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PubMed1995

Urban economic reform and access to health care coverage in the People's Republic of China.

While the economic reforms since 1978 have brought about substantial changes in the rural health care system, there have been many and far-reaching implications for the urban health insurance system as well. This paper describes the evolving urban economy and examines the implications of these changes for access to health care coverage. Provided first is a brief description of the Chinese urban health care system. Three major areas of urban economic reform since 1984 are outlined and the possible effects of these reforms on health care coverage are discussed. The analysis reveals, first, the emergence of insurance coverage inequities under employment-based health insurance as China moves toward a open market economy. Second, the process of focusing on health services in rural and urban areas as separate systems is unnecessary and even counter-productive in light of the emerging integration of China's urban and rural-economies. Finally, some reasons for why China continues to search for employment-based health financing approaches are offered.

China↗
PubMed1988

Urban-rural differences in 12 year coronary heart disease mortality: the Puerto Rico Heart Health Program.

Preliminary observations of the Puerto Rican population in 1965 indicated that the coronary heart disease mortality rate was lower than in the U.S., and that the rate in rural areas might be less than urban ones because of lower levels of cardiovascular risk factors. This prompted a prospective investigation of 8793 urban and rural men, aged 45-64 years. A 12-year mortality study has been completed with almost total follow-up. After excluding those with known coronary heart disease at baseline, age-adjusted rates for coronary heart disease, sudden, and stroke death are 19-37% higher in urban than rural men. Urban men had higher average blood pressure, cholesterol, glucose, and heart rate and were less physically active than rural men. When urban-rural differences for the known risk factors, including education and alcohol intake, are adjusted for by multivariate logistic regression analysis, no remaining significant urban-rural coronary heart disease mortality differential is present. Thus, it appears that variation in identified risk factors could explain the difference in mortality within Puerto Rico. The presence of unidentified protective factors cannot be excluded.

Adult↗
PubMed2004

The influence of urban, suburban, or rural locale on survival from refractory prehospital cardiac arrest.

There are many variables that can have an effect on survival in cardiopulmonary arrest. This study examined the effect of urban, suburban, or rural location on the outcome of prehospital cardiac arrest as a secondary end point in a study evaluating the effect of bicarbonate on survival. The proportion of survivors within a type of EMS provider system as well as response times were compared. This prospective, randomized, double-blind clinical intervention trial enrolled 874 prehospital cardiopulmonary arrest patients encountered by prehospital urban, suburban, and rural regional EMS area. Population density (patients per square mile) calculation allowed classification into urban (>2000/mi2), suburban (>400/mi2), and rural (0-399/mi2) systems. This group underwent standard advanced cardiac life support (ACLS) intervention with or without early empiric administration of bicarbonate in a 1-mEq/kg dose. A group of demographic, diagnostic, and therapeutic variables were analyzed for their effect on survival. Times were measured from collapse until onset of medical intervention and survival measured as the presence of ED vital signs on arrival. Data analysis used chi-squared with Pearson correlation for survivorship and Student t test comparisons for response times. The overall survival rate was approximately 13.9% (110 of 793), ranging from 9% rural, 14% for suburban, and 23% for urban sites for 372 patients (P=.007). Survival differences were associated with classification of arrest locale in this sample-best for urban, suburban, followed by rural sites. There was no difference in time to bystander cardiopulmonary resuscitation, but medical response time (basic life support) was decreased for suburban or urban sites, and intervention (ACLS) and transport times were decreased for suburban sites alone. Although response times were differentiated by location, they were not necessarily predictive of survival. Factors other than response time such as patient population or resuscitation skill could influence survival from cardiac arrest occurring in diverse prehospital service areas.

Advanced Cardiac Life Support↗
PubMed2006

Aging in Italy: urban-rural differences.

Urban and rural living environments play a key role in social gerontology. The aim of this paper is to examine urban-rural differences in Italy against some influencing key factors as well as to analyse whether these differences can be explained by the environmental setting or the age and, in some cases, the education of its elderly population. The study is based on data collected from the European funded MOBILATE 2000 project, which was carried out in Finland, The Netherlands, Hungary, Germany, and Italy. The Italian sample (600 subjects) was divided into rural and urban areas, and stratified according to gender and age. Older people living in rural areas were always significantly less well educated than those in urban areas. The average rural household size was larger than its urban counterpart. In general, Italian elderly people living in rural areas were less likely to live alone than their European peers. The social network was usually located close to the respondents' houses. Investigation of leisure activities and the use of new technologies revealed that elderly urban dwellers were not only more active than their rural peers, but also more technologically minded. A regression analysis (R(2)=0.551) of the number of new technologies used by subjects, yielded living area, age, years of education (the strongest explanatory variable), and number of leisure activities performed as predictors.

Aging↗
PubMed2005

Scaling up postabortion contraceptive service--results from a study conducted among women having unwanted pregnancies in urban and rural Tanzania.

INTRODUCTION: It is well recognized that unwanted pregnancies and unsafe abortion are significant public health problems in sub-Saharan Africa. At the International Conference on Population and Development held in Cairo in 1994, postabortion care was prioritized as a means to reduce maternal morbidity and mortality associated with unsafe abortion. However, only a few postabortion care programs have been implemented and most of them have been confined to urban settings. The present study describes the magnitude of the problem of unwanted pregnancies among women with incomplete abortion in urban and rural Tanzania and evaluates the outcome of a postabortion care intervention. METHODS: Data were collected among 781 women admitted with incomplete abortion in Dar es Salaam region (urban Tanzania) and 575 women in Kagera region (rural Tanzania). RESULTS: Sixty-seven percent of the women in urban Tanzania and 42% in rural Tanzania stated that their pregnancy was unwanted. Contraceptive acceptance among women with unwanted pregnancies was high; 93% in urban Tanzania and 71% in rural Tanzania left with a contraceptive method. CONCLUSION: The high proportion of women with unwanted pregnancies in urban and rural Tanzania underlines the need of scaling up postabortion contraceptive service.

Abortion, Illegal↗
PubMed2004

Effects of wintertime ambient air pollutants on asthma exacerbations in urban minority children with moderate to severe disease.

BACKGROUND: Urban minority children with asthma are at higher risk for severe exacerbations leading to hospitalizations and deaths. Because multiple studies have reported associations between air pollution and asthma worsening, elevated levels of air pollution are cited as a possible trigger for increased asthma morbidity in urban areas. Few studies have prospectively followed panels of urban children with asthma to determine whether air pollution levels are associated with clinically relevant outcomes such as asthma exacerbations. OBJECTIVE: To determine the association between levels of ambient air pollutants and asthma exacerbations in urban poor children with moderate to severe asthma. METHODS: A school-based panel of children with difficult-to-control disease was followed over a period of 3 consecutive winters in Denver, Colo. The panel consisted of predominantly urban African American children with moderate to severe asthma. Levels of Environmental Protection Agency criteria air pollutants were measured on a daily basis with concurrent monitoring of lung function, bronchodilator use, symptoms, and asthma exacerbations. RESULTS: After controlling for time-varying factors such as upper respiratory infections and meteorologic factors, a weak association was found between ambient carbon monoxide levels and bronchodilator use. Ozone levels were associated with daytime symptoms only. No association was observed between daily air pollution concentrations and daily levels of FEV 1 , peak flow, nighttime symptom scores, or asthma exacerbations over the 3-year period. CONCLUSION: Ambient levels of Environmental Protection Agency criteria air pollutants in Denver do not lead to clinically significant asthma worsening in urban children with moderate to severe asthma during winter months when children are primarily indoors.

Air Pollutants↗
PubMed2004

Managing the adverse thermal effects of urban development in a densely populated Chinese city.

Guangzhou city in South China has experienced an accelerated urban development since the 1980s. This paper examines the impact of the urban development on urban heat islands through a historical analysis of urban-rural air temperature differences. Remote sensing techniques were applied to derive information on land use/cover and land surface temperatures and to assess the thermal response patterns of land cover types. The results revealed an overriding importance of urban land cover expansion in the changes in heat island intensity and surface temperature patterns. Urban development was also related to a continual air temperature increase in the 1980s and 1990s. The combined use of satellite-derived vegetation and land cover distributions with land surface temperature maps provides a potential useful tool for many planning applications. The city's greening campaigns and landscaping designs should consider the different cooling effects of forest, shrubs and grassy lawns for temperature control and should plant more tall trees.

China↗
PubMed2005

Relationship between oxidative stress and cognitive impairment in the elderly of rural vs. urban communities.

Psychological stress and environmental pollution are frequently associated to urban environment and oxidative stress (OxS). Likewise, OxS is a risk factor for cognitive impairment (CI) in the elderly. Therefore, we hypothesized that the prevalence of CI in subjects of the urban area could be higher than in those of the rural area, and linked to higher OxS. The aim of the study was to determine the relationship between OxS and CI in elderly individuals from rural and urban settings in Mexico. Plasmatic TBARS, plasma total antioxidant status, and the antioxidant enzymes superoxide dismutase (SOD) and glutathione peroxidase (GPx) were measured in 104 urban and 85 rural elderly individuals. Cognitive functions were evaluated through the Mini Mental State Examination. We found a greater proportion of subjects with OxS and CI in urban than in rural areas (25% vs. 9%), with an odds ratio of 5.67 (CI95% 1.14-38.02, p < 0.05). Our findings suggest that the elderly in urban areas have more OxS and a higher risk of developing CI compared with elderly individuals in a rural environment.

Aged↗
PubMed2005

Refractive error in urban and rural adult Chinese in Beijing.

PURPOSE: To evaluate refractive error and its demographic associations in an urban and rural population in northern China. DESIGN: Epidemiological study. PARTICIPANTS: The Beijing Eye Study is a population-based cohort study in northern China including 4439 subjects. Excluding pseudophakic and aphakic patients, the present study involved 4319 subjects. It was divided into a rural part (1905 [44.1%] subjects) and an urban part (2414 [55.9%] subjects). Mean age was 55.85+/-10.33 years (range, 40-90). METHODS: Standardized ophthalmologic examination. For statistical analysis, the spherical equivalent was converted to binary variables, and logistic regression was used to investigate the association with continuous or categorical independent variables. MAIN OUTCOME MEASURE: Refractive error. RESULTS: Mean refractive error measured -0.33+/-2.22 diopters (D) (range, -20.88 to +7.88). Myopia of >-0.50 D, -1.0 D, >-6.0 D, and >-8 D, respectively, occurred in 22.9% (95% confidence interval [CI], 21.7-24.2), 16.9% (95% CI, 15.8-18.0), 2.6% (95% CI, 2.2-3.1), and 1.5% (95% CI, 1.1-1.9) of the subjects, respectively. Myopic refractive error was associated significantly with younger age (P<0.001), urban region (vs. rural region) (P<0.001), higher educational background (P<0.001), higher degree of nuclear cataract (P<0.001), decreasing uncorrected visual acuity (UCVA) (P<0.001), decreasing best-corrected visual acuity (BCVA) (P<0.001), and female gender (P<0.001). Prevalence of high myopia (myopic refractive error >-8 D) was associated with age (P<0.001), female gender (P = 0.020), urban region (P = 0.023), and lower BCVA (P<0.001). Mean anisometropia was 1.09+/-2.03 D (median, 0.38; range, 0-22.0). Prevalence of anisometropia of > or =1 D was associated significantly with age (P<0.001), refractive error (P<0.001), BCVA (P<0.001), and region (P<0.001). Mean astigmatic error measured 0.62+/-0.90 D (median, 0.25; range, 0-7.50). Astigmatism of > or =1 D was associated significantly with age (P<0.001), lower UCVA (P = 0.003), lower BCVA (P<0.001), urban area (P<0.001), and degree of cortical cataract (P = 0.027). CONCLUSIONS: As in other population-based studies on Chinese, myopia was more prevalent in younger subjects. Myopia was associated with urban region, educational background, female gender, decreasing visual acuity, and nuclear cataract. If longitudinal studies confirm the association of refractive error with age, refractive surgery may achieve emmetropia only for a limited time.

Adult↗
PubMed2006

Exploring differences in caseloads of rural and urban healthcare providers in Alaska and New Mexico.

OBJECTIVES: Although it is commonly accepted that rural healthcare providers face demands that are both qualitatively and quantitatively different from those faced by urban providers, this conclusion is based largely on data from healthcare consumers and relies on qualitative work with small sample sizes, surveys with small sample sizes, theoretical reviews and anecdotal reports. To enhance our knowledge of the demands faced by rural healthcare providers and to gain the perspectives of healthcare providers themselves, this study explored the caseloads of rural providers compared with those of urban providers. METHOD: An extensive survey of over 1500 licensed clinicians across eight physical and behavioural healthcare provider groups in Alaska and New Mexico was undertaken to explore differences in caseloads based on community size (small rural, rural, small urban, urban), state (Alaska, New Mexico) and discipline (health, behavioural). RESULTS: Findings indicated numerous caseload differences between community sizes that were consistent across both states, with complex case presentations being described most commonly by small rural and rural providers. Substance abuse, alcohol use, cultural diversity, economic disadvantage and age diversity were issues faced more often by providers in rural and small rural communities than by providers in small urban and urban communities. Rural, but not small rural, providers faced challenges around work with prisoners and individuals needing involuntary hospitalization. Although some state and discipline differences were noted, the most important findings were based on community size. CONCLUSIONS: The findings of this study have important implications for provider preparation and training, future research, tailored resource allocation, public health policy, and efforts to prevent 'burnout' of rural providers.

Adolescent↗
PubMed2006

Different effects of urban and rural environments in the respiratory status of Greek schoolchildren.

We hypothesized that asthma symptoms and lung function of schoolchildren living in Athens urban area are adversely affected as compared to others living in a rural environment, over a period of 8 years. We recruited 478 and 342 children aged 8-10 years living within a short radius around the urban and rural area monitoring stations, respectively. Respiratory health was assessed by a parent-completed questionnaire in three phases: 1995-1996 (phase-1), 1999-2000 (phase-2), 2003-2004 (phase-3) and by spirometry in phases-1 and 2. Reported asthma and wheeze did not differ in the two areas, whereas cough was more prevalent in the urban area in phase-1. Children from the rural environment had lower levels of percent-predicted forced vital capacity (FVC%) in phase-1 and higher of percent-predicted-forced expiratory flow at mid-FVC (FEF(50)%) in both phases. Independent associations were detected between FVC% as-well-as FEF(50)% and residential area. High FVC% was associated with outdoor systemic athletic activities; there was lower FVC% growth in the urban versus the rural area. Nitrogen dioxide and sulfur dioxide were higher in the urban area, whereas ozone concentrations differed less between the two areas. These results suggest that long-term exposure to urban environment is associated with sub-clinical airway narrowing and slower rate of FVC growth.

Air Pollution↗
PubMed2005

Sources, distribution and variability of hydrocarbons and metals in atmospheric deposition in an urban area (Paris, France).

Total atmospheric deposition, i.e., both wet and dry deposition, was sampled during 11 months in the "Ile-de-France" region, France. Monthly fluxes of aliphatic hydrocarbons (AHs), polycyclic aromatic hydrocarbons (PAHs) and heavy metals (HMs) were studied at three representative sites (two urbanised and one semiurban). A combination of spatial and temporal variability of total fluxes and pollutant fingerprints allows a better understanding of atmospheric pollutant dynamics over this region. In the whole studied area, aggregated total atmospheric fluxes of AHs, PAHs and HMs range from 19 to 33 mg m(-2) y(-1), 99 to 161 mug m(-2) y(-1) and 48 to 103 mg m(-2) y(-1), respectively. The highest values are observed in Paris centre, reflecting the importance of the urban centre as a source of pollutants, with a decline in many atmospheric deposits when moving away from urban areas. The seasonal distribution of these pollutants suggests the impact of residential heating on urban atmospheric deposition of hydrocarbons and the increase of dust loads containing HMs during summer. The qualitative study performed on atmospheric deposition data highlights the main sources of pollutants. Aliphatic fingerprints suggest a marked contribution of biogenic inputs to aliphatic contamination in the whole Ile-de-France region and slight petroleum inputs in urban areas. Aromatic fingerprints, characterised by the great predominance of phenanthrene, fluoranthene and pyrene, associated with some specific ratio values, suggest the mixture of petrogenic and pyrolytic contaminations of atmospheric deposition in the whole "Ile-de-France" region. HM distribution shows the presence of anthropogenic sources of Al and Fe in this area and the stationary sources (incinerators and plants) as a significant source of Si, S and Sb in the urban atmosphere. Moreover, a pollutant mix phenomenon, occurring in such an urban atmosphere, shows a significant influence on atmospheric deposition at the semiurban site.

Air Pollutants↗
PubMed2006

Metal contamination in urban, suburban, and country park soils of Hong Kong: a study based on GIS and multivariate statistics.

The urban environment quality is of vital importance as the majority of people now live in cities. Due to the continuous urbanisation and industrialisation in many parts of the world, metals are continuously emitted into the terrestrial environment and pose a great threat on human health. An extensive survey was conducted in the highly urbanised and commercialised Hong Kong Island area (80.3 km2) of Hong Kong using a systematic sampling strategy of five soil samples per km2 in urban areas and two samples per km2 in the suburban and country park sites (0-15 cm). The analytical results indicated that the surface soils in urban and suburban areas are enriched with metals, such as Cu, Pb, and Zn. The Pb concentration in the urban soils was found to exceed the Dutch target value. The statistical analyses using principal component analysis (PCA) and cluster analysis (CA) showed distinctly different associations among trace metals and the major elements (Al, Ca, Fe, Mg, Mn) in the urban, suburban, and country park soils. Soil pollution maps of trace metals (Cd, Co, Cr, Cu, Ni, Pb, and Zn) in the surface soils were produced based on geographical information system (GIS) technology. The hot-spot areas of metal contamination were mainly concentrated in the northern and western parts of Hong Kong Island, and closely related to high traffic conditions. The Pb isotopic composition of the urban, suburban, and country park soils showed that vehicular emissions were the major anthropogenic sources for Pb. The 206Pb/207Pb and 208Pb/207Pb ratios in soils decreased as Pb concentrations increased in a polynomial line (degree=2).

Environmental Monitoring↗
PubMed2006

Differences and similarities between rural and urban operations.

BACKGROUND: The importance of rural operations is magnified by super-specialization, uneven geographic distribution, and special educational needs. Definition of practice patterns and quality measures are needed. METHODS: A statewide network of 60 operative specialists studied costs, quality, and outcomes in 17,319 patients undergoing 46 different specialty operations between 1998 and 2003, comparing 9,544 rural to 7,775 urban patients. These data are augmented by additional data from 5,339 operative patients in 2004. RESULTS: Both high volume rural and urban surgeons achieved fewer deaths than less frequent practitioners of colon or rectal resections (2/309 vs 5/167). Urban surgeons had sicker patients undergoing more extensive procedures, and used fewer consultations, but had more complications and reoperations. Laparoscopic cholecystectomy had similar outcomes with 5 deaths among 1,788 patients. Urban surgeons converted to an open procedure more frequently, whereas rural surgeons used hepatobiliary iminodiacetic acid (HIDA) scans as indication for cholecystectomy more often (P < .01). Indications for upper and lower endoscopy varied, but abnormalities were noted in 64%; only 11 of 6,938 patients undergoing endoscopy were admitted for complications, 5 required operations, 3 due to totally obstructing cancers. Hysterectomy, urologic procedures, and tympanostomy had admission/readmission rates as low as 1/400. Documented patient preoperative education occurred in 94% of both groups. Overall, performance measures were addressed more consistently by rural surgeons (P < .001). CONCLUSIONS: Operative practice reaches high standards in both settings; indications for operations vary, and rural practice is broader than urban practice. Rural surgeons exceed their urban colleagues on some quality process measures.

Cholecystectomy, Laparoscopic↗
PubMed2001

A preliminary model for predicting heavy metal contaminant loading from an urban catchment.

The toxicity of heavy metals to biota in urban catchments has been regarded as a very important non-point source pollution issue. Numerous studies on heavy metal pollution in urban receiving waters have found that metal transport by surface runoff is closely correlated to the partitioning of the metal forms between dissolved and particulate phases, where sediment plays an important role in the transport process. Sediment cycling on urban streets, metal binding form, and rainfall character in the catchment area are considered to be the key factors for metal transport. A preliminary model is developed based on these considerations. Starting from classical build-up and wash-off processes for the suspended sediment (SS) on the urban impervious surface, the model links the transport of suspended sediment to the transport of metal species. Monitoring data from a small highway catchment were used in the model development. A total of 47 rain events over 1 year were monitored intensively at short time intervals (5-10 min) for hydrological data, rainfall intensity, and stormwater quality. In developing the model, lead was used for the metal load prediction, as it has been a common fuel additive for urban transportation. Agreement between model results and monitoring data indicates that the model can be used in predicting metal load from impervious urban areas, such as streets and roadways, on a long-term basis.

Animals↗
PubMed1998

Prevalence of type 2 diabetes mellitus and risk of hypertension and coronary artery disease in rural and urban population with low rates of obesity.

OBJECTIVE: To compare the prevalence of type 2 diabetes mellitus (DM) and coronary artery disease (CAD) and hypertension in DM in the rural and urban populations of north India. DESIGN AND METHODS: Two populations of the same ethnic background were randomly selected for this cross sectional survey. There were 1769 rural (894 men, 875 women) and 1806 urban subjects (904 men, 902 women) between 25-64 years of age. The survey methods included fasting and 2 h blood glucose and electro-cardiogram and blood pressure measurement of all subjects. RESULTS: Using the criteria of World Health Organization, the prevalence of diabetes mellitus (6.0 vs 2.8%) hypertension (24.0 vs 17.0%) and CAD (9.0 vs 3.2%) was significantly (P<0.001) higher in urban compared to rural subjects. Hypertension and CAD were significantly more frequent among subjects with diabetes compared to nondiabetes. The association of CAD and hypertension with diabetes was greater in urban than rural subjects. Excess body weight and obesity, central obesity, sedentary lifestyle, higher visible fat intake (>25 g/day), and social class 1-3 (higher and middle) were significantly associated with diabetes. Multivariate logistic regression analysis showed that after adjustment of age and sex, body mass index, central obesity, sedentary lifestyle and higher visible fat intake and alcohol intake in men were significant risk factors of diabetes among all the sub-groups. CONCLUSIONS: The study showed a high prevalence of diabetes in urban north Indian population compared to rural subjects in the same ethnic group. CAD and hypertension were significantly associated with diabetes more in urban than rural subjects. The findings suggest that higher body mass index, waist-hip ratio and visible fat intake and sedentary lifestyle were risk factors of diabetes.

Adult↗
PubMed2003

Effect of air pollution on peri-urban agriculture: a case study.

Peri-urban agriculture is vital for the urban populations of many developing countries. Increases in both industrialization and urbanization, and associated air pollution threaten urban food production and its quality. Six hour mean concentrations were monitored for SO(2), NO(2) and O(3) and plant responses were measured in terms of physiological characteristics, pigment, biomass and yield. Parameter reductions in mung bean (Vigna radiata), palak (Beta vulgaris), wheat (Triticum aestivum) and mustard (Brassica compestris) grown within the urban fringes of Varanasi, India correlated directly with the gaseous pollutants levels. The magnitude of response involved all three gaseous pollutants at peri-urban sites; O(3) had more influence at a rural site. The study concluded that air pollution in Varanasi could negatively influence crop yield.

Air Pollutants↗
PubMedDate not supplied

Is Lolium pollen from an urban environment more allergenic than rural pollen?

BACKGROUND: Allergy to grass pollen is a highly prevalent allergic disease. Hay fever is more predominant in urban than in rural areas, despite the increasingly smaller areas of surrounding grassland. The effect of vehicle exhaust pollutants, mainly diesel particles, and other industrial sources of atmospheric pollution leading to plant damage has been implicated in this phenomenon. OBJECTIVE: This study compared the in vivo and in vitro allergenicity of pooled samples of Lolium perenne grass pollen harvested from 10 different urban areas with that of samples of the same pollen from 10 neighboring rural areas. METHODS: Lolium perenne pollen from different parts of a city and from a nearby rural area was harvested in 1999 and 2000 during the peak pollination period. Protein composition was compared by SDS-PAGE and in vivo and in vitro IgE-binding capacity was compared by skin-prick tests, RAST-inhibition and measurement of the major allergen, Lol p 5. RESULTS: In the two years under study, urban samples contained approximately twice the protein content of the rural samples. Biological activity and Lol p 5 content was higher in urban pollen than in rural pollen and showed differences in the two years under study. CONCLUSIONS: The protein content and allergenicity of Lolium perenne pollen was higher in urban areas than in rural areas. These differences might explain why allergy to grass pollen is more prevalent in urban areas. This finding should be taken into account in diagnosis, preventive measures and specific immunotherapy.

Air Pollutants↗