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PubMed2005

HIV-1 diversity and prevalence differ between urban and rural areas in the Mbeya region of Tanzania.

OBJECTIVE: To characterize HIV-1 strains in a potential vaccine trial cohort (CODE) in the Mbeya region of southwest Tanzania. DESIGN: Study volunteers (n = 3096) were recruited from urban areas in Mbeya Town, using two different recruitment strategies, and in a nearby rural village. METHODS: Cryopreserved plasma from 507 HIV-1 prevalent cases was the source of viral RNA for HIV-1 genotyping by the Multi-region Hybridization Assay, the MHA(acd), and selected strains were confirmed by complete genome sequencing. RESULTS: The overall HIV-1 prevalence was 16.6% [95% confidence interval (CI), 15.3-17.9] within the cohort. HIV-1 prevalence was higher among women, and in urban areas. Recruitment through advertisement targeted a high-risk urban male population for HIV-1 infection [adjusted odds ratio (adj. OR), 1.68; 95% CI, 1.13-2.51] when compared with men recruited door-to-door. The complexity of the HIV-1 epidemic was also higher in urban areas evidenced by the high-risk of HIV-1 infection with a recombinant strain (adj. OR, 2.69; 95% CI, 1.08-6.69) and HIV-1 dual infection (adj. OR, 5.16; 95% CI, 1.07-24.9), mainly driven by urban men recruited through advertisement. CONCLUSIONS: Overall the urban epidemic was more genetically complex, with higher prevalence and more recombinants and dual infections. Vaccine trials in Mbeya region can assess a complex HIV-1 population dynamic and determine vaccine efficacy in relationship to the genetic diversity of HIV-1 strains that challenge vaccines.

Adolescent↗
PubMed2004

Disparities in birth outcomes by neighborhood income: temporal trends in rural and urban areas, british columbia.

BACKGROUND: Knowledge of socioeconomic disparities in health is of interest to both the general public and public health policymakers. It is unclear how disparities in birth outcomes by socioeconomic status have changed over time, particularly in settings with universal health insurance and favorable socioeconomic conditions. METHODS: We identified a cohort of all births (n = 713,950) registered in British Columbia, 1985-2000. We compared rates and relative risks (RRs) of preterm birth, small-for-gestational-age (SGA), stillbirth, and neonatal and postneonatal death across neighborhood-income quintiles from Q1 (richest, the reference) to Q5 (poorest) by 4-year intervals in rural and urban areas. Logistic regression was used to control for maternal and pregnancy characteristics. RESULTS: Maternal characteristics varied widely across neighborhood-income quintiles in both rural and urban areas. There were moderate and persistent disparities in birth outcomes across neighborhood-income quintiles in urban but not rural areas. The relative disparities in urban areas did not diminish over time for all birth outcomes and actually rose for postneonatal mortality. For example, crude RRs (95% confidence intervals) for Q5 versus Q1 in urban areas for SGA were 1.44 (1.37-1.52) in 1985-1988 and 1.41 (1.33-1.49) in 1997-2000; for postneonatal death, the corresponding results were 1.61 (1.17-2.20) and 2.20 (1.24-3.92), respectively. Most of the observed disparities could not be explained by observed maternal and pregnancy characteristics. CONCLUSION: Moderate disparities in birth outcomes by neighborhood income persist in urban areas (although not rural areas) of British Columbia, despite a universal health insurance system and generally favorable socioeconomic conditions.

British Columbia↗
PubMed2006

Urban amphibian assemblages as metacommunities.

1. Urban ecosystems are expanding throughout the world, and urban ecology is attracting increasing research interest. Some authors have questioned the value of existing ecological theories for understanding the processes and consequences of urbanization. 2. In order to assess the applicability of metacommunity theory to urban systems, I evaluated three assumptions that underlie the theory - the effect of patch area, the effect of patch isolation, and species-environment relations - using data on assemblages of pond-breeding amphibians in the Greater Melbourne area of Australia. I also assessed the relative impact of habitat fragmentation, habitat isolation, and changes to habitat quality on these assemblages. 3. Poisson regression modelling provided support for an important increase in species richness with patch area (pond size) and a decrease in species richness with increasing patch isolation, as measured by surrounding road cover. Holding all other variables constant, species richness was predicted to be 2.8-5.5 times higher at the largest pond than at the smallest, while the most isolated pond was predicted to have 12-19% of the species richness of the least isolated pond. Thus, the data were consistent with the first two assumptions of metacommunity theory evaluated. 4. The quality of habitat at a pond was also important, with a predicted 44-56% decrease in the number of species detected at ponds with a surrounding vertical wall compared with those with a gently sloping bank. This demonstrates that environmental differences between habitat patches were also influencing amphibian assemblages, providing support for the species-sorting and/or mass-effect perspectives of metacommunity theory. 5. Without management intervention, urbanization may lead to a reduction in the number of amphibian species persisting in urban ponds, particularly where increasing isolation of ponds by roads and associated infrastructure reduces the probability of re-colonization following local extinction. Journal of Animal Ecology (2006) 75, 757-764 doi: 10.1111/j.1365-2656.2006.01096.x.

Adaptation, Physiological↗
PubMed2004

Human African trypanosomiasis amongst urban residents in Kinshasa: a case-control study.

BACKGROUND: Increasing numbers of human African trypanosomiasis (HAT) cases have been reported in urban residents of Kinshasa, Democratic Republic Congo since 1996. We set up a case-control study to identify risk factors for the disease. METHODS: All residents of the urban part of Kinshasa with parasitologically confirmed HAT and presenting for treatment to the city's specialized HAT clinics between 1 August, 2002 and 28 February, 2003 were included as cases. We defined the urban part as the area with contiguous habitation and a population density >5000 inhabitants per square kilometre. A digital map of the area was drawn based on a satellite image. For each case, two serologically negative controls were selected, matched on age, sex and neighbourhood. Logistic regression models were fitted to control for confounding. RESULTS: The following risk factors were independently associated with HAT: travel, commerce and cultivating fields in Bandundu, and commerce and cultivating fields in the rural part of Kinshasa. No association with activities in the city itself was found. DISCUSSION: In 2002, the emergence of HAT in urban residents of Kinshasa appears mainly linked to disease transmission in Bandundu and rural Kinshasa. We recommend to intensify control of these foci, to target HAT screening in urban residents to people with contact with these foci, to increase awareness of HAT amongst health workers in the urban health structures and to strengthen disease surveillance.

Adolescent↗
PubMed1992

Horse chestnut (Aesculus hippocastanum) pollen: a frequent cause of allergic sensitization in urban children.

We investigated the incidence of allergic sensitization and the risk factors underlying sensitization in 214 urban children exposed to horse chestnut pollen. By means of the Phadezym RAST, we found IgE specific to horse chestnut pollen in 12.6% of the urban children, whereas it occurred in only 1.9% of control subjects recruited from a rural area. Reports of allergic symptoms in spring during the horse chestnut pollen load coincided with the presence of specific IgE in 5.1% of the urban group as against 1.4% of the recruited from the rural area. Environmental factors other than those related to urban living and higher horse chestnut pollen counts had no significant impact on allergic sensitization. Increased total IgE levels (greater than 100 kU/l), however, and the sensitization to pollen of other species significantly raised the odds for sensitization to chestnut pollen. They were highest in highly atopic children with sensitization to pollen, especially to that of plane trees (OR = 73.9). These results suggest the relevance of horse chestnut pollen because of the high allergic sensitization rate among urban children, and they should also be borne in mind when it comes to the planting of trees in urban areas.

Allergens↗
PubMedDate not supplied

Hypertension management: a comparison of urban versus rural general practitioners in Western Australia.

1. We have conducted a survey of 75 rural and 75 urban randomly selected general practioners (GPs) in Western Australia to ascertain how closely current practice mirrors published Australian guidelines for the management of hypertension. 2. Fifty-one rural and 49 urban GPs completed the 19 item questionnaire. The two groups were well matched in terms of age and years in general practice. An assessment of the criteria utilized to diagnose hypertension revealed a tendency for much greater scatter in the cut points used to define systolic compared to diastolic hypertension, but no systematic difference between urban and rural GPs. 3. After an initial finding of mild hypertension the follow-up time to the next check-up was significantly longer for rural patients compared to urban patients (72 +/- 13 and 36 +/- 5 days respectively, P < 0.01). Urban GPs reviewed established hypertensive patients more commonly at 1-3 monthly intervals (89%) while rural GPs reviewed more commonly at 3-6 monthly intervals (86%). 4. In terms of target blood pressure (BP) for BP reduction, 67% rural compared to 83% urban GPs aimed for a systolic BP of < 140 mmHg (P = 0.06), while 95% of both groups aimed for diastolic BP < 90 mmHg. 5. The profile of first line antihypertensive agents most commonly used was also similar in both groups with 46% preferring angiotensin converting enzyme inhibitors, 18.5% diuretics, 18.5% beta blockers, 16% calcium entry blockers and 1% prazosin. 6. This study demonstrates a clear preference for the newer anti-hypertensive agents.(ABSTRACT TRUNCATED AT 250 WORDS)

Antihypertensive Agents↗
PubMed2004

Dental visits in older Western Australians: a comparison of urban, rural and remote residents.

OBJECTIVE: It has been reported that the aged in rural areas may not access regular dental care. The aim of this study was to describe dental visits for those 60 years of age and older living in urban, rural and remote locations in Western Australia and to determine factors associated with such visits. The main outcome was having had a dental visit in the previous 12 months. DESIGN: A cross-sectional telephone survey was conducted. SETTING: Urban, rural and remote locations in Western Australia. SUBJECTS: A total of 2100 participants, 60 years of age and older. RESULTS: The present study demonstrated that people in rural and remote areas of Western Australia had a longer time since their last dental visit than people in urban areas. Within each sex, age, country of birth, income, occupation and education group, the highest proportion of people having attended a dentist in the previous 12 months was in urban areas and the lowest was in remote areas. Controlling for sex, age, education and oral health status, compared to urban residents, rural residents were 14% less likely to have seen a dentist and remote residents were 27% less likely. CONCLUSION: The present study demonstrated that for the aged sector of the Western Australian population, geographical location is a major factor in the frequency of use of dental services and the reasons for dental visits. This raises concerns that improvement of oral health by prevention and early detection of tooth and gum problems is less likely to occur in rural and remote areas than in urban areas.

Aged↗
PubMed2001

Behavioural factors as predictors of motor vehicle crashes: differentials between young urban and rural drivers.

OBJECTIVE: To describe the driver and behavioural factors that predispose young drivers to crash in the first 12 months of driving and to compare whether these factors differ between young urban and rural drivers. METHODS: A cohort comprising 1,796 newly licensed urban and rural drivers from Western Australia was recruited and followed over the first 12 months of driving. Using Cox proportional hazard analysis, driver and behavioural factors were assessed to determine whether they predicted the likelihood of a crash. RESULTS: The incidence rate for a motor vehicle crash was marginally higher for urban drivers compared with rural drivers (Urban: IR=4.2/10,000 driving days; Rural: IR=3.7/10,000 driving days). There was no significant difference in the time to crash between urban and rural drivers. Two factors, namely the frequency of driving before obtaining a learner-driver permit and the driver's level of risk taking, were significantly associated with a motor vehicle crash in the first year of driving. CONCLUSION: Irrespective of whether the driver is licensed in a rural or urban area, high risk-taking drivers are at an elevated risk of a motor vehicle crash in the first 12 months of driving. IMPLICATIONS: Aspects of Graduated Driver Training and Licensing Programs (GDTLP) could be effective in targeting this at-risk group.

Accidents, Traffic↗
PubMed1998

Balance and gait performance in an urban and a rural population.

OBJECTIVE: To compare the differences in standing balance and gait performance between two populations, correlated with age and physical activities of daily living. DESIGN: A cross-sectional study. SETTINGS: Malmö, the third largest city in Sweden, and Sjöbo, a typical agricultural community 60 km east of Malmö. PARTICIPANTS: Participants were 570 men and women from the urban community (urban) and 391 from the rural community (rural), born in 1938, 1928, 1918, and 1908, and women born in 1948. The two cohorts were subdivided into true urbans, who had lived only in the city (n = 269), and true rurals, who had never lived in a city (n = 354). MEASUREMENTS: Information about workload, housing, spare time activities, medication, and illness during different decades of life was gathered using two questionnaires. The first questionnaire was sent to the home after agreement to participate, and the second was presented at the test session. The clinical measurements were standing balance, gait speed, and step length. RESULTS: The urban subjects had significantly (P < .001) impaired balance compared with rural subjects. This difference increased with increasing age. The urban subjects walked faster than the rural subjects (P < .001), and the urban subjects used fewer steps than their rural counterparts (P < .001). Spare time activities had a significant influence on the above tests, but, except for gait velocity (P = .011), workload was of minor importance according to analysis of covariance. CONCLUSION: Background factors such as usual daily activities of living and lifestyle seem to be of importance when evaluating and comparing different populations with respect to their balance and gait performance.

Adult↗
PubMed1994

Health and well-being of childbearing women in rural and urban contexts.

As part of the national focus on women's health issues, it is important to identify those health-related characteristics of rural women that distinguish them from women living in urban settings. The aim of this study was to compare rural and urban childbearing women on socioeconomic characteristics, perceived stress, health-related practices, illness symptoms, parenting confidence, and body weight. One hundred sixty-five midwestern women responded to a health survey sent to them six months after childbirth. Rural women were younger and less educationally and economically advantaged compared to urban women. Before adjusting for these differences, rural women were less self-actualized, more interpersonally isolated, and reported less healthy nutrition than urban women. These differences disappeared when socioeconomic differences were adjusted. Rural and urban mothers did not differ in most other areas, including perceived stress, parenting confidence, and body weight. Compared to national norms, the perceived stress levels of both rural and urban mothers were significantly higher than a probability sample of U.S. women. Findings support the role of socioeconomic factors as contributing to risk of poor health promotion among rural childbearing women.

Adolescent↗
PubMed2001

Urban and rural dimensions of global population aging: an overview.

In keeping with the worldwide pattern of increased urbanization, the elderly population has become more concentrated in urban areas during the past 50 years. In developed countries as a whole, an estimated 73 percent of people aged 65 or over lived in urban areas in 1990, a figure that is projected to reach 80 percent by the year 2015. In developing nations, which are still predominantly rural, just over one-third of people aged 65 or over lived in urban areas in 1990, projected to exceed one-half by 2015. This article provides an overview of global data on urban elders, examines extant data on gender balances and migration patterns, and considers the importance of subnational urban/rural differences and whether rural elderly are disadvantaged relative to their urban counterparts.

Aged↗
PubMed2002

Primary care practice management in rural and urban Veterans Health Administration settings.

Limited access to specialty care in rural settings may result in more expectations of primary care providers and a higher demand for primary care. The authors used survey and administrative data from 1999 from the Veterans Health Administration (VHA) to compare primary care practice management and performance in 19 rural to 103 urban VHA hospitals nationally. Rural VHA hospitals were smaller, less likely to be academically affiliated, and had fewer integrated specialty care services. Primary care providers in rural settings were more likely to manage specialty care services, provide continuity across patient care settings, and have complete responsibility for a broader range of services. However, rural hospitals had more staff per patient allocated to primary care than did urban hospitals. Patients in rural settings received comparable quality care to those in urban settings, and they appeared to be more satisfied with the care they received. Within the VHA system, primary care providers in rural settings provided a broader range of services than those in urban ones. This increased breadth may be attributable to the lack of availability of integrated specialty care services in rural settings. Because of this broader range of responsibilities, the provision of primary care in rural settings may require higher staffing patterns and may be inherently more costly than in urban settings; therefore, researchers should be cautious when comparing primary care expenditures across rural and urban settings.

Female↗
PubMed2002

Rural-urban home health care differences before the Balanced Budget Act of 1997.

This study arose from concerns that home health care may be more difficult to provide to rural than urban elderly patients (because of geographic barriers, personnel shortages, and other factors) and may therefore be less effective in terms of patient outcomes. Case mix, home health care service use, and outcomes (primarily discharge status) were analyzed for a national random sample of 3,869 rural and urban elderly home health patients. Longitudinal data covered the period from home health admission to discharge or 120 days (whichever occurred first). Primary data collection instruments were designed to obtain longitudinal patient-level health status data; agency records and Medicare data provided service use information. (The study did not address access but focused on services and outcomes after admission to home health care.) Two-group statistical tests and multivariate analyses were employed to assess rural-urban differences. The major findings were that, after adjustment for rural-urban case mix and agency differences, rural compared to urban patients received fewer home health services and attained less favorable discharge outcomes. For example, the rural patients had a higher case mix adjusted hospitalization rate. Because the study data pertain to 1995 through 1996, the results provide a baseline for future analyses of possibly different rural compared to urban effects of the Balanced Budget Act of 1997, which resulted in major changes in Medicare payment for home health care.

Aged↗
PubMed2003

Rural-urban differences in ductal carcinoma in situ as a proxy for mammography use over time.

CONTEXT: With emphasis on increasing use of mammography, the rate of ductal carcinoma in situ (DCIS) of the breast has increased dramatically in the United States starting in the early 1980s. It is unclear if rural and urban women have experienced similar increases. PURPOSE: To describe differences in incidence of DCIS between rural and urban women 50 to 69 years of age over time. This may be a proxy indicator of mammography use for the early detection of breast cancer. METHODS: The study population consisted of women 50 to 69 years of age who were diagnosed with DCIS during 1973-1997 and resided in Iowa, Utah, or New Mexico. Data from the Surveillance, Epidemiology, and End Results (SEER) programs in these states were used in the analysis. Location of the woman's residence was classified into urban when she lived in a county considered a Metropolitan Statistical Area, while she was considered rural if she resided elsewhere at the time of her diagnosis. FINDINGS: Increases in rates were different between rural (annual percentage change [APC]: 15.1) and urban women (APC: 34.4). During the 1990s among urban women, the rate of DCIS was still increasing (APC: 3.8), while there was no increase among rural women (APC: 0.2). Differences between rural and urban women within these 3 states were also identified. CONCLUSIONS: The data suggest differences in utilization of mammography between both populations; the increase was lower and started later for rural women. Possible reasons for such differences over time are discussed.

Aged↗
PubMed2006

Does rural or urban residence make a difference to neonatal outcome in premature birth? A regional study in Australia.

BACKGROUND: Patients living in rural areas may be at a disadvantage in accessing tertiary health care. AIM: To test the hypothesis that very premature infants born to mothers residing in rural areas have poorer outcomes than those residing in urban areas in the state of New South Wales (NSW) and the Australian Capital Territory (ACT) despite a coordinated referral and transport system. METHODS: "Rural" or "urban" status was based on the location of maternal residence. Perinatal characteristics, major morbidity and case mix adjusted mortality were compared between 1879 rural and 6775 urban infants <32 weeks gestational age, born in 1992-2002 and admitted to all 10 neonatal intensive care units in NSW and ACT. RESULTS: Rural mothers were more likely to be teenaged, indigenous, and to have had a previous premature birth, prolonged ruptured membrane, and antenatal corticosteroid. Urban mothers were more likely to have had assisted conception and a caesarean section. More urban (93% v 83%) infants were born in a tertiary obstetric hospital. Infants of rural residence had a higher mortality (adjusted odds ratio (OR) 1.26, 95% confidence interval (CI) 1.07 to 1.48, p = 0.005). This trend was consistently seen in all subgroups and significantly for the tertiary hospital born population and the 30-31 weeks gestation subgroup. Regional birth data in this gestational age range also showed a higher stillbirth rate among rural infants (OR 1.20, 95% CI 1.09 to 1.32, p<0.001). CONCLUSIONS: Premature births from rural mothers have a higher risk of stillbirth and mortality in neonatal intensive care than urban infants.

Australian Capital Territory↗
PubMed1986

Hepatocellular carcinoma in urban born blacks: frequency and relation to hepatitis B virus infection.

Chronic hepatitis B virus infection is far less common in urban born than in rural born southern African blacks, who also have a high incidence of hepatocellular carcinoma. A case-control study was carried out to determine the relative frequency of hepatocellular carcinoma and its relation to hepatitis B virus infection in urban born blacks. Three hundred and ninety two black patients with hepatocellular carcinoma and matched controls seen at two city hospitals were classified by questioning as urban born or rural born. The ratio of rural born to urban born blacks among the controls was 1.1:1.0 (207/185), whereas in the patients with cancer the ratio was 4.8:1.0 (324/68) (p less than 0.0001). Analysis of the prevalence of hepatitis B markers in 62 urban born and matched rural born blacks with hepatocellular carcinoma showed no differences in the frequency of current or past hepatitis B virus infection. It is concluded that urban born blacks are less likely than rural born blacks to develop hepatocellular carcinoma, but when they do the tumour is equally likely to be related to infection with hepatitis B virus. The findings lend further support to an important role for chronic hepatitis B virus infection in the aetiology of hepatocellular carcinoma.

Adolescent↗
PubMed2005

Urban-rural variation in mortality and hospital admission rates for unintentional injury in Ireland.

OBJECTIVE: To explore urban-rural differences in the mortality and hospital admission rates for unintentional injuries in the Republic of Ireland. DESIGN: Standardised mortality ratios (SMRs) in residents of urban and non-city areas (called rural areas) from all causes of unintentional injury were calculated using Central Statistics Office mortality data from 1980-2000. Hospital admission data (Hospital In-Patient Enquiry) from 1993-2000 were used to calculate standardised hospital admission ratios (SARs) in urban and rural residents. Population data were obtained from the 1981, 1986, 1991, and 1996 censuses. RESULTS: The rate of unintentional injury mortality was significantly higher in rural residents for all-cause unintentional injury mortality (SMR 103.0, 95% confidence interval 101 to 105), and specifically for deaths related to motor vehicle trauma (MVT), drowning, machinery, and firearms. There were significantly higher SMRs in urban residents for falls and poisoning. The rate of unintentional injury hospital admission was significantly higher in rural residents for all-cause unintentional injury (SAR 104.6, 95% confidence interval 104 to 105) and specifically for injuries from falls, MVT, being struck by or against an object, injuries in pedal cyclists, fire/burn injuries, and machinery injuries. SARs were significantly higher in residents of urban areas for poisoning and injuries in pedestrians. CONCLUSIONS: There are urban-rural differences in mortality and admissions for injuries in Ireland. Possible reasons for the higher rural mortality rates are higher case fatality in MVT and rural exposure to hazardous farm machinery, firearms, and open areas of water. This information could assist in targeting prevention programmes under the proposed National Injury Prevention Strategy.

Accidental Falls↗
PubMed2005

Thinking inside the bubble: evidence for a new contextual unit in urban mental health.

OBJECTIVE: Previous quantitative research has suggested that there is a link between housing, the urban environment, and mental health. However, methodological and design issues make it difficult to disentangle the relative influence of dwelling specific and wider urban environmental influences on individual mental health. The aim of this study was to explore the link between the dwelling, the immediate urban environment, and mental health to generate a new conceptual framework by which understanding of dwelling and urban environmental influences on mental health can be advanced. DESIGN AND PARTICIPANTS: Qualitative interviews and focus groups were conducted with 32 inner city residents. Participants, stratified by sex and mental health status, were randomly recruited from a wider quantitative survey. An almost equal number of men and women as well as people with or without mental health problems participated, allowing for comparison of experience. Data were analysed inductively to generate an appropriate theoretical framework regarding dwelling and urban environmental influences on mental health. SETTING: An inner city neighbourhood of about 6200 people in north west London. Most of that population live in public housing. MAIN RESULTS: The principal study finding is that between the dwelling unit and the neighbourhood unit, evidence was found for another meaningful contextual unit of analysis, the "residential bubble" through which effects on mental health can be mediated. The residential bubble describes a limited area of three dimensional space that surrounds a dwelling, encompassing immediate neighbours (above, below, and adjacent) and shared public space bordering the dwelling. Positive events and processes within the bubble had a beneficial influence on mental health whereas negative ones tended to have a damaging influence. These seemed to disproportionately have an impact on people with pre-existing mental health problems. CONCLUSION: The concept of the "residential bubble" may be a meaningful new contextual unit of analysis in urban mental health. This may have important implications with regards to interventions and measurement development.

Environment↗