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PubMed2004

Functional independence of residents in urban and rural long-term care facilities in Taiwan.

PURPOSE: To compare the score of functional independence measure (FIM) between urban and rural residents living in long-term care facilities (LTCF) in Taiwan. METHODS: A total of 437 subjects in 112 licensed LTCF in Taiwan were randomly selected by stratification strategy. Physical therapists interviewed the subjects in nursing homes (NH) and intermediate care facilities (ICF) to obtain the basic data, and the FIM score. RESULTS: (1) There was no significant difference in basic demographic data between urban and rural LTC subjects. (2) Most of the subjects in urban and rural LTCF were males, less than 80 years old, single/widowed, having multiple diseases, using more than one assistive devices, and having social welfare financial support. (3) Motor abilities (eating, grooming, and transfer) and cognition (comprehension, social interaction and problem solving) in rural LTCF subjects were significantly (p < 0.05) higher than those in urban areas as revealed by the FIM assessment. (4) The median of FIM total score of rural LTCF subjects was 90.5, which was significantly (p < 0.05) higher than that of urban LTCF subjects (median = 76). CONCLUSIONS: Some of the functional performance of subjects in rural long-term care institutions is better than those in urban areas. Our results may provide guidelines for the manpower and equipment supply estimation.

Activities of Daily Living↗
PubMedDate not supplied

Serum pneumoproteins and biomarkers of exposure to urban air pollution: a cross-sectional comparison of policemen and foresters.

Very few biomarkers are available for the non-invasive detection of effects of urban air pollution on the respiratory tract. The objective was to evaluate whether Clara cell protein (CC16) and surfactant-associated protein-A (SP-A), two pulmonary secretory proteins, were useful in the detection of effects of urban air pollutants on the pulmonary epithelium. These proteins were determined in the serum of 53 policemen working in Brussels, Belgium, and a control group of 59 foresters working in the countryside. Except for ozone (O(3)), annual concentrations of the main air pollutants (PM(10), NO(2), CO, SO(2) and benzene) were significantly higher in Brussels than in the country. The proportion of smokers was lower in urban policemen compared with foresters, but they smoked on average a similar number of cigarettes per day as confirmed by their urinary excretion of cotinine. Muconic acid, a marker of benzene exposure, was significantly higher in urban policemen than in foresters, in both smokers and non-smokers. Multiple regression analysis showed that the type of work, smoking habits and time spent outdoors and in a car were significant determinants of benzene uptake. Tobacco smoking impaired lung function to a similar extent in urban policemen and foresters. The serum levels of SP-A were significantly increased in smokers but were not different between policemen and foresters. Serum CC16 was significantly reduced by tobacco smoking and slightly decreased in policemen compared with foresters. Interestingly, the reduction of serum CC16 was more pronounced in the subgroup of traffic compared with survey policemen, the latter being also less exposed to benzene. The results suggest that serum pneumoproteins and especially serum CC16 could be useful in the detection of chronic effects of urban air pollutants on the respiratory epithelium of populations particularly at risk.

Adult↗
PubMed2006

Rural-urban differences in health and health behaviour: a baseline description of a community health-promotion programme for the elderly.

STUDY OBJECTIVE: To (1) describe the setting and design of the Good Ageing in Lahti Region (GOAL) programme; (2) by using the baseline results of the GOAL cohort study, to examine whether living in urban, semi-urban, or rural communities is related to risk factors for chronic diseases and functional disability in ageing individuals. DESIGN: The baseline data of a cohort study of ageing individuals living in three community types (urban, semi-urban, rural). Data were collected by two questionnaires and laboratory assessments. SETTING: Fourteen municipalities in the Lahti region (Päijät-Häme County) in Finland. PARTICIPANTS: A regionally and locally stratified random sample of men and women born in 1946-50, 1936-40, and 1926-30. A total of 4,272 were invited and 2,815 (66%) participated. MAIN RESULTS: Elevated serum cholesterol, obesity, disability, sedentary lifestyle (<2 times/week walking), and high fat intake were more prevalent in rural vs. urban and semi-urban communities. After adjustment for sex, age, education, obesity, diet, physical activity, smoking, and alcohol use, rural communities remained the only community type with increased (p<0.05) probability for high BMI (OR 1.33) and high waist circumference (OR 1.43). CONCLUSIONS: The unfavourable health and lifestyle profile, together with an old population, makes health promotion for elderly citizens a special challenge for rural communities such as those in Päijät-Häme County, Finland. Most, if not all, of the differences in health between the three community types were explained by educational background, physical activity, and smoking.

Aged↗
PubMed2000

Regional variations in the use of diagnostic coronary angiography. A one-year population-based study of all diagnostic coronary angiographies performed in a rural and an urban Danish county.

The aim of this study was to monitor coronary angiography activity and results, and to evaluate indications and treatment consequences using regional hospital registers and case records in the rural county of Ringkjøbing and urban county of Aarhus The study included all patients who had undergone a coronary angiography during 1996. For women, there were 606 (rural) and 1296 (urban) coronary angiographies per one million inhabitants (p < 0.0001) and for men, 1884 (rural) and 3051 (urban) coronary angiographies per one million inhabitants (p < 0.0001). In both counties the age distribution of the women examined was the same as that for the men. The angiographic rates were the same in the two counties for patients examined for valvular heart disease and severe arrhythmias. For patients with ischaemic heart disease, the angiographic rate for rural patients was two to three times lower than that for urban patients (p < 0.01). Revascularization procedures were performed in 39% (rural) and 40% (urban) of the examined women (NS) and 66% (rural) and 59% (urban) of the examined men (p < 0.05). Despite wide regional differences in coronary angiography activity, angiography was deployed to the same extent for examination of patients with valvular and severe arrhythmia heart disease. For patients examined for ischaemic heart disease, angiography activity was considerably lower in the rural area. The female patients had a higher frequency of normal coronary angiograms than the male patients.

Adult↗
PubMed2004

Treatment counselor's attitudes about lesbian, gay, bisexual, and transgendered clients: urban vs. rural settings.

Treatment counselors' attitudes about lesbian, gay, bisexual, and transgendered (LGBT) clients can have important effects on these client's recovery. There is a common, but unexamined, perception that LGBT people are more accepted in urban areas (and thus urban treatment programs) and that urban counselors have greater knowledge of the needs of the LGBT community. This study examined the attitudes and knowledge of treatment counselors from two geographic regions: urban Chicago (n = 109) and rural Iowa (n = 242) in 2000. The instrument assessed demographic characteristics, knowledge, and experiences working with LGBT clients, and attitudes about LGBT clients (an adaptation of Herek's Attititudes about Lesbians and Gays rating scale). Only a few demographic differences between the urban and rural counselors were identified. Chicago counselors were more racially diverse and more likely to have grown up in an urban area than the Iowa counselors. The Iowa counselors had slightly higher levels of formal education. Although the Chicago providers reported having considerably more contact with LGBT clients and more formal and continuing education about LGBT people, they did not have more positive attitudes or report more knowledge of specific LGBT issues that might influence alcohol and drug treatment. Overall, both Chicago and Iowa counselors had very little formal education regarding the needs of LGBT clients, and nearly half reported negative or ambivalent attitudes. Many of the counselors lacked knowledge about legal issues such as domestic partnership and power of attorney, the concepts of domestic partnership and internalized homophobia, and issues related to family of origin and current family.

Attitude of Health Personnel↗
PubMed1980

Urban-rural differences in the growth of Peruvian children.

The growth characteristics of children from four villages in northern Peru were compared with those of poor urban children in the capital city, in whom short stature but generally satisfactory weight for height relationships after infancy had been demonstrated. Height for age and weight for age fell more rapidly during infancy in the rural than in the urban children of both sexes. Rural girls caught up with the urban girls in height during childhood but did not match them in weight until late adolescence. Their weight to height ratios were consistently lower after 1 year of age, most strikingly between 2 and 5 years of age, and did not approach or match those of the urban girls until adolescence. Rural boys did not catch up with the urban boys in height or weight (differences in height were not statistically significant between 6 and 10 years, however) and their ratios remained consistently lower until late adolescence, most strikingly in early childhood and during puberty. Such urban-rural and sex differences, if typical and current, might well call for very different remedial measures at different ages in each of the populations.

Adolescent↗
PubMed1981

Urban-suburban differences in the predictors of morale among the aged.

Research on the habitability of the city for older people and research on the predictors of well-being have led to the search for patterns of adaptation which distinguish the urban elderly adults from their non-urban counterparts. This study compares neighborhood perceptions and use and social network involvement in an urban and suburban sample of older people. Differences in patterns of adaptation characteristic of urban and suburban elderly adults were sought by comparing the ability of neighborhood and social network factors to predict morale in each sample. Results revealed differences in urban and suburban elderly adults' perceptions and use of neighborhood facilities. Urban older people reported more frequent interactions with friends, greater dissatisfaction with friendships and greater organizational participation. Informal social relationships were related to elderly urbanites' morale but had practically no bearing on suburbanites' morale. Differences in cultural heterogeneity and environmental demand seem to provide the best explanation for the findings.

Aged↗
PubMed2002

School journeys and leisure activities in rural and urban adolescents in Norway.

Health promotion measures in order to increase physical activity should include environmental and policy approaches. Studies in natural living environments such as rural and urban areas may provide valuable information about the effects of environmental factors on physical activity. The present study was performed among 88 adolescents living in one rural and one urban area in Norway, with particular focus on the availability of cycling tracks and walking trails. The study showed that both rural and urban adolescents spent more time on sedentary activities, such as watching TV/video and playing TV/data-games, than on regular physical activity. No differences were observed between the two groups in regard to activity patterns. However, the median distance the urban adolescents walked or cycled to school was three times greater than the median distance the rural adolescents walked or cycled to a bus stop or to school. The urban adolescents also walked or cycled more to regular activities than the rural ones. Positive correlations were found between walking or cycling from home to school and walking or cycling to regular activities. In multiple regression analysis, urban area, female gender and distance walked or cycled to school or bus stop predicted increased walking or cycling to activities. The results confirm other studies on adolescents, showing that much more time is spent on sedentary rather than on physical activity. Knowledge is still lacking concerning predictors of sedentary and general physical activity, but the results indicate that access to cycling tracks and walking trails in residential areas may increase both walking or cycling to school and to leisure activities. A relevant strategy for health promotion may therefore be to make cycling tracks and walking trails accessible; some passive transport both to school and to leisure activities may thus probably be replaced by walking or cycling.

Adolescent↗
PubMed1988

The prevalence and transmission of hepatitis B virus infection in urban, rural and institutionalized black children of Natal/KwaZulu, South Africa.

The sera of statistically selected urban (805), rural (238) and institutionalized (127) black children were tested for markers of hepatitis B virus (HBV) infection. The age-standardized (6-14 years) prevalence rates of HBs antigenaemia for comparison between urban, rural and institutionalized children were 10%, 18.5% and 25.1% and the HBV exposure rates were 31.4%, 62.1% and 72.0% respectively. In the newborn to six years age group the prevalence rates of HBsAg and HBV exposure were 2.5% and 7.1% for urban children and 53.1% and 70.3% for institutionalized children. Peak prevalences of HBsAg occurred in the 6-8 year age group and were 14.4% and 22.6% in urban and rural children respectively. Hepatitis Be Antigen (HBeAg) was detected in 46.5% and antibodies to hepatitis Be antigen (HBeAb) in 10.0% of all HBsAg positive children. Multiple mechanisms involving horizontal rather than vertical transmission appeared to be important in urban children, with HBV exposure in females being significantly associated with ear-piercing (p less than 0.001) and scarification (p less than 0.05). In addition, HBsAg was detected in 25 of 29 pools of bloodfed mosquitoes caught at the children's institution and was negative in all four pools of unfed mosquitoes, suggesting that these arthropods may also be one factor in the horizontal spread of HBV infection. Familial clustering of HBV infection was suggested by a significantly higher (p less than 0.01) prevalence of HBsAg amongst family contacts of HBsAg positive urban children (17.7%) than in the control groups of family contacts of HBsAb positive children (8%) and children who were negative for all HBV markers (2.4%). The significance and implications of these findings are discussed.

Adolescent↗
PubMed1980

Urban-rural differential in breast cancer incidence and mortality in Olmsted County, Minnesota, 1935-1974.

Between 1935 and 1974, 580 new cases of breast cancer were diagnosed among the residents of Rochester, and 187 cases were found among the women living in the remainder of Olmsted County, Minnesota. The age-adjusted incidence of breast cancer was 79.1 per 100 000 person-years among Rochester women and 56.3 per 100 000 person-years among the rural women, for an urban-rural ratio of 1.40:1. The rural incidence increased more rapidly than did the urban incidence during the period of the study, especially among women 50 years old or older; and the urban-rural ratio seemed to decline with time. No convincing explanation for these changes was found, but migration and increasing urbanisation of rural areas may be important factors. The greater urban incidence and the net migration of rural patients with breast cancer into the urban area explain the higher urban mortality rates for breast cancer.

Adult↗
PubMed2000

Giant cell arteritis is more prevalent in urban than in rural populations: results of an epidemiological study of primary systemic vasculitides in Germany.

OBJECTIVE: To investigate the period prevalences of primary systemic vasculitides (PSV) in urban and rural populations in northern and southern Germany in 1994. METHODS: Questionnaires were sent to all hospital departments, all physicians, health insurance providers and pension funds, reference laboratories for autoimmune diseases, and death registries in two catchment areas in northern and southern Germany (combined population 875 983) to identify patients with PSV between 1 January and 31 December 1994. Each catchment area encompassed both an urban and a rural area. Each case was re-evaluated by the authors by applying the definitions of the 1992 Chapel Hill Consensus Conference on the Nomenclature of Systemic Vasculitis. RESULTS: A total of 180 PSV patients were identified. The overall prevalence of PSV was 216 cases per 1 000 000 inhabitants (95% confidence interval (CI) 173-259) in northern Germany vs 195 (95% CI 153-236) in southern Germany. The prevalence of PSV was two-fold higher in women than in men, and five-fold higher in people aged > or =50 yr than in people aged <50 yr. The most frequent type of PSV was giant cell arteritis (GCA), with 87 cases per 1 000 000 in northern and 94 in southern Germany, followed by Wegener's granulomatosis, with 58 and 42 cases respectively. In the population aged > or =50 yr the prevalence of GCA was 240 per 1 000 000 in northern and 300 in southern Germany. In both northern and southern Germany the prevalence of GCA in this older population was significantly higher in urban than in rural populations (355 per 1 000 000 vs 115 in northern Germany (P<0.01) and 395 vs 220 (P<0.05) in southern Germany). The relative risk for the older urban population having GCA was 2.25-fold higher (95% CI 1.4-3.6) than in the rural population, and for the female population it was 4.7-fold higher in the urban than in the rural areas (95% CI 2.4-9.3). CONCLUSION: In both northern and southern Germany, GCA was significantly more prevalent in urban than in rural populations, especially among people aged > or =50 yr and in women. It remains unclear whether this disparity was due to underdiagnosis of GCA in the rural regions associated with differences in the German health-care system in cities vs rural areas. Further studies must examine the role of (chronic) exposure to the environmental factors characteristic of cities.

Adolescent↗
PubMed2005

Schizophrenia and urbanicity: a major environmental influence--conditional on genetic risk.

More than 10 studies have consistently shown that around one-third of all schizophrenia incidence may be related to unknown but likely unconfounded environmental factors operating in the urban environment that have an impact on developing children and adolescents to increase, relatively specifically, the later expression of psychosis-like at-risk mental states and overt psychotic disorders. The available evidence suggests that causation (urban environment causes psychosis) is more important than selection (high-risk individuals move into urban areas) and that the effect of the environmental factors in the urban environment is conditional on genetic risk (i.e., there may be gene-environment interaction). The effect associated with urbanicity has grown in more recent birth cohorts, while studies focusing on within-city contrasts have found important within-city variation in the incidence of schizophrenia associated with neighborhood social characteristics. Future approaches may focus on the complex interactions between neighborhood cognitive social capital and genetic risk as the substrate for the increased incidence of schizophrenia in the increasingly urbanized areas that children are growing up in.

Cohort Studies↗
PubMed1993

Rural-urban child psychopathology in a Northeastern U.S. state: 1986-1989.

Parent and teacher symptom reports from two epidemiological surveys of 2,519 Connecticut children were used to study rural-urban differences in childhood psychopathology. Parents and teachers of girls in cities reported elevated total disturbance and social withdrawal. Parents of urban girls also reported higher rates of behavioral disturbance. For boys, urban excesses were primarily observed in emotional disturbance. Rural-urban variation was largely associated with economic and cultural differences between sites and not with urbanization per se. Findings suggest that certain assumptions about rural-urban differences in specific forms of psychopathology, such as delinquency, should be reevaluated.

Anxiety Disorders↗
PubMed1996

Increased rate of conduct problems in urban areas: what is the mechanism?

OBJECTIVE: To compare the prevalence of conduct problems (CP) according to level of urbanization and to determine which factors account for the potential difference in prevalence rates. METHOD: Study 1 used a questionnaire survey of a nationally representative sample of 10,462 Norwegian adolescents. Study 2 used a questionnaire survey of a representative sample of 1,346 adolescents living in Oslo. Self-reported CP included most DSM-III-R criteria for conduct disorder. RESULTS: CP rates were similar in all levels of urbanization, except for the only semimetropolitan city in the country, the capital Oslo, which had CP rates twice those of the rest of the country. This increase rate could not be explained by a series of commonly advocated explanations: family structure and parental practices, social network, socioeconomic status, integration in community activities, religious involvement, and race. However, involvement in "soft" drugs and associating with antisocial peers could explain the statistically differential rates. Furthermore, in the Oslo study, adolescents' CP did not vary according to density of population or region within the city. CONCLUSIONS: The results support previous studies showing increased rates of CP in urban areas. However, urbanization must pass a certain threshold before it has this effect. Moreover, the lack of support for commonly advocated explanations for the difference between urban and nonurban areas suggests that investigations specifically addressing potential explanations for this difference should be conducted. The results indicate that the increased rates of substance use in highly urbanized areas may account for the difference in CP rates by prolonging and aggravating CP.

Adolescent↗
PubMed1985

A study of urinary sodium and potassium excretion rates among urban and rural Zulus and Indians.

A study was carried out to evaluate the relationship between blood pressure, plasma renin activity, serum aldosterone and patterns of urinary sodium and potassium excretion rates in urban Zulus, rural Zulus and Indians in order to explain the high prevalence of hypertension in the urban adult Zulu (25%) compared to the rural adult Zulu (10%). Urinary sodium and potassium were not significantly different between urban and rural Zulus. There was no association between sodium excretion and blood pressure. Urinary potassium correlated negatively with blood pressure in rural Zulus and Indians but not in urban Zulus. The urinary sodium:potassium ratio was significantly lower in rural Zulus than in urban Zulus. The sodium:potassium ratio of Indians was not significantly different from that of Zulus. Plasma renin activity levels were significantly lower in urban than in rural Zulus. This difference is an enigma but may be due to an environmental factor. Serum aldosterone correlated positively with plasma renin activity and negatively with the urinary sodium:potassium ratio.

Adult↗
PubMed1987

Correlates of blood pressure in rural and urban Zaïre.

Blood pressure and anthropometric characteristics were studied in 312 rural and 675 urban Bantu of Zaïre aged 10 years and more; proteinuria and the urinary sodium to potassium ratio were determined. On average, systolic and diastolic pressure were higher in rural than in urban Bantu, and rose with advancing age in both populations. However, rural Bantu were older, lighter and smaller, and had a lower sodium:potassium ratio than urban Bantu. Using multiple regression analysis, systolic and diastolic pressures correlated positively with age, weight, pulse rate, sex and sodium:potassium ratio; diastolic pressure also correlated negatively to height. After adjusting blood pressure for these independent correlates, systolic pressure remained significantly higher in rural Bantu. However, no significant difference persisted between the two populations after adjusting blood pressure for age alone. The prevalence of hypertension in rural and urban Bantu increased with age and was 14.2 and 9.9%, respectively, for participants at least 20 years old; women were more affected in the rural area, whereas men were more affected in the urban population. The occurrence of proteinuria was higher in rural Bantu than in urban; it was similar in participants with and without definite hypertension. It is suggested that higher blood pressure in the rural setting was mostly accounted for by the older age of the population.

Adolescent↗
PubMed1997

Urban-rural differences in prehospital care of major trauma.

OBJECTIVES: To compare differences in response times, scene times, and transport times by advanced life-support-trained paramedics to trauma incidents in urban and rural locations. METHODS: This report was a prospective cohort study of professional emergency medical services conducted in a five-county area in the state of Washington. Ninety-eight percent of trauma transports are provided by professional paramedics trained in advanced life support. Subjects were included in this study if they qualified as a major trauma victim and were transported or found dead at the scene by one of the region's advanced life support transport agencies between August 1, 1991, and January 31, 1992. The severity of injury was rated using the Prehospital Index. Incident locations were defined as "rural" if they occurred in a US Census division (a geographic area) in which more than 50% of the residents resided in a rural location. RESULTS: During the 6-month data collection period, advanced life support agencies responded to a total of 459 major trauma victims in the region. A geographic locations was determined for 452 of these subjects. Of these, 42% of subjects were injured in urban areas and the remainder in rural areas. The severity of injuries, as determined both by the triage classification (p = 0.17) and the distribution of Prehospital Index scores (p = 0.92), was similar for urban and rural major trauma patients. Twenty-six (5.7%) subjects died at the scene. About one quarter of both groups had a severe injury, as indicated by Prehospital Index score of more than 3. The mean response time for urban locations was 7.0 minutes (median = 6 minutes) compared with 13.6 minutes (median = 12 minutes) for rural locations (p < 0.0001). The mean scene time in rural areas was slightly longer than in urban areas (21.7 vs. 18.7 minutes, p = 0.015). Mean transport times from the scene to the hospital were also significantly longer for rural incidents (17.2 minutes vs. 8.2 minutes, p < 0.0001). Rural victims were over seven times more likely to die before arrival (relative risk = 7.4, 95% confidence interval 2.4-22.8) if the emergency medical services' response time was more than 30 minutes. CONCLUSIONS: Response and transport times among professional, advanced life-support-trained paramedics responding to major trauma incidents are longer in rural areas, compared with urban areas.

Algorithms↗
PubMed1987

Comparison of hypertension prevalence and control in 5,237 rural and urban Alabama residents.

Selected urban and rural Alabama populations were compared by age, sex, and race on the prevalence of hypertension and uncontrolled hypertension and the percentage of treated hypertensives with controlled blood pressure. We found the following results: (1) Rural women had a significantly higher prevalence of hypertension than urban women. (2) The prevalence of uncontrolled hypertension was significantly higher for urban white men than for their rural counterparts. (3) The prevalence of uncontrolled hypertension was significantly higher for rural black women aged 30 to 39 than for the same age group of urban black women. (4) Rural dwellers generally had much better blood pressure control than urban, though this was not manifested evenly across groups. Statistically significant differences were found for white men and women of all ages combined and in three of four age groups. Reasons for the rural-urban differences are unclear, but the rural area surveyed was served by nurse practitioner clinics that strongly emphasized patient education.

Adult↗