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PubMed1979

Intestinal disease and the urban environment.

Factors in the urban environments of highly industralized societies are important causes of disease. This review examines urban diseases of small and large intestine. The urban environment is pervaded by chemicals including drugs, food additives, pesticides, industrial products, etc., which are potential causes of disease. Examples of typical urban, as contrasted with rural, intestinal disease are considered in terms of differing etiological factors. Urban intestinal disease is examined from the following standpoints: the population at risk; the chemical agents to which the population is exposed; a model for the physiology of distribution and metabolism of chemicals in relation to the alimentary tract; the application of this model to treatment of an industrial disease; a major urban disease of the alimentary tract, carcinoma of the colon, considered in terms of this model; approaches to characterizing, identifying, and controlling urban intestinal disease.

Bacterial Infections↗
PubMedDate not supplied

Non-planed urbanization as a contributing factor for malaria incidence in Manaus-Amazonas, Brazil.

OBJECTIVES: This paper presents a study on the dynamics of malaria in Manaus and its relationship with the urban expansion and environmental factors related to it. The purpose of this paper is: to analyse how the form of occupying the emptied space in the city, together with the urbanization and factors related to the environment, have contributed for the establishment, increase and/or sustainability of malaria in the urban area of the city of Manaus, Amazonas, Brazil. METHODS: A retrospective study was carried out on malaria epidemiology from 1986 to 1997; data on the evolution and urban expansion of the city of Manaus were surveyed. Data were descriptively analysed making a relationship between the environmental aspects of urbanization and the way the city of Manaus was occupied and how this has contributed to malaria epidemiology in the city. RESULTS: The findings point out to the importance of the environment on malaria incidence, and to the influence of the anthropic interventions on the modification of the ecosystem, making the urban environment ideal for the proliferation of Anopheles sp mosquitoes, vectors of this disease. CONCLUSION: These elements in association continue to favour the maintenance of the incidence of malaria in the urban area of Manaus.

Brazil↗
PubMed2004

Inflammatory mediators in nasal lavage among school-age children from urban and rural areas in São Paulo, Brazil.

CONTEXT: Some studies have shown that inflammatory processes in the nasal air passages may reflect or affect those in the lower airways. We decided to indirectly assess the inflammatory status of the nasal airways in two groups of children with different sensitization rates to aeroallergens. OBJECTIVE: To compare the inflammatory activity in the nasal airways, through the determination of mediators in nasal lavage fluid in two distinct populations. TYPE OF STUDY: Cross-sectional study. SETTING: Two public elementary schools, one in an urban setting and the other in a rural setting of the State of São Paulo, Brazil. METHODS: Two groups of 40 elementary school children with different sensitization rates to aeroallergens were formed. Samples of nasal lavage fluid were assessed for eosinophil cationic protein (ECP) and tryptase. Non-parametric tests were used for statistical analysis. RESULTS: Significantly higher levels of ECP were observed among students living in the urban area than those in the rural area (p < 0.05). No significant difference in the tryptase levels was observed. Also, the urban children who were sensitized to aeroallergens presented higher levels of ECP in nasal mucosa than the non-sensitized children, while this difference was not observed among the rural children. DISCUSSION: The lack of mast cell activity and increased eosinophil degranulation revealed a chronic inflammatory state in the nasal air passages. The higher eosinophil activity in the urban area, coinciding with higher sensitization to aeroallergens, suggests that there must be some factors in the urban area that can modulate airway inflammation by influencing the activation of inflammatory cells. CONCLUSION: Our findings showed that there was no difference in the concentrations of tryptase in nasal lavage fluids between the two studied groups. However, the children from the urban area presented with higher concentrations of eosinophil cationic protein than did those from the rural area. Also, the urban children who were sensitized to aeroallergens presented with greater concentrations of eosinophil cationic protein in nasal mucosa than the non-sensitized children, while this difference was not observed among the rural children.

Adolescent↗
PubMed2001

The metabolic syndrome in the West Bank population: an urban-rural comparison.

OBJECTIVE: To compare the prevalence of components of the metabolic syndrome, including hypertension, abnormal glucose metabolism, dyslipidemia, central obesity, and overall obesity, between a rural and an urban Palestinian West Bank community. RESEARCH DESIGN AND METHODS: A total of 500 rural and 492 urban men and women aged 30-65 years participated in a community-based cross-sectional survey Diabetes and impaired glucose tolerance were diagnosed using the oral glucose tolerance test. BMI, waist-to-hip ratio, and blood pressure were measured, and blood samples were taken from each subject. Sociodemographic characteristics were investigated using a questionnaire. RESULTS: Hypertriglyceridemia, low HDL cholesterol, overall obesity, and smoking were significantly more prevalent in the urban population, whereas central obesity was more prevalent in the rural population. Prevalence of hypertension was not significantly different between the rural and urban populations (25.4 and 21.5%, respectively; P = 0.15). The age-adjusted prevalences of diabetes were high: 11.3% (8.5-14.1 95% CI) and 13.9% (10.8-17.0) in the rural and urban populations, respectively, but not significantly different. In each community, the age-adjusted prevalence of the metabolic syndrome as defined by the World Health Organization was 17%. CONCLUSIONS: Although no significant differences were found in the prevalences of hypertension and diabetes between the two populations, other components of the metabolic syndrome, namely elevated triglycerides, low HDL cholesterol, and overall obesity, were more prevalent in the urban population. Given the rapid urbanization of the Palestinian population, the implications for a rise in noncommunicable diseases should be a major public health concern.

Adult↗
PubMed2004

Knowledge, barriers, and benefits of fruit and vegetable consumption and lay conceptions of nutrition among rural and semi-urban Black South Africans.

This study investigated fruit and vegetable consumption and psychosocial variables among rural and semi-urban Black adults in South Africa. The sample consisted of 200 adults, 100 from a semi-urban and 100 from a rural area chosen by two-stage cluster sampling. Only seven (7%) of the villagers and none of the semi-urban dwellers reported the recommended 5 or more fruit or vegetable servings per day. The majority (63% rural and 58% semi-urban dwellers) indicated that they had 2-4 servings a day. Fruit and vegetable intake was not associated with perceived barriers, perceived health benefits, or diet knowledge, but there was a significant correlation between good perceived eating habits and fruit and vegetable consumption. Villagers perceived more barriers to fruit and vegetable consumption regarding expense, confusing recommendations, and time and effort than semi-urban dwellers. Insensitivity to high exposure was seen in responses to the question about positively regarded nutrients: for vitamins, 54% and 37% and for protein 63% and 53% of semi-urban and rural dwellers, respectively, believed that one cannot consume too much. The majority recognized the essential values of salt and fat. More semi-urban participants did not recognize that salt and fat are dietary essentials and that too much salt or fat is better than none at all.

Adolescent↗
PubMed1998

A neural network investigation of the crucial facets of urban sustainability.

This paper focuses on the concept of a sustainable city and its theoretical implications for the Italian urban system. Urban sustainability is based on positive interactions among three different urban subsystems: social, economic and physical, where social well-being coexists with economic development and environmental quality. This utopian scenario does not appear in the existing cities. The aesthetic quality of natural and man-made environment is often associated with marginality and poverty, labor market variety and urban efficiency coexisting with pollution, criminality and high settlement costs. Moreover, since each city differs institutionally, historically, culturally and economically, few attempts have been implemented to build a comparative synthetic vision of the urban sustainability in different cities. The interactions among these selected systems are complex and unpredictable and present the opportunity for a new methodology of scientific investigation: the connectionistic approach. The dual aim of this study is to: investigate the underlying relationships among the three subsystems with a set of social, economic and physical attributes of the chief towns of a Province in Italy and ; verify if this underlying structure could reproduce the heterogeneity of urban realities, allowing one to distinguish groups of cities with different assets or drawbacks in their sustainability. The Data Base (DB), composed of 43 attributes for 95 cities, was processed by Self-Reflexive Neural Networks (SRNN) (Buscema, 1995). These Networks are a useful instrument of investigation and analogic questioning of the Data Base. Once the SRNN has learned the structure of the weights from the DB, by querying the network with the maximization or minimization of specific groups of attributes, it is possible to read the related properties and to rank the cities' urban profile.

Cities↗
PubMed2004

Comparison of quality of life between urban and rural gastric cancer patients and analysis of influencing factors.

AIM: The conception of quality of life has been widely accepted by clinic doctors. Evaluations of the treatment effect of chronic diseases have been changed to depend not only on the survival time, but also on the quality of life of the patients. Fuzhou City and Changle County are high-incidence areas of the gastric cancer in Fujian Province. The aims of this research were to compare the quality of life of urban patients with that of rural patients and analyze the factors influencing quality of life of gastric cancer patients in Fujian Province. METHODS: The samples were drawn with cluster sampling. The urban sample consisted of 162 patients aged 25 to 75 with 143 males and 19 females. The rural sample consisted of 200 patients aged 32 to 78 with 166 males and 34 females. The patients in both the urban and rural areas were investigated, and their scores on 21 items reflecting the quality of life were measured. The methods of t test and stepwise regression were used to analyze the data. RESULTS: The average total scores of quality of life of the urban patients and rural patients were 64.11 and 68.69 respectively. There was a significant difference between the means of two samples (P = 0.0004). Seven variables in the regression model estimated by the urban sample and 4 variables in the model by the rural sample were at the level of significance alpha = 0.05. Family income, nutrition and rehabilitating exercise were selected into both the urban and rural regression models. CONCLUSION: Most of the gastric cancer patients have poor quality of life in Fujian Province and the rural patients have lower quality of life than that of urban patients. The patients having more family income have better quality of life, and enhanced nutrition and doing rehabilitating exercise are helpful in improving the quality of life of the gastric cancer patients.

Adult↗
PubMedDate not supplied

Urban form and older residents' service use, walking, driving, quality of life, and neighborhood satisfaction.

PURPOSE: This study explored the relationship between pedestrian-friendly urban form as reflected in new urbanism design guidelines, and neighborhood service use, walking, driving, quality of life, and neighborhood satisfaction among older women. DESIGN: A cross-sectional survey compared residents of census tracts similar indemographic characteristics but differing in urban form. SETTING: The setting was urban and suburban areas of Portland, Oregon. SUBJECTS: The sample consisted of 372 females living alone over age 70 in six census tracts; 133 (36%) completed surveys. MEASURES: The New Urbanism Index rated the physical features of respondents' neighborhoods. The Neighborhood Resident Survey assessed travel modes and neighborhood satisfaction. The Quality of Life Index measured resident well-being. The Dartmouth COOP Functional Health Charts measured health status. Group comparisons were made with t-tests and regression analysis. RESULTS: Although limited by the cross-sectional design, the study showed that new urbanism partially explained several differences in service use and activity: distance to a grocery store (r2 change = .11, p = .001), number of services used within 1 mile from home (r2 change = .06, p = .007), number of walking activities (r2 change = .08, p = .001), number of services accessed by walking (r2 change = .14, p = .000), and number of services accessed by driving (r2 change = .05, p = .001). CONCLUSIONS: Traditional urban neighborhoods with mixed services and good pedestrian access were associated with increased walking among older residents.

Aged↗
PubMed2003

Growth and morbidity in children in the Aboriginal Birth Cohort Study: the urban-remote differential.

OBJECTIVES: To describe the prevalence of markers of growth, chronic and infectious disease in peripubertal Aboriginal children living in the Darwin Health Region in the "Top End" of the Northern Territory, and to compare prevalence between children living in urban and remote areas. DESIGN: Cross-sectional survey nested in a prospective birth cohort. SUBJECTS: 482 children living in the region who were recruited at birth (Jan 1987 to Mar 1990) and were followed up between 1998 and 2001, when aged 8-14 years. MAIN OUTCOME MEASURES: Selected parameters of growth and nutrition, infectious disease and potential markers of chronic adult disease were compared between children living at follow-up in suburban situations in Darwin-Palmerston (urban) and those living in rural communities with an Aboriginal council (remote). RESULTS: Remote children were shorter than urban children (mean height, 141.7 v 146.3 cm; P < 0.001), lighter (median weight, 30.3 v 37.1 kg; P < 0.001) and had lower body mass index (median, 15.3 v 17.9 kg/m(2); P < 0.001) and haemoglobin level (mean, 125.1 v 130.9 g/L; P < 0.001). Some potential markers of adult chronic disease were higher in urban than remote children: systolic blood pressure (mean, 109.6 v 106.2 mmHg; P = 0.004), and levels of total cholesterol (4.3 v 4.0 mmol/L; P < 0.001), high-density lipoprotein cholesterol (mean, 1.4 v 1.2 mmol/L; P < 0.001) and insulin (median, 7 v 4 mU/L; P = 0.007). Diastolic blood pressure, levels of red cell folate, serum glucose and low-density lipoprotein cholesterol, and urinary albumin-creatinine ratio did not differ by location. The prevalence of visible infections was also higher in remote than urban children (P < 0.05). CONCLUSION: As some markers of health differ between peripubertal Aboriginal children living in urban areas and those in remote areas, results of surveys in remote areas cannot be generalised to urban Aboriginal populations.

Adolescent↗
PubMed1993

Rural and urban differentials in Medicare home health use.

This article addresses whether the use of Medicare home health services differs systematically for rural and urban beneficiaries. It draws on Medicare data bases from 1983, 1985, and 1987, including the Health Insurance Skeleton Write-Off (HISKEW) files and the Home Health Agency (HHA) 40-percent Bill Skeleton files. It presents background information on rural and urban beneficiaries and contrasts the use rates, visit levels and profiles, episodes of home health use, and primary diagnoses in rural and urban areas. The results point to higher home health use rates in urban areas and to a narrowing of the urban-rural use differential from 1983 to 1987. Rural home health users receive on average three more visits than their urban counterparts, with many more skilled nursing and home health aide visits. However, rural enrollees are much less likely than urban enrollees to receive medical social service or therapeutic visits, even after controlling for primary diagnosis. These findings point to the need for further analysis to understand the consequences of these differences.

Data Collection↗
PubMed1997

An empirical comparison of rural and urban safety-net hospitals.

This study compares the characteristics of rural hospitals with urban safety-net hospitals and with "other urban hospitals" (non-teaching, non-safety-net urban hospitals that provide mainstream care in the United States). The objective is to examine if there are similarities between rural and urban safety-net hospitals, both of which serve underserved populations. The authors also wish to study if there are areas in which rural and urban safety-net hospitals are closer together compared to "other" urban hospitals. Based on the results, some potential areas of cooperation between rural and urban safety-net hospitals are discussed.

American Hospital Association↗
PubMed2000

Tuberculosis in the urban poor settlements in the Philippines.

SETTING: Urban poor settlements in the Philippines. OBJECTIVE: To determine the magnitude of the tuberculosis problem in urban poor settlements in comparison with urban areas studied in the Nationwide Tuberculosis Prevalence Survey. STUDY DESIGN AND METHOD: A multistage cluster survey of BCG scar, tuberculin test, chest radiography and sputum examination for bacillary disease, in urban poor areas. RESULTS: The prevalences of culture-positive and smear-positive tuberculosis were 17.5 +/- 2.3 (95% CI 13.3-22.4) and 7.9 +/- 2.3 per thousand (95% CI 2.611.5), respectively. Extrapolated to the total population, the rates in the urban poor settlements were 12.4 +/- 1.7 (95% CI 9.6-16.2) and 5.6 +/- 1.6 per thousand population (95% CI 1.3-8.3), respectively. The prevalence of active pulmonary tuberculosis in subjects aged 10 years or more was 66 +/- 5.6/1000 (95% CI 55-77). The BCG vaccination rate was 72%. The overall prevalence of tuberculosis infection was 66%, and 39% in those aged 5-9 years, corresponding to an annual risk of infection (ARI) of 6.5%. CONCLUSION: The problem of tuberculosis was substantial in the urban poor settlements, and was appreciably worse than that in the general urban population.

Adolescent↗
PubMed2001

Costs-effectiveness of the urban health center in Nakhon Ratchasima: a case study on diabetes and hypertension.

Health care reforms in Thailand are looking for a better health infrastructure within the urban setting. The urban health center is one of the models tried in many provinces. This study compared the costs--effectiveness of the urban health center in Nakhon Ratchsima with the Maharaj Nakhon Ratchasima Hospital, using diabetes and hypertension as tracer conditions. The point estimates by a retrospective review and cross-sectional study revealed that the overall costs (provider plus patient costs) of the urban health center for these tracers were lower than the costs of the Maharaj Hospital. The effectiveness of treatment at the urban health center was also better. It was concluded that the urban health center should be considered as a better alternative of primary care institution within the urban area.

Chronic Disease↗
PubMed2003

Malaria transmission in urban sub-Saharan Africa.

The rapid increase in the world's urban population has major implications for the epidemiology of malaria. A review of malaria transmission in sub-Saharan African cities shows the strong likelihood of transmission occurring within these sprawling cities, whatever the size or characteristics of their bioecologic environment. A meta-analysis of results from studies of malaria transmission in sub-Saharan Africa shows a loose linear negative relationship between mean annual entomologic inoculation rates (EIR) and the level of urbanicity. Few studies have failed to find entomologic evidence of some transmission. Our results show mean annual EIRs of 7.1 in the city centers, 45.8 in periurban areas, and 167.7 in rural areas. The impact of urbanization in reducing transmission is more marked in areas where the mean rainfall is low and seasonal. Considerable variation in the level of transmission exists among cities and within different districts in the same city. This article presents evidence from past literature to build a conceptual framework to begin to explain this heterogeneity. The potential for malaria epidemics owing to decreasing levels of natural immunity may be offset by negative impacts of urbanization on the larval ecology of anopheline mosquitoes. Malaria control in urban environments may be simpler as a result of urbanization; however, much of what we know about malaria transmission in rural environments might not hold in the urban context.

Africa South of the Sahara↗
PubMed2002

Prevalence of asthma, asthma-like and allergic symptoms in the urban and rural adult population in Eastern Turkey.

There is no study assessing the prevalence rates for asthma, asthma-like symptoms, and allergic symptoms in Eastern Turkey. In this study, we investigated these rates in the urban and rural adult population of Elazig Region in Eastern Turkey. A questionnaire was prepared based on the standard inquiry form of the European Community Respiratory Health Survey. The survey included 3,591 consented adults who were randomly selected. Each questionnaire was interviewed face-to-face by a physician. It was found that the cumulative prevalence rates of asthma and asthma-like symptoms of the rural and the urban respondent groups were 29.6% and 25.8%, respectively. The periodic prevalence rates of the same symptoms were 27.3% and 19.3%, respectively. The percentages of the patients living in rural and urban areas diagnosed as asthma by a physician were 5.5% and 3.1%, respectively. The proportions of patients with a history of at least one allergic disorder were 36.4% and 23.7% in the rural and urban groups, respectively. Asthma and asthma-like symptoms in patients with allergic rhinoconjunctivitis were significantly higher than those without (p < 0.01). The cumulative rates of a previous diagnosis of asthma among respondents with a history of asthma-like symptoms were 18.4% in the rural and 11.2% in the urban groups (p < 0.05). Among those who had had periodic asthma-like symptoms, the rural and urban rates of previous asthma diagnosis were 18.6% and 14.3%, respectively (p < 0.01). Unexpectedly, the prevalence rates for asthma, asthma-like and allergic symptoms in adults living in the rural areas of Elazig Region in Eastern Turkey were significantly higher than the rates in the urban population.

Adult↗
PubMed2004

Nutritional problems in urban slum children.

Nutritional problems like protein energy malnutrition (PEM), anemia and vitamin A deficiency continue to plague a large proportion of Indian children. The diets and nutritional status of urban slum children in India is far away from being satisfactory. The nutritional status of slum children is worst amongst all urban groups and is even poorer than the rural average. Urban migration has not provided them salvation from poverty and undernutrition. Another distressing feature is the lack of any significant improvement over the years in this population. Most common causes of malnutrition include faulty infant feeding practices, impaired utilization of nutrients due to infections and parasites, inadequate food and health security, poor environmental conditions and lack of proper child care practices. High prevalence of malnutrition among young children is also due to lack of awareness and knowledge regarding their food requirements and absence of a responsible adult care giver. With increasing urban migration in the years ahead, the problem of malnutrition in urban slums will also acquire increasing dimension unless special efforts are initiated to mitigate the health and nutrition problems of the urban poor. Improving nutritional status of urban poor requires a more direct, more focused, and more integrated strategy.

Child↗
PubMed2004

Comparison of nutritional risk between urban and rural elderly.

Urban and rural elderly face a multitude of barriers to healthy aging and maintaining adequate nutrition. Looking at commonalties and differences between urban and rural elderly that are associated with nutritional risk is an important first step in identifying and correcting nutritional insufficiencies. To examine health behaviors and nutritional information associated with nutritional risk in urban and rural areas and to develop a profile of nutritional risk for rural and urban elderly, data from one retrospective and two prospective studies were analyzed. One hundred, eighty-three (183) urban-living and 167 rural-living older adults (average age 77 years old) participated in the studies. More than 60% of participants were women. Overall health ratings were significantly higher for urban than for rural elderly. Rural dwellers had significantly fewer dental visits (41% versus 76%) but higher albumin values than their urban counterparts. Results from the synthesis of these four studies indicate that as people become more physically debilitated and lose independence in daily activities, their risk for malnutrition increases and their quality of life decreases. Although rural residents are believed to be at higher risk of malnutrition, these results suggest that this may not be the case. Physical, social, and environmental factors may affect the nutritional status of seniors regardless of where they reside.

Aged↗
PubMed2004

[The prevalence and its screening methods of primary open angle glaucoma in defined population-based study of rural and urban in Beijing].

OBJECTIVE: The purpose of the study is to determine the prevalence of primary open-angle glaucoma (POAG) in persons aged 40 or above in Beijing, China. METHODS: From June 2001 to October 2001, the screening population was identified by a door-to-door census in five metropolitan resident areas in the north of Beijing and three villages in a county south to Beijing. The screening included visual acuity, frequency doubling perimetry (FDP, C-20 screening program), non-contact tonometry, slit lamp microscopy, anterior chamber depth (Van Herick method), and fundus photography. The suspect glaucoma and definite glaucoma patients were asked to have an examination of Octopus 1-2-3 perimetry (G1X TOP threshold program), repeat tonometry, gonioscopy and fundus stereo-photography at Beijing Tongren Hospital. RESULTS: There were 4451 subjects who were examined at the study sites. The response rates in rural and urban were 79.58% and 87.13%, respectively. In this 40 years-old or above population, the prevalences of POAG were 1.97% in rural men, 2.07% in urban men, 1.04% in rural women and 1.42% in urban women. In this study, 92.30% POAG patients in rural and 87.30% POAG patients in urban were new diagnosed cases. The prevalence of POAG increased with age and the change was exponential. In 50% POAG patients first IOP measurement was less than 21 mm Hg (1 mm Hg = 0.133 kPa). The prevalence of monocular eye blindness was 15.40% and 10.90% in rural and urban, respectively. CONCLUSIONS: Owing to use fundus photography and integrated evaluation of optic disc, it is possible to diagnose in earlier stage of POAG. This study identifies more patients with POAG than any previous population-based studies of China, and is similar to other studies of Asia such as in India and Singapore. The reason of lower POAG prevalence in rural women than in urban may be that the anterior chamber depth of rural women is shallower than that of urban women. It may cause difficult to differentiate the chronic primary angle closure glaucoma from POAG at screening sites, so the part POAG patients may be included in primary angle closure glaucoma patients.

Adult↗