-related quality of life, demonstrated previously among veterans, persist among veterans with common psychiatric disorders. METHODS: A cohort of 748,216 users or anticipated users of Veterans Affairs services completed the Veterans Short Form Health Survey in 1999. From the survey, the authors determined health-related quality-of-life scores (physical [PCS] and mental [MCS] health component summaries) and used ICD-9-CM codes to identify veterans with six mental health disorders-depression, anxiety, posttraumatic stress disorder, alcohol dependence, schizophrenia, and bipolar disorder. With Rural-Urban Commuting Area codes to determine urban residency, the prevalence of psychiatric illness and health-related quality of life were compared across rural and urban groups. RESULTS: All psychiatric disorders except anxiety disorders not related to posttraumatic stress disorder were more prevalent in urban settings. However, rural veterans within mental illness cohorts had worse PCS and MCS scores. Differences in PCS scores were substantial, ranging between 2.27 for schizophrenia and 3.39 for alcohol dependence (p<.001 for all diagnoses). Differences in MCS scores were statistically significant but modest. In regression models, rural-urban disparities within psychiatric disorder cohorts persisted after sociodemographic factors were controlled for. CONCLUSIONS: Although less likely than their urban counterparts to have mental disorders, rural veterans with mental illness experienced a greater disease burden and were likely to incur greater health care costs. Improving access to mental health care for veterans in rural settings may narrow quality-of-life disparities among rural and urban veterans.

Adult↗
PubMed1998

Urban-rural differences in questionnaire-derived markers of asthma in Kenyan school children.

Grade 4 Kenyan children attending 10 randomly selected public primary schools in Nairobi (urban) and the Muranga District (rural) were surveyed to establish the prevalence of symptom markers of asthma and to assess the impact of urbanization. A respiratory health and home environment questionnaire was administered at school to parents or guardians. The questionnaire response rates were 94.2% (568/ 603) for Nairobi and 89.6% (604/674) for Muranga. The prevalence rates for asthma, defined as "attacks of shortness of breath with wheeze", were 9.5% for urban and 3.0% for rural children (odds ratio (OR) urban versus rural: 3.42; 95% confidence interval (CI): -1.96-5.91). This urban-rural gradient persisted after adjusting for urban-rural differences in host factors (including duration of breastfeeding and family history of asthma and/or allergy), but was largely explained by urban-rural differences in environmental factors, including indoor animals, sharing a bedroom with a smoker, parental education, house ventilation and exposure to motor vehicle fumes en route to school (adjusted OR: 1.59; 95% CI: 0.70-3.55). Similar results were obtained for all other symptoms. These findings confirm the clinical impression that asthma is an important illness in Kenya and underline the need for the further study of environmental factors amenable to intervention, particularly in urban areas.

Adolescent↗
PubMed2003

Health-related quality of life in urban elementary schoolchildren.

BACKGROUND: Health disparities between children from urban minority backgrounds and children from more affluent backgrounds are well-recognized. Few studies specifically address urban children's perceptions of their health-related quality of life (HRQOL) or the factors that contribute to these perceptions. Since schools are pivotal to children's intellectual, social, and emotional development, school connectedness may be a factor that contributes to their perception of HRQOL. OBJECTIVE: To examine children's perceptions of HRQOL in an elementary school-based population of urban children. METHODS: The study population consisted of 2nd, 3rd, and 5th graders from 6 urban kindergarten to 8th grade schools and their parents. Children completed a survey that included questions on HRQOL and school connectedness. Parents completed a telephone survey that assessed demographics, the child's health, health care usage, and parental health status. Data on school absences and mobility from the computerized school database were linked to survey data. Bivariate analyses were used to evaluate the association between child report of HRQOL and collected variables, including school connectedness. Multivariable linear regression was conducted to identify the factors best predicting HRQOL in these urban children. RESULTS: Of the 1150 eligible students, parent and child survey data were available for 525 (45.6%). Fifty-one percent of students were male and 89% were black. Ninety-four percent of parents were female, 29% were married, and 62% had family incomes below 20,000 dollars per year. The mean total score for HRQOL was 67.2, with a possible range of 0 to 100 (higher scores reflecting better HRQOL). In the multivariable analysis, child grade, the relationship of the " parent" to the child, employment, family income, type/presence of insurance, and school connectedness were significantly associated with the HRQOL total score. CONCLUSIONS: Young urban children self-report low HRQOL scores and do so as early as the 2nd grade. These low scores, which reflect children's own perceptions of impaired psychological and physical health, have potential implications for the success of urban children in their learning environments. The association between HRQOL and school connectedness might suggest that health and educational programs that improve a child's attachment to school could result in improved perceptions of health by urban children.

Adolescent↗
PubMed1995

Profile of drug use in urban and rural India.

Information on pharmacoepidemiology is particularly important in developing countries where a rational drug policy has not been adopted. In the present study, a profile of 1769 doctors' prescriptions and 763 self-orders were monitored at pharmacy outlets in the twin cities of Hyderabad and Secunderabad and 4 rural areas of Andhra Pradesh with the aim of identifying urban and rural differences, if any, in the self-medication rate, prescription costs, types of drugs purchased and factors influencing self-medication. Self-medication, expressed as the percentage of the total population that self-medicates, was found to be high in urban areas (37%) compared with rural areas (17%), and the majority of the over-the-counter sales were for prescription-only drugs. The majority of physicians' prescriptions were incomplete with respect to diagnosis and dosage regimen. The mean cost of the drugs purchased on doctors' prescriptions was 2-fold higher than the cost of drugs sold over the counter. A higher proportion of patients from rural areas (80%) purchased all the prescribed drugs compared with those from urban areas (54%). Financial constraints in urban areas were a major determinant in the partial purchase of prescribed drugs. In addition, the urban elite (i.e. professional people with high incomes, who comprise 18% of the total population) considered that all of the prescribed drugs were not necessary for their present disease. Nutritional products, potent compounds with analgesic, antipyretic and anti-inflammatory effects, and broad spectrum antibiotics constituted a high proportion of prescriptions in both urban and rural areas. The consumption of food supplements was higher in rural areas than in urban areas. Based on WHO criteria, most of the drugs (60%) prescribed in rural areas were nonessential, compared with 47% in urban areas. The results of this study emphasise the need for comprehensive measures, including information, training, legislation and education at all levels of the drug delivery system, to rationalise drug therapy by improving prescribing patterns and influencing self-medication.

Anti-Bacterial Agents↗
PubMed1979

Urbanization and mental health: psychiatric morbidity, suicide and violence in the State of Victoria.

Australia is one of the most urbanized countries in the world with over 85% of the population living in metropolitan and other urban areas. More important, the change from a predominantly rural society to an urbanized society has occurred within the last 100 years. To assess the effects of urbanization on mental health, rates of admissions to psychiatric institutions, suicides and violent crime in Victoria have been analysed for the last hundred years. Data on admissions to psychiatric facilities in Victoria from metropolitan, other urban and rural areas, as well as results of community health surveys carried out in metropolitan and rural areas were compared to examine for evidence of urban-rural differences in psychiatric morbidity. The findings do not support the notion that the level of psychiatric and psychosocial disorders in Victoria are related to urbanization or to urban living.

Adolescent↗
PubMed2002

Food habits and nutrient density of diets of Pakistani children living in different urban and rural settings.

Food habits and nutrient density of diets of six groups of rural and urban school children aged 10-12 years were compared. Data were collected from three-day food records. In the UK, data were collected during October-November 1994 and in Pakistan during April-May 1995. Based on the apparent level of urbanism, the six groups were arbitrarily assigned urbanization rank 1-6. Patterns of their food and intake of nutrients were different from each other in various aspects and were not always associated with the apparent level of urbanism of the group. With urbanization, the intake of fat and sugar increased steadily. The intake of carbohydrate, fibre, riboflavin, and vitamin E decreased with urbanization. The intake of vitamin C, vitamin B12, and folates was higher among group 4, 5, and 6 than other groups. Due to various factors, in terms of micronutrient density, diets of various urban groups could have more differences than similarities. While these differences point toward the need for comprehensive nutrition education and community nutrition surveys, they also indicate the possibility of having healthy diets in urban settings.

Analysis of Variance↗
PubMed2004

[The comparative study on maturation of metacarpal bone in puberty children during their growth spurt period between urban and rural areas].

OBJECTIVES: To study maturation of the metacarpal bone in puberty children during their growth spurt period and its difference between urban and rural areas. METHODS: Totally, 560 pupils/students were selected from primary and secondary schools in urban and rural areas each, with 35 children in each gender and age group, ranging 12 - 15 years of age for boys and 10 - 13 for girls. An X-ray film of left hand-wrist site was taken for each of them. Length and width of the metacarpal bone were measured and the metacarpal index was calculated. RESULTS: Increment of length of the metacarpal bone was great in puberty children both in urban and rural areas, (6.26 - 9.31) mm in boys and (5.28 - 9.12) mm in girls. Mean length of the metacarpal bone was longer in children of urban areas than that of rural ones, regardless of their age and gender. There was significant difference in mean length of the metacarpal bone between boys aged 14 - 15 years and girls aged 12. Mean width of the metacarpal bone in most children was wider in rural areas than that in urban ones. Mean metacarpal index in children was higher in urban areas than that in rural ones, with very statistical significance, except for girls of 13 year age group. The peak age of metacarpal maturation was 1 year earlier in urban areas than in rural ones. CONCLUSIONS: Maturation of the metacarpal bone was rapid during puberty growth spurt period, with relatively significant difference in urban and rural ares.

Adolescent↗
PubMed2004

Development of a semi-quantitative food frequency questionnaire to determine variation in nutrient intakes between urban and rural areas of Chongqing, China.

Nationwide surveys of food and nutrient intake in China have revealed geographical variation between urban and rural areas. This study developed a semi-quantitative food frequency questionnaire (SQFFQ) for cancer risk assessment suitable for both urban and rural populations by conducting a survey of food intake in Chongqing, China. We recruited 100 urban and 104 rural healthy residents aged from 35 to 55 years in Chongqing, and collected dietary data with 3-day weighed records to assist in the development of the SQFFQ. The intake of 35 nutrients was calculated according to Standard Food Composition Tables for China and Japan. For each nutrient estimated by percentage contribution analysis (CA) and multiple regression analysis (MRA), foods with up to a 90% contribution or a 0.90 cumulative R(2) were selected as items for SQFFQs. The food items of the combined SQFFQ were selected from all items listed in either urban or rural SQFFQs. Mean intake of energy, protein and carbohydrate did not differ between the urban and rural residents. The latter consumed more fat than their urban counterparts. We selected 119 food items for the combined SQFFQ, comprising 22 specific items for the urban SQFFQ, 6 for the rural, and 78 common and 13 additional items. The combined SQFFQ covered 33 nutrients with up to a 90% contribution in each area. We were able to develop a data-based SQFFQ that can estimate nutrient intake of both urban and rural populations, with suitable coverage rates. Further reliability and reproducibility tests are now needed to assess its applicability.

Adult↗
PubMed2006

Therapeutic itineraries in rural and urban areas: a Portuguese study.

INTRODUCTION: When people become ill they use strategies to solve their problem that include existing therapeutic resources in the community. Their choices are guided by the beliefs of local communities regarding the body, health and illness, and the therapeutic resources available. This study compares the uses of alternative and traditional treatments in a rural area and an urban area of the north of Portugal, investigating the differences and similarities in the behaviour of people when they become ill. METHODS: This descriptive study provides interviews with two groups of adults, in a rural area (Alfandega da Fe and Miranda do Douro) and in an urban area (city of Porto), Portugal), with the aim of understanding the knowledge and uses of alternative and traditional therapists and treatments. RESULTS: Approximately half of those in the urban area and almost all of those in the rural area knew of alternative therapists and treatments, the most known being bonesetters, acupuncturists and herbanarias (shops where people sell medicinal plants for teas) in the urban areas; and bonesetters, sorcerers (bruxos) and local healers (curandeiros) in rural areas. In relation to the use of these therapists and treatments, approximately 25% in the urban area and 75% in the rural area reported that they used such treatments. Bonesetters were the most used in both areas, followed by sorcerers and teas in the rural areas, and acupuncturists and teas in the urban areas. When asked about the reasons for using these therapists and treatments, the majority reported pain in the bones, muscle and joints, followed by psychological complaints in urban areas; and traditional diagnostics in rural areas for leaned souls (almas encostadas), fears or anxieties and visions etc. Most of the people who had used these treatments had not spoken to their family doctor about them because they believed 'doctors do not accept these medicines'. Approximately 80% in the two studied groups said they have been totally or partially satisfied with the treatments and the main reason was their effectiveness. The majority did not consider these treatments expensive. CONCLUSIONS: We found differences in the use of the alternative and traditional diagnostics and therapeutic resources in the urban and rural areas studied. However, we also found similarities between the two areas, such as the use of bonesetters to deal with problem of muscular and joint pains, and the use of teas.

Attitude to Health↗
PubMed1990

Dental health in urban and rural areas of central and western Bangladesh.

A survey of the prevalence of dental caries and periodontal disease was carried out in 826 individuals residing in Central and Western Bangladesh. The survey included 6, 12, 18 and 35-45 year olds in privileged and slum urban areas as well as in rural areas. Dmft, DMFT and CPITN indices were used. The results showed that the highest mean dmft-values were found in urban privileged children (5.0). The mean DMFT-values ranged from 1.1 (urban privileged 6 year olds) to 4.7 (rural 34-45 year olds). The percentage of 12 year old children affected by caries was higher than in the 18 and 35-45 year olds in all socioeconomic groups. No statistically significant differences were found in the mean DMFT values within the age groups between urban privileged, urban slum and rural people. There was a high prevalence of bleeding on probing and of calculus in all age groups. Except for the 6 year olds, less than 10% in all age groups had a healthy periodontium. In the 18 year olds, shallow pockets were found in 34% of the urban slum group and in 42% of the rural group, but not in the urban privileged group. Deep pockets (greater than 6 mm) were found in the 18 and 35-45 year olds, except in the urban privileged groups.

Adolescent↗
PubMedDate not supplied

Pediculosis among urban and rural school children in Kumba, Meme division, south-west Cameroon.

Pediculosis is an important and common health problem in both urban and rural areas of Kumba. Out of a total of 2,312 children examined (1,462 urban and 850 rural), there was a rather disquieting overall infestation rate of 31.6% in the urban and 32.6% in the rural schools, respectively, and there was a much higher incidence of infestation among girls (36.3% urban, 35.1% rural) than boys (26.9% urban, 30.0% rural). Pubic infestation was more rampant among girls aged 13-15 years (0.3%) than boys (0.1%) of the same age-group, an age which coincides with the characteristic pubertal development of pubic hair. There was a higher incidence of lice infestation in the 9-12 year age-group (33.6% urban, 33.3% rural) than in both the 5-8 year age-group (29.3% urban, 31.6% rural) and the 13-18 year age-group (31.1% urban, and 31.7% rural). Given the nature of Cameroonian society with its African extended family system and its peculiar hospitality traits, it was not possible to correlate socioeconomic status of the children with their infestation rates. Additionally, the schools studied were not class-oriented thus social mixing occurred. Body hygiene has become a mere theoretical exercise in today's schools. Children are neither closely monitored for body cleanliness nor expelled for scandalously poor and unkempt hair and clothing. Inspection of children must be stepped up in order to improve these declining health standards.

Adolescent↗
PubMed1995

Dietary profile of adults in an urban & a rural community.

A community based dietary survey was carried out in 906 adults (25-64 yr) from 489 families in Delhi urban population and 275 adults from 196 families in rural population of Gurgaon district (Haryana state). A combination of 24 h recall and weightment method was used to assess the individual dietary intake. Daily average intake of various nutrients was calculated. A higher intake of cereals, milk and milk products and sugar and jaggery and a lower intake of pulses, vegetables, fruits, flesh foods and oils and fats were observed in the rural population. The average total calorie intake was 1,749 kcal in the urban and 1,910 in the rural population. The average intake of carbohydrates and proteins was 257.3 g (59.0 en %) and 54.7 g (12.5 en %) in the urban population compared to 295.6 g (61.9 en %) and 63.0 g (13.2 en %) respectively in the rural group. The fat intake was the lowest in the urban low socio-economic group (45.5 g). The contribution of total fat to energy intake ranged from 24.6 en to 31.2 en per cent in different population groups. The rural group showed higher intake of calcium and iron than the urban population. Intake of retinol was higher in the high socio-economic group (urban) than other population groups. Urban/rural differences were observed in intake of retinol, thiamine, niacin, vitamin C and vitamin E. Daily dietary cholesterol intake was the highest in the urban high socio-economic group (119 mg). The fibre intake was higher in the urban than the rural population (8.0 g vs 7.4 g).

Adult↗
PubMed1996

[Level of cardiovascular risk factors in the urban and rural populations of Cap-Bon: Tunisia].

Cardiovascular risk factors were studied in a random sample from the urban and rural population of the Cap-Bon, including 692 men and women, aged 35-50 years. In this sample, including 56 % urban dwellers, the mean total cholesterol was higher in urban areas (4.64 mmol/l) than in rural areas (4.16 mmol/l). In urban areas 10.2 % of the subjects had values above 6.2 mmol/l compared with 6.6 % in rural areas. Obesity was much more frequent among women (35.2 % versus 26.3 %) but less frequent among men (16.0 % versus 5.4 %) in urban and rural areas. Diabetes was found in 8.8 % of men and 10.4 % of women in urban areas, and only 0.8 % and 3.9 % in rural areas. Hypertension was found in 13.8 % of women and 11.6 % of men in urban areas, 13.3 % and 4.0 % in rural areas (13.3 %). Cigarette smoking was found in 60.7 % of men in urban areas and 75.8 % in rural areas (p < 0.05).

Adult↗
PubMed1995

Selected aspects of the population health status in ecological hazard areas in comparison with ecologically "clean area". III. localisation of urban regions with high mortality from all and from the circulatory system diseases.

Territorial localisation of urban regions with particularly high mortality from all diseases and from diseases of the circulatory system in males and females was the aim of the study. Altogether 177 urban regions within ecological hazard areas (EHAs) and 76 urban regions within reference area (RA) were subjected to evaluation. In the group of urban regions in which mortality rate from all diseases exceeded the value of arithmetic mean + 1/2 of standard deviation, 32 urban regions of EHA and 12 of them with RA were selected for assessing male mortality and 44 and 7, respectively, for assessing female mortality. Applying the same criteria 53 and 16 urban regions and 50 and 11 urban regions were identified because of mortality from diseases of the circulatory system in males and females, respectively. It was revealed that urban regions with the highest mortality rates were located in regions of the highest ecological hazard.

Cardiovascular Diseases↗
PubMed1996

Risk profiles for non-communicable diseases in rural and urban schoolchildren in the Republic of Cameroon.

OBJECTIVES: In developing countries, there is evidence that the median age of the population and the life expectancy at birth are increasing as a result of decreasing fertility rates and infant mortality. The result is an aging population more prone to non-communicable diseases such as diabetes, cancer, or heart disease later in life. In addition, changing lifestyle factors such as tobacco use, physical inactivity, and high fat diets, may accelerate the emergence of such chronic diseases as major causes of death and disability in these countries, particularly in urban areas. To test the premise that urban living predisposes residents to reduced activity levels, less healthy diets, cigarette smoking, elevated blood pressure, and increased body fat early in life, we studied rural/urban differences in these risk factors among schoolchildren in the Republic of Cameroon. METHODS: One hundred and nineteen Class 7 schoolchildren (50 urban and 69 rural) were interviewed concerning diet, physical activity, smoking, and alcohol use; blood pressure and anthropometric measurements were also taken. RESULTS: Physical activity among rural children was more than twice that of urban children, and most of the activity for rural children was work-related. Rural children consumed fewer foods containing fat and more fruits and vegetables. Adjusting for age, systolic and diastolic blood pressures of urban boys were higher than those of rural boys, and among urban children there was a trend toward a larger age-adjusted mean body mass index (BMI). There were no differences in alcohol or tobacco use between urban and rural children. CONCLUSIONS: In this study, urbanization was associated with a less active lifestyle and a dietary pattern that was higher in fat and lower in fruit and vegetable intake. Since risk factors for non-communicable diseases tend to appear early in life and track into adulthood, it is important to identify those children, or groups of children, with unfavorable risk profiles and to structure health education and promotion programs to modify these trends.

Adolescent↗
PubMedDate not supplied

Investigating the effect of clustering of the urban field on sustainable population growth of centrally located and peripheral towns.

In a previous study (Portnov and Erell, 1998a), an Index of Clustering was defined, which allowed an analysis of the combined effect of spatial isolation and remoteness of peripheral towns on the long-term patterns of their population growth. In the present paper, the analysis of the effect of clustering of the urban field on the patterns of population growth is extended to centrally located urban places, and the validity of this index is tested in two unevenly populated countries--Israel and Norway. In both countries, the effect of clustering of the urban field on the patterns of urban growth is twofold. In sparsely populated areas, the presence of neighboring towns appears to increase their chances of attracting potential migrants due to inter-urban exchanges, while in more densely populated areas, increasing clustering tends to reduce migration influx to a given locality due to inter-town competition. Following this conclusion, a strategy of "redirecting priorities" leading to the formation of urban clusters is proposed, which may enhance the potential of urban growth in geographical areas where this is desirable.

Asia↗
PubMed1998

Urbanization and childhood leukaemia in Taiwan.

BACKGROUND: In the 1980s socioeconomic development was dramatically rapid in the urbanized municipalities of Taiwan due to a prospering economy. This study addressed the question: Could differences in the incidence of childhood leukaemia (age <15) be demonstrated between urban and rural communities in Taiwan between 1981 and 1990? METHODS: The log-linear regression model was used to assess the effects of age, level of urbanization, and calendar year on the variation of childhood leukaemia incidence rates between 1981 and 1990. RESULTS: Between 1981 and 1990, the overall incidence rate of childhood leukaemia increased by 20% (rate ratio (RR) = 1.2, 95% CI: 1.0-1.5). As compared to rural areas, metropolitan regions showed a significantly higher incidence rate during the study period (RR = 1.3, 95% CI: 1.1-1.6). This urban-rural difference was particularly notable among children <5 years old (RR = 1.5, 95% CI: 1.2-1.9). Dose-response analysis further indicated that risk of childhood leukaemia was monotonically associated with levels of urbanization. The significant gradient in the risk of childhood leukaemia with urbanization was contributed solely by children in the 0-4 years age group. CONCLUSIONS: We noticed a relationship between urbanization and risk of leukaemia in children. Because of a dramatic influx of people into metropolitan areas during the 1980s, our findings may have provided support for the putative association between 'population mixing' or 'population density' and risk of childhood leukaemia. Whether such association can be attributable to virus infection or other aetiologically related leukemogens warrants further investigations.

Adolescent↗