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PubMed2002

Hyperhomocysteinemia, and low intakes of folic acid and vitamin B12 in urban North India.

BACKGROUND AND AIM: An adverse coronary risk profile has been reported amongst rural-to-urban migrant population living in urban slums undergoing stressful socio-economic transition. These individuals are likely to have low intakes of folic acid and vitamin B12, which may have an adverse impact on serum levels of homocysteine (Hcy). To test this hypothesis, we studied serum levels of Hcy in subjects living in an urban slum of North India and healthy subjects from urban nonslum area. METHODS: Group I consisted of 46 subjects (22 males and 24 females) living in an urban slum, while group II consisted of healthy subjects (n = 26, 13 males and 13 females) living in the adjacent non-slum area. Anthropometric measurements, biochemical profile (fasting blood glucose, total cholesterol, serum triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol) and fasting serum levels of Hcy were measured. Dietary intakes of folic acid, vitamin B12, vitamin B1, and iron were calculated by the 24-hour dietary recall method. Serum levels of Hcy were correlated with dietary intakes of nutrients, anthropometry, and metabolic variables. RESULTS: Sex-adjusted serum levels of Hcy in micromol/L (Mean +/- SD) were high, though statistically comparable, in both the groups (group I: 20.8 +/- 5.9 and group II: 23.2 +/- 5.9). Overall, higher than normal serum levels of Hcy (> 15 micromol/L) were recorded in 84% of the subjects. A substantial proportion of subjects in both groups had daily nutrient intakes below that recommended for the Asian Indian population (folic acid: 93.4% in group I and 96.7% in group II, vitamin B12: 76.1 % in group I and 88.4% in group II). However, between the two groups, average daily dietary intakes of both the nutrients were statistically comparable. As compared to non-vegetarians, vegetarians showed lower intakes of folic acid (p < 0.01) and vitamin B12 (p < 0.01) in both groups. On multivariate linear regression analysis with serum Hcy as the response variable and vegetarian/non-vegetarian status and sex (male/female) as predictor variables, higher serum levels of Hcy were observed in vegetarians vs non-vegetarians (1 = 4.6, p < 0.05) and males vs females (beta = 5.3, p < 0.01). CONCLUSIONS: Low intakes of folic acid and vitamin B12, and hyperhomocysteinemia, in both the healthy population living in urban slums and adjacent urban non-slum areas, are important observations for the prevention of nutritional and cardiovascular diseases in the Indian subcontinent.

Adult↗
PubMedDate not supplied

Comparison of rural and urban certified nurse-midwives in Arizona.

A survey of certified nurse-midwives (CNMs) in Arizona was carried out in 1990 to provide data for maternity service planning in the state. Information was gathered on location and scope of CNM practice, barriers to practice, and the contribution of CNMs to maternity care. Demographic and clinical practice characteristics of urban and rural CNMs were also compared. Urban and rural CNMs are significantly different in terms of education (urban CNMs are much more likely to have master's degrees) and number of years since first certification (urban CNMs have been certified significantly longer). Rural midwives are more likely to be under the age of 40. Health services provided by urban and rural CNMs were compared with each other and with national data. Midwives in rural areas of Arizona are more likely to provide comprehensive nurse-midwifery services than are either urban Arizona midwives or U.S. midwives as a whole. Urban and rural CNMs described lack of physician backup as a major barrier to nurse-midwifery practice in rural areas. Lack of hospital privileges was another major obstacle noted by rural nurse-midwives. Arizona CNMs felt they could provide comprehensive, cost-effective maternity services in rural areas that would improve access to care, patient satisfaction, and maternal and child health outcomes.

Adult↗
PubMed1992

Fertility differentials among the Ijo in southern Nigeria: does urban residence make a difference?

The paper tests some of the conflicting hypotheses regarding the effects of urban living and education on fertility by examining the fertility levels of women migrants--some educated, others not--to various urban centers in one Nigerian ethnic group. Of particular interest are the conditions under which the urban residents live and the concept of 'urban' is examined in this West African context. Research methodology consisted of a two-pronged approach and combined an intensive ethnographic study of the families in the rural home community and in one urban center with a demographic survey administered to a larger sample of the rural residents and urban migrants. Analysis indicates that the effect of education on fertility is more powerful than urban or rural residence. The importance of utilizing culturally appropriate categories in demographic research is discussed.

Adolescent↗
PubMed2005

Comparison of urban and rural general surgeons: motivations for practice location, practice patterns, and education requirements.

BACKGROUND: The purpose of this study is to determine the differences between rural and urban surgeons with regard to practice patterns, factors in choosing a practice location, and educational needs. STUDY DESIGN: A list of surgeons obtained from the American Medical Association was examined using the Office of Management and Budget definition of rural. Seventeen hundred rural surgeons were mailed surveys; 421 responded. One hundred fourteen urban surgeons were contacted by telephone. Questions were designed to measure job and community satisfaction, factors influencing their decision to practice in their current location, spectrum and volume of cases, and their perceived educational needs. RESULTS: Age distribution did not differ markedly between urban and rural surgeons. Motivation to practice in their current location varied considerably between urban and rural surgeons. Both groups equally rated quality of life as the leading factor influencing their current practice location. Urban surgeons rated other factors, such as income, practice growth, hospital facilities, and proximity to family, higher than rural surgeons. Practice patterns and educational needs also varied between the two groups. Rural surgeons performed more procedures per year with more variety in procedure type. Both groups felt that additional training in advanced laparoscopic techniques would be helpful, and rural surgeons felt that additional training in the surgical subspecialty areas was important. CONCLUSIONS: Although rural and urban surgeons do not differ in age or the importance of lifestyle in deciding career location, different factors do impact their choice of location. Practice pattern and educational needs varied markedly between rural and urban general surgeons.

Attitude of Health Personnel↗
PubMed2006

Confronting limitations: new solutions required for urban water management in Kunming City.

Despite continuous investment and various efforts to control pollution, urban water environments are worsening in large parts of the developing world. In order to reveal potential constraints and limitations of current practices of urban water management and to stimulate proactive intervention, we conducted a material flow analysis of the urban water system in Kunming City. The results demonstrate that the current efficiency of wastewater treatment is only around 25% and the emission of total phosphorous from the city into its receiving water, Dianchi Lake, is more than 25 times higher than its estimated tolerance. With regard to the crisis of water quantity and quality, the goal of a sustainable urban water environment cannot be attained with the current problem-solving approach in the region due to the technical limitations of the conventional urban drainage and treatment systems. A set of strategies is therefore proposed. The urban drainage system in Zurich is used as a reference for a potential best-available technology for conventional urban water management (BAT) scenario in terms of its low combined frequency of sewer overflow.

Cities↗
PubMed2005

Biodiversity in urban habitat patches.

We examined the biodiversity of urban habitats in Birmingham (England) using a combination of field surveys of plants and carabid beetles, genetic studies of four species of butterflies, modelling the anthropochorous nature of the floral communities and spatially explicit modelling of selected mammal species. The aim of the project was to: (i) understand the ecological characteristics of the biota of cities model, (ii) examine the effects of habitat fragment size and connectivity upon the ecological diversity and individual species distributions, (iii) predict biodiversity in cities, and (iv) analyse the extent to which the flora and fauna utilise the 'urban greenways' both as wildlife corridors and as habitats in their own right. The results suggest that cities provide habitats for rich and diverse range of plants and animals, which occur sometimes in unlikely recombinant communities. The studies on carabids and butterflies illustrated the relative importance of habitat quality on individual sites as opposed to site location within the conurbation. This suggests that dispersal for most of our urban species is not a limiting factor in population persistence, although elements of the woodland carabid fauna did appear to have some geographical structuring. Theoretical models suggested that dormice and water voles may depend on linear habitats for dispersal. The models also indicated that other groups, such as small and medium sized mammals, may use corridors, although field-based research did not provide any evidence to suggest that plants or invertebrates use urban greenways for dispersal. This finding indicates the importance of identifying a target species or group of species for urban greenways intended as dispersal routeways rather than as habitat in their own right. Their importance for most groups is rather that greenways provide a chain of different habitats permeating the urban environment. We suggest that planners can have a positive impact on urban biodiversity by slowing the pace of redevelopment and by not hurrying to tidy up and redevelop brownfield sites.

Animals↗
PubMed2006

Local understandings of, and responses to, HIV: rural-urban migrants in Tanzania.

Migration is an important process of change for rural populations in developing countries. Migration is a primary cause of behaviour change-by their very act of migrating, migrants are different from those who do not migrate. The focus of the current study is male rural-urban migration in Tanzania and its interaction with sexual behaviour. The analysis presents results from a comparison with individual-level analyses of two populations, one (composed of recent rural-urban migrants) in an urban area and one made up of residents in a rural area. Detailed migration histories (n=96 rural-urban migrants) and in-depth interviews form the basis of the analysis. Three key research questions are addressed: How does the sexual behaviour of migrants differ from that of rural residents? How do HIV knowledge levels vary between rural-urban migrants and rural residents? What factors are associated with either intentions of behaviour change or reported behaviour? The results are counter-intuitive: rural-urban migrants-both married and unmarried-are not having sex in town. Despite limited understanding of the nature of HIV, the migrant population studied here regulates its behaviour in a way that reflects local understandings of the disease. This finding is important, not least because it challenges the view that HIV in sub-Saharan Africa is largely transmitted to rural areas by return migrants. Maasai rural-urban migrants in Tanzania-both married and unmarried-are not having sex in town. The policy and service provision implications of the results are explored.

Adult↗
PubMed2006

China's transition: the effect of rapid urbanization on adult occupational physical activity.

China has recently undergone rapid social and economic change. Increases in urbanization have led to equally rapid shifts toward more sedentary occupations through the acquisition of new technology and transitions away from a mostly agricultural economy. Our purpose was to utilize a detailed measure of urbanicity comprising 10 dimensions of urban services and infrastructure to examine its effects on the occupational physical activity patterns of Chinese adults. Longitudinal data were from individuals aged 18-55 from the years 1991-1997 of the China Health and Nutrition Survey (N=4376 men and 4384 women). Logistic multilevel regression analyses indicated that men had 68% greater odds, and women had 51% greater odds, of light versus heavy occupational activity given the mean change in urbanization over the 6-year period. Further, simulations showed that light occupational activity increased linearly with increasing urbanization. After controlling for individual-level predictors, community-level urbanization explained 54% and 40% of the variance in occupational activity for men and women, respectively. This study provides empirical evidence of the reduction in intensity of occupational activity with modernization. It is likely that urbanization will continue unabated in China and this is liable to lead to further transitions in the labor market resulting in additional reductions in work-related activity. Because occupational activity remains the major source of energy expenditure for adults, unless alternative forms are widely adopted, the Chinese population is at risk of dramatic increases in the numbers of overweight and obese individuals.

Adolescent↗
PubMed2006

Urbanization and the ecology of wildlife diseases.

Urbanization is intensifying worldwide, with two-thirds of the human population expected to reside in cities within 30 years. The role of cities in human infectious disease is well established, but less is known about how urban landscapes influence wildlife-pathogen interactions. Here, we draw on recent advances in wildlife epidemiology to consider how environmental changes linked with urbanization can alter the biology of hosts, pathogens and vectors. Although urbanization reduces the abundance of many wildlife parasites, transmission can, in some cases, increase among urban-adapted hosts, with effects on rarer wildlife or those living beyond city limits. Continued rapid urbanization, together with risks posed by multi-host pathogens for humans and vulnerable wildlife populations, emphasize the need for future research on wildlife diseases in urban landscapes.

Animals↗
PubMed2004

Prevalence of anti-Neospora caninum antibodies in dogs from urban, periurban and rural areas of the city of Uberlândia, Minas Gerais--Brazil.

In Brazil there are few reports on the prevalence of anti-Neospora caninum antibodies in dogs from urban, periurban and rural areas. Serum samples from 450 dogs, 300 from urban, 58 from periurban and 92 from rural areas, were tested for the detection of anti-N. caninum IgG antibodies using IFAT: indirect fluorescent antibody test (IFAT, > or =50). Antibodies were observed in 63 (14%) of the 450 serum samples analyzed, with 32 (10.7%) in dogs coming from the urban area, 11 (18.9%) from the periurban area and 20 (21.7%) from the rural area. Statistical differences were seen between the occurrences in animals from the urban area and those of the rural area (P = 0.01). The antibody titers found were: 1:50 in 20 dogs, 1:100-1:800 in 41 dogs, and 1:3200 in two dogs. In the female dogs, a smaller prevalence of dogs with antibodies was observed in those from the urban area (7.5%) in comparison with those of the rural (21.0%) (P = 0.05) and periurban (23.3%) (P = 0.01) areas. There were growing levels of antibody prevalence with the increase in age of the dogs in all three areas studied. Although this increase was not significant, it indicates a tendency towards more infections with age, suggesting post-natal exposure to N. caninum. However, a significant difference (P = 0.05) was observed in the occurrence of anti-N. caninum antibodies in dogs with ages = 2 years in urban (13.1% urban) versus rural environments (27.1% rural). Among the other age brackets studied the difference was not significant. The results confirm the presence of N. caninum in the region and reveal the important role of dogs in the parasite's epidemiology.

Age Factors↗
PubMed2004

An investigation of factors reducing seat belt use amongst Spanish drivers and passengers on urban roads.

Seat belt use on Spain's highways is more than 80%, while on the urban roads this figure is around 50%. As there was little information available to explain the difference in seat belt use rates, the main aim of this study was to investigate why there is a lower rate of seat belt use on urban roads. A number of perceptions, beliefs and expectancies about seat belt use were examined to identify variables that discriminated between seat belt users and non-users on urban roads. The subjects were 398 undergraduate students (aged 17-47) studying at the University of Girona, Spain. On the urban roads reported discomfort from using the seat belt was higher, while perceptions of risk (for non-users), safety perceptions (for those using a seat belt), beliefs about the seriousness of a crash or the effectiveness of the seat belt were all lower than on the highway. Perceptions of safety, discomfort, and social influence predicted seat belt use on urban roads. Concern about being fined for not using a seat belt did not predict seat belt use. The results of this research suggest that in order to increase seat belt use on urban roads, the issue of discomfort must be addressed. In addition, prevention campaigns should include information about the effectiveness of the seat belt in preventing/reducing injuries or deaths on urban roads. The results also highlight the importance of social influence for determining seat belt use/non-use and the potential role social influence could play in increasing seat belt usage.

Accidents, Traffic↗
PubMed2002

Home management of febrile convulsion in an African population: a comparison of urban and rural mothers' knowledge attitude and practice.

To determine the knowledge, attitude and practice (KAP) of home management of febrile convulsion (FC), by mothers in the community, focus group discussions (FGD) were conducted in two communities, Uselu (urban) and Evbuomodu village (rural), both in Edo State, Southern Nigeria. The study was conducted between December 2000 and February 2001. Our findings show that 71% of urban mothers compared to 25% of rural mothers attributed the cause of FC to fever (chi(2)=24.17: p<0.001). Seventy-five percent of mothers from rural community and 28.6% of urban mothers attributed the cause to witchcraft and/or evil spirits. Twenty-five percent of rural mothers also attributed abnormality of the spleen as a cause of FC. All the mothers, both urban and rural, were not directly involved in the management of the convulsive episode due to panic and confusion. Ninety-two percent of urban and all the rural mothers permitted the use of traditional medicine while 7.1% of urban mothers employed prayers during convulsion. Twenty percent of urban and twenty-two percent of rural mothers use urine (human and or cow's) for treating FC at home. Other home remedies include kerosene, fuel and crude oil. Mass enlightenment campaign for the community, especially the rural, against use of harmful traditional remedies to treat FC at home is strongly advised.

Attitude to Health↗
PubMed1984

Ambulance utilization in Sweden: analysis of emergency ambulance missions in urban and rural areas.

Data concerning ambulance utilization in a rural and an urban region were registered in a computer. In both regions approximately 30% of missions were emergencies. In the urban area, 20% of the emergency missions were due to trauma, compared with 10% in the rural area (P less than .01). The major symptoms were unconsciousness (34%) and shortness of breath (24%) in the rural region, while in the urban region pain (32%) was the dominating symptom. The response time in emergency missions, used as a measure of the service level of the emergency medical system, was shorter in the urban area than in the rural area (P less than .01): less than 15 minutes in 93% of emergencies in the urban area (mean time, 8.1 minutes) and in 78% of emergencies in the rural area (mean time, 10.2 minutes). Ambulance utilization was higher (P less than .01) in the urban region (0.37 missions/ambulance/hour) than in the rural region (0.22 missions/ambulance/hour). The study indicates that there are great differences between urban and rural areas with respect to the incidence and character of ambulance missions. This difference must be considered when analyzing the cost effectiveness of emergency medical services.

Ambulances↗
PubMed1994

A prospective in-field comparison of intravenous line placement by urban and nonurban emergency medical services personnel.

STUDY HYPOTHESIS: Emergency medical services personnel are highly proficient at rapid i.v. line placement in the prehospital setting, with little difference between urban and nonurban areas in a geographically diverse state. DESIGN: Prospective evaluation by an in-field observer of timing, sequence, success rates, and patient characteristics for IV line placement by prehospital personnel for 1 year. SETTING: Twenty advanced life support agencies from all four emergency medical service regions of Arizona. PARTICIPANTS: Fifty-eight patients encountered by participating emergency medical service agencies who had at least one i.v. line placement attempt in the prehospital setting. RESULTS: Urban agencies encountered 24 patients (41.4%), and nonurban agencies encountered 34 (58.6%). Fifty-seven of 58 patients (98.3%) had at least one successful i.v. line started before arrival at a hospital. All 24 urban patients and 33 of 34 nonurban patients (97.1%) had a successful i.v. line attempt (P = .586, power = .09). In the urban setting, 24 of 31 attempts (77.4%) were successful, and in the nonurban setting 35 of 52 attempts (67.3%) were successful (P = .464, power = .28). Mean i.v. line procedure intervals were 1.6 minutes in urban and 1.4 minutes in nonurban settings (P = .408, power = .7). Thirty of 31 i.v. line attempts (96.7%) were completed in less than 4 minutes in urban systems, and 49 of 52 IV line attempts (94.2%) were completed in less than 4 minutes in nonurban systems (P = .520, power = .13). Mean i.v. line procedure intervals were 1.3 minutes for successful attempts and 2.1 minutes for unsuccessful ones (P = .015). Mean i.v. line procedure intervals for on-scene attempts were 1.3 minutes compared with 2.0 minutes for attempts during transport (P = .005). On average, i.v. line attempts in trauma patients took only 1.0 minutes compared with 1.7 in medical patients (P = .017). CONCLUSION: Personnel in the 20 advanced life support agencies studied were extremely adept (rate of 98.3%) at obtaining i.v. line access in the prehospital setting. The time required to complete i.v. line placement was very short, and little difference was noted between urban and nonurban providers. I.v. procedure intervals were shorter for successful attempts, on-scene attempts, and attempts in trauma patients compared with their counterparts.

Adolescent↗
PubMed2000

Differences between burns in rural and in urban areas: implications for prevention.

This study aimed to identify typical features of burns in rural areas and to improve their prevention by comparing the characteristics of burnt patients and their burns in rural and urban areas. A cross-sectional survey was conducted in 19 of the 23 French burns units over one year, using a structured questionnaire. We analysed the resulting database. Of the 1422 patients, excluding 188 burnt in unclassified areas, 420 (34%) were burnt in rural areas. Burns were more frequent in rural than in urban areas. Occupational burns were more frequent in rural than in urban areas. The characteristics of patients and burns did not differ between the areas. Patients burnt during everyday activities were older and more frequently had predisposing factors in rural than in urban areas. Burns occurred outdoors more often in rural than in urban areas and were frequently due to flames or explosions or to the use of barbecues or open fires. The hands and perineum were burnt more frequently in rural than in urban areas. Rural burns were more severe than urban burns: they were deeper, involved a larger body surface area and caused more deaths. Preventive measures in rural areas should take into account occupation and everyday activities. They should be specifically adapted to the profiles of burnt patients.

Accidents↗
PubMed2003

Safety and delay time in prehospital thrombolysis of acute myocardial infarction in urban and rural areas in Sweden.

Sixteen hospitals in Sweden, including those in urban and more sparsely populated areas, and the associated ambulance organizations were enrolled in a prospective evaluation of the feasibility of treating patients with a ST-elevation infarction with a thrombolytic agent (reteplase) before hospital admission. A physician staffed the ambulances in 1% of cases, a nurse in 67%, and a staff nurse in 32% of cases. In all, 64 patients in urban areas and 90 patients in rural areas were included. The occurrence of complications before hospital admission was low and similar in the 2 groups. The median interval between the onset of symptoms and the start of thrombolysis was 1 hour 44 minutes in urban areas versus 2 hours 14 minutes in rural areas (P = 0.03). The median arrival time (interval between onset of symptoms and arrival of the ambulance) tended to be shorter in urban areas (1 hr 10 min vs 1 hr 33 min; not significant) and the median interval between the arrival of the ambulance and the start of thrombolysis was shorter in urban areas (27 min vs 36 min; P < 0.0001). When comparing urban areas with the least-populated rural areas, differences in various delay times became even more marked. Patients in urban areas had a higher ejection fraction and fewer symptoms of heart failure after 30 days and a lower 1-year mortality.

Aged↗
PubMed2000

Preliminary study of the role of red foxes in Echinococcus multilocularis transmission in the urban area of Sapporo, Japan.

In order to assess the infection risk of alveolar echinococcosis among urban residents of Sapporo, the capital of Hokkaido, Japan, a survey was conducted on fox distribution in the urban area and on the prevalence of Echinococcus multilocularis among the foxes. The fox distribution, evaluated from fox footprints left on the snow in parks and woodlands, and from locations of fox carcasses recorded by the Sapporo municipality, was concentrated along the border of the urban area and in the southwestern part of the city, facing the mountain. Fox faeces were collected around active fox dens, and analysed by a coproantigen detection assay and parasite egg examination for the Echinococcus infection. Thirty-three out of 155 faeces were coproantigen positive. Coproantigen-positive faeces were collected from 11 den sites (57.9% of total den sites), and all except 1 were located in the urban fringe. A high intensity of taeniid eggs (> 100 eggs per 0.5 g) containing faeces were also collected in the 3 sites of them. Although Echinococcus infection in rodents was not observed from the necropsy of 23 rodents captured around active fox dens, arvicolid rodents, a suitable intermediate host for E. multilocularis, were captured in the urban fringe. Therefore, the urban fringe offers suitable conditions in which the life-cycle of E. multilocularis could be maintained. Prompt measures to control echinococcus infection should be taken, even in urban areas.

Animals↗
PubMed1998

Urbanization and psychosis: a study of 1942-1978 birth cohorts in The Netherlands.

BACKGROUND: Urban birth is associated with later schizophrenia. This study examined whether this finding is diagnosis-specific and which individuals are most at risk. METHODS: All live births recorded between 1942 and 1978 in any of the 646 Dutch municipalities were followed-up through the National Psychiatric Case Register for first psychiatric admission for psychosis between 1970 and 1992 (N = 42115). RESULTS: Urban birth was linearly associated with later schizophrenia (incidence rate ratio linear trend (IRR), 1.39; 95% confidence interval (95% CI), 1.36-1.42), affective psychosis (IRR, 1.18; 95% CI, 1.15-1.21) and other psychosis (IRR, 1.27; 95% CI, 1.24-1.30). Individuals born in the highest category of the three-level urban exposure were around twice as likely to develop schizophrenia. Associations were stronger for men and for individuals with early age of onset. The effect of urban birth was also stronger in the more recent birth cohorts. CONCLUSIONS: There are quantitative differences between diagnostic categories in the strength of the association between urban birth and later psychiatric disorder. High rates of psychosis in urban areas may be the result of environmental factors associated with urbanization, the effect of which appears to be increasing over successive generations.

Adult↗